OCD vs. psychosis

How can you tell the difference the easiest over OCD and psychosis? Even if the obsessive thoughts are just ridiculous?

***this is a tough subject and my response should be read with a TRIGGER WARNING***

I recently did a paper on Psychosis and OCD. There is no consensus on the comorbidity of each affliction. From what I have read, however, OCD cannot bring on Psychosis. The piece I did had to do with those who manifested OCD-like symptoms after their first major psychotic episode.

But there is a practical answer to any confusion there might be about each illness.

As far as I know there is only one group of symptoms that can be confused as to which is which; and that is the difference between intrusive thoughts and delusions.

My OCD was worst in the first half of it's existence; that is, for the first fifteen years. In those years I didn't know anything about OCD, and I felt very alone having the strange thoughts. I also thought I was delusional. unfortunately the result was, I never told my doctor. So I never knew it was OCD, and I never got treated for it. Once I got treated, 70% of the OCD went away. Fifteen year wasted because I didn't talk to my doctor about it.

When someone suffers a strange intrusive thought, the first thing they are probably going to think is, "I'm going crazy". Or, "I'm delusional."

Here is an example.

Let's say there is a guy named Tom. Tom is 19 years old and for the past few months he has been feeling very anxious. Every so often he feels a spike of fear, but it goes away almost as quick as it came.

One day it doesn't go away. He suddenly finds himself in his bathroom gripped by a fear he can't name. He is having a panic attack.

The panic attack goes away, but he feels like he has crossed over into another world. Things seem unreal but he can't tell you how they are unreal - they just seem that way. On top of it, he hasn't been eating well, he doesn't sleep well, and he is having a hard time keeping his mind organized.

One day he goes to take a shower and as he closes the door, his hand slips and the door doesn't close. As he attempts to close it, he stops. His brain tells him not to shut it or something bad will happen. So Tom doesn't shut it, but he keeps staring at the door handle. Suddenly he thinks, "if I turn the handle twice and then close the door, it will be OK." So he does, and he feels some relief.

Later that night he is sitting on the couch with his girlfriend. Tom is still thinking about that moment in the shower. He is wondering whose "voice" it was telling him to turn the handle twice. But then he thinks, "it wasn't a voice, it was a thought". But still, it felt alien, like it wasn't himself telling him about the impending doom, if he didn't turn the handle twice.

At some point his girlfriend says she has to go home, and then leaves. As she closes the door, Tom sees her disappear. He keeps looking at the door for reasons he can't explain. Suddenly he has a thought,

"What if she is not real? What if she never existed? What if she is a figment of your imagination."

This throws Tom into a panic. It's the same panic as before only worse. His whole being begins to collapse, and he spends the next two hours crying on his bed.

Tom finally tells himself, "I'm going crazy. I know she is real, so I must be going crazy. I love her so much, I don't want to lose her".

No sooner does he tell himself what he thinks to be true, when his mind tells him, "But what if she isn't real? How can you tell for sure? How do you know, 100%? And if she isn't real the whole thing is lost, you will never love her like you used to".

For the next week Tom is fighting this battle of thoughts. He knows what is true, but his mind wont stop telling him, "What if...! What if...!". Further more, he feels like this is causing him to love his girlfriend less, and he really thinks he will never love her again, the way he used to. But he never tells anyone his thoughts, least of all his girlfriend. He knows he will sound crazy if he does. He'll never tells anyone. But he thinks he is crazy.

Is Tom suffering delusions or intrusive thoughts? Is this a prolonged bout of Psychosis, or is it OCD?

Otter.

That's interesting. I think I've had some events before that I would consider psychosis and ocd thoughts. The common thread with me seems to be that both mental states seem to cause psychological distress, but they seem different as well.

Yes, both OCD and Psychosis will cause very distressful psychological problems for those who suffer them both.

Psychosis is different from OCD in-so-far as the person suffering breaks with reality. In the example above Tom would believe in the thoughts he was having and act on them to some degree, or fully. There would be no battle to resist the belief.

I'm sorry that you suffer some sort of Psychosis. Next to chronic/acute depression it is one thing I am glad my Bipolar Disorder has not produced in any significant way.