OCD and Schizophrenia

by david castillo dominici freedigitalphotos.net

by david castillo dominici

A recent study published this month in JAMA Psychiatry suggests that those who suffer from OCD might be at a higher risk than the general population for developing schizophrenia. I immediately thought back to a post I wrote just one year ago titled OCD and Psychosis, where I discuss the fact that symptoms of severe OCD can sometimes overlap with symptoms of a psychotic disorder.

As I read the synopsis of the study, a few things jumped out at me that I think are important to keep in mind. For one, the incidence of schizophrenia in the general population is about one percent. The new study concludes that the occurrence of schizophrenia in those previously diagnosed with OCD is two percent. So while this is a significant increase, there is still a ninety-eight percent chance that those with OCD will not develop schizophrenia. Additionally, Dr. Aaron Pinkhasov, chairman of the department of behavioral health at Winthrop University Hospital in Mineola, NY, makes this observation about the study:

Notably, the study only looks at patients who have come in contact with a psychiatric hospital. As the majority of mild and moderate OCD patients are treated by general practitioners in an outpatient setting, it makes it difficult to apply these findings to all patients suffering from OCD. Hence the risk may in fact be somewhat overestimated.”

So there might be less than a two percent chance of those with OCD developing schizophrenia.

Also, in discussing the study, Dr. Pinkhasov makes this thought-provoking comment:

“At least some of the association may have been a result of misdiagnosis in patients before they developed more specific symptoms of schizophrenia.”

Interesting. While my post, OCD and Psychosis, discusses OCD being mistaken for schizophrenia, Dr. Pinkhasov talks about schizophrenia being mistaken for OCD.

There is no question in my mind that this study should be taken seriously. Future research could lead to findings that benefit both those with OCD and schizophrenia. But I believe we need to be careful as well, because things are not always as they seem. In the case of brain disorders, where we’ve categorized certain behaviors as belonging to specific illnesses, it can be difficult to know where one disorder ends and another one starts. Research results are also not always clear-cut. In this particular study, the authors conclude, “Further research is needed to disentangle which genetic and environmental risk factors are truly common to OCD and schizophrenia.”

OCD, schizophrenia, and other brain disorders can be complicated and confusing in their origins, their diagnoses, and their treatment. As more research is conducted, my hope is that all the pieces of the “OCD puzzle” will one day fall into place. Diagnosis and treatment will be easier, and as long as I’m wishing, a cure will be found.



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12 Responses to OCD and Schizophrenia

  1. Matt Marinello says:

    Yeah but I’ve known this for some time….. and there is knew subtype of schizophrenia called ‘schizo-obsessive’ not to be confused the web slang ‘schiz-ocd.’ I have both. Schitzes have a high chance of developing ocd on the other hand and I guess according to this study you read it’s not the otherway around 2 percent isn’t that high. But the occurence of oc symptoms in people with schizophrenia are high in the 40% range. Higher even than the occurence with the personality disorder OCPD which last time I checked I think was 34%. The highest which makes sense to me is OCD and Tourettes which is in the 60% range. It makes sense after talking to a guy with it who said the more he tried to stop the tics the more they got worse. So to me that’s just like a physical outward version of what happens to ocders who try and try and try to stop the thoughts or whatever and they just get worse and worse. So I think of tourettes as physical ocd and ocd as mental tourettes though that really is an over simplification cuz last time I checked tics don’t make you feel guilty or ashamed or stuck motionless for hours in your room. Then again I don’t really know if I really am schizo at all. Half the doctors tell me I’m not at all and that I’m too lucid and make too much sense. The other half look at the history and if I tell them about thought broadcasting and telepathy they’ll say yes I am schizo (though I don’t believe in that so does that make me schitz?) What I know is this…… OCD is a problem of excessive doubt….. Schizophrenia is excessive certainty. They are complete opposite disorders. So if I really do have both maybe I’m more lucid because of the ocd and I can’t feel certain of anything including the delusions. Also I’ve never hallucinated. At times I wonder about all of my dxes. Do I really have OCD? Do I really have this or that. Am I psycho? It’s pretty funny. People think I have bad memory but really I doubt my memories like did I turn the coffee pot off or was that just a memory of turning it off yesterday? I actually remember things real well. I’m not as bad as those who check doors and locks thousands of times a day…… That would be horrible especially cuz I like to feel certainty and clarity.

    • Thank you so much for sharing, Matt, and your comment is a great illustration of how symptoms of various disorders overlap and often make diagnoses difficult. It can be so hard to sort it all out! I hope you have a doctor now who you are comfortable with so you can work toward a proper diagnoses and recovery. I wish you all the best!

      • Janet, a psychiatrist cured me of OCD. I didn’t follow through and he later died. This is what I’ve learned. You train the subconscious to give up it’s secrets by reading the patients repetitive thought pattern aloud as they free associate, in brief word groups. Spread it out over the course of three and a half months till the patient acts out the repressed experience(s) and relates them to the therapist. Get the patient to face them so the therapist can reverse them. Make sure the patient follows through or the could end up in worse shape like me. To learn more visit schizophreniarepressioncured.blogspot.com (Oct 24, 2016 post) I swear dead childhood pets are a primary cause of repression.

      • Hi Stephen, Thank you so much for sharing. I can’t really comment on your situation or therapy, but I continue to advocate for ERP therapy, as it is the number one evidence-based psychological treatment for OCD. I wish you all the best as you work toward recovery.

  2. Tom Cordy says:

    Interesting post. There is a history of schitzophrenia in my family and I always wondered if I had it. However, as Dr Steven Phillipson says, OCD is not a thought disorder but an anxiety disorder. We are, for the most part, (except when we enter into psychosis) aware that our obsessions are irrational. From what I understand, schitzophrenia IS a thought disorder which results in people fully believing their delusions.

    Sometimes I feel that having OCD is like being totally insane and sane at the same time. We (usually) appear to be ‘normal’ people but are equally capable of believing the most outlandish of possibilities.

    • Thanks for your comment Tom, and I think you hit the nail on the head with your description of having OCD. “Totally insane and sane at the same time.” I think that’s what makes OCD so tormenting at times. I’ve had people tell me they’d rather not be aware of how outlandish their thoughts are. It would be easier to deal with!

  3. Thank you for telling us about this study. It certainly is thought provoking. I wonder what, if any, genetic similarities the two disorders share.

    I recently read a memoir by a woman who has schizophrenia. Some of the symptoms she described having as a child, before she ever had a psychotic episode, sounded like OCD to me. When symptoms are shared across different disorders, it must make diagnosis difficult. But proper diagnosis is so important.

    • Thanks for sharing, Tina. Yes, it is certainly understandable that overlapping symptoms can make a diagnosis challenging. Just another reason to choose our health care providers very carefully!

  4. WR381 says:

    I do believe it. I also believed that such a study should open up the conversation about how anxiety is not the same thing as depression. SSRIs work better for anxiety than depression (the latter is even questionable). Severe anxiety, which can ultimately lead to paranoia and psychosis, appears to be linked to a high dopamine state that gets blunted when serotonin levels are increased. On the opposite end, low dopamine states can produce depression (as is often seen in diseases like Parkinson’s). Yet what’s interesting is that dopamine boosters for PD often produce side effects like compulsive gambling, shopping, and severe anxiety. Note that some SSRIs are known to worsen PD symptoms.

    As someone with treated OCD, I know for a fact that the severest anxiety episodes make you feel as though you are losing your mind and you are, in a sense, out of touch with reality.

    • Thanks for your insight WR381, and for your first-hand description of severe OCD. I have heard other OCD sufferers describe severe OCD just as you do; that feeling that you are losing your mind. I can’t even begin to imagine how frightening that must be. Thank you for your comment and I wish you all the best.

  5. 71º & Sunny says:

    Yep, I JUST told someone yesterday that when my OCD really got severe for the first time in 1996, I was seriously concerned that I was going insane. I truly thought I would end up in an insane asylum. And let me tell you, that is one scary thought.

    This is interesting. I had not heard about this study. Ironically, I have known people with OCD who have an obsessive fear about developing schizophrenia.

    • Amazing, Sunny, that OCD can latch onto absolutely anything! As I said above, I can’t even begin to imagine how frightening that must have been to feel you were going insane. And it must be even scarier when you feel you are totally alone and have nowhere to turn for help. Another reason to keep up all our mental health advocacy! Thanks for sharing.

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