Differential Diagnosis: Schizophrenia Versus OCD

From Yahoo Answers:

I have really aggressive thoughts sometimes. I don’t even understand why I have them. Usually (not limited to) they’re about hurting people. I feel really crappy about myself after these thoughts. I won’t go into all of my thoughts because some of them are really disturbing and they come out of no where sometimes. It’s surprising and then I start feeling like maybe I’m just a really evil person although I’m considerate of other people, most of the time.

I have a heart but sometimes I feel like how can I have a heart with these thoughts in my head! They don’t pop up in my head unless I think about it.

So then I thought well these thoughts might be schizophrenia, I started looking up what schizophrenia was. Then right as I saw the symptoms and examples of the symptoms I started like displaying the symptoms in my head. It’s almost like once I absorb an idea my mind plays on it. Like when I saw this CSI episode where this person got poisoned with Cyanide, I started worrying about cyanide poisoning. When I read the symptoms of Schizophrenia where you have like hallucinations (Like voices in your head) I started making a voice in my head. Once these ideas are in my head I can’t get them out. It’s like they become apart of me. Like sometimes I think “what if” all the time for every symptom of schizophrenia. Like people watching you. I started thinking: WELL, WHAT IF someone was watching me. Errr! I can’t get these thoughts out of my head and I think I’m starting to convince myself that I have schizophrenia. I’m scared. I feel like a sicko. My mind is also very contradicting: Like if I say I’m not a bad person my mind says “yes you are” and really self-deprecating thoughts. Every time I want to feel good about myself my mind will convince me that I shouldn’t and that I’m a sick freak who thinks horrible thoughts. I’m 19 about to be 20 soon and I heard schizo starts early 20s. I just don’t know what to do…I don’t have any insurance to go see a doctor. I’ve been a worry-wart ever since I was in elementary school. Also, like schizo, I heard you hear voices in your head and you believe what they’re telling you. Like let’s say something says, “This is God talking to you!” and I’m an agnostic and I don’t really believe in God. I like create scenarios and voices in my head ever since I heard about schizophrenia. NEVER before. It’s like my mind is trying to give me these symptoms it’s hard to explain. It’s like I know they’re my voices but I don’t understand why my voices are saying these things. It’s like WTF? :\

A most interesting case. This is a completely clear-cut case of OCD, screaming loud and clear across the landscape. I won’t tell you how I know this, but I know this illness like the back of my hand, since I have it. Been there, done that, ok? Not that subtypes matter, but this person has a couple of subtypes of OCD. The first is Harm OCD. The second may as well be called Schiz OCD. This is a person who starts to worry that they have schizophrenia. In the case above, he is starting to invent crazy voices in his head due to his fear. These voices in his head are causing him to worry that he had schizophrenia. This person clearly does not have schizophrenia. First of all, the voices in the head. The person with schiz hears these as actual voices with his ears, the same you would hear the voices of the people around you. The voices sound just like the external voices of persons near you, so much so that it is hard to figure out who is really talking and what’s just a hallucination. So the voices are not really in the head but in the ears, so to speak. We all have internal voices in our heads that we hear all day long. Nothing to be alarmed about. The “what if” questions are typical of OCD. A person with schizophrenia or other psychosis simply says, “People are watching me.” If you try to question them about the belief, you run into a brick wall and get a big argument. It’s a rock-solid delusion, and all delusions are hard as stone. The person also has “contradictory thoughts.” This is unfortunately quite common with OCD. The person thinks a good thought, like “I’m a good person,” and the OCD chimes in with a contradictory thought saying, for instance, “No you aren’t. You’re evil. You’re the most evil person on Earth.” These thoughts will probably be violently resisted. When doing differential diagnosis, look first of all at how hard the person fights or resists the thought. The more ferociously the person fights or resists the thought, the more likely you are dealing with an obsession. A good rule of thumb is: If you try to stop the thought, it’s an obsession. Unfortunately, clinicians understand OCD very poorly, and I doubt if this person is going to get a good diagnosis or treatment. In particular, OCD patients these days are often diagnosed as psychotic and treated with anti-psychotic drugs.

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7 thoughts on “Differential Diagnosis: Schizophrenia Versus OCD”

  1. My daughter has been diagnosed with severe OCD. She has intrusive thoughts where she is ridiculed and mocked by her female friends. Lately, she started to smile for no reason. I asked why and she told me that now, when she has those bad intrusive thoughts, another pops up in her mind. In this last one, someone pulls down the skirt of the girl mocking her as if trying to defend her. She says she is aware that these are baseless thoughts but she says she cannot help laugh every time this funny thought pops up.
    Her psychiatrist said that this laughing behavior/thought don’t match OCD symptoms. She prescribed Rispedol 0.25 mg and said that there may be something else in addition to OCD.

    1. Not necessarily true. People with OCD can react in all sorts of ways to their thoughts. Smiling or laughing at your thoughts is perfectly compatible with OCD. It doesn’t necessarily mean anything else at all, and I am an expert on this illness.
      How old is the girl?

      1. Thanks for your reply. She is 19 years old. This is in the 4th day on Risperidone and we have noticed that her thoughts have worsened. She has also told us that she feels worst since she started this new medication.

  2. Hi Robert. We noticed some problems when she was 11 or 12 years old. Symptoms like repeating certain movements with her hands, blinking repeatedly or walking forward and backwards one step. During this time she became extremely shy and irritable. She says she fought these weird routines and they subsided later. Al this happened while we never knew what was going on because she would not talk to us about it. At this point, she had not many irrational thoughts.
    This year in February, her allergist prescribed Zyrtec and according to her, this is when the mental obsessions started. At the beginning of November she started to deteriorate rapidly. She was not eating nor sleeping. We took her to a psychiatrist at the end of November. The psychiatrist told us that it was OCD. She prescribed Clonazepam 0.5mg and Prozac 0.20mg. That helped her to get some sleep but her thoughts did not improve.
    A week ago we took her again to the doctor and informed the doctor that she now was laughing due to other ideas popping in her mind. Then is when the doctor said that there could be some other component besides OCD and prescribed Risperidone 0.25mg instead of Clonazepam.
    After 4 days within Risperidone, her obsessions became worst and now she is not sleeping again. My wife and I decided to stop Risperidone and go back to Clonazepam. I think that at this point it will help her to go into a in-patient intensive therapy program at a hospital.

    1. Hi Robert. We noticed some problems when she was 11 or 12 years old. Symptoms like repeating certain movements with her hands, blinking repeatedly or walking forward and backwards one step.
      That’s all pretty strange, but it looks OCDish. Some OCD’ers indeed do engage in odd behaviors like that. Those are some sort of rituals, probably compulsions. Why she was doing them, I am not sure.
      Tell her to stop laughing at the good thoughts. Tell her it looks funny. She’s probably a rational person deep down inside, so the idea that it looks weird to be laughing for no reason would probably impact her.

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