Schizophrenia and OCD

Schizophrenia disrupts daily life due to episodes of psychosis, delusions, and extremely disordered thinking. Obsessive-compulsive disorder (OCD) involves unwanted thoughts and fears that lead to repetitive behaviors and compulsive acts.^1-5

A lot remains unknown about the link between schizophrenia and OCD. But research shows that they occur together at high rates. And although they are separate mental health conditions, they share some common symptoms.^1,2

Co-occurrence of schizophrenia and OCD

Studies show that schizophrenia and obsessive-compulsive symptoms (OCS) often occur together, but the reason why is not clear. Researchers have classified these as schizo-obsessive spectrum disorders.^1,2,5

About 25 to 30 percent of people with schizophrenia report OCS, and 12 to 14 percent may meet the criteria for OCD. Research also suggests that having OCD is a risk factor for developing schizophrenia or psychosis later in life.^1,2

According to 2019 research on co-occurring schizophrenia and OCD:¹

• OCS occurred before schizophrenia symptoms in about 4 out of 10 people.
• Schizophrenia symptoms occurred before OCS also in about 4 out of 10 people.
• Around 2 in 10 of people reported symptoms of both at the same time.

Impact of quality of life

Studies suggest a decline in quality of life for people diagnosed with both disorders. Lower quality of life may look like:^1,5

• Earlier age of psychosis
• Longer duration of illness
• Increased depression and suicide attempts
• Higher rates of hospitalization
• Being less likely to be employed or married
• Increased disability

How are OCD and schizophrenia similar?

OCD and schizophrenia share some common traits. For example, family history increases the risk of developing both OCD and schizophrenia. Research also has linked abnormalities in brain structure and functioning to both conditions.^1,2

Overall, both schizophrenia and OCD can interfere with a person's ability to function. This can cause problems at work and school or in relationships.^1-5

People with 1 of these conditions also may have:^1-5

• Anxiety or other mental health disorders
• Extreme or unusual behavior
• Repetitive behaviors
• Irrational thoughts
• Isolation and paranoia
• Troubled relationships
• Poor quality of life
• Trouble going to work or school or taking part in social activities

How are OCD and schizophrenia different?

Despite their overlapping symptoms, schizophrenia and OCD have some key differences. Schizophrenia leads to erratic behavior and serious complications if left untreated. People with schizophrenia experience delusions, hallucinations, and psychosis. This disordered thinking can be disabling and lead to hospitalization.^2,3

OCD includes obsessions that can become compulsive or irrational. It involves intrusive thoughts, repetitive unwanted behaviors, or extreme anxiety. Yet it does not involve a false reality or typically occur in the context of a delusion or psychotic episode.^2-4

Telling them apart

An example of how the differences in these conditions play out is that a person with schizophrenia may neglect personal hygiene, while someone with OCD may compulsively wash their hands.^3,4

Unfortunately, it can be hard to distinguish between a delusion and an obsession. This can make schizophrenia and OCD hard to tell apart.²

OCD versus schizophrenia treatments

Treatments for OCD and schizophrenia can overlap, but they usually take different approaches. If you live with both conditions, they can be more complex to manage.^1-5

Typical OCD treatment helps you learn to manage obsessions and compulsions so they do not interfere in your daily life. Your doctor may prescribe antidepressants for OCD, but symptoms rarely respond to antipsychotics.²

Doctors often use a different combo of psychotherapy and medicine for schizophrenia. Antipsychotics are usually more effective to balance mood and manage symptoms of psychosis.^1,2

Limited research available

Research is limited on how to best treat people who live with both conditions. The American Psychiatric Association recommends antidepressants, antipsychotics, and cognitive behavioral therapy (CBT) for the treatment of schizophrenia with OCD. But combining some antipsychotics with an antidepressant can cause serious side effects such as seizure or worsen obsessions in people with OCD.^1,2

Research is also limited on the benefits of cognitive behavioral therapy for OCD with schizophrenia. It is important to get a correct diagnosis so you can get the right treatment for you.⁵