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Are intrusive thoughts ever a sign of schizophrenia?

Jul 24, 20236 min read minute read

Reviewed byPatrick McGrath, PhD

We all experience intrusive thoughts. Whether it’s about driving off a bridge, physically harming someone, or yelling inappropriate words, everyone has unpleasant, unwanted thoughts, urges, and other experiences that pop into their mind from time to time. 

Sometimes people who have intrusive thoughts are naturally concerned that something serious could be going on. “Are my intrusive thoughts a sign of schizophrenia?” “What if I have another mental illness that’s causing these unwanted thoughts to spring into my mind?” 

It’s normal to be concerned. It’s even fine to want to do some digging into the mental health conditions that have intrusive thoughts as a symptom. 

We’ll help you get to the bottom of your questions—including whether intrusive thoughts are linked to schizophrenia—but first let’s understand intrusive thoughts a bit better.

What are intrusive thoughts?

It’s worth reiterating that intrusive thoughts are shared by everyone and harmless on their own. In some cases, however, intrusive thoughts are involved in the symptoms of a number of different mental health conditions.

Intrusive thoughts can be about a variety of topics and themes. Some examples include: 

  • Contamination: What if that airplane seat I sat in was contaminated with a deadly disease? 
  • Harm: What if I veered off this cliff as I’m driving my car right now? 
  • Existential Topics: What if life has no meaning or purpose? 
  • Relationships: What if I’m just pretending to love my husband?
  • Religion: What if I’m not a faithful person despite all the praying I do?
  • False Memories: What if I’ve done something terrible but forgotten about it?

Do these experiences sound familiar? Learn how you can overcome them.

Here at NOCD, we know how overwhelming OCD symptoms can be—and how hard it is to open up about your experience. You’re not on your own, and you can talk to a specialist who has experience treating OCD.

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Are intrusive thoughts the same as hallucinations or delusions?

A delusion is a belief that’s disconnected from reality, yet feels very real to the people experiencing them. Some people wonder if a delusion is the same as an intrusive thought. And when they hear that delusions (as well as hallucinations) are associated with schizophrenia, a bit of panic can set in. 

So let’s get to the bottom of things. Schizophrenia is a serious mental health disorder that affects less than 1% of the US population. Someone with schizophrenia is likely to experience symptoms such as delusions, disorganized speech, trouble with thinking, hallucinations and lack of motivation. 

Hallucinations refer to the experience of hearing, seeing or smelling things that are not there. Hallucinations are often vivid and difficult to distinguish from reality, leading people to fully believe that they’re real. Meanwhile, delusions are consistent false beliefs that persist, even in the face of clear or reasonable evidence that they are not true. An example of delusion is believing that your neighbor is secretly spying on you for the FBI when no such evidence exists to indicate that this is true. 

On the other hand, people tend to have some insight into their intrusive thoughts, meaning that they partially or fully understand that their thoughts, images, or feelings are not entirely real or true. The degree of insight people have about their intrusive thoughts can vary significantly, but they are generally quite distinct from hallucinations or delusions.

Are intrusive thoughts ever a sign of schizophrenia?

So if you’re having intrusive thoughts, does that mean you have schizophrenia? It’s quite unlikely—as we’ve mentioned everyone experiences intrusive thoughts of one type or another, while schizophrenia is a pretty rare condition. 

Intrusive thoughts alone are certainly not enough to indicate a possible schizophrenia diagnosis, or even any real likelihood of one. There’s a difference between the kind of distorted thinking that’s characteristic of schizophrenia and intrusive thoughts that are commonly associated with other mental disorders such as obsessive-compulsive disorder (OCD). Let’s explore.

The difference between intrusive thoughts and delusional thoughts 

Intrusive thoughts are one of the primary symptoms of OCD. People with this condition experience intrusive thoughts about a variety of topics. The resulting obsessions cause a great deal of distress or anxiety, leading people with OCD to feel a persistent, strong urge to engage in compulsions in an attempt to alleviate this distress or prevent unwanted outcomes from occurring. The intrusive thoughts and images that a person with OCD experiences may sometimes feel real and urgent, even though they are highly unlikely to be true or are unsupported by reasonable evidence. 

Intrusive thoughts in OCD are not the same as delusions in schizophrenia. The main reason is that individuals with OCD are often aware, at least to some degree, that their beliefs and actions are irrational. This is called insight. Most people with OCD have some level of insight; they look at their OCD and say, logically, that they understand it doesn’t really make sense. (It’s worth noting that there is a much smaller percentage of people with OCD who have little to no level of insight, but this is much more rare. Even in these cases, though, they still do compulsions to try to neutralize their thoughts, images, or urges.) 

Now you may be still wondering if individuals with schizophrenia can experience distressing intrusive thoughts. The answer is yes, but it’s less likely. The main reason for this is that with schizophrenia, people may not be able to recognize these thoughts as intrusive at all.

Can you have both OCD and Schizophrenia? 

Yes, it is possible to have both conditions. However, OCD is more common among those with schizophrenia than the other way around. Estimates suggest that 12 to 23 percent of people with schizophrenia also have OCD. On the other hand, individuals whose primary diagnosis is OCD are unlikely to have or develop psychotic symptoms, with studies suggesting that it occurs in only 1.7 percent of patients.

How to get help for intrusive thoughts 

Now that we’ve clarified that intrusive thoughts are not a sign of schizophrenia, you’re probably wondering: Okay, but how do I get help for my intrusive thoughts?

Let’s start with what not to do. Intrusive thoughts can make it very tempting to avoid the situations that might trigger them. Doing so, however, will only make things worse, reinforcing the belief that these thoughts are dangerous and should be avoided.

In fact, facing the situations that your mind tells you to avoid is the fundamental aspect of exposure and response prevention (ERP) therapy—the most effective line of treatment for OCD—in which individuals work with a trained professional to confront obsessions or intrusive thoughts without engaging in their typical compulsive behaviors. Through ERP, individuals with intrusive thoughts learn to accept uncertainty, tolerate the distress and anxiety caused by their obsessions, and reduce the impact of their unpleasant, unwanted thoughts. 

ERP should only be conducted by someone who specializes in OCD and ERP treatment. NOCD offers affordable and effective ERP therapy with therapists who have received specialty training in OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.

How to get help for schizophrenia

While you need a different type of treatment for schizophrenia, know that help is out there. Schizophrenia is usually treated and managed with antipsychotic medicines and cognitive behavioral therapy (CBT). To find a provider in your area contact your insurance provider and ask for a list of providers in your area. Proper treatment can help people with schizophrenia reduce the degree to which their condition interferes with their goals and vastly improve their quality of life. 

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