Obsessive-compulsive disorder (OCD) is a mental health condition, and psychosis is a more general term that describes a range of experiences. They may both share similar symptoms, such as intrusive thoughts that can disrupt daily life.

Obsessive-compulsive disorder (OCD) is a significant mental health condition that causes recurring intrusive thoughts and repetitive behaviors. Psychosis describes a group of symptoms or mental states in various other conditions, including OCD.

There can be overlaps in symptoms that may make diagnosis and management challenging. Individuals with OCD can experience psychosis. However, this does not mean that OCD is a psychotic disorder. Not everyone with OCD experiences symptoms of psychosis. In fact, most people with OCD do not experience a psychotic disorder.

This article explores the connection between OCD and psychosis, highlighting their similarities and differences and discussing effective treatment options and support systems.

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According to a 2021 study, 5.5% of subjects at ultra-high risk of psychosis also have comorbid OCD. They may also be at an ultra-high risk (UHR) for psychosis in comparison to the general population. UHR individuals also have higher rates (13.7%) of obsessive-compulsive symptoms (OCS).

Research suggests that OCD symptoms are similar among those with psychosis. However, further investigations are necessary to gather evidence to provide patients with a more targeted therapeutic approach.

Approximately 22% of those who are UHR for psychosis develop a psychotic disorder within 3 years of seeking clinical help. The term “psychotic disorder” describes multiple types of mental health conditions that involve psychosis. Doctors consider individuals to be at UHR for psychosis if they meet a set of standardized criteria, including:

  • brief limited intermittent psychotic symptoms (BLIPS)
  • attenuated psychotic symptoms (APS)
  • presumed genetic vulnerability (trait)

What is OCD?

OCD is a chronic mental health condition affecting 1% to 3% of the global population. It causes symptoms such as obsessions and compulsions.

An individual with OCD may perform compulsions ritualistically to alleviate symptoms of obsessions. These symptoms can significantly interfere with an individual’s life and impair daily functioning. Obsessions include recurring intrusive thoughts, such as fears of:

  • contamination
  • harming others
  • making mistakes

Compulsions may involve repetitive behaviors such as:

  • washing
  • checking
  • counting

Learn more about OCD.

What is psychosis?

Psychosis is a group of symptoms that affect the mental state due to a loss of contact with reality. An episode of psychosis can disrupt an individual’s thoughts and perceptions, making it challenging for them to distinguish between what is real and what is not. It may affect their ability to function in daily life.

Individuals experiencing psychosis may have hallucinations, which involve seeing or hearing things that are not present, and delusions, which are strongly held false beliefs. Psychosis can occur as a symptom of various mental health conditions, including:

Learn more about psychosis.

Though OCD and psychosis are different, they share some overlapping symptoms that might appear similar to someone else, including:

  • Intrusive thoughts: Both individuals with OCD and those experiencing psychosis may have intrusive thoughts. In OCD, these thoughts are distressing, leading to compulsions to manage the anxiety.
  • Anxiety and distress: Both conditions can cause significant anxiety and emotional distress. In OCD, the distress arises from the obsessions and the compulsion to perform rituals. In psychosis, anxiety can stem from the fear and confusion caused by hallucinations and delusions.
  • Impact on daily functioning: Both disorders can severely disrupt an individual’s ability to function in everyday life, affecting work, relationships, and social interactions.

Despite some overlapping symptoms, OCD and psychosis have key differences, including:

  • Response to reality: Those experiencing psychosis have a distorted sense of reality and altered perception, whereas people with OCD are generally in touch with reality.
  • Nature of thoughts: In OCD, individuals recognize that their obsessive thoughts are irrational and unwanted, even though they feel compelled to act on them.
  • Types of symptoms: OCD causes repetitive behaviors and mental rituals aimed at reducing anxiety due to obsessions. Psychosis, on the other hand, involves more profound disruptions in thought processes.

Treating OCD and psychosis involves a combination of medication, psychotherapy, and support.


  • OCD: Doctors commonly prescribe selective serotonin reuptake inhibitors (SSRIs) to manage OCD symptoms. In some cases, a doctor may recommend antipsychotic medications if there are overlapping symptoms with psychosis or when an individual does not respond to SSRIs.


  • OCD: Talk therapies, such as cognitive behavioral therapy (CBT) and exposure and response prevention (ERP), are highly effective in treating OCD. They can help individuals confront their obsessions and reduce their compulsions.
  • Psychosis: CBT is also beneficial for psychosis, helping individuals manage symptoms and improve coping strategies.
  • Integrated treatment: For individuals with co-occurring OCD and psychosis, an integrated treatment approach is essential. This may involve a combination of medications, tailored CBT, and ongoing support from mental health professionals.

Support systems play a vital role in managing both OCD and psychosis, including:

  • Professional support: Regular consultations with psychiatrists, psychologists, and therapists are crucial. These professionals can adjust treatment plans as necessary and provide ongoing therapeutic support.
  • Support groups: Peer support groups offer a sense of community and understanding. Sharing experiences with others facing similar challenges can reduce feelings of isolation and provide practical advice.
  • Family and friends: Family therapy can help educate family and friends about OCD and psychosis and foster a supportive environment. Loved ones can assist in monitoring symptoms, encouraging treatment adherence, and offering emotional support.
  • Educational resources: Psychoeducation and access to reliable information about OCD and psychosis empowers individuals and their families to understand the conditions better and navigate the complexities of treatment and management.

While OCD and psychosis are different, their symptoms can sometimes overlap, making diagnosis and treatment challenging. OCD causes obsessions and compulsions, whereas psychosis involves a profound disconnection from reality, including hallucinations and delusions. Despite these differences, both conditions can cause significant distress and disrupt daily life.

Effective treatment often requires a combination of medication, psychotherapy, and robust support systems. Understanding the unique and shared aspects of OCD and psychosis can lead to a more accurate diagnosis, treatment, and support, ultimately improving the quality of life for those living with these challenging conditions.