Schizophrenia and obsessive-compulsive disorder (OCD) are separate conditions that can occur together. They involve similar experiences of anxiety and unusual behavior but have major differences that set them apart.

Schizophrenia is a mental health condition featuring symptoms of psychosis, a mental state in which the brain’s perception of reality becomes skewed or inaccurate. Hallucinations, delusions, and disorganized thoughts are the hallmark symptoms of psychosis seen in schizophrenia.

Obsessive-compulsive disorder (OCD) involves intrusive thoughts, urges, and mental images called obsessions that are neutralized by repetitive, ritualistic behaviors known as compulsions.

Both schizophrenia and OCD can involve unusual behaviors, anxiety, and impaired daily function, but major differences set them apart.

Schizophrenia and OCD are associated through comorbidity, the technical term for conditions that occur at the same time. According to current research, schizophrenia and OCD are commonly seen together.

Older research from 2014, still cited in current literature, states as many as 30% of people living with schizophrenia report obsessive-compulsive symptoms, and 12–14% meet the diagnostic criteria for OCD.

Can you receive a diagnosis of both OCD and schizophrenia?

Yes, you can receive a diagnosis of OCD and schizophrenia at the same time.

Erin Davis, a licensed clinical mental health counselor from Taylorville, North Carolina, explained, “Comorbidity is diagnosed when the client has several major symptoms that are interfering with the quality of their life and the clinician can assess that there is more than just one condition occurring.”

Schizophrenia and OCD seem similar on the surface. Both can involve feelings of anxiety, emotional distress, functional impairment, and behaviors seen by others to be unusual or bizarre.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) indicates that both schizophrenia and OCD can feature anosognosia, a lack of insight into the disorder in which you don’t recognize that you’re experiencing a mental health condition.

The DSM-5-TR also notes that preoccupations with OCD may become so extreme and irrational that they can resemble delusions. Delusions, a primary symptom of schizophrenia, are false beliefs about reality that you keep despite clear, rational evidence against them.

How to distinguish between OCD and schizophrenia

Despite some overlapping symptoms, OCD and schizophrenia have important distinguishing features. Davis explains that, while both involve anxiety, the underlying fears are different.

“The worries involved in OCD and schizophrenia are different,” she said. “Someone with schizophrenia can have paranoia (a type of delusion), which is the fear that someone is plotting against them, whereas someone with OCD has a fear of something bad happening.”

Fears in OCD are often very specific, like fear of contamination, whereas delusions in schizophrenia can be broader, involving many different behaviors and beliefs within the delusion.

The DSM-5-TR notes fears in OCD are also set apart from schizophrenia by the presence of prominent repetitive behaviors, also known as compulsions, which are directly used to neutralize a specific fear.

Possibly the most significant difference between schizophrenia and OCD is how they affect your reality perception.

“More specifically,” said Davis, “someone with schizophrenia believes that their thoughts, delusions, and hallucinations are real. [Someone living with OCD] is in touch with reality and, to an extent, logically recognizes that their intrusive thoughts are not actual, real situations.”

She added that someone living with OCD can recognize that their thoughts are just thoughts. They’re often distressed by them because they go against that person’s inner values.

“Someone with schizophrenia will believe that their thoughts are true, real, actual experiences and do not [always] see their thoughts as distressing or unwelcome.”

OCD doesn’t lead to schizophrenia, although these conditions may share genetic pathways that increase your risk of both disorders.

Davis notes that while OCD doesn’t lead to schizophrenia, living with OCD may naturally make you concerned about the possibility.

“This can absolutely be a fear of [someone living with OCD],” she said. “It can often be the case that [someone living with OCD] is experiencing the health OCD theme where they are worried about developing a chronic mental health issue like schizophrenia.”

OCD and schizophrenia are both treated using psychotherapy approaches and medication. Treatments can overlap but often have different purposes.

For example, cognitive behavioral therapy (CBT) is a psychotherapy framework used in both OCD and schizophrenia. In OCD, its objective is to help you recognize and challenge unhelpful thought patterns related to obsessions.

CBT for OCD also involves exposure and response prevention, which is controlled exposure to the underlying fears of OCD to help reduce anxiety.

In schizophrenia, CBT works to restructure your thinking and behavior, but the focus is on helping you recognize when your reality perception is altered. CBT for schizophrenia is part of a multidimensional care model including psychoeducation, community support, and family therapy.

Antidepressants are the most common medications prescribed for OCD, but they aren’t a first-line choice in schizophrenia. Schizophrenia is primarily treated with antipsychotics to help manage symptoms of psychosis.

Treatments for co-occurring OCD and schizophrenia

When OCD and schizophrenia occur together, they’re still treated as separate conditions. Your psychotherapy and medications will be tailored to your symptoms and where you’re experiencing impairment in daily life.

According to a 2019 review, antidepressants, antipsychotics, and CBT are recommended by the American Psychiatric Association for the treatment of comorbid OCD and schizophrenia.

Schizophrenia and OCD are separate conditions that can occur together. Although they share general symptoms of anxiety, unusual behavior, and functional impairment, these conditions are very different at the core.

Schizophrenia is a psychotic disorder featuring disrupted reality perception. OCD doesn’t involve false reality, even though obsessions may become extreme or irrational.

If you’re living with schizophrenia, OCD, or both, psychotherapy and medications can help you manage symptoms and improve your overall well-being.