OCD and Schizophrenia: What's the Link? - PsychCentral.com

At first glance, you might not think obsessive-compulsive disorder (OCD) and schizophrenia have much in common at all.

Symptoms of obsessive-compulsive disorder (OCD) and schizophrenia can occasionally overlap. And when they do, telling them apart can become confusing.

Symptoms of OCD include often include obsessions and unwanted or intrusive thoughts, as well as compulsions, or urges to act out specific — and often repetitive — behaviors.

Meanwhile, schizophrenia typically looks like:

• hallucinations: seeing or hearing things that don't line up with reality
• delusion: beliefs that don't match up with reality
• speech patterns that can be difficult to understand
• atypical behaviors
• catatonia, or a state or unresponsiveness
• negative symptoms, such as lack of expression or interests

Knowing which condition you or a loved one is experiencing might start with identifying your symptoms as well as figuring out how you relate to those symptoms.

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) classifies schizophrenia as a spectrum disorder. Meanwhile, OCD gets its own category in the DSM-5.

Still, the two conditions share key symptoms. For example, behavior patterns caused by either OCD or schizophrenia might appear similar to an outsider. And both conditions can involve strong thoughts that might seem strange to others.

It's also not uncommon for schizophrenia and OCD to occur together, especially if either condition runs in your family. Around 30% of people with schizophrenia may also have symptoms of OCD, and up to 14% may live with co-occurring OCD.

Although the two conditions share some symptoms, they also feature key differences. Here's where their symptoms overlap and diverge:

Delusions vs. obsessions

The sometimes blurry line separating delusions and obsessions can make schizophrenia and OCD especially hard to tell apart.

While a delusion is a belief that's disconnected from reality, an obsession is an intrusive thought that often feels troubling to experience.

Delusions tend to feel very real to the people experiencing them. Meanwhile, 2022 research explains that people who experience obsessions are more likely to actively fight against these thoughts.

In other words, it may be easier to recognize an obsession, rather than a delusion.

Insight

Insight, or self-awareness into your symptoms and condition, is where things can get messy. For example, consider someone with such a strong fear of snakes that it causes severe anxiety when they go outside.

• If this person has higher insight about their fear, they probably understand they're not really going to be attacked by snakes whenever they leave home. They may feel frustrated by thoughts they recognize as irrational but can't seem to stop having.
• For someone with little or no insight, the threat of being harmed by snakes if they go outside may feel real all or most of the time. They might even try to convince others of the dangers of venturing outside.

It's possible to have an obsession with little or no insight — and this is where some researchers recognize overlap between obsessions and delusions and between OCD and schizophrenia.

Obsessions without insight

When obsessions present with no insight, they feel very real to the person experiencing them. The person might not recognize that the obsession is creating a disconnect between them and reality.

Psychosis

In rare cases, people with OCD may also experience psychosis, which involves hallucinations and delusions and might look like schizophrenia.

Catatonia

OCD can also mimic schizophrenia when it comes with catatonia, which is characterized by:

• lack of movement or response
• repetitive behaviors
• restlessness or agitation

Catatonia is more often connected with schizophrenia, but 2017 research suggests that those with OCD may experience catatonia at higher rates than people without a mental health condition.

Additionally, since both OCD and catatonia can bring on repetitive movements, a person with OCD and obsessions with no insight might seem to behave similarly to a person with schizophrenia.

It's unlikely that OCD can actually cause schizophrenia to develop. But while OCD doesn't necessarily cause schizophrenia, it can come with higher chances of experiencing it than people without OCD.

A sudden onset of OCD symptoms may also be connected to the development of conditions involving psychosis, like schizophrenia.

So does either condition cause the other? The answer is still unclear. According to 2019 research on co-occurring schizophrenia and OCD symptoms:

• 40% of people experienced symptoms of OCD first
• 40% of people experienced symptoms of schizophrenia first
• 20% of people started experiencing symptoms of both at the same time

While it's still unclear whether OCD could ever cause schizophrenia (and vice versa), OCD might lead to a schizophrenia diagnosis in a few ways.

Some 2019 research suggests that receiving an OCD diagnosis raises the chances that you'll later receive a schizophrenia diagnosis. OCD could also increase your chances of experiencing hallucinations and delusions without schizophrenia.

In addition, you may have higher chances of developing schizophrenia if one of your parents lives with OCD.

Care for OCD and schizophrenia involves different treatment approaches. And if you live with both conditions, treatment can get a bit trickier.

OCD treatment

If you live with OCD, treatment might focus on helping you manage obsessions and compulsions and their impact on your day-to-day life. You might use:

Schizophrenia treatment

Treatment for schizophrenia may also involve a combo of therapy and medication, but the therapeutic approaches and medications may be different than the ones that help with OCD.

• Medication. A class of medications called antipsychotics can help with symptoms of psychosis.
• Therapy. Some people find therapy alongside medication helps them manage symptoms, too. Both acceptance and commitment therapy (ACT) and CBT could help you learn to practice mindfulness in handling symptoms when they arise.
• Support groups. If you live with schizophrenia, you might also find talking with a peer support group — people who understand more about what you're going though because they're also living it — helpful.

Treatment for co-occurring OCD and schizophrenia

Researchers are still learning how treatment can best support people living with both OCD and schizophrenia. So far, findings indicate:

• Antipsychotic medications could help people with symptoms of both schizophrenia and OCD.
• Some psychiatrists might consider prescribing an antipsychotic medication and an antidepressant to manage both conditions, but combining these medications can cause serious side effects, including seizures.
• CBT could help you manage a combination of these conditions, but more research is needed to confirm its effectiveness.

If you're not sure whether you or a loved one is experiencing OCD, schizophrenia, or both, managing symptoms can feel daunting. But both of these conditions are manageable with the right treatment and support.

A first step toward sorting out your symptoms might involve chatting with your therapist and doctor who can use screenings to help you figure out what's causing your symptoms.

Treatment plans for both conditions often consist of a combination of:

• therapy
• medication
• self-care and lifestyle changes

Like all mental health conditions, it may take time — along with trial and error — to find what works best for managing your symptoms.

Involving loved ones who can support you with either schizophrenia or OCD is another way to gain a sense of security as you learn more about your condition.

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