The Connection Between OCD and Psychosis: Can Obsessive-Compulsive Disorder Cause Psychosis? 

Written by Colter Bloxom, LPC

Colter is a licensed psychotherapist and the owner and founder of Thrive Therapy. He specializes in the treatment of anxiety, OCD, pornography addiction, identity issues, and more.

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Living with obsessive-compulsive disorder (OCD) can be frightening. You might experience an intrusive thought and find that it feels so real. Somewhere inside of you, you might recognize that the obsessive thought is irrational — but it feels so real in the moment that you may start to worry that you're experiencing delusions or hallucinations (psychosis). 

OCD and psychosis are different types of conditions, but they can sometimes mimic each other, especially when OCD is severe. But that doesn't mean that OCD causes psychosis. I'll explain in this blog, where we go deep into the complex relationships between obsessive-compulsive disorder and psychosis and how you can get support for both.

Does OCD cause psychosis?

Some people with OCD can experience symptoms that look like psychosis, but it’s more complicated than saying that OCD “causes” psychosis. 

OCD and psychotic disorders are distinct types of conditions. But research does show that OCD and psychosis are linked. Around 1 in 10 people who are diagnosed with OCD might meet the symptom criteria for another diagnosis of schizophrenia, and research shows that being diagnosed with OCD increases your risk of developing a psychotic disorder later in life.

That doesn’t mean OCD directly causes psychosis. Neither OCD nor psychotic disorders are caused by one single thing. There are multiple risk factors that come together to increase the risk of developing one or the other (or both).

OCD and hallucinations

Hallucinations are one of the key features of psychosis — seeing, hearing, smelling, or feeling things that aren’t really there.

In one qualitative case study, people with OCD experienced hallucinations like: 

• Hearing voices that they were evil or that the devil would take their soul
  
  
• Seeing nonexistent black dots on their hands that they feared to be small pieces of feces
  
  
• Feeling drops of urine on their legs
  
  
• Imagining needle pricks
  
  
• Smelling an unpleasant odor coming from their own body
  
  

These were all hallucinations related to their obsessions — for example, the person who saw black dots on their hands had fears about contamination. Even if you do start to experience hallucinations, they’d most likely be what are called quasi-hallucinations — you see, hear, smell, or sense things that aren’t there, but you may have some insight that they’re not real. In the case report, most of the OCD patients realized, to some degree, that they were imagining things. This isn’t usually the case with people who have true psychosis.OCD and delusionsYour OCD obsessions could also feel so real that they start to mimic delusions. Delusions are beliefs that aren’t connected to reality. When OCD is diagnosed, the healthcare provider can add on a “specifier” that indicates the level of insight that you have into your delusions. OCD symptoms can come with: 

• Good or fair insight: You have obsessions, but you recognize that they’re probably not true. That doesn’t mean they feel any less real, but you understand, to some degree, that they aren’t actually true.
  
  
• Poor insight: You think that your obsessions are probably true, although there may be a part of you that recognizes, sometimes, that they may not be true.
  
  
• Absent insight: You are completely convinced that your obsessions are true.
  
  

 Most people with OCD have good or fair insight — in one study, only around 15% had poor or absent insight. At some point, if the level of insight gets low enough, obsessions may become delusional thoughts. That doesn’t mean, necessarily, that you live with psychosis — you might not meet the other diagnostic criteria for a psychotic disorder.  To be clear, most people with OCD, even OCD with poor insight, do not develop psychotic symptoms like hallucinations and delusions. And if you are experiencing these symptoms, it’s possible that you live with a co-occurring psychotic disorder on top of OCD — not that the OCD itself is causing psychosis.Differences between OCD and schizophreniaOCD and schizophrenia are different types of conditions with different sets of symptoms. Although there can be some overlap between OCD and schizophrenia, like I talked about earlier, they present differently.Symptoms of OCDOCD is defined by obsessions (intrusive thoughts, fears, or doubts) and compulsions (repetitive behaviors or mental rituals meant to neutralize those thoughts).Obsessions (Intrusive Thoughts)Obsessions are unwanted, repetitive thoughts, images, or fears that cause extreme anxiety. Common obsessions include:

• Fear of harming someone, even though you don’t want to
• Fear of being contaminated or getting sick
• Doubts about whether you did something “correctly” (like locking the door)
• Unwanted, taboo thoughts (sexual, violent, religious)
• Fear of losing control and acting on a thought

These thoughts aren’t just everyday worries. They’re intrusive, frightening, and often completely opposite to your values and beliefs.Compulsions (Repetitive Behaviors)Compulsions are rituals or behaviors meant to relieve the anxiety caused by obsessions. Common compulsions include:

• Checking (doors, appliances, locks)
• Washing and cleaning excessively
• Counting, tapping, or repeating words in a specific way
• Seeking reassurance from others
• Avoiding situations that trigger anxiety

The problem is, compulsions never actually make the fear go away. They might provide temporary relief, but in the long run, they make OCD worse.Symptoms of schizophreniaUnlike OCD, schizophrenia is a psychotic disorder, meaning it involves a fundamental break from reality rather than anxiety-driven thoughts and compulsions. People with schizophrenia don’t experience intrusive thoughts in the same way someone with OCD does — thoughts in schizophrenia often feel imposed by an external source rather than originating from within. They also don’t engage in compulsions to relieve distress. Some of the core symptoms of schizophrenia include:

• Hallucinations: Seeing, hearing, or sensing things that aren’t there
• Delusions: False beliefs that remain fixed despite evidence to the contrary. Unlike OCD, where doubts and fears create anxiety, delusions in schizophrenia feel unshakably true. 
• Disorganized thinking and speech: Conversations may be hard to follow, jumping between unrelated topics. This is different from OCD, where thoughts are repetitive but follow a clear anxious logic (e.g., I touched this, so now I’m contaminated).

• Flattened emotions: A person with schizophrenia may seem distant, with little facial expression or outward emotions. In contrast, OCD often comes with intense emotional distress — like fear, guilt, and anxiety.
• Avolition (lack of motivation): Tasks that were once normal, like showering or cooking, may feel impossible for someone with schizophrenia. People with OCD may avoid tasks too, but it’s usually because of fear (e.g., I can’t touch the stove because I might leave it on and burn the house down). In schizophrenia, the avoidance isn’t rooted in fear—it’s a disconnection from motivation itself.

Overlaps between OCD and psychotic disorders

Even though they’re distinct conditions, OCD and psychosis share some similarities. Here are a few key areas where they overlap:

Both involve irrational thoughts

OCD obsessions and schizophrenia delusions can both seem bizarre, intrusive, or disconnected from reality. The difference is that OCD is fueled by doubt. People with OCD may question whether their thoughts are true, but desperately seek reassurance that they aren’t. In schizophrenia, delusions feel absolute — the person truly believes in them, even when others provide evidence to the contrary. They don’t seek reassurance that they’re not true.

Both conditions are highly stigmatized

Unfortunately, despite the strides we’ve made in mental health awareness, both OCD and schizophrenia continue to carry a heavy stigma. People make jokes about OCD as a quirk or personality trait, and people with schizophrenia are often misrepresented as violent or dangerous (even though most people with schizophrenia are more likely to be victims of harm than perpetrators). Stigma around both conditions can make it harder for people to seek help or feel safe talking about their symptoms.

Both cause emotional distress

Both disorders are deeply distressing to the people experiencing them. People with OCD often feel trapped in an endless cycle of intrusive thoughts and compulsions. People with psychosis struggle with distressing hallucinations or delusions. In both cases, the emotional toll can be severe. These conditions can make it difficult to feel safe, in control, or at peace in daily life.

Both can severely impact daily life

OCD and schizophrenia can both make work, relationships, and daily routines difficult. OCD can consume hours of a person’s day through compulsions and avoidance behaviors, and many people feel like OCD has ruined their life. Psychotic symptoms like disorganized thinking, paranoia, or negative symptoms can make it difficult to function independently. Without treatment, both conditions can become debilitating.

Get OCD treatment at Thrive: Mental Health IOP in Arizona

If you're suffering from severe OCD, or even comorbid OCD and psychotic disorder, you don't need to go through this on your own. There is support available to you, even if you feel that once-a-week counseling isn't enough. 

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Our Phoenix-based IOP meets multiple times per week for multiple hours per day. We offer evidence-based therapy like Exposure and Response Prevention (ERP) and Cognitive-Behavioral Therapy (CBT) to help you break free from intrusive thoughts and compulsions. With a flexible schedule that allows you to continue your daily responsibilities, our program is designed to give you the intensive OCD care you deserve — without the commitment of inpatient treatment.

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