Can OCD Cause Psychosis? How These Disorders Overlap
Obsessive-compulsive disorder (OCD) can be considered a long-term mental illness that usually affects a person's thoughts and behaviors. OCD symptoms may include obsessions, compulsions, or both. Obsessions can be defined as anxiety-inducing intrusive thoughts, mental images, or urges. Meanwhile, compulsions can be described as behaviors in which a person engages to manage or reduce obsessive thoughts. People with OCD usually can't control their obsessions and compulsive behaviors, and they may spend over an hour a day focused on them.
A disconnect from reality, often referred to as psychosis, is a mental state that can also affect a person's thoughts and behaviors, but in ways that differ from OCD. When a person has psychosis, they often experience hallucinations and delusions. Hallucinations generally involve seeing, hearing, smelling, tasting, or feeling stimuli that aren't actually there. Delusions usually consist of untrue beliefs.
Multiple research studies suggest there could be a connection between OCD and mental disorders involving psychosis. However, experts do not yet entirely understand this connection, and more research is needed. Having OCD does not mean a person will develop psychosis, and vice versa. Both can often be treated with a combination of therapy and doctor-prescribed medication.
Can OCD cause psychosis?
Psychosis is not a diagnosable mental health condition, but a mental state that can be a symptom of various mental illnesses. Recent research suggests that OCD and schizophrenia, a psychotic disorder, may involve similar genetic and biological origins. Brain imaging studies show that similar neurological dysfunction tends to occur in both disorders. More research is needed to understand if one disorder can cause the other, or if other variables can cause both.
Genetic overlap between schizophrenia and OCD
Researchers analyzing gene data from genome-wide association studies (GWAS) found that there is often some genetic overlap between schizophrenia and OCD. They suspected that this could explain why a past study found that 19% of people hospitalized for schizophrenia also had OCD. They argued that this genetic overlap could explain why some medications used to treat psychosis have been found to help people with OCD who don't respond well to OCD medications.
The connection between OCD and psychosis
The underlying cause of OCD could involve similar biological workings to the underlying cause of psychosis. Most of the recent research looking at the overlap between OCD and psychosis concludes that there is likely a connection between the two disorders, but more research is needed.
Historical views on OCD and psychosis
Historically, most experts thought that OCD and psychosis were unrelated and that having one didn't increase a person's risk of developing the other. More recent research has refuted this but has not yet uncovered many details about the connection between the disorders.
Can OCD cause psychosis?
One older study found that people who had long-term OCD usually faced a greater risk of developing psychotic disorders. These disorders included schizophrenia, as well as mood disorders with psychotic features, like major depression and bipolar disorder. Although people with OCD may face a greater risk of developing psychosis, the proportion of people with OCD who develop psychosis tends to remain low.
Can OCD reduce the severity of schizophrenia symptoms?
In addition, some experts have argued that developing OCD may stop a person from later developing schizophrenia. Some studies show that people with schizophrenia who also have OCD tend to have less severe schizophrenia symptoms. Further research may be needed to understand if OCD can cause psychosis, reduce its severity, or affect it in some other way.
Psychosis-focused obsessive-compulsive disorder (OCD)
If a person constantly worries that they have schizophrenia or psychosis, that could be a sign of psychosis-focused OCD. Most people with OCD do not go on to develop schizophrenia or other psychotic disorders. However, some people with OCD may have obsessive worries about developing schizophrenia or losing their minds. Fearing schizophrenia or psychosis is not necessarily a sign that a person is developing either. Instead, these fears are usually a manifestation of anxiety.
Obsessive-compulsive disorder: Intrusive thoughts related to schizophrenia fears
A person with severe OCD could become convinced they are on the brink of losing their mind or developing schizophrenia, even if that isn't true. If this is their primary obsessive thought, then their compulsions may include reading about schizophrenia online to make sure they don't fit its description and seeking professional evaluation for reassurance that they're not experiencing psychosis or losing their mind. While OCD treatment can help, continuing to perform these "checking" behaviors may worsen obsessive-compulsive symptoms.
Psychosis and lack of insight into delusions
Most people experiencing psychosis do not question their delusions and hallucinations. Because they believe their hallucinations and delusions are real, they generally have little reason to worry about experiencing psychotic symptoms or to question their mental health.
Psychosis-focused OCD and anxiety signs
Most people with psychosis don’t actively reflect on their hallucinations and delusions in this way unless someone has encouraged reflection as part of their treatment. Therefore, if someone is overly focused on the possibility of experiencing psychosis, this may be a sign of psychosis-focused OCD or an anxiety disorder.
Can psychosis symptoms cause OCD?
Analysis conducted as part of a gene study showed that having schizophrenia may be a risk factor for developing OCD. Historically, many experts assumed that when a person with schizophrenia developed OCD, they did so because of antipsychotic medications.
Antipsychotics and OCD risk in schizophrenia
Specific antipsychotics called second-generation antipsychotics may be linked to a higher risk of obsessive and compulsive symptoms. These antipsychotic medications are frequently used to treat disorders like schizophrenia and schizotypal personality disorder. However, the gene study suggested there's likely something beyond antipsychotic medication use that may make people with schizophrenia more likely to develop OCD.
Remote therapy for obsessive-compulsive disorder (OCD) and intrusive thoughts
Just as remote therapy has been found to effectively treat generalized anxiety disorder and depressive symptoms, online therapy can also be a treatment option for people with OCD, psychosis, or both, although individuals experiencing acute psychotic symptoms may require in-person support.
Benefits of remote therapy for mental illness
In general, remote therapy allows a person to meet with a therapist virtually, from the comfort of home or another preferred location, so they can avoid the travel and social interaction involved with seeing a professional face-to-face. BetterHelp is a remote therapy platform that can connect you with an appropriate therapist for your situation if you are interested in pursuing remote therapy.
Effectiveness of remote therapy for mental illness
A meta-analysis of 18 studies found that remote therapy could effectively treat OCD symptoms. People receiving remote therapy for OCD typically improved more than control groups, and remote therapy for OCD proved to be just as effective as in-person therapy. Remote therapy for OCD usually reduced symptoms by "a large magnitude," showing that online therapy could be an effective option for individuals living with this mental health disorder.
Takeaway
Experts used to think that OCD and psychosis were unrelated, but more recent research studies have found potential connections between the two. Some research suggests that people with long-term OCD could be more likely to experience psychosis and that people with schizophrenia could be more likely to develop obsessive-compulsive symptoms. OCD and psychosis seem to have some genetic overlap and similar neurological underpinnings. More research is likely needed to better understand this connection. Individuals living with OCD, psychosis, or other mental health challenges may benefit from working with a therapist in their local area or online.
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