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Obsessive-Compulsive Disorder with psychotic episodes

Obsessive-Compulsive Disorder with psychotic episodes

June 21, 2024

All people have ever had some obsessive thought, some thought, fear or doubt that we can not get out of our heads even if we want to. Also, most of us have had thoughts that do not embarrass or dislike us, like wishing someone else does not get what we want for us or the temptation to give four shouts to the unscrupulous person who is talking on the phone at the cinema. Most people do not give them more importance.

However, for those affected by an Obsessive-Compulsive Disorder these ideas generate great anxiety about their possible implications and their possible consequences, so that They try to perform different ritual actions to control their thoughts and take back control.


Most people with OCD consider and recognize that deep down these thoughts and fears have no basis that really should concern them and have no real effects on the world. Others no. Among the latter we can find cases in which obsessive ideas become delusions and may even hallucinate. Although it is something very unusual, There are cases of Obsessive-Compulsive Disorder with psychotic episodes . We will discuss this in this article.

  • Related article: "Obsessive-Compulsive Disorder (OCD): what is it and how does it manifest?"

Obsessive-Compulsive Disorder

It is called Obsessive-Compulsive Disorder or OCD to the condition characterized by the continued presence over time of Obsessions, mental contents or ideas that appear intrusively in the mind of the subject without it being able to control them but which are recognized as their own and which in most cases are generators of a high level of anxiety. Frequently appear with these ideas a set of acts or rituals called compulsions that are carried out in order to reduce the anxiety generated by ideas or avoid the possibility that obsessive thoughts occur or have consequences in real life.


It is one of the mental disorders that causes the greatest suffering to those who suffer it, since in most cases the subject is aware that he can not control the appearance of his thoughts and that the acts he performs as a ritual do not they have a real effect beyond a temporary and brief reassurance, which in fact reinforces the future emergence of new thoughts. In fact, a vicious circle is established between obsession and compulsion that increasingly aggravates the anxiety that the subject suffers, feeding back the symptoms of the disorder.

The sensation is of lack of control over their own thinking, or even of confinement within a dynamic from which they can not escape. Much of the problem is in fact the excessive attempt to control thought and actively avoid the appearance of the thought that generates anxiety, which indirectly reinforces its appearance. So we are faced with a disorder of egodistonic character.


It is common for there to be a certain level of magical thinking and thought-action fusion, unconsciously considering that it is possible that one's own thoughts may have an effect on real life despite recognizing at a conscious level that this is not the case.

This disorder has serious repercussions in the daily life of those who suffer it, since the repeated presence of obsessions and compulsions can require a great number of hours and limit their personal, work and academic life. Personal relationships can deteriorate , also tending the subject to isolate himself to avoid social rejection, and his performance and work and academic performance can be greatly diminished by devoting much of his attention and cognitive resources to the avoidance of obsession.

  • Maybe you're interested: "The 8 types of Psychotic Disorders"

OCD with psychotic episodes: an atypical slope

In general, the subject with Obsessive-Compulsive Disorder is aware and recognize that their obsessive thoughts and compulsions are not based on a real basis, may come to consider them a stupidity without being able to control them. This fact generates an even higher level of discomfort and suffering.

However, there are cases in which obsessive ideas are considered true and in which the subject is completely convinced of their veracity, not putting them in doubt and turning them into explanations of reality. In these cases the ideas can be considered delirious, acquiring OCD psychotic characteristics .

In these cases, considered and also called atypical obsessive or schizo-obsessive, it is observed that the insight necessary to detect that their behaviors have no real effect on what they intend to avoid is not present. Also in these cases Compulsions may not be experienced as annoying or egodistonic but simply as something to do, without appearing to be intrusive or forced. Another option is that the continued suffering of an obsessive idea ends up reactively triggering hallucinations or delusions as a way of trying to explain the functioning of the world or the situation experienced.

Three great possibilities

The comorbid presence of obsessive and psychotic symptomatology is not especially common, although in recent years there seems to be some increase in this joint pattern. Studies show that there are three great possibilities:

1. Obsessive disorder with psychotic symptoms

We are facing the most prototypical case of Obsessive-Compulsive Disorder with psychotic episodes. In this clinical presentation, people suffering from OCD can present transient psychotic episodes derived from the transformation and elaboration of their ideas, in a comprehensible way depending on the persistence of the obsessive ideation. It would be episodes that will be produced reactively to mental wear generated by anxiety .

2. OCD with lack of insight

Another possibility of presenting an obsessive disorder with psychotic symptoms stems from, as we have said previously, the lack of capacity to perceive the non-correspondence of the obsession with reality . These subjects would have stopped seeing their ideas as anomalous and would consider that their ideas do not contain overvaluation of their influence and responsibility. Generally, they tend to have a family history of severe psychopathology, and it is not surprising that they only show anxiety in the face of the consequences of noncompliance and not the obsession itself.

3. Schizophrenia with obsessive symptoms

A third possible comorbid presentation of psychotic and obsessive symptoms occurs in a context in which obsessive-compulsive disorder does not really exist. It would be those patients with schizophrenia that during the disease or already before the presence of psychotic symptoms present obsessive characteristics, with repetitive ideas that they can not control and some compulsiveness in his performance. It is also possible that some obsessive symptoms appear induced by the use of antipsychotics.

What causes this disorder?

The causes of any type of Obsessive-Compulsive Disorder, both those with psychotic characteristics and those that do not, are largely unknown. However, there are different hypotheses in this regard, considering that the OCD is not due to a single cause but because it has a multifactorial origin.

At a medical and neurological level , through neuroimaging it has been possible to observe the presence of a hyperactivation of the frontal lobe and the limbic system, as well as an affectation of the serotoninergic systems (reason for which the pharmacological treatment is usually based on antidepressants in those patients who need it) and dopaminergic The implication in this disorder of the basal ganglia has also been observed. With regard to those modalities of Obsessive-Compulsive Disorder with psychotic episodes, it has been observed that level of neuroimaging tend to have a smaller left hippocampus.

At a psychosocial level, OCD is more frequent in people with a sensitive nature who have received an education or excessively rigid or very permissive, which has generated in them the need to have control of their own thoughts and behavior. They tend to be hyper-responsible for what happens around them and have a high level of doubt and / or guilt. Nor is it uncommon to suffer bullying or some type of abuse that has led them to need, initially in an adaptive way for them, to control their thoughts. The association with psychotic symptoms may also be due to the condition of traumas or experiences that have generated a rupture with reality , together with a predisposition to this type of symptomatology.

An existing hypothesis regarding the operation of TOC is the bifactor theory of Mowrer , which proposes that the cycle of obsessions and compulsions is maintained by a double conditioning. In the first place there is a classical conditioning in which thought is associated with the anxious response that in turn generates the need to flee from it, and then through operant conditioning to maintain the behavior of avoidance or escape through compulsion. Thus, compulsion is associated with the reduction of immediate discomfort, but has no effect on the real aversive stimulus (the content of thought). In this way it is not prevented but in fact facilitates the appearance of future obsessive thoughts.

Bibliographic references

  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-5. Masson, Barcelona.
  • Rincón, D.A. and Salazar, L.F. (2006). Obsessive-compulsive disorder and psychosis: a schizo-obsessive disorder? Colombian Journal of Psychiatry, 35 (4).
  • Toro, E. (1999). Psychotic forms of OCD. Vertex, Revista Argentina e Psiquiatría; 37: 179-186.
  • Yaryura-Tobias, J.A. & Neziroglu, F- (1997). Obsessive-Compulsive Disorders Spectrum.Washington DC, American Psychiatry Press.

Obsessive Compulsive Personality Disorder - OCD - Kati Morton treatment help perfect therapy (June 2024).


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