OCD and Psychosis

exhausted (2)

by graur codrin freedigitalphotos.net

A version of this post first appeared on my blog in September 2013….

When my son Dan’s obsessive-compulsive disorder became severe, he was in college, fifteen hundred miles away from home. We arranged for him to see a psychiatrist near his school, who called us (with our son’s permission) after he met with Dan. He certainly didn’t sugarcoat anything. “Your son is suffering from severe OCD, and he is borderline psychotic.”

I knew very little about OCD at that time, but I knew what psychotic meant: out of touch with reality. I was terrified. Psychosis made me think of schizophrenia, though that illness was never mentioned. In fact, after I united with Dan and we met with the psychiatrist together, there was no more reference to psychosis.

So what was going on? A post on Psychiatric Times discusses the fact that OCD with poor insight should not be mistaken for a primary psychotic disorder, and a thorough history of the patient is warranted. There is also a good deal of discussion in the article regarding medication, because antipsychotics which are often prescribed in these cases have been known to induce and/or exacerbate symptoms of OCD. In addition, research has shown that these antipsychotics often do not help those with severe OCD who are dealing with poor insight, or borderline psychosis.

The DSM-5 states that OCD may be seen with: good or fair insight, poor insight, or absent insight/delusional beliefs. While many people with OCD realize their obsessions and compulsions are irrational or illogical, this is not always the case. When Dan was first diagnosed with OCD, he did indeed have good insight. But by the time he met with this psychiatrist his OCD had gotten so bad that he was at the point of borderline psychosis. At least at that moment. It should be noted that the insight of those with OCD into their disorder can fluctuate. For example, while calmly discussing a particular obsession and compulsion, people with OCD might realize their thoughts and behaviors are unreasonable. But when they are panic-stricken and in the middle of what they perceive as danger, they might totally believe what they had previously described as nonsensical.

So did Dan have something else going on aside from OCD? Thankfully, no. Once his OCD was treated, any possible issues related to psychosis resolved. This scenario reminds me of his misdiagnosis of ADHD. The same thing happened: When his OCD was treated, his symptoms that had been attributed to ADHD also disappeared.

Certainly there are lessons to be learned from Dan’s experiences. Things are not always what they seem. And in the case of brain disorders, where we’ve categorized certain behaviors as belonging to specific illnesses, we really need to be careful not to jump to conclusions in reference to diagnoses and subsequent treatments. In the case of obsessive-compulsive disorder, maybe the best way to proceed is by treating the OCD first, and then reassessing the situation. Once OCD has been reined in, we might be surprised to find that symptoms typically associated with other disorders have fallen by the wayside as well.




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4 Responses to OCD and Psychosis

  1. Hello and thanks! This is a very good articulation of how necessary it is for constant upgraded education about OCD. I have also been ‘borderline’ psychotic, ugh sounds so awful, when terribly afflicted by periods of severe OCD, and insight is certainly missing. To others it can look and sound totally insane when a normally level headed and rational person is gripped so hard by doubt about what appears nonsensical.
    Thank you for your articles, I always read and enjoy them.

  2. Daniel Walker says:


    I am psychotic. I also have OCD. It is the OCD that is more obvious. And that’s even when it is all pure O!

    I have kind of had to treat them both at the same time, but the OCD was picked up on first like 10 years ago. The psychosis only roughly 3 years ago.

    My journey has reached new heights, and I am able to reduce both my anti-psychotic and anti-depressant.

    I am really interested to hear about your Dan’s journey. It is not too dissimilar to my own. I do believe, however that they were right about my Psychosis. Things have got much better.

    I would be happy to chat anytime if you want more info! or check out my book I’m about to write!

    Hope you are well.


  3. Hi Daniel, Thanks for sharing. You certainly are dealing with a lot! Hopefully you have good doctors and a support system to help you through the difficult times. Good luck writing your book!

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