Schizophrenia Vs. OCD: What’s The Difference?

Schizophrenia and obsessive-compulsive disorder (OCD) can often be comorbid conditions, so developing one may heighten the risk of developing the other. However, they are also distinct disorders, each with its own set of symptoms. Building a more thorough understanding of the ways schizophrenia and OCD are similar and different may allow for more effective navigating of one or both conditions or better supporting a loved one who may have symptoms of either or both disorders. 

What is schizophrenia?

Schizophrenia is a serious mental illness defined primarily by psychotic symptoms. These symptoms involve a break from reality, potentially leading an individual to have difficulty determining what is truly happening. The symptoms are typically categorized as positive, negative, and cognitive.

Positive symptoms 

These experiences include:

• Hallucinations: Hallucinations are sensory perceptions prompted by stimuli that do not exist, such as hearing voices that no one else can hear.
• Delusions: Delusions are false belief systems that have no basis in reality and are often highly illogical, such as believing that every person who is wearing a specific color is secretly an alien.
• Disorganized speech: Disorganized speech could involve a person responding to questions with random or unrelated answers or engaging in “word salad,” a string of words that don’t connect to each other at all. 
• Abnormal motor behavior: This symptom can look like repetitive, often bizarre movements, difficulty gaining enough control of one’s body to perform basic activities like walking, or a lack of movement or responsiveness, known as catatonia.

Negative symptoms 

Like positive symptoms, the use of the phrase “negative symptoms” does not indicate symptoms that are more unpleasant or unhealthy but symptoms that demonstrate an absence of behaviors that would be expected in someone who does not have schizophrenia. These symptoms include:

• A lack of facial expressiveness, gestures, changes in voice tone, and other typical methods of verbal communication
• Difficulties in maintaining personal hygiene and other forms of essential self-care and autonomy
• Anhedonia, or the inability to feel happiness
• A lack of desire to interact or communicate with other people

Cognitive symptoms 

Unlike positive symptoms and negative symptoms, cognitive symptoms are not defined by the presence or absence of expected behaviors but those that impact overall functioning, including:

• Difficulty with decision-making
• Memory issues
• Confusion 
• Difficulty navigating everyday situations, even if not currently experiencing hallucinations or delusions
• Inability to focus on or comprehend specific stimuli

What is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by two main components listed as diagnostic criteria: 

• Obsessions: Obsessions are unwanted, uncontrollable thoughts and urges related to fears that something terrible will happen or has happened. 
• Compulsions: Compulsions are repetitive or ritualistic physical or mental behaviors that soothe the distress caused by obsessions but can impede everyday functioning.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), individuals can experience primarily obsessions or obsessions and compulsions together to be diagnosed. 

Obsessions 

Obsessions can be related to a person’s moral code, values, or belief systems. Some people with OCD symptoms may believe they are flawed or broken because of their obsessions, which they might view as problematic, corrupt, or “dirty.” In addition, they may experience difficulties with self-loathing or low self-esteem. 

Compulsions 

Compulsions may often be directly related to the fears inherent in a person’s obsessions. Examples of common compulsions include:

• If a person experiences obsessions related to cleanliness and contamination, they may compulsively wash their hands.
• If a person worries about losing control and accidentally hurting someone they care about, they may continuously check in on people they love.
• Repetitive behaviors, such as making sure one always takes the same number of steps across the front porch or rearranging items over and over, can be frequent compulsions for several obsessions.

Compulsions can also be purely mental, such as repeating a specific word or phrase in one’s mind. Seeking reassurance from others is a compulsion that is often not noted but also exists. 

The relationship between OCD and schizophrenia

Psychologists have long noted that people with schizophrenia are more likely to display obsessive-compulsive symptoms in addition to psychotic symptoms. 

In an article from 2014 titled “Prevalence and clinical correlates of obsessive-compulsive disorder in schizophrenia,” the researchers analyzed whether the incidences of comorbid OCD symptoms in patients with schizophrenia rose to the level of potentially requiring a new disorder or classification group, such as “schizo-obsessive disorder” or “schizo-obsessive spectrum disorders.” However, current psychological understanding typically views the two disorders as distinct conditions that may be more likely to occur together than other mental illnesses.

In looking at key symptoms of the two conditions, it may be easy to confuse the obsessions associated with OCD with the delusions associated with schizophrenia. However, there are core differences between the two. 

Obsessions vs. delusions 

An OCD-associated obsession is not a belief system in and of itself but rather a fear that may or may not be related to a belief system. For example, a person with OCD who is religious may become obsessed with adhering to the tenets of their religion and be mortally afraid of violating their religious code, using compulsive behaviors like reciting Bible verses to soothe their fears. 

This behavior is distinct from that associated with a schizophrenic delusion. Some people with OCD can be capable of recognizing that their obsessions and their related compulsions are irrational (which can worsen the low self-esteem associated with the condition). In contrast, people with schizophrenic delusions often demonstrate a phenomenon called anosognosia, in which they are unaware that their beliefs or behaviors are bizarre in any way. 

Wondering if symptoms are obsessive-compulsive or psychotic?

Talk to a therapist for guidance

Finding support for schizophrenia and OCD

Treating OCD and schizophrenia can be a complicated process, whether a person has one or both of the disorders. OCD treatment can involve exposure therapy or cognitive-behavioral therapy (CBT). Schizophrenia can also be treated using cognitive-behavioral therapy but may additionally require medication, group therapy, and medical intervention.

The fear and anxiety associated with OCD and schizophrenia may make the thought of attending an in-person therapy appointment seem overwhelming. In these instances, online therapy through a platform like BetterHelp may be a helpful alternative. With online therapy through a reputable platform, you can attend sessions from the comfort of your home. Some therapeutic modalities for treating OCD and schizophrenia can be offered online, and clients can choose between phone, video, or live chat sessions. Additional resources like weekly support groups may also be beneficial. 

Research has indicated that online therapy can be a beneficial treatment option for various mental health conditions, including those that may be thought of as more “serious,” such as schizophrenia, OCD, and conditions like bipolar disorder. One study found that online therapy could improve symptoms of psychosis associated with schizophrenia, and another found that online therapy was an effective intervention for treating obsessive-compulsive disorder.