OCD and Psychosis – Updated


In my previous post on OCD and Psychosis, I stated that one of the criteria for the diagnosis of obsessive-compulsive disorder is the sufferer’s realization that their obsessions and compulsions are irrational or illogical.

I was wrong. While this used to be the case, the DSM-5  now specifies that OCD may be seen with: good or fair insight, poor insight, absent insight/delusional beliefs.

Additionally, the statement, “At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable,” has been removed.

I’d like to thank Dr. Seth Gillihan for letting me know about my error.
All in all, I think this is good news, as hopefully this new definition will help reduce misdiagnoses.
To quote Dr. Gillihan: It’s good to see the criteria evolve with a better understanding of the condition!”
I agree. It’s a step in the right direction!
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25 Responses to OCD and Psychosis – Updated

  1. ocdmom says:

    I recently read Obsessed: The Compulsions and Creations of Dr. Jeffrey Schwarz. I found it incredibly intriguing.

  2. I wouldn’t say you were wrong per se–that is such recent information! Thanks for the update; at times I have worried whether something else was wrong with me (besides OCD) if I couldn’t quite wrap my head around an obsession. That seemingly small side note made me question myself a lot: DO I know it’s irrational? If I do, why is it still bothering me so much?

    • Thanks, Alison! That’s interesting, that knowing you are supposed to know your thoughts are irrational in and of itself can be distressing. OCD certainly always gives you things to worry about!

  3. 71º & Sunny says:

    Thanks for the post and the update, Janet. I think this is a real positive step in the diagnosis of OCD. Hopefully, it will reduce the number of misdiagnoses, ’cause let’s face it, there are a lot.

  4. Thanks for letting us know about this, Janet. It is a change, isn’t it? I hope it will cut down on misdiagnoses, too.

  5. Cat says:

    Sounds a bit wrong for the old diagnosis to only include someone if they are aware of their MH problem.

    • Hi Cat, Thanks for sharing. I believe those who suffer from OCD do typically realize their behavior is not the norm, but this change is now more comprehensive to include those with no insight as well. Definitely a step forward I think.

  6. CannotSay2013 says:

    An expansive definition of OCD has only one objective: to make more people eligible for a prescription of psychiatric drugs, which is a common theme in DSM-5.

    The side effect, that many here I am sure do not realize, is that it expands the pool of people eligible for psychiatric abuse. Most state laws for civil commitment/forced drugging require two things: 1) a diagnosis based on the DSM, 2) dangerousness proved according to the “clear and convincing” evidence standard. You need both to be simultaneously satisfied. The change makes more people eligible for both civil commitment and forced drugging.

    Note that a criminal commitment where a DSM diagnosis is not present requires to show dangerousness beyond reasonable doubt. An OCD finding lowers that bar. The DSM-5 makes more people subject to abuse, especially abuse coming from “helping” family members.

    • Abigail says:

      CannotSay, while abuse is definitely a scarey thing that I know can happen, the recent change for someone with borderline delusional belief in their obsessions/compulsions isn’t going to change whether or not the person could be labeled by the DSM. Rather, it might change their diagnosis from other diagnosis that include psychosis in their symptoms back to a more accurate OCD diagnosis. Perhaps this could add protection for them, since I don’t think OCD is generally seen as making people particularly dangerous.

      • CannotSay2013 says:


        As a survivor of psychiatric abuse, I see things primarily from that angle. An OCD so called “diagnosis” (which I call “dehumanization”) was used to civilly commit me for several months.

        Granted, it happened in Europe, where such things are possible, not in the US, but I am concerned every time that a DSM label is changed in a way that makes more people eligible for a DSM insult (I am using here Jim Gottstein’s notion that the DSM is a book of insults). OCD was the insult used to abuse me.

        Especially in the aftermath of tragedies like last week’s, that psychiatrists use to call for ever increasing powers to abuse people, we have to keep in mind that many innocent people will pay with their dignities and lives the fact of having an expanded definition of OCD (or any other DSM insult).

      • I’m so sorry that happened to you, but I have to disagree that being diagnosed is an insult. Of course if someone uses your diagnosis against you, that’s terrible and wrong. But being diagnosed saved me. I see OCD as a helpful label because I suddenly knew how and where to get help–I may still think of myself as a dirty, immoral person if not for the diagnosis of OCD. I didn’t feel insulted at all. I hope you find more supportive people!

      • CannotSay2013 says:


        It might be the case that the OCD label helped you, but you have to be kidding that an OCD label cannot be used against you. In fact, the legal system uses it against you all the time.

        Here are a list of things that an OCD label, or any other label, prevents you from doing:

        – If you are unlucky, and get locked in because somebody thinks that your OCD makes you dangerous (and remember that the standard for doing this is lower with an OCD label than without it), you cannot legally own guns. Regardless of one stands in the gun ownership debate, the fact remains that the second amendment is an individual right on the same footing as the first amendment per SCOTUS rulings in 2008 and 2010. And OCD label makes it easier for you to lose a constitutional right.

        – Security clearances. Again, it might never cross your mind to work for the government or for a private company that does sensitive work for the government but an OCD label, regardless of your dangerousness, will make it difficult or close to impossible for you to get a job that requires a security clearance.

        – Public scrutiny. Try to have a job that exposes you to public scrutiny, such as being a top manager at a public company or running for office. You’ll soon realize that indeed, a DSM label will be used against you.

        And that’s just the “official stuff”. Unofficially, DSM labels make social lives toxic, among other things, because the APA quacks have invested a lot of time and money in the propaganda that their invented labels reflect defectiveness in the brain.

      • I didn’t say it couldn’t be. I said it would be wrong. I just don’t agree that a diagnosis itself is the worst thing that can happen to a person–the mental illness is. I’d rather be denied some of those rights than live in my OCD-riddled brain any day of the week. I’d like to see evidence that an OCD diagnosis would deny someone their right to bear arms, though–people with OCD are not considered dangerous. They are considered the least likely to cause harm, actually. And currently it doesn’t seem to matter what mental health diagnosis an American has, because we’re still seeing guns in the hands of unstable people.

      • CannotSay2013 says:


        On the second amendment matter, check the federal code 18 U.S.C. § 922(d),

        (4) has been adjudicated as a mental defective or has been committed to any mental institution;

        Note that there is no requirement of dangerousness there. There is a lot of controversy about what is the actual meaning of that statute, but it is there. Some states have even more stringent prohibitions.

        With respect to so called OCD, I am very happy with it. It has served me very well in life. When I obsess about something, typically professionally, I never give up even in the face of what most people would consider surmountable obstacles. This personality trait of mine is what has allowed me to have the life of a highly educated professional in the US despite growing up in an environment where very few people went to college in the first place. I wouldn’t trade my so called “OCD” for anything :D.

      • Maybe it is just so-called OCD, then. You’re honestly the first person I’ve run across who hasn’t considered OCD itself to be hell on earth.

    • CannotSay, Of course you are entitled to your opinion, but for a lot of people, as Alison points out, the diagnosis of OCD is the first step toward recovery. Obviously you have had terrible experiences and I am sorry for that, but I would appreciate it if we could keep the dialogue respectful to all. Thank you.

      • CannotSay2013 says:


        What is that I have said that is not respectful? Have I insulted anybody? I don’t think so. I am just pointing out, very politely, the legal and social consequences that come with a DSM insult. Calling DSM labels “insults” is not being disrespectful for anybody, I believe.

        Look, my whole point is that psychiatry, as it happens with other pseudosciences, should be an entirely voluntary endeavor. I have yet to find a single psychiatrist who doesn’t believe in psychiatric coercion, at least in “some cases”, whatever “some cases” means. Typically, “some cases” means whenever that particular psychiatrist thinks it is warranted.

        I don’t know if you follow 1boringoldman, but if you do, something very extraordinary happened over the weekend. We had Dr Mickey Nardo blasting the DSM depression committee for having removed the so called “bereavement exception” from the depression criteria in DSM-5 saying that by doing so they gave ammunition to those who claim that psychiatrists in general elevate opinion to the level of fact.

        The funny thing is that this was written right after he had written a different post claiming that he had a “sixth sense” to detect dangerous people and that he would have committed the Navy shooter using it. Of course, he was called for his contradiction and hypocrisy by me and others but the whole episode reflects well a basic truth of psychiatry, namely, that since there is no objective truth to begin with, just opinions of self appointed mind guardians, the DSM is nothing but a reflection of the power struggles within psychiatry. He/she who screams louder, or has the biggest pockets, has his/her opinions elevated to “fact” in the DSM.

        The only objective of this particular change that you mention here, which BTW was used against me even before DSM-5 was approved, is to expand the pool of those eligible for an OCD label, with the ultimate objective of enriching Big Pharma companies. I challenge you to follow the members of the DSM-5 committee who pushed for this change and research their Big Pharma conflict of interests. You’ll find the true motivations behind the change.

  7. Abigail says:

    I agree with Allison; I, too, knew that with OCD, (at least if you were an adult – kids got an exception), you were supposed to recognize that your obsession/compulsion was irrational. That added into my worry for a time that I had schizophrenia. So I’m pretty happy that they made that particular change. Thanks for reporting it, Janet!

  8. Lisa says:

    In February 2013, I was hospitalized and made to take antipsychotics. (I have OCD). I was severely depressed and had beliefs that were not true. They told me I was psychotic. I was in hospital for about 3-4 months. The antipsychotics caused me to gain 50 lbs! It was incredibly difficult to get off of the antipsychotics as they seem to have very bad withdrawl effects. I felt so sick physically and mentally and had panic attacks while trying to wean off. Now I’ve been off of them completely for 5 months and I’ve lost 40 lbs. I am so glad I found this article as it makes me feel like maybe I wasn’t psychotic after all. Thank you for posting this!

    • Hi Lisa, Thank yo so much for sharing and I’m sorry you went through such a difficult time. I’m so happy to hear you were able to get off those antipsychotics! I know the withdrawal effects can be horrible. I wish you all the best and hope to hear from you again!

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