The problem is that when OCD gets really bad, they can actually appear psychotic. Emphasis on the appear. I had a therapist who basically told me that was going on with me when I saw him. I’m far better now but if I go off these damned pills, I swear I’m going to be back in that way-out space. By the way, that sort of severe OCD is not pleasant at all. It’s a 24-7 nightmare with no hope in sight. You’re always trying to make it go away and nothing ever works.
I’ve had some clients like this, and it took a bit of figuring out over the phone, but no way were they psychotic. They were even getting perceptual distortions too, but lots of people get that stuff, and just because you have some weird perceptual stuff going on, it doesn’t mean you’re psychotic.
The key is insight.
A psychotic person has perceptual abberations but they think they’re real. If you’re getting perceptual distortions and you’re not psychotic, your attitude will be,
Jesus Christ! I’m getting perceptual distortions! I hate this shit! It seems crazy! Make it go away!
And yeah I’ve been there, sorry to say. But not for over 30 years.
Also, all of my “psychotic” perceptual stuff including some really weird thought processes that could easily be diagnosed as delusions but were not and have in fact been after the fact vanished on an SSRI antidepressant and if you’re actually psychotic, that won’t happen. You’ll need to take an antipsychotic. I have “psychotic” diagnoses based on what I told clinicians after the fact but when I checked with the man who saw me at the time, he said they were wrong.
I’ve had some OCD clients where I had a really hard time figuring out if they were psychotic or not.
One was afraid of take showers because she thought there were “demon eggs” in the shower water. Upon questioning, she didn’t really believe it; she just thought it might be true, and she was terrified that it might be true. And she jumped in the shower anyway. A psychotic person would never do that!
She was also getting some really weird ideational stuff with thoughts being transmitted out of her brain to and from electrical sockets in the wall. She didn’t really believe that either, but once again, she was scared it might be true.
Curiously, there is an OCD Psychosis, and this is a rather typical delusion that they have: transference of identities or thoughts, often via electrical appliances and wall sockets!
She was only 15 and I told her she need to get a handle on this real quick before it got even worse. I also told her she had a very serious case since it was hitting so hard at such a young age.
I’ve actually had a number of OCD’ers present to me diagnosed by psychiatrists with various psychotic diagnoses (Schizoaffective Disorder was a favorite) with “delusions” and “hallucinations.”
I quickly figured out that the “delusions” were fake, and so were the “hallucinations.”
In one case, a young man had all sorts of weird perceptual stuff going on in the context of OCD that I was genuinely baffled about whether he was psychotic or not. But he didn’t give off the “feel” of psychosis, if you catch my drift. We are talking intuition here.
Medicine is as intuitive as it is logical and don’t let any MD tell you otherwise.
I eventually reassured him enough that his anxiety levels went way down. Oddly enough, as his anxiety levels collapsed, the “psychotic” perceptual disorders faded too! So anxiety can literally cause perceptual aberrations that look very much like a psychosis!
Any of you readers, if you suffer from this illness, feel free to email me as a work as a peer counselor for OCD’ers. I have had people coming from all over the world to work with me, and I’ve been called an expert by psychiatrists. I’ve worked hundreds of hours with hundreds of clients for over a decade. Very reasonable rates.