# *Trigger Warning* This should make a lot of people feel wayyy better.



## sirlee (Mar 5, 2014)

What Is Schiz OCD?

Repost from the old site.

Well, to be honest, it's nothing, officially anyway. It's just a colloquial name given to a certain type of OCD, or obsessive-compulsive disorder, this type being a pure-O type, or obsessions without compulsions*. I have recently discovered, after hanging out on some OCD boards, that schiz OCD is actually quite common, though it is a very disturbing type of OCD and is probably also often misdiagnosed.

The person with OCD starts out worrying that they either have schizophrenia or are going to get schizophrenia. They start to read all about schizophrenia, including all of the symptoms. Then they start to misinterpret stimuli in their environment as being due to hallucinations.

They hear noises in the environment and think that they are hearing voices or hallucinating. They see things out of the corner of their eye and start worrying that they are having visual hallucinations.

Keep in mind that it is considered normal to hallucinate for brief periods on rare occasions. It is not uncommon for normals to report hearing indistinct voices for 5-10 seconds a couple of times over a 5-10 year period - a person who experiences such an experience will likely say, "My mind is playing tricks on me." Transient hallucinations are not necessarily pathognomic of anything.

The real problem with schizophrenia is that the person is afflicted with frequent or continuous tormenting voices that the person insists are real.

Then they start worrying that they are going to get schizophrenic or psychotic delusions. Pretty soon, "delusions" or "psychotic thoughts" start popping into their minds. In more serious cases, the "delusions" or "psychotic thoughts" repeat endlessly in typical OCD style.

Some are reporting just about every schizophrenic and psychotic thought and delusion known to mankind (they are either getting them out of the books or making them up on their own). I am doing amateur therapy now with a man who has experienced hundreds of "psychotic delusions". It is clear that, at the moment anyway, he has OCD.

Some of these folks have committed themselves to mental hospitals, often repeatedly, insisting that they must have schizophrenia. At the hospitals, the doctors are not very nice to them, and the nurses make fun of them, saying that they have "medical student syndrome".

Some of them insist that they are delusional - their delusion being that they have schizophrenia. The "delusion that one has schizophrenia" is not an appropriate symptom for a diagnosis of a psychotic disorder.

People with schiz OCD are often in a great deal of pain, but they are not psychotic at all, and, in general, they are not dangerous in any way whatsoever. The "delusions" are simply obsessions that are often vigorously resisted. Sometimes the person spends a lot of time checking to make sure the "psychotic thoughts" are not true.

Some of the thoughts that they get are, "They are poisoning me," when being served food, "They are against me", about anyone, especially a loved one, "This is a message for me", if they see a piece of paper, etc.

The thought about being poisoned proved to be quite common, with many OCDers reporting it. They all said that they went ahead and ate the food anyway. I do not think someone who really thought they were being poisoned would go ahead and eat the food.

Proper diagnosis is essential in these cases, as a number of clinicians are diagnosing these folks as psychotic. They are not psychotic; they have OCD. It is very important to distinguish between obsession and delusion. The bizarre, psychotic-like nature of the obsession does not mean it is a delusion.

An obsession is defined as the following:

Obsessions as defined by (1), (2), (3), and (4):

1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

2. the thoughts, impulses, or images are not simply excessive worries about real-life problems

3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action

4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

If the "psychotic thought" or "delusion" has the qualities above, it is an obsession. A person with a true delusion simply accepts the thoughts as absolute fact, with a conviction so deep that you cannot change their minds even if you argue with them all day and night. They believe it the same way that you believe your name is whatever your name is. Furthermore, delusions are never resisted.

I have known psychotic persons who had delusions and hallucinations; it is simply impossible to try to argue them out of their false ideas and sensory illusions. Typically, persons in the midst of a psychosis do not have the slightest clue that they are ill.

It is true that in the early stages of psychosis or even schizophrenia, the person often has some level of awareness and insight. This is especially true of more educated persons who know a lot about mental illness.

I recall a poignant case where a young man experienced the early stages of schizophrenia, went to the library and researched his symptoms and diagnosed himself with schizophrenia. However, soon afterwards, he became full-blown psychotic and all insight was lost.

The lack of awareness of being psychotic makes it difficult to get these persons to take medication. Often they have to be convinced to take medication via subterfuge.

It is also true that schizophrenics who are on anti-psychotics and are getting a good response sometimes have excellent insight.

I have lived with psychotic persons for months on end, have spent months befriending and socializing with a schizophrenic and have talked with other schizophrenics who were actively psychotic. I have never met a psychotic individual who had the slightest bit of insight into their condition.

All of my efforts to talk psychotic individuals out of their delusions or convince them of the false nature of their hallucinations have been fruitless. It is a mystery to me how anyone can claim to do psychotherapy with an actively psychotic person.

Persons with schiz OCD are being diagnosed psychotic or even schizophrenic. Let this post serve as a warning that differentiation between obsession and delusion is of profound importance, as proper diagnostics is an essential pillar of treatment. Incorrect diagnosis poses numerous risks to clients, including exposure to dangerous drugs, damage to self-esteem, confusion, etc.

Persons with schiz OCD often have a history of other forms of OCD, such as HOCD (obsession with being gay), POCD (obsession of being a pedophile), harm OCD (obsession of being a rapist or murderer), germ OCD (obsession about contamination), etc.

A man I know with schiz OCD just got back from a visit to a psychiatrist who diagnosed him as "a little bit psychotic" and tried to put him on anti-psychotics.

She gave the following reasons why he was psychotic: because harm OCD and schiz OCD were not "typical" forms of OCD, and, if he was worried about going psychotic, it must be because he is going psychotic. She also said that most psychotic people have insight into their illness - in fact, the very definition of psychosis precludes insight.

Nevertheless, although anxiety disorder does not lead to psychosis, and OCD in general does not progress to psychosis, sometimes OCD presents as the leading edge of schizophrenia, usually in a young person. In such cases, full-blown schizophrenia occurs within about two years after development of OCD. OCD and schizophrenia can also co-occur, strange as it may seem.

And some persons who seem to be suffering schiz OCD may be experiencing the onset of schizophrenia. In cases where a person with schiz OCD is regularly actually hearing things, further investigation is warranted.

However, it is likely that a person in the early stages of schizophrenia will experience their strange thoughts as ego-syntonic instead of ego-dystonic - that is, the thought will not be immediately marked as crazy and vigorously resisted, but will instead be embraced as verifiable reality.

Perspective is important. The main problem here is OCDers being diagnosed as psychotic, not the other way around.

Little has been written about the treatment of schiz OCD. A man I interviewed experienced an almost 100% loss of schiz OCD on Anafranil, one of the best anti-OCD drugs out there. He also told me that other SSRI's have been successful in preventing relapse. When schiz OCD is very bad, medication may be necessary. A successful response to SSRI's will typically vindicate the OCD diagnosis.

Little has been written on the cognitive-behavioral therapy (CBT) of schiz OCD. One sufferer told me that the strategy of accepting the thought and just letting it pass on through without debating it seems to be helpful. Resistance is often counterproductive, as it often just strengthens the obsession.

There is a serious dearth in the literature and understanding of schiz OCD. This post will hopefully spur more articles on this poorly-understand type of OCD.

Here and here are a couple of more articles on schiz OCD.

*Fred Penzel suggested to me that actual pure-O OCD is quite rare. He is correct. What he means is that most pure-O types engage in reassurance seeking, checking and mental compulsions. Sure they do.

On the other hand, OCD'ers seem to want to distinguish between the more ruminative types who do not have overt rituals (no one who knows me would think I have OCD because I do not wash my hands all day or turn lights off and on 20 times). Furthermore, clinicians also seem to want to make this distinction. I was told I was a "classic obsessive" - implying rumination and lack of overt rituals.

http://robertlindsay...t-is-schiz-ocd/

i found on this site a while ago a post by Doberg and I think it will help many of us. it sure as hell helped me. Understand that if you have Depersonalization/Derealization you most likely are going to share comorbidity with depression, anxiety disorders, and Ocd. I rarely get on here because I feel as if i have slowly but surely been recovering from everything, and it is when i feel the most depersonalized which is only at night now, that all the strange thoughts and perceptions show up. Therefore I know they are rooted in anxiety and Ocd. Hope this finally gives you guys the diagnosis you need to finally start helping yourselves. This is the last time I get on here, since I know when i get back this is my rumination and it doesnt help me recover. I still believe that Ocd of this sort is something you can recover from, I have read of people who have, and if you can get through depression and anxiety, why not ocd? good luck everyone.


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## Michael22 (Jan 15, 2015)

Hi there,

I must say that was a great bit of information to read about, as id never heard of schiz ocd beore. After reading this i beleive i may have schiz ocd, for the last couple of weeks ive read a few things about my dp and anxiety and there have been one or two links to schizophrenia, which have terrified me and led me to do minor research to calm me and let me know i dont. I mean ive never heard any voices in my head, if that day comes my world will crumble. I do have intrusive thoughts, horrible thoughts about harming my loved ones occasionally, and twinned with dp and anxiety it all gets on top of me. Your post was great, but this passage alarmed me intensely,

Nevertheless, although anxiety disorder does not lead to psychosis, and OCD in general does not progress to psychosis, sometimes OCD presents as the leading edge of schizophrenia, usually in a young person. In such cases, full-blown schizophrenia occurs within about two years after development of OCD. OCD and schizophrenia can also co-occur, strange as it may seem.
And some persons who seem to be suffering schiz OCD may be experiencing the onset of schizophrenia. In cases where a person with schiz OCD is regularly actually hearing things, further investigation is warranted.


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## *Dreamer* (Feb 18, 2014)

This is interesting, and yet I find it very innacurate. As noted this is not noted or recognized as a diagnosis ... anywhere.

A person can have OCD and it will never develop into schizophrenia. OCD is a life-long illness, on a spectrum with tourette's and tics as far as I know at this time. It is an anxiety disorder, not a psychotic disorder.

Also, one can have OCD and not have DP/DR. If you have both you have two disorders -- they are "co-morbid" ...the are occurring together. A person with anxiety can have DP/DR or not. Someone with depression can have DP/DR or not. A person with schizophrenia and have DP/DR or not.

DP/DR is a dissociative disorder. I think it should be considered an anxiety disorder.

I could not find "Schizo OCD" in any manual or on PubMed. There are some current articles on the occurence of both at the same time. But that is advanced research that is still in progress. Bottom line, someone with schizophrenia can have OCD symptoms, but it is highly unlikely the average indivdiual with OCD will ever develop psychosis -- and also the psychotic thinking is an extreme exagerration of the OCD thinking. It is one thing to be afraid to eat food as you "THINK" it may be contaminated, vs. LITERALLY BELIEVING it is poison and you refuse to eat anything. But the progression of OCD to that state ... as I understand is VERY rare.

I will say, in a VERY small group of people with OCD, their thinking CAN progress to psychosis. But this has nothing to do with DP/DR.

Merck Manual definition of OCD. And also, this expression "Schizo" ... it really bothers me. It is schziophrenia ... an illness. Those who have it can be very high functioning.

http://www.merckmanuals.com/professional/psychiatric_disorders/obsessive-compulsive_and_related_disorders/obsessive-compulsive_disorder_ocd.html?qt=schiz%20ocd&alt=sh

Also, if this information is very old, it is likely out of date. If you want current information on any illness, you have to look at articles written in professional journals that are dated this year. Research goes out of date the moment it is published. Things change that fast. Understanding can grow that fast, or be disproved in further studies.


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## *Dreamer* (Feb 18, 2014)

Also, OCD is not a symptom of DP/DR. I would say obsessive rumination is a part of it. But I wouldn't call that OCD. Also, new understanding of Hoarder/Clutterer disorder has been classified as a form of OCD. It doesn't seem to be. It is different. It is also an anxiety disorder and related to inability to make decisions, etc., etc.

In Hoarder/Clutterer there really isn't the cycle of anxiety ----> compulsive rituals to alleviate anxiety ----> brief periods of relief, or no relief. And the individual with OCD KNOWS what they are doing in terms of their rituals is NOT NORMAL, yet they can't stop doing them. Someone will wash their hands until they bleed, and they know it is illogical, but they MUST do it as they feel compelled to do so. They have insight.


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## Guest (Jan 16, 2015)

You can do all the research you want about schizophrenia. None of us on here our trained to diagnose it, with that being said, some know more than others. Dreamer knows a hell of a lot about this topic, so I usually tend to agree with her on these types of situations. It is a good post to relieve some peoples worries, But please in the future be sure to put *Trigger Warning* Whenever mentioning something like this. The main reason is because many of our members already think psychosis is coming, when 99.9 percent of the time it is not, so to introduce them to a new disorder can do more harm than good sometimes.


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