More OCD and Psychosis: Differential DX

Let us look at some more cases from the Internet.
Case 1 here and here.

I’m trying to pin down one of my major symptoms that can and has completely impaired my life. My OCD revolves around harm, such as fears that I will harm someone, violent thoughts of harming someone, and even urges to harm someone. I don’t think I want to hurt anyone, but my OCD tells me differently. Sometimes I will get a violent thought when I am standing near someone, and I will not hurt them, but I will quickly walk away to avoid any chance of ever acting on my thought/urge.
Ok, here’s the weirdest part: Later on, after I have walked far away from people in order to avoid hurting them, I believe that I actually did hurt someone after all, and that my memory of avoiding him/her is a false memory, or I just forgot the true memory of actually harming the person in question. I truly have believed many times that I was a murderer, despite tons of evidence to the contrary.
Looking back, I realized I’ve wasted so much time believing I’d done something terrible and waiting to be locked up forever. However, at the time, my beliefs were unshakable and persisted despite all the evidence that my family/friends/counselor threw at me to try to convince me that I had done nothing wrong.
I think my OCD may involve hallucinations as well. Whenever I think I may have harmed someone I hear police/ambulance sirens. Coincidence? Maybe, I’m not sure. When my OCD started to improve at school I was hearing less sirens.
This is the situation I’m in. It started with me walking beside people on my (very hilly) campus that has a lot of ravines. I got the anxious thought “What if I pushed someone into one of the ravines?” So I’d actually go DOWN into ravines to search for bodies. Crazy huh?
Well, it got crazier. One day, the thought or belief (delusional) came into my mind: I DID push someone into the ravine and kill him/her. I compulsively searched, but I couldn’t search very well because I was embarrassed and scared because I was getting weird looks.
So I dropped out of school. And I believe that there is STILL a body in one of those ravines (even though I called my counselor numerous times asking if there were missing students and she always said no) and I checked the news for five weeks – nothing. No evidence, but I still believe I killed somebody.
I had to drive today as an OCD exposure and I had to drive very close to a bicyclist because he was hogging the road. I drove as far away from him as possible, even onto the curb to avoid him. Of course my senses were heightened and I would have felt a bump even if I sideswiped him, which I don’t think I did.
There was no damage to my car or anything, and when I drove back on the opposite side of the road cars were driving normally and I didn’t see emergency vehicles but I still believe deep down that I hit him. It sucks. And I can’t check the news either – in program we are discouraged from checking and other compulsions.

There is a lot of back and forth about this in various threads for some reason. She also has a dx of schizoaffective disorder, which is never explained. Various people feel that this symptom is a combination of OCD and a psychotic symptom, but I am not so sure about that. The part about searching the ravines is also OCD, though it’s rather extreme in that it made her drop out of school.
I honestly feel that this presentation is simply OCD of the Harm OCD type. The person fears that they will attack others, but they never do it. Apparently it’s all just fear.
Going back and checking over and over to make sure she didn’t kill someone or push someone into the ravine is also very OCD-like. A psychotic person simply says that they killed someone by pushing them into the ravine, and that’s that. There’s no going round and round about it, checking the ravines, calling people, reading the papers. That’s called “checking,” and it’s an OCD thing.
Although these symptoms are very disturbing in that they involve violence, a person with this type of OCD is very unlikely to act on the obsession, and probably will never act it. They are less likely to commit a violent act than anyone else. The presentation is rather strange in that most OCD folks don’t have this degree of certainty in the obsession.
The hallucinations of police sirens are odd. Some clinicians are saying that there can be hallucinations in OCD, but they are generally minor. The whole idea of hallucinations in OCD seems very strange to me, and I don’t know what to make of it. OCD experts claim that there are no hallucinations in OCD.
Case 2 and here

The other night I had a thought about gouging my dog’s eyes out; it was terrifying to me. I could never do that, but the thought alone was enough to keep me obsessing about it for hours. Made me very anxious.
Woke up the other day worried I was going to spontaneously run someone over or grab a knife and stab someone, like it would be a compulsion I couldn’t control. My therapist said that’s classic OCD.
Sometimes I hear music playing, like tonight I was hearing a band playing, but it turned out to be just some noise from the a/c cause i left the room and returned.
Sometimes I hear people saying “hey” or think I heard someone else say something when they didn’t, but that’s really not a big deal, I imagine everyone has thought someone said something once in awhile, but the music thing is pretty real.
It sounded like a parade going on outside my house, until I got up and moved around. Not a big deal, just enough to make me stop what I was doing and listen.

This is classic stuff – Harm OCD. In general, they never act on the thought, even if they are thinking of it 24-7. There is controversy on whether or not there have been cases of people acting on antisocial or violent obsessions. Some say there have been some cases, but I have never heard of any. I do therapy with some people who have this type of “harm OCD,” and I never worry that they will act on it.
Note that this person is also worried that they are going to go psychotic, just as Case 1 is obsessed with whether she is psychotic or not. The worry that one will go psychotic is pretty OCD like right there. People with psychotic disorders don’t generally worry about such things.
The part about the hallucinations is stranger. First of all, they are not hallucinations. He just thinks he is hallucinating. He heard the AC, and it sounded like music because he didn’t realize that it was the AC. We live in a noisy environment, and mechanical objects will often make sounds that sound like auditory hallucinations. Other noises in the environment can also fool you. These are called illusions, not hallucinations.
Case 3

I have thoughts that someone is going to poison me or slip me drugs or somehow do something “bad” to me. When I was a kid there was all the talk about people putting razor blades and drugs in Halloween candy; there was a rash of OTC drug packages that were tampered with that killed someone and had these drugs pulled from the shelf, and there was also a case of someone getting poisoned by their friends. This was all in a relatively short span of time.
I seem to have latched on to all of that in an unhealthy way.
I don’t think people are out to get me. I don’t think there’s a conspiracy to hurt me. What I fear is that there are a lot of nutty homicidal people out there, and they may decide to tamper with food or whatever, and that it would be my luck to be one of the unlucky people that would be the victim.
I’m afraid that people are crazy, unpredictable, and there’s just a lot of random Bad Shit out there that people do. I also worry that somehow food will be contaminated with deadly microbes – botulism is a fun one to worry about.
I know this is insane. I know that the likelihood of something like that happening is very small. Still, it can drive me to panic attacks and anxiety as well as some fun compulsions. If there’s only one of something left at the grocery store, I can’t buy it. I have to take the package of food that’s the second one back, not the first.
I inspect packages. I give my dog food that is “suspect” knowing that if she’s okay, I’ll be okay. I know it’s stupid and silly, but the actions reduce my anxiety so I don’t have a panic attack or start freaking out.
In some ways it feels like a fear of flying. It could happen, even if the chances are low. Very low.

Strange case. The doc said that these were symptoms of “paranoia,” but I don’t agree. I think it’s just OCD. Thing is, your food could be being poisoned at any time. Most of us just assume it is not and go ahead and eat it anyway. That’s all you can do in life really.
Case 4

I have similar thoughts. Whenever I go to the supermarket, I’m always thinking that the food that I’m about to buy has been tampered with. So for example, when I grab a jar of pasta sauce, I start to think that someone injected poison into the the jar.
So I put that jar back and grab the one behind it. But then I become convinced that the person who poisoned the jar would know that someone like me will be expecting the jar in front to be poisoned, so they must have put the poisoned jar in the second row instead. So then I put the second jar back because I get convinced that it may have been poisoned. Then I sit there debating the whole thing in my mind because I don’t know which jar to buy. Ultimately I just say fuck it and take one of them.
I also worry that people will tamper with my food at restaurants and food courts. So lets say I’m eating at a food court by myself and I sit at the table and realize that I forgot to get a straw, when I go back to food place to get a straw, I always make sure that I keep an eye on my food the whole time.

Not sure what to do with this one, but it looks like Case 3. The way he takes jars our and puts them back and stands in front of the shelf debating which jar to take looks awfully OCD like. It’s a Hell of a way to live your life though, I must say.
Case 5

I was at a comprehensive psychiatric clinic/ward recently, and one of the patients there had very bad OCD. He would often ask me for reassurance about things that really didn’t make any sense at all. On the night that his new roommate was moving in, he was terrified that he brought a bomb in his luggage. He asked me if I thought that his roommate brought a bomb, and I obviously told him no.
Later that night (maybe under an hour later), he decides to pull the fire alarm and make a run for it (he wasn’t able to get too far because of the severity of his OCD). I don’t believe that he ever actually thought that there was a bomb with complete certainty. The uncertainty just became so severe that for him to act as if there was actually a bomb became the better option. It was the only way that he could diffuse his anxiety.

As you can see, the illness gets pretty weird, but it’s just OCD. He pulled the fire alarm because he could not be completely sure that this roommate had not brought a bomb into his room in his suitcase.
Case 6

Does anyone else have such poor insight into their OCD that instead of knowing that its irrational, you think its real? For example, I think that I’m a dead person living in a fake world to the point that its considered delusional. I’m also paranoid to the point that I truly believe people are poisoning me because they have something against me.
My doctors are confused as to whether I have OCD with psychosis or just OCD. Multiple doctors have said they can’t tell, but most lean towards OCD. Anyone else experience this?
Also does anyone else hear voices in their head which aren’t their own but instead like a family member or a priest or even someone you don’t know?

Strange case. The responders are all saying that this is psychosis rather than OCD. I am inclined to believe them. He hears voices apparently, and believes that he’s dead and the world is fake. But he says he hears voices in his head. This is crucial? Are they really just inner voices like we all hear (in which case they are not hallucinations) or is he actually hearing them with his ears (in which they are auditory hallucinations). He also thinks people are conspiring to kill him.
Case 7

Ok I have a boyfriend, and he is 30 yrs old, he said he had OCD and phobias, lately after some stress, he came to me crying and asked, “What if no one else but me exists? I feel so lonely like I am alone in the universe and that everything else is fake.”
Then I asked him, “What r u talking about?” And he replied, “I walked out of my office onto the street, and I thought ‘if I see someone I know this thing I am thinking its true.'” He saw one of his colleagues, and now he thinks that this thought of his is true, and he is anxious and crying.
Do you find this normal for a 30 year old? Then he asked, “I thought, What if I am a cat?” He listened to some cats meowing, and he started crying and asked, “What if I am a cat???” Is this normal? He had lots of stress before he starting saying all these things; he was afraid that he had some serious illness but in the end he didn’t, and after that he started this paranoia.

I am afraid that this is just OCD, but it’s pretty serious. He is not psychotic, although the symptoms are strange.
Case 8

Years ago I went through a serious bout of depression. I had fits of rage and crying and purposely avoided friends and places I enjoyed. A doctor put me on Lexapro, an antidepressant. I got better. Years later, I have a new problem. I thought it was the same old depression with a new twist. But it’s not.
My last psychiatrist tried treating me for a problem I had. He diagnosed it as depression and said that I also had OCD. This was because I had a depressed mood and frequently battled thoughts of anxiety.
This doctor tried me on a few different medications. Either they had no effect or they had terrible effects. They made me more depressed, anxious, and at one point suicidal. They were all small doses, but they showed their effects within days. The drugs that had these disastrous effects were Imipramine and Lexapro.
I’m seeing a new doctor now. This one says the root problem is NOT depression or OCD. He says it’s psychosis. His reasons for his diagnosis are this:
The obsessive negative thoughts are a manifestation of the paranoia attribute of psychosis. These thoughts include worrying about getting diseases, worrying about dying tomorrow from something, worrying about aging or getting Alzheimer’s, worrying about thinning on top, worrying about getting diabetes, worrying that I might be schizophrenic, worrying that I got brain damage from the smell of a dry-erase marker, the list goes on and on.
Some of these are too irrational to list. Some days they’re tolerable, other days they make me anxious, even cry, or prevent me from doing my work.
Another symptom that I had described to both doctors was the fact that nearly every task that I start, or even think about starting, causes me stress and anguish as if it were some daunting job having to clean up after a hurricane. This is true for nearly everything I do, including things I enjoy doing. Hanging out with friends, just watching a movie alone, or painting which I love to do will sometimes feel this way and compel me to avoid these things.
The first doctor said that this anxiety over starting things was possibly ADD. He tried me on Ritalin for that with equally disastrous results. Then he tried me on biofeedback treatment. It improved my memory, that I am sure of. The second Doctor said that symptom was also due to psychosis because it shows there are two thoughts fighting each other simultaneously with each of these actions I take. Things do seem much easier for me when decisions are made for me.

Strange case. One thing for sure, this person is not psychotic. I don’t see the OCD. Where is it? The worries about bad things happening could be a variety of things, GAD, OCD or depression. In the context of the Depression that is going on, these could well be what we call depressive ruminations . Feeling like everything is too much is also not ADD, it is instead just a symptom of Depression. The inability to get things done or even start things in the first place is typical of depressives.
Case 9

When I saw my psychiatrist last year, he seemed to think I had OCD because I was having problems with various obsessions including a morbid fear of death or dying young and several compulsions (such as repeating actions and counting in sets of 4 whilst avoiding ‘bad’ numbers etc) to prevent bad things from happening or ward off my obsessive thoughts and images. I would often see images of myself lying dead in bed, and it would freak me out.
However that was a year ago. He wanted me to change to Anafranil at the time, and I freaked out because I have a fear of chemicals I am not familiar with and didn’t return to my next appointment thinking I could deal with it myself. It did lose its intensity after a while but didn’t go away completely. Now I seem to have developed a completely new obsession, if that is even what it is.
I fear that I am suffering from some kind of psychosis because I feel spaced out a lot of the time, as though I’m walking around in a dream state. I am also having problems with chronic daily headaches. I am now spending hours researching psychosis, schizophrenia and headaches on the internet. I am analyzing every single thought I have to check for signs of psychosis, and it is driving me around the bend.
How much research does one person need to do anyway? It’s not like im a Dr. and can diagnose myself? Why cant my brain just drop the subject until I have seen my Dr. about it again?
I have made an appointment to see my psychiatrist again shortly, but I am terrified that he will want me to try the Anafranil again. Not only do I have to contend with my original fear regarding changing medications (which in short is that I will take it, and I will have a bad reaction it and become ill or die) but now I have this awful fear that I will take it, get worse, won’t know what im doing and will hurt my son as a result.
I’m terrified, I couldn’t stand it if I hurt my son, the thought is making me feel sick. I am worried that I may not know what I’m doing and hurt someone or my son at the best of times, especially with feeling spaced out, but I am even more concerned that the Anafranil will make matters worse. It does say on the cautions list not to give it to patients who suffer from psychosis or schizophrenia.
I used to have a fear of hurting myself or my son in my sleep so I’m not sure if this is a variation of that one or not? I do know that my mother suffered with anxiety and depression and during her later years (65 onwards), she became paranoid and delusional. I am terrified that my depression and anxiety will take a similar course.
I also feel like I can’t organize my thoughts as well as I used to be able to. I will try to organize my household chores for the day, my brain will take one look at the washing pile and give up because it doesn’t quite know where to start! I also can’t remember when I took my medication. I’m on painkillers for sciatica and my headaches, and I will often need to debate with myself over when I took my last dose.
I will go to take one and will find myself thinking “Am I sure I haven’t already taken one?” to which I respond “I’m sure I haven’t, but I could have, but I don’t think I have anyway,” to which I respond again, “Am I sure I haven’t taken one? Perhaps I shouldn’t take it in case I have already taken one,” to which I then respond, “I’m sure I haven’t taken one,” and then start trying to retrace my steps over the last 4 hours to check I haven’t in fact already taken one.
I worry I will forget that I have taken one, take another one and overdose by mistake, become ill and then die as a result. I have tried writing down when I take one but then I find myself questioning if I have written it down correctly. I have tried putting out what I need for the day/hour, but then I worry I that I didn’t put them out correctly in first place.
Also I have a nagging feeling that I have forgotten something a lot of the time, and I don’t know what exactly. The last few times I’ve left the house, I’ve had to check I had my keys and purse 4 times before I even shut the door!
I feel like I’m developing early onset Alzheimer’s or something, its seriously doing my head in.
I also tend not to go out very much at the moment because I’m afraid I will forget who I am, where I live, get confused or not know what I’m doing and hurt someone when I’m outside. So I find myself only going out when I absolutely have to in order to avoid the anxiety it creates.

This really looks like OCD. It doesn’t look like anything else. The doubting about whether or not she has taken her meds, the fears of going psychotic, fear of medication, Harm OCD about her son, having to check for her keys over and over, the endless checking to see if she has schizophrenia or not, etc. The spacey feeling is disassociation, which comes from anxiety. Get rid of the anxiety, and the spacey feeling goes away.

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0 thoughts on “More OCD and Psychosis: Differential DX”

  1. I never had any desire to hurt anyone, just the thought that I was capable (or anyone was capable) scared me to death.

  2. Man, if I was laying in bed with some chick like this and she talked for more than 3 mins I’d bolt & go down to the nearest mosque to sign up for a suicide mission.

    1. I’m not afraid of this chick at all. The weird thing is they think this violent stuff all the time, but they never do anything violent at all. What kind of sense does that make?
      If I was around this chick, I would give her a knife and tell her to hold it the whole time she was around me. I’d tell her to take knives and just lay them all over the house when I was around. I admit I might be a little scared, but I think I could get over it. If I was going to sleep with her, I would tell her to put knives on the counter next to our bed. I hope I could sleep then! That’s the therapy of someone like this. She seems to be very ill though, and she’s on some high-powered meds, and she does not seem to be getting that much better.

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