The nature of obsessive thoughts is distressing and repetitive. They are ego-dystonic (not liked or believed by the individual). The thoughts come into the mind without one’s control. People are aware that they are their thoughts. It distresses an individual and is amenable to counter-evidence. Obsessive thoughts will improve when counter-evidence is provided.
A Delusion is a psychotic symptom in which a person has a fixed and unshakeable false belief that is out of keeping with one’s cultural beliefs. Delusions are irrational and not amenable to reasoning. There are several types of delusions, including persecutory, delusions of reference, grandiose delusions and nihilistic delusions. Delusions can occur in mood disorders and schizophrenia. It is helpful to differentiate between a delusion and an obsessive thought.
The main hallmark of an obsessive thought is the presence of insight. Insight into the nature of their thoughts being their own is present. They can identify that it is their thought and do not believe it is true. However, it can come to a stage when the insight falls so low that the thought can be considered an overvalued idea or a delusion. However, it may not be helpful to change the diagnosis to primarily psychotic as that will confound the treatment.
Sometimes, obsessions can coexist with delusions side by side. People with OCD have relatives who have a higher risk of developing schizophrenia and psychosis. Some people with OCD may go on to develop psychosis and schizophrenia later in life. A psychotic illness can be present alongside a psychotic illness as an unrelated disorder. Sometimes, it may prove challenging to differentiate obsessional symptoms from psychotic symptoms, and people may be misdiagnosed.
OCD begins in childhood, around ten years of age. Another peak is around adulthood, where again OCD may peak. Schizophrenia starts around age 18-25. Schizophrenia, though it can be more disabling than obsessive-compulsive disorder, shares similar traits to OCD in that both can be chronic and disabling conditions which can affect functioning significantly. Both are linked to abnormalities in brain structure and functioning.
In people with schizophrenia, it is evidenced that 25% of the people have obsessive-compulsive symptoms and full-blown OCD in 12% of the cases. However, we know that in the general population, the prevalence of OCD is only 1%. Due to the overlap of the symptoms in these conditions, they confound the diagnosis and psychopathology. The following blog is about schizo obsessive disorder, which is proposed as a type of illness where OCD and schizophrenia symptoms are present. This is different to OCD symptoms in schizophrenia.
The diagnosis of OCD must be side by side with a diagnosis of schizophrenia in schizo-obsessive disorder. The more one understands mental illnesses, the more compliant they are with treatment. Several treatment options are available for OCD, which one can make avail of and improve their quality of life.
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