Schizophrenia can manifest itself in many different ways. It has many forms that are similar in its symptoms to other mental disorders and neuroses. For example, pseudoneurotic schizophrenia (neurosis-like schizophrenia or schizoneurosis) strongly resembles obsessive-compulsive disorder. There is a connection between the two, but they are still two different diseases. Let’s find out the difference between OCD and schizophrenia. To do this, let’s look at their features.

OCD different from schizophrenia

 

Features of OCD

OCD is an obsessive-compulsive disorder. It consists of obsessive-compulsive thoughts that periodically force a person to perform specific actions – compulsions. With their help, the body relieves stress and gets rid of anxiety.

A typical example of OCD is the desire for perfect cleanliness and fear of infection. To get rid of the fear, a person constantly washes his hands, rarely touches objects, does not shake other people’s hands, etc.

In this case, there is usually no real reason to be afraid. Obsessive thoughts don’t give the patient peace until they do a particular ritual, such as washing their hands, turning off all appliances, leaving the house, checking several times whether the front door is closed, and so on. A person performs all of these actions spontaneously. Sometimes it comes to the point where he tears his hands to blood, trying to wash them from the non-existent dirt.

Obsessive-compulsive disorder is listed in ICD-10 under F42. According to this classification, the disorder is characterized by obsessive thoughts and stereotypical actions. They are perceived as intrinsic and not imposed, as with schizophrenia, when a person does or speaks as if under the influence of external forces.

With OCD, the patient realizes that the intrusive thoughts and actions are disturbing his life, becoming chronic, but cannot do anything about it. The level of anxiety is so high that it is possible to get rid of it only by committing rituals.

 

Causes

People with OCD have serotonin dysfunction. Serotonin is one of the brain’s neurotransmitters. It has different functions, one of which is to bring joy. It is also called the “good mood hormone.” The impaired production of serotonin impairs the transmission of impulses between brain neurons. It occurs due to pathological changes in the following departments:

  • Basal ganglia;
  • The amygdala;
  • Caudate nucleus;
  • Frontal cortex.

In turn, these changes can be provoked by the following factors:

  • Genetic predisposition. Specific genes are responsible for the production and distribution of serotonin. If a mutation occurs, the risk of developing OCD increases.
  • Autoimmune causes. Most often, group A streptococcal infections, such as tonsillitis or scarlet fever, can lead to the disorder.
  • Acquired. First, we are talking about injuries, birth trauma, and defects associated with trauma.
  • Perfectionism. This character trait, which is the striving for perfection, can lead to obsessions with cleanliness and order. Perfectionism is often the result of exaggerated requirements imposed on the child by parents.

In a person with OCD, the brain is in a constant state of agitation. He does not get the signals that would force him to calm down or enjoy himself. To relax a little, you have to perform rituals.

 

Symptoms

The main symptoms of OCD are obsessive thoughts and stereotypical actions. The following signs are also observed:

  • Weakness, rapid fatigue;
  • Insomnia;
  • All kinds of painful feelings;
  • Memory impairment;
  • Impaired logical thinking;
  • Aggression or, on the contrary, apathy;
  • Problems with personal hygiene;
  • Visions and voices.

When suffering from OCD, the patient’s mood changes frequently. He may be cheerful or sad. He sometimes feels he is the chosen one, often trying to convince voices and perspectives.

The disorder can occur at any age and is equally likely to occur in both men and women.

If a person experiences an irresistible urge to constantly wash their hands or arrange objects in certain places, clearly observing symmetry, it must be shown to a psychotherapist. Gradually, the number of obsessions, compulsions, and rituals will increase.

 

Features of behaviour

Patients with OCD have unusual behavioural features. They are not specific and cannot be used to make a diagnosis, but experts say that obsessive-compulsive disorder is common in people with these traits:

  • Task responsibility. They strictly follow the rules and regulations, often make them up for themselves, and then cannot abandon them.
  • Demanding. It is especially true for managers. They not only follow the rules themselves but also require strict compliance from their subordinates. The problem is that many people consider such orders senseless and are unwilling to tolerate such an attitude.
  • Superstition. People with OCD are very superstitious and believe in all kinds of omens. Usually, the rituals they devise are connected with superstition.

Often the person is bored with rituals, and as a result, he tries to get rid of them. However, anxiety prevents him from doing this. Some believe that with time, everything will pass on its own. However, in most cases, the condition worsens, and the symptomatology of the disorder expands. It can eventually develop into a long-term neurosis.

One of the distinguishing features of OCD is its resistance to therapy.

As can be seen, some symptoms, such as voices, visions and intrusive thoughts, resemble the signs of schizophrenia, especially pseudoneurotic.

However, there are many more differences. An experienced professional will never confuse the two disorders. Let’s take a closer look at schizoneurosis or neurosis-like schizophrenia.

 

General features of schizophrenia

Pseudoneurotic schizophrenia is partially similar to flaccid schizophrenia, but generally, it is dominated by neurotic symptoms. The symptoms typical of most forms of schizophrenic disorder, i.e. delirium and hallucinations, are usually absent in schizophrenia. If the patient is not treated, the signs become increasingly numerous, and eventually, psychopathology is diagnosed.

Specific causes of pseudoneurotic schizophrenia are almost impossible to identify. However, risk factors are known, including:

  • Heredity;
  • Genetic mutations;
  • Neurotransmitter dysfunction;
  • Psychomotor disorders;
  • Uncomfortable social conditions;
  • Psychological trauma.

The development of the disorder usually occurs at a young age. As a rule, it is detected in adolescent boys. However, the risk of becoming ill persists into adulthood in both men and women.

 

Differences from Neurosis

Symptoms of neurotic schizophrenia are similar to signs of neurosis. The following criteria allow to differentiate the diagnosis:

  • Neurosis occurs after a severe psycho-emotional shock or as a result of prolonged stress. Schizophrenia can develop without any apparent cause.
  • Neurotic people are aware of the illness; they understand that they need to seek help. People with schizophrenia do not see anything strange in their behaviour. As a rule, their relatives bring them to the clinic.
  • Neurosis causes excellent discomfort in one’s personal life and work, but it does not affect one’s sense of identity. Schizophrenia, even if it is sluggish, leaves an imprint on personality traits, often leading to their complete disintegration.
  • The neurosis is successfully treated completely. Pseudoneurotic schizophrenia is well treated, but the diagnosis remains forever. The person will have to take medications and engage in prevention for the rest of his life.

Now let’s move on to the specific symptoms of neurotic-like schizophrenia. Some of them are part of the symptomatology of OCD.

 

Manifestations

Symptoms of the disease appear suddenly. And there can be many of them, depending on each case. They are divided into behavioural, psychoemotional, sensorimotor and cognitive groups. Let us list the most widespread ones.

Behavioural manifestations:

  • High-intensity obsessions. The person performs rituals for long periods without paying attention to comments from outside. Some patients wash their hands 3-5 times just before leaving the house; others count to a certain number before opening the door, etc.
  • Alienation. The patient withdraws from society and communicates less with people, including loved ones. It is more out of necessity than out of the patient’s desire.
  • Changes in speech patterns. Strange abstract phrases appear in the person’s vocabulary, which only he understands.
  • An atypical style of clothing. Often it is simply unkempt, but it can also be pretentious or overly flashy.
  • Decrease in the range of interests. Even things that once interested a person very much are now considered indifferent.
  • Withdrawal from food. Sometimes it reaches the point of anorexia. At the same time, the motives for losing weight are unclear since they are not connected with slenderness and beauty.
  • Suicide attempts. It occurs in extreme cases when a person cannot cope with his emotions and anxiety.

Psychoemotional manifestations:

  • Mood swings for no reason;
  • Constant anxiety;
  • A tendency to reflect;
  • Several different emotions in one situation;
  • Anhedonia (inability to take pleasure);
  • Bizarre phobias (fear of the letter “K”, colour, sound, etc.)
  • Hypochondria;
  • Suicidal tendencies.

Sensomotor manifestations:

  • Depersonalization – the sense of loss of self, loss of identity.
  • Dysmorphomania – belief in the presence of defects or imperfections in one’s appearance and ugliness.

All of this leads to the patient stop communicating with people. He begins to wear clothes that cover most of the body and can even sign up for plastic surgery. Many patients are prone to anorexia and bulimia.

Cognitive manifestations:

  • Poor concentration of attention;
  • A fine line between the real and the imaginary;
  • Impaired logical thinking;
  • Decreased level of intelligence.

A patient with neurosis-like schizophrenia may not have all of these symptoms. However, just a few are enough to seek help from doctors.

 

Case

The most frequent sign of pseudoneurotic schizophrenia is phobias. In this case, patients are afraid of insignificant things, sometimes pretentious things. At times, they are afraid that they can be frightened of something. In clinical practice, there are cases when patients are afraid to put on glasses because they can transfer them into another reality.

The most common fear in this type of schizophrenia is open spaces and illness. However, there are times when a person is simply afraid of dying if they don’t count to ten. Gradually, the fears get bigger and bigger, and they begin to rule his life. The patient loses control of his actions.

Another symptom is obsessions which develop along with fears. Because of them, this form of schizophrenia is often confused with OCD. The person with schizophrenia constantly performs some rituals: walks around a chair several times before sitting down, forces his mother to touch a chair leg, goes to bed wearing a hat and one sock, etc.

Often people with schizophrenia of this type find faults in themselves that do not exist. The problem is that such delusions can lead to self-torture, including various diets. There is a risk of organ damage. Then the mental illness is joined by a bodily one.

There are also patients with the compulsion of a shopaholic. In this case, the person is ready to spend all the money and won’t even worry about it. With OCD, the patient can also become a spender, but he is aware that he is acting irrationally and is ready to accept help from doctors.

 

Differences between OCD and Schizophrenia

OCD differs from schizophrenia in many ways. A doctor would never confuse the two disorders. Obsessions and compulsions are common. However, with neurosis, a person tries to overcome them or at least hide them. The person with schizophrenia does not do this because he believes he is doing well.

Neurotics retain their common sense. They are aware of their actions, even if they are done automatically, i.e. in the form of compulsions. At the same time, they understand that this condition is not normal. Moreover, they try to behave correctly. Only in severe cases the control completely disappears.

People with schizophrenia, on the other hand, have split mental functions. They are not critical of their condition. They can behave defiantly or strangely, but they do not realize that they cause shock to those around them. In other words, people with this form of schizophrenia perceive themselves as healthy.

Hallucinations in neurosis also occur, but they are short-lived and appear mostly before going to sleep when the brain is tired and after waking up when brain activity is not as active as it is during the day. The OCD patient understands that the cause of the hallucinations is his illness.

In schizophrenia, voices and visions are spontaneous and may be chronic. Delusions and hallucinations can transport a person’s consciousness to another reality.

The main difference between OCD and schizophrenia is that the former does not cause a personality disorder. A person can completely get rid of the disorder without tracing consciousness. Schizophrenia leaves a defect; it affects the person. In severe cases, there is a complete breakdown of the personality.

 

Treatment of OCD and Schizophrenia

OCD is treated with the help of psychotherapy. Mild sedatives may be prescribed to relieve symptoms, i.e. anxiety. Antidepressants are used only as a last resort. After elimination of the factor which provoked the disorder and the primary symptomatology, the patient returns to everyday life.

Even with an unfavourable outcome, OCD cannot progress to schizophrenia, as they are two different origins. One is neurosis, and the other is psychopathology.

Schizophrenia requires long-term treatment. And it continues throughout life, even if the symptoms don’t bother you anymore. It does not mean you have to lie in hospital and take medication until death, but you will need to see a psychotherapist and psychologist systematically.