Are OCD And Psychosis Related?

While OCD and psychosis may be distinct conditions with separate symptoms, they could be connected. Individuals diagnosed with OCD may have a higher risk of developing psychosis later on in life. However, to fully understand how psychosis and OCD are related, it may be beneficial to start by researching each of these conditions separately. 

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What is OCD?

According to the National Institute of Mental Health (NIMH), obsessive-compulsive disorder (OCD) is a mental health condition that can cause recurrent intrusive thoughts and compulsive behaviors. These symptoms, typically referred to as obsessions and compulsions, are often two of the most common for those living with OCD. 

Obsessions

Individuals with OCD may experience thought patterns that they cannot control. These thoughts may include mental images or urges directed toward themselves, others, or their environment. Obsessions can vary in topic or subject material but might be oriented around the following: 

• Losing, misplacing, or forgetting an important item or event 
• Contamination or germs
• Fear of losing control
• Fear of aggression toward oneself or others
• Relationships, including various aspects of a romantic partnership
• Taboo thoughts, including those that relate to sex or religion
• A desire for symmetry or order in one's surroundings
• Superstitions, such as avoiding the use of certain words or actions

Obsessions often prompt fear and are often based on fears that one is going against their moral code in some way. Images of distressing scenarios can also occur, commonly referred to as intrusive thoughts. 

Compulsions

In addition to obsessions, those with OCD may experience compulsions which often result in repetitive behaviors, or a sense of urgency to complete a particular action. These compulsions are often tied to obsessions. For example, if a person is obsessed with germs or contamination, they may experience a compulsive urge to wash their hands constantly. 

Other potential compulsions may include:

• Arranging objects to match a desire for symmetry
• Checking certain devices or objects constantly, including checking whether lights are off, doors are closed, or windows are open
• Repeating specific words or phrases silently
• Counting to avoid anxiety (often referred to as “compulsive counting”)
• Reassuring oneself by reading articles or asking for reassurance from others repeatedly with little relief 

Those with OCD often cannot control their compulsive behavior but can sometimes comprehend that a specific action isn’t appropriate. They may experience some relief when performing a compulsion, even if the behavior may cause other challenges. However, this relief is often temporary, and compulsive behaviors can take up a significant amount of time and interrupt numerous areas of life.  

Due to the way that OCD can affect the way a person thinks, it may be confused with certain psychotic symptoms. However, those living with psychosis have distinct experiences that may help health professionals provide an accurate diagnosis. 

What is psychosis?

Delusions

Delusions are false beliefs held with complete conviction by individuals with psychosis. These beliefs may confuse others due to their lack of evidence or basis in reality. For example, a person with psychosis may think that the characters on a television show are speaking directly to them or that government agents are following them. 

Confused thinking or speaking

The thoughts of a person living with psychosis may rapidly shift and make it difficult to focus on a single idea. Because of these confused thoughts, individuals may struggle to communicate. These struggles can involve speaking quickly, making up words, changing topics abruptly, or stopping speech in the middle of a sentence. 

Hallucinations

Those with psychosis can also experience hallucinations, which may cause them to see people and sensory stimuli that do not exist. Hallucinations can also affect other senses, including hearing, smell, and touch. Auditory hallucinations can be particularly common, with individuals hearing voices or carrying on conversations with other people who are not actually there. 

While there may not be one singular cause of psychosis, there are a variety of reasons a person may develop psychotic symptoms. These include genetics, stress, trauma, and certain mental health disorders, such as schizophrenia, depression, and bipolar disorder. 

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Other potential compulsions may include:

Research suggests that OCD has a high rate of comorbidity with mood disorders and psychotic disorders that involve psychotic symptoms, such as schizophrenia, schizotypal personality disorder, brief psychotic disorder, major depressive disorder with psychotic features, schizoaffective disorder, and bipolar disorder. However, while OCD may have symptoms that present in similar ways to those associated with psychosis, OCD may not cause psychosis directly. 

In a 2015 study, 243 patients (133 of which were non-psychotic OCD patients) were assessed to determine the occurrence rate of psychotic symptoms and whether they were associated with specific types of treatment. Researchers found that non-psychotic OCD patients did not report a higher degree of psychotic symptoms than the control group, nor were psychotic symptoms associated with OCD symptoms before or after exposure and response prevention treatments. They concluded that psychotic symptoms had a stronger link to depressive symptoms rather than those related to OCD.

However, other research suggests that those with OCD may be at a higher risk for later development of psychosis and mental disorders like bipolar disorder, which can have psychotic symptoms and cause obsessive-compulsive symptoms to worsen. In addition, it may be possible for individuals with OCD to experience psychosis. 

Understanding OCD and psychotic symptoms

Some OCD symptoms, like obsessions, may also be mistaken for psychosis. For this reason, an untrained individual may misinterpret obsessive thoughts for delusions or the disordered thinking of psychosis. To determine which condition a person is experiencing, seek the help of a licensed medical or mental health professional. Professionals can provide a diagnosis based on prevalence and clinical characteristics and create a viable treatment regimen. 

How are obsessive compulsive disorder (OCD) and psychosis treated?

Several treatment methods may be effective in treating OCD and psychosis, including but not limited to the following. 

Exposure and response prevention therapy (ERP) for OCD and psychosis

According to the International OCD Foundation, the most effective treatments for OCD include medications like serotonin reuptake inhibitors (SSRIs) and different forms of cognitive-behavioral therapy (CBT). One of the most effective types of CBT for OCD and anxiety disorders like generalized anxiety disorder (GAD) is exposure and response (ERP) therapy. 

Obsessive compulsive disorder and psychosis

Individuals who attend ERP therapy may be exposed to objects, images, or situations related to their obsessions. While a person may initially want to respond to this exposure with compulsive behavior, they’ll learn to avoid this response throughout treatment. Over time, and with the help of a trained mental health professional, ERP therapy may help a person resist their compulsions and understand their obsessive and compulsive symptoms. 

Cognitive behavioral therapy for psychosis (CBTP)

In addition to antipsychotic medication, various forms of therapy may also be effective for psychosis. The UK National Health Service (NHS) recommends different types of talk therapy, such as CBT for psychosis (CBTp). 

CBT for psychosis may involve addressing the thoughts and behaviors of an individual associated with psychotic symptoms. This process can increase a person’s awareness of what they are experiencing, after which a CBT therapist may help them find ways to replace these thoughts and avoid potentially harmful behaviors. In addition, CBT can help people build valuable skills to cope with their symptoms.

Family therapy

Family therapy or family intervention therapy may be beneficial for not only the person experiencing psychosis but also those around them. These sessions often involve families meeting with a therapist to discuss their loved one’s condition, how they can support them, what treatments are available, what happens if their condition progresses, and how psychotic episodes can be managed in the future. 

Group therapy

In some cases, it can be beneficial for individuals who have experienced psychosis to discuss their experiences with others in the same situation. In addition to providing a safe space guided by a mental health professional, these groups may offer a way for individuals with psychosis to socialize and form a support system. 

Alternative support options 

Some individuals may not have access to in-person therapy or find it convenient for several reasons, including but not limited to: 

• Living in an area with a shortage of mental health providers
• Lacking reliable transportation
• A preference for other forms of communication, such as video chats, phone calls, or messaging 
• Wanting to access therapy for a potentially lower price
• Lacking health insurance
• Wanting to attend therapy from home

In these cases, it may be beneficial to seek treatment through effective alternatives, such as online therapy. Online therapy through a platform like BetterHelp can be effective in treating various disorders, including OCD. In addition, online platforms allow clients to choose between phone, video, or live chat sessions and send messages to their therapist throughout the week, receiving a response as soon as the provider is available. 

Teletherapy success in OCD treatment

In a 2022 study, researchers assessed the efficacy of ERP delivered via video teletherapy in the treatment of 3552 adults with OCD. They found that teletherapy treatment was effective at reducing obsessive-compulsive and comorbid symptoms while also improving quality of life.