OCD Psychosis: Signs, Symptoms, And Treatment
Connection between psychosis and OCD
Psychosis can be defined as a mental state involving symptoms that indicate a loss of contact with reality. Psychosis can be caused by a variety of factors, including environment, genetics, and various mental health disorders. One example is obsessive-compulsive disorder (OCD), which may lead to psychosis in a small percentage of people. Understanding psychosis and its connection to OCD can be a step toward finding effective treatment for both mental health challenges, which often includes medication and therapy.
What is obsessive compulsive disorder OCD?
Obsessive-compulsive disorder (OCD) is classified as an obsessive and compulsive-related disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). OCD usually involves obsessive, intrusive thoughts that are often distressing, alongside compulsive behaviors that aim to reduce the distress associated with the obsessions.
OCD can take various themes and is often based on one’s moral code or values. For example, someone may live with religious-based OCD. They may value their religion highly and have obsessive fears that they aren’t practicing their religion correctly or that they are disrespecting a god or deity. They may perform excessive religious rituals to reduce this fear. However, the fear may remain and even intensify, as compulsions usually only reduce anxiety temporarily.
Each person with OCD is unique, and the themes of their compulsions and obsessions may not make sense to someone else. In general, the themes of the thoughts and compulsive behaviors are not as important as the meaning behind them and their causes, which often involve trauma, anxiety, and difficulty letting go of control. When a compulsion is not completed, someone with OCD may experience extreme fear and anxiety, sometimes leading to panic attacks.
What is psychosis and its symptoms?
Psychosis is not considered a mental illness on its own. Instead, psychosis is generally viewed as a cluster of symptoms associated with several mental health conditions in the DSM-4.
Symptoms of psychosis
Symptoms of psychosis may include the following:
- Hallucinations: Sensory perceptions of stimuli that do not exist
- Delusions: Firmly held false beliefs that are difficult to change, even with evidence against them
- Disorganized thinking, speech, and behavior: Confused, unusual, and broken-up thought and speech patterns, as well as a lack of response to external stimuli
Psychosis can also involve symptoms like social withdrawal, absence of motivation, and lack of self-care. People experiencing a psychotic episode may not understand that their symptoms constitute a mental health emergency due to their disconnect from reality. For this reason, psychosis can sometimes put individuals into harmful situations. Crisis support interventions are often recommended for acute psychosis.
What is OCD psychosis?
Psychosis caused by OCD tends to be rare. Some individuals may mistakenly believe that OCD symptoms constitute psychosis due to their repetitiveness and the seemingly nonsensical connections between obsessions and compulsions. However, people with OCD often remain rooted in reality despite their compulsive urges. They often have extreme shame or anxiety due to being aware that their compulsive urges are irrational or don’t align with the severity of the situation. However, because the urges are so intense, they can seem impossible to avoid.
Contrarily, psychosis can make it highly difficult for an individual to know they’ve lost touch with reality. Instead of experiencing shame, they may be confident in their delusional beliefs, which can be a distinction from OCD. Psychosis can cause repetitive behaviors and seemingly neurotic tendencies. However, this disorganized behavior is usually not based on obsessions or moral beliefs but on delusional concepts or a lack of connection with one’s environment.
In some cases, OCD may co-occur with disorders that are associated with psychotic episodes, such as schizophrenia spectrum disorders like schizophrenia, schizotypal personality disorder, schizoaffective disorder, and schizophreniform disorder.
Someone may also develop OCD with psychotic features. However, there is limited research on whether OCD directly causes psychosis on its own. More research may be needed to understand whether there is a confirmed connection and whether obsessive-compulsive symptoms can worsen due to psychosis.
Signs you may be experiencing early psychosis
Signs of early psychosis may sometimes mimic the symptoms of certain mental health conditions, including OCD. Early intervention is often considered effective in treating a psychotic episode. Early intervention can reduce emotional pain, stop psychosis in its tracks, and help individuals manage symptoms so they don’t lose crucial systems in their lives, such as social support, jobs, or schooling.
Early symptoms of psychosis
Below are some of the early symptoms of psychosis to look out for before an active episode occurs:
- Sudden, unusual personality changes
- Irritability
- Depressive symptoms or depressive disorders, like major depressive disorder (MDD)
- Anxiety or anxiety disorders, such as generalized anxiety disorder (GAD)
- Suspiciousness and slight paranoia
- Intense emotions connected to specific ideas
- A drop in performance at school or work
- Difficulty thinking clearly or concentrating
- A decline in self-care
- Social withdrawal
- Apathy
- Difficulty responding to external stimuli
These symptoms can worsen quickly, so consider reaching out for mental or medical intervention as soon as you notice them.
Causes of obsessive-compulsive (OCD) psychosis
Psychosis related to obsessive-compulsive disorder and obsessive-compulsive symptoms is often caused by an external factor, such as a psychotic disorder or bipolar disorder.
Causes of OCD psychosis
However, OCD psychosis may also be caused by the following:
- Medical conditions, such as stroke or epilepsy
- Sleep deprivation
- Extreme stress and burnout
- A family history of psychosis
- Traumatic events
- Post-traumatic stress disorder (PTSD)
- A history of psychotic episodes
If you’re experiencing psychosis and have been diagnosed with obsessive-compulsive disorder, reach out to your diagnostic physician or mental health provider to discuss treatment options and a safety plan.
Support options
Psychosis and OCD, when occurring alone, often need treatment for affected individuals to experience relief. This may make treatment especially helpful in cases where OCD and psychosis occur together. Multiple options may be used to support people with psychosis or OCD. These options are summarized below.
Medication for obsessive compulsive disorder (OCD) and psychosis
Medication is often used to treat OCD and psychosis, although different medications may be used for these mental health challenges. For psychosis, doctors often prescribe antipsychotic medications, which may reduce the frequency and severity of hallucinations and delusions. Without these symptoms actively occurring, people experiencing psychosis may be better able to care for themselves and reach out for further support.
Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Crisis intervention
Psychosis can be a mental health emergency. Seek support from crisis services in your area if you or someone you love is experiencing a psychotic episode. Hospital emergency room staff are typically trained to triage people who are experiencing a mental health crisis.
Support groups
Support groups can offer a place for people living with mental illnesses to receive peer support and talk to those who may understand what they’re going through. In addition, support groups are often free, which can make them affordable to a wide range of individuals from various backgrounds. To find a support group near you or online, consider the following resources:
- National Alliance on Mental Illness (NAMI): NAMI offers a support group connection page to connect people with mental illness to groups in their area or online.
- Mental Health America (MHA): Mental Health America provides a tool to find support groups online affiliated with their organization.
- Schizophrenia & Psychosis Action Alliance (S&PAA): S&PAA offers online support groups for people with schizophrenia spectrum and psychotic disorders, as well as their loved ones.
Self-care
Lifestyle changes can be helpful in preventing future psychotic episodes and improving overall mental well-being. These changes may be helpful for both OCD and psychosis. Consider the following when practicing self-care:
- Sleep hygiene: Sleep hygiene can mean ensuring you have a comfortable place to sleep, sleeping at the same time every night, and putting away devices at least an hour before bed.
- Physical movement: Physical movement can mean going for a walk, dancing, or following along with a workout video. Thirty minutes of exercise daily may improve mental health, as exercise usually increases endorphins in the brain.
- Drinking water: Water can be considered a vital life source for the body. Water can keep you hydrated and reduce the risk of health complications.
- Eating nutritious foods: Talk to a nutritionist and your doctor about the healthiest meals for you. In general, try to eat nutritious foods that nourish your body.
- Practicing hobbies: Enjoying your hobbies may be another way to connect with yourself and distract yourself from challenging symptoms or emotions. If you don’t have a hobby, consider taking a class or learning a new skill online, such as DIY home improvement projects, blogging, or art.
Self-care can mean caring for your body but also having fun and finding ways to enjoy life. If you’re unsure where to start, building a self-care plan with a therapist might be helpful.
Therapy
In therapy, individuals with OCD or psychosis can target symptoms directly and receive personalized advice from a professional. Often, the recommended treatment plan for OCD is cognitive behavioral therapy (CBT) or exposure and response prevention therapy (ERP), also called exposure therapy. These options may also be helpful for those in early psychosis or people who are recovering from a psychotic episode.
However, in-person therapy can sometimes be unattainable for people living with psychosis or OCD, as symptoms can make it difficult to attend appointments. In these cases, online therapy platforms like BetterHelp may be a helpful alternative. Clients may choose between phone, video, and live chat sessions and connect with a therapist from home. Please note that individuals experiencing acute psychosis may require in-person care.
Studies have found that internet-based interventions can be effective in treating OCD. In one study, online OCD treatment appeared to be more effective than face-to-face therapy, and participants also found online therapy more cost-effective.
Takeaway
While it can be rare for OCD to involve symptoms of psychosis, OCD and psychosis sometimes co-occur when an individual is diagnosed with both OCD and a psychotic disorder. If you believe you may be experiencing the early signs of psychosis, reach out for help as soon as possible. Treatment is available for both OCD and psychosis, and treatment is often highly effective in helping clients manage symptoms and live productive lifestyles. Consider contacting a therapist online or in your area to develop a personalized treatment plan.
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