Lynn writes:
I’m really struggling with schiz-related OCD, and I know that for a fact. However, what I’m not sure about is whether I have schizophrenia (or maybe schizotypal personality) as well… or if it’s just the OCD, or if I might even also have factitious disorder imitating schizophrenia.
So, about me:
I first noticed OCD symptoms in myself when I was about 14, though it may have been subclinical then. It took the forms of “wanting to be a good person”, order/symmetry/pattern stuff, and the occasional vague “I need to do X or Y will go wrong somehow”. As I got older the order and symmetry faded somewhat and the “good person” got bad–for example, fears of violence to the point of feeling weapons in my hands and needing to rub them against surfaces to make sure nothing was actually there.
This later came to include an obsession with schizophrenia, but not of the “I’m afraid I have it” sort–rather, I wanted to prove I had it because that would provide an explanation for certain things wrong with me, taking the blame off of me, and subsequently I realised I could be (likely was) faking symptoms and started to obsessively examine if all my so-called symptoms were legitimate. I could be exaggerating, or outright fabricating.
On the other hand, I was the star pupil in my high school for the first two and a half years. All my teachers loved me. Then in the second semester of my junior year, I started skipping classes and forgetting assignments, gradually stopped bathing, started getting comments (sometimes concerned, sometimes angry) about how I never paid attention in class and my writing had gone from excellent to a mess of unnecessary words and long tangents…
Other students started to call me “weird” and avoid me, and those who were my friends either cut contact or pointed out as nicely as possible that my social and conversational skills were terrible and it made me really difficult to deal with. In response to all of this, I thought “eh, whatever, I don’t really care about school or friends anyway”, eventually dropped most of my classes, graduated early, and spent the next few years locked in my bedroom playing online games and watching anime.
I had a couple friends online, however, and the opportunity came to move out and stay with one of them when I was 21. I lived with her and her girlfriend (all three of us were bisexual) for a few weeks, but three things came up in that time.
First, my attention span and general awareness was next to none, and sometimes it was to the point that I would just stare at people really confused when they spoke to me, totally unable to make sense of their words.
Second, my roommates told me a few times that things I remembered them saying to me had never been said.
Third, I was convinced that the other girl was just trying to use me to pay the rent, had no intention of accommodating me as a proper roommate, and was taking incriminating pictures of me to show the police to kick me out. She did actually call the police, however, so I was probably right. She hated me. Bad. I did start to think I might be reaching a little when I accused her of stealing money out of my wallet, and I now think I was probably wrong on that, however.
I ended up moving back in with my family, and a couple months later the idea that I might have schizophrenia first crossed my mind. I thought about it off and on for months, but it seemed like a huge stretch, so I shelved it eventually.
Over the next year I would start seeing shadow bugs (like the typical shadow people, but the size of and moving like bugs), thinking people were breaking into my window at night… Move out again, fear that people were going to kidnap or rape me, that they were following me and planning to mug me, see whole crowds of people just coldly stare at me on the streets for several seconds…
And then over the next year after that, I’d move back with my family (evicted this time, for being a bad roommate–spending all day lying in bed and never doing chores), start noticing my hands looked strange, occasionally hear a voice repeating my thoughts aloud, and then…
And then my OCD landed on the subject of schizophrenia when researching why I was so lazy, and it was sort of like a million bells went off at once saying “YES HELLO PLEASE NOTICE ME, YOU HAVE STRUCK GOLD” …And then I shrugged it off again after a couple months of intense obsession.
And started thinking people I met online were actually people I already knew in the past, but using different names and ages and such… They acted so similar though! And then the obsession would hit again.
So basically, right now I’m sort of thinking I’m an immortal nonhuman being who reincarnated into this plane and various others of my kind are active here and occasionally contact me but usually just monitor me from a distance while doing their own things with human experiments and such.
But then there are like three voices (not actual voices lol) in my head saying “you are delusional”, “you are faking being delusional”, and “you are just being OCD, calm down” and I don’t know which to believe and the more I think and research the more distressed I get.
So, um… What do you think? (please don’t say “e-mail me”!)
This comment appeared on one of my articles, so I will publish it while keeping anything about the person’s identity confidential as is proper.
There is clearly a psychotic process going on here that looks very much like classic schizophrenia. Then we also have some very classic OCD going on at the same time. The OCD came on at age 14, and the schizophrenia came on 2.5 years later at age 16. It has long been known that OCD sometimes appears as the leading edge of schizophrenia. Schizophrenia often occurs ~2 years after the onset of the OCD, and the schizophrenia might have some of the same OCD symptoms, now magnified to psychotic level.
I am aware of several cases of OCD preceding schizophrenia. In two cases, the OCD appeared quite early around age 11-12 and was extremely severe during high school years to the point where they were nearly disabled. The schizophrenia then appeared at the classic age of 19-20.
In another case, OCD appeared at age 19 and then schizophrenia occurred at the classic age of 23.
This data has been interpreted to show that OCD is a risk factor for schizophrenia. This interpretation is false. First of all, most if not all people with schizophrenia are now known to have been ill from a very early age, possibly form birth. The schizophrenia is simply subclinical until the real hard symptoms hit often in late adolescence to early adulthood. If schizophrenics have had the illness since birth, OCD cannot possibly be a risk factor for schizophrenia as OCD appears later in life, often in late childhood to adolescence.
The question then is whether OCD is a risk factor the triggering of full schizophrenic symptoms in someone with subclinical schizophrenia since birth. This is uncertain, but it is probably not the case. Probably the stress of OCD is not a risk factor for triggering full blown schizophrenia either, as in the cases above, full blown OCD occurred for 2, 4, and 7-9 years before the onset of full schizophrenia. OCD is a very stressful illness. If the stress of OCD triggered schizophrenia, it would trigger it very soon after the OCD onset, not 2-9 years later. Stress as a trigger for schizophrenia is typically a serious stress where the schizophrenia occurs soon after the stress, not years later like some sort of time bomb.
In recent years, there has been discussion of something called schizo-obsessive disorder. These are cases of OCD and schizophrenia in the same person where the OCD is impacting the schizophrenia. Often these people retain more insight into their delusional processes than typical schizophrenics as OCD is a disorder of doubt whereby schizophrenic is a disorder of knowing. So the OCD can lead to better reality testing where the factor of doubt may be introduced into delusional material.
Schizo-obsessive disorder is probably just OCD and schizophrenia occurring in the same individual with different onsets for each illness. Each illness is discrete and neither one was causative or the other, yet both illnesses are impacting each other probably via an endless feedback loop whereby they feed into each other like a dog chasing its tail and sometimes it is difficult to tell where one illness ends and the other begins.
The above case looks like classic schizo-obsessive disorder. Schneiderian symptoms such as hearing ones thoughts spoken out loud are common as are ideas of reference and in particular paranoia. The prototypical “voice in the head” of OCD is often quite a loud voice, louder than in most OCD cases. In fact it is so loud that sufferers sometimes worry that others must be able to hear their thoughts. There is sometimes difficult diagnostics between a very loud OCD voice and and worrying that others can hear it, which has more of an OCD character to hearing one’s thoughts spoken aloud which is more schizophrenic..
Auditory hallucinations occur, but they are not common.
Functioning is often better than for schizophrenics. In the above case, you can see that this person has been able to move out of the parental home several times. They had to move back home, but most schizophrenics would probably be too ill to even survive living on their own for any length of time.
Delusions are often reported but are then denied as the person says that they do not really believe this. This is because these people often cannot accept being delusional. Probably what is happening is that delusional material is simply being hidden and then denied when a clinician confronts the person with it. Paranoid and grandiose delusions are common.
Insight wavers between complete loss to partial to even full insight on a spectrum where the symptoms move back and forth along the spectrum without any particular order or reason. These people may be more likely to recognize that they have schizophrenia than other schizophrenics because the presence of OCD enables improved insight. It is common for sufferers to waver between believing they have schizophrenia, insisting that they do not, being unsure whether they have it or not or saying that they have some illness other than schizophrenia to explain symptoms.
Thought disorder is often present but is less severe than in schizophrenia. Often written and spoken communications with schizo-obsessives can be quite clear and cogent whereas most schizophrenic communications typically have an odd to incoherent character abut them.
Mood symptoms are sometimes present and can take a bipolar character.
They are often highly intelligent, much more intelligent than schizophrenics. This is because OCD tends to strike more intelligent persons.
Treatment is often difficult as atypical antipsychotics often worsen the OCD, in many cases dramatically so.
