What is the Connection Between OCD and Schizophrenia?

Obsessive-compulsive disorder or OCD and schizophrenia spectrum disorders are connected in several ways that aren’t completely understood. These conditions have a high incidence of presenting together and they may complicate a diagnosis when they are comorbid. There are varying conclusions on how the presence of OCD and schizophrenia spectrum disorders together affects treatment. Some studies find the conditions are easier to treat when they are together and others suggest comorbid presentation results in a less favorable treatment outcome. Mental health researchers have been conducting limited studies on this matter for a considerable time period, but the research only suggests that additional studies are needed to understand the connections between these conditions and to develop the best treatment protocols.

Studies of people with schizophrenia or any of the schizophrenia spectrum disorders show a significant percentage of individuals with these conditions also have OCD. The percentages vary based on each study, but a figure of about 20-25% is considered reasonable. The diseases may present together, some patients get schizophrenia after they’ve been diagnosed with OCD, or schizophrenia occurs first and obsessive-compulsive disorder develops later.

Some researchers feel that OCD may be a predicting factor for schizophrenia, and that OCD and schizophrenia spectrum conditions carry considerable risk for comorbidity. It should be mentioned that obsessive-compulsive disorder is an anxiety disorder. There is even greater risk for all anxiety disorders preceding schizophrenia, or being present with any illness on the schizophrenia spectrum.

Clinicians also mention the difficulty of diagnosing both diseases concurrently. Extreme obsessive or compulsive behavior can appear to be symptoms of schizophrenia spectrum disorders, and there are features of these disorders that resemble OCD. It can take time to arrive at an accurate diagnosis if OCD and schizophrenia occur together. Especially when a patient has schizophrenia, underlying OCD may not be recognized, and treatment for schizophrenia alone doesn’t successfully address obsessive-compulsive disorder. It’s essential for psychiatrists to consider hidden OCD as a possible adjunct condition when they diagnose schizophrenia spectrum disorders.

The literature on the connection between OCD and schizophrenia is definitely unclear on how treatment outcome is impacted by comorbidity. When one of these illnesses is undiagnosed, treatment clearly suffers. Some research suggests that people with both conditions don’t fare as well.

It can certainly be difficult to pursue any type of cognitive therapy that might address OCD issues, before freedom from extreme positive or negative schizophrenia symptoms is achieved. On the other hand, there are studies suggesting that OCD and schizophrenia spectrum disorders are easier to treat and predict a better outcome. These direct contradictions are part of the reason larger and more definitive studies are required.

Many researchers argue that the sum total of what is known about OCD and schizophrenia still isn’t enough to most effectively treat patients. The fact these conditions occur together so often indicates they may have a shared, underlying physiological, genetic, or other component that is not currently understood. More research to fully investigate the relationship of these diseases to each other appears warranted.