Politics Magazine

Severe OCD: The Borderlands Between Obsession and Delusion

Posted on the 11 May 2016 by Calvinthedog

For about eight months in 1991, from March-November, I was about as crazy as I have ever been in life. I wasn’t psychotic, but I was getting some weird perceptual alterations, and my mind had seriously gone off. On the one hand, I was painfully aware of these things. On the other hand, I was pretty convinced that I was going psychotic, mostly because of the way I felt. I got into therapy within a few months. The psychologist did go round and round a bit about whether I was psychotic or not, but he and the psychiatrist agreed after a bit that I wasn’t psychotic. He said, “The only delusion you have is that you think you’re nuts.”

When OCD gets very bad, they can appear psychotic and they often feel like they are going psychotic themselves. They often present as either afraid they are going psychotic or convinced that they have gone psychotic. It is not not uncommon for them to get a diagnosis of psychosis or even schizophrenia. I deal with people like this all the time. In fact, I currently have two clients with this theme and another one is waiting in the wings. There are others I am talking to who have not signed on.

It is best described as Fear of Psychosis, but on the OCD boards they call it “Schiz OCD.” That is a misleading name, but it means that they have OCD with the Schizophrenia or Psychosis theme. That theme translates as a fear that they are schizophrenic or psychotic or that they are going to become schizophrenic or psychotic.

I have had some OCD clients with Schiz OCD and a couple with the Harm and Pedophile themes who were all misdiagnosed as psychotic, and a few were misdiagnosed schizophrenic.

The Harm theme means they are afraid they will attack or kill other people or fear of harming others. The Pedophile theme is entails the fear that one is a pedophile.

Harm OCD’ers are generally completely harmless in spite of their creepy symptoms. These are simply completely harmless people who fear that they are murderers, rapists, or violent people, etc.

Pedophile OCD’ers are almost always not pedophiles at all. They are simply sexually normal people who fear that they are pedophiles. They are generally harmless to children, though I am familiar with a case where a woman with Pedophile OCD actually molested her three year old boy, though not seriously. Anyway, three year olds hardly remember anything that happened to them at that age. She was arrested and charged with child molestation, but the charges were dropped on the basis that she was in treatment. She has as whole team working with her, and the main thrust is to keep her from molesting the boy again.

All of the psychosis diagnoses I have seen with my clients were in error, and these folks simply had OCD. But if the clinician doesn’t understand how OCD can look like a psychosis but not be a psychosis, they might misdiagnose someone. It boils down to the difference between an obsession and a delusion. The two can be confused, and clinicians do misdiagnose obsessions as delusions. The difference can be a bit fine-tuned, but generally it is straightforward.

The problem is that many clinicians simply have no idea how to tell an obsession from a delusion. Also obsessions can get unbelievably bizarre, and at first look, they can appear in content like the sort of delusions that psychotics get.

I did have two very ill people come to me who seemed to have both OCD and schizophrenia, among other things. It took me a while to figure that out, and one was a diagnostic confusion for a while. But both of them did seem to have some sort of psychotic process going on, one had had a clear psychotic break and another had gone through an obvious schizophrenic prodrome in late adolescence and early adulthood.

One was hallucinating most of the time, including a lot of visuals. The other appeared to be hallucinating as they were experiencing their thoughts being broadcast out into the environment, and they were afraid people could hear them. They were both functioning very poorly, were on disability, not working and one was living at home and had had a conservatorship set up for them. This entailed some sort of trustee who doled out  the monthly SSI check to the person as they saw it, so this person had no control over his finances. One was in and out of the hospital on involuntary hold on a pretty regular basis.

What is odd is that both of them were highly lucid during our email conversations such that you wondered how they could be psychotic.


You Might Also Like :

Back to Featured Articles on Logo Paperblog

These articles might interest you :

  • Big Food Giants Manipulate Public Health Policy in China

    Food Giants Manipulate Public Health Policy China

    Coca-Cola is at it again. As soda sales decline in the United States and Europe, beverage companies look to emerging economies like China for growth. And, it... Read more

    The 15 January 2019 by   Dietdoctor
    DIET & WEIGHT, HEALTH, HEALTHY LIVING, MEDICINE
  • Jewellery for a Precious You

    Jewellery Precious

    Jewellery is always close to a woman’s heart. It completes her look and boost confidence. Considering the changing trends in jewellery fashion, it becomes... Read more

    The 15 January 2019 by   Dr.jenifer Sayyed
    LIFESTYLE
  • Rajshri Productions’ Next Is A Film On Friendship | Hum Chaar | Trailer

    Abhishek Dixit’s debut feature film Hum Chaar is a Bollywood film made under the banner of Rajshri’s film. Hum Chaar is written and directed by Abhishek Dixit. Read more

    The 15 January 2019 by   Themoviean
    ENTERTAINMENT, MOVIES
  • Saint Paul the First Hermit

    Saint Paul First Hermit

    Today is the feast day of Saint Paul the hermit. This is a sweet and delicate Oatmeal Bread topped with rolled oats and naturally sweetened with agave. Saint... Read more

    The 15 January 2019 by   Veronica46
    FOOD & DRINK, RECIPES
  • Irupathiyonnaam Noottaandu | Teaser | Pranav Mohanlal | Arun Gopy

    Arun Gopy’s Irupathiyonnaam Noottaandu is an upcoming Malayalam action-drama feature film starring Pranav Mohanlal and Zaya David in the lead roles. Read more

    The 15 January 2019 by   Themoviean
    ENTERTAINMENT, MOVIES
  • A Year Of Body Positivity

    Year Body Positivity

    Last January, as I sat there on New Years eve all set to make the same old resolutions I've made year after year for as long as I can remember, I realised how... Read more

    The 15 January 2019 by   Sparklesandstretchmarks
    DIARIES, SELF EXPRESSION
  • Garden Bloggers Bloom Day – Jan 2019

    Garden Bloggers Bloom 2019

    Euphorbia rigidaWhen I went out to take the photos for this blog post I was surprised at how much was in flower dotted around the garden. Read more

    The 15 January 2019 by   Patientgardener
    GARDENING, HOME

Magazines