Can OCD verge on paranoia/delusional?

[Robin43]

I just wanted to ask, as all my thoughts are so believable to me and I feel so scared can OCD verge on delusional/paranoia?

[PolarBear]

Yes.

You should also know that sufferers can have good or poor insight.

Having good insight means having the ability to see your obsessions and compulsions are silly or not real. Poor insight means just what you said, that your obsessions and compulsions seem perfectly reasonable.

[hetty]

Yes. I've had obsessions and intrusive thoughts where I've legitimately thought to myself 'I'm being absolutely delusional right now'.

All mental illnesses overlap to some degree, and OCD just so happens to overlap somewhat with paranoia/delusions.

[Angst]

Paranoia in a clinical sense is about believing that other people are threatening you in some way where there is no evidence that this is the case. Acts or looks of others are often interpreted as hostile while others would not interpret these acts or looks in such a way. Generally there is some form of ‘them’ out to get you. A good source of information is the Mind leaflet on paranoia. Delusion tends to be defined as a fixed near unshakeable belief in something that other members of your culture do not believe in. NHS choice provides information as well as Mind and the Royal College of Psychiatrists.

[Robin43]

Thanks everyone!

[Precontemplative]

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Some problematic responses here, in my opinion.

'PolarBear' wrote on 10 Apr 2021: "Poor insight means just what you said, that your obsessions and compulsions seem perfectly reasonable."

Dr David Veale explains that OCD is regarded by psychiatrists as 'the really weird one' of all the mental illnesses, as sufferers generally have good insight, but have 'strange' beliefs that they are aware are 'strange'. That means they have good insight. I suspect poor insight is a clue that there is another illness about, for example, bipolar disorder.

So, that statement does not square with the typical angst that sufferers have about their OCD, that it is powerful in perturbing them, but really, they know it is _not_ reasonable as seen by most people on an everyday level. Also, 'reasonable' is not the same as 'believeable', and neither it the same as 'true'. I think what 'Robin43' means is something like: "I seem to really believe this food _is_ adulterated, but my family don't think this is a reasonable opinion." Neither opinion tells one if the food is truly adulterated.

'hetty' wrote on 10 Apr 2021: "Yes. I've had obsessions and intrusive thoughts where I've legitimately thought to myself 'I'm being absolutely delusional right now'."

Heh, that's the very proof of _not_ being delusional. Delusion involves not accepting being delusional!

Further to this, when I was first admitted to a psychiatric hospital, the doctor assessing me told me their are three levels of (mis-)belief in mental illness:

1) Over-ideation (believing ideas more strongly than usual).
2) Delusion (believing ideas that are actually false, though could have been true, but refusing to accept the falsity).
3) Psychosis (believing ideas that are unreal, such as "I am physically invisible right now, and no one can see me").

He rated me as 1) on my OCD, which was at a similar level and nature as I described in my first post at https://www.ocdforums.org/index.php?/topic/89311-precontemplative-first-posting/. So, I'm not delusional, nor psychotic (apparently).

'Angst' wrote on 11 Apr 2021: "Paranoia in a clinical sense is about believing that other people are threatening you in some way where there is no evidence that this is the case."

Yes, correct when you mean clinical as in a diagnosis of paranoid schizophrenia: these sufferers are psychotic and without insight. I got to know a few while in hospital.

I admit I am paranoid, I have always admitted this since my OCD diagnosis. However, I'd rate myself as lucidly paranoid, with insight.

I recall that the literal meaning of 'paranoia' is 'everyone is alike'. It refers to when you hold a particular belief, but everyone else holds a same-but-different-to-yours belief. One can feel very discomfitted by this, though not necessarily threatened, depending on the subject.

'Angst' wrote on 11 Apr 2021: "Delusion tends to be defined as a fixed near unshakeable belief in something that other members of your culture do not believe in."

Mmm, not sure. This definition could also cover over-ideation. I wonder if the problem with that definition is the word 'near'. I think the difference between over-ideation and delusion might be the possibility of contemplating an alternative. Remove the word 'near' and I think it does become a definition of 'delusion'.

Also, it is possible for many members of your culture to share the delusion. If we take Mr Hitler and his claims of a global Jewish conspiracy, he was deluded about it, and many of his party were too. He committed suicide on the basis that the Soviet Union invaders outside Berlin were controlled by Jews out to get him.

Note that neither this delusion nor any other Nazis merely being over-ideated about a global Jewish conspiracy count as psychosis, because it is in principle possible for there to be a global Jewish conspiracy, it's just that there wasn't actually one.


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[snowbear]

27 minutes ago, Precontemplative said:

I suspect poor insight is a clue that there is another illness about, for example, bipolar disorder.

You suspect wrong, I'm afraid.

Poor insight means poor understanding of how OCD (or whatever disorder you have) is distorting your thinking.

Recovery from an anxiety disorder is a process where you

1.gain insight

2. change how you interpret things

3. recover from disordered thinking and apply normal thinking.

No need to go looking for other problems/ complications.

[PolarBear]

Um, yeah... NOT!

 

[Precontemplative]

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'snowbear' wrote on 24 Apr 2021: "You suspect wrong, I'm afraid."

Interesting, because in the book Dr. David Veale wrote about OCD, he states that OCD sufferers generally have good insight compared to other illnesses. He makes the point that OCD sufferers are 'not mad' and are often quite aware that they have thoughts that are 'not normal', it's just that they can't stop them or stop acting on them.

When I was in hospital, the staff remarked on how I had very good insight, and I was as bad then as I am now. Indeed, one charge nurse who helped me a lot often asked me to be an interviewee for trainee medical students. They were supposed to 'diagnose' my illness via questions. I was glad to do so, and of course a reason why I was asked was because I was one of the few who was coherent. It was often fun! The number of dumb disgnoses I got as the students made ever more complicated theories about why I was holding a tissue in my hand ... (I should just say that it's inexperience that made these dumb diagnoses, not stupidity, so I hope the charge nurse's intent of this exercise is apparent!) Best diagnosis was a female student in a wheelchair who went straight for OCD as she watched me as I used the tissue as a buffer when opening the door to come in. Simmples!

I think the period of poor insight in OCD does exist, but it is very short. By the time OCD sufferers are asking for therapy, they're already aware of how out of step with non-sufferers they are. That's they have _OCD_ is still something they mustwork out, but we see how many people come on this forum asking "Is this OCD?" They already suspected by themselves. Good insight doesn't necessarily help them pass steps two and three of your list.

'snowbear' wrote on 24 Apr 2021: "No need to go looking for other problems/ complications."

Except there was another patient who had OCD and bipolar at the same time. She joined a programme to investigate the simultaneity of these two illnesses; they are not mutually exclusive, but not co-morbid. Bipolar Disorder is not an Anxiety Disorder, it's an Impulse Disorder. Insight is generally poorer for bipolar sufferers than OCD sufferers.

It is precisely because OCD sufferers know that what they are doing is unreasonable but can't stop it that they have such difficulties, especially at the GP stage.


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[BelAnna]

On 10/04/2021 at 20:05, Robin43 said:

I just wanted to ask, as all my thoughts are so believable to me and I feel so scared can OCD verge on delusional/paranoia?

You can have a diagnosis of 'OCD with poor insight' where OCD reaches a psychotic state but it doesn't sound like this is what's happening for you because you have some awareness and that's why you're telling yourself that you're being delusional just now. People who are psychotic aren't able to do that during an episode of psychosis! 

I think sometimes OCD can feel like a lucid dream- you're stuck in the dream but part of you knows that you're dreaming- you have some insight that you're suffering from OCD but you're still stuck in the OCD (dream). 

[Precontemplative]

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Yes, also true. It is the psychosis that ruins the insight here. So, I think OCD sufferers have poor insight at the beginning (everyone goes through this), or when OCD is so severe it goes psychotic (quite rare, I think). In the middle (and it's quite a wide middle, OCD sufferers have a good insight. It's why they come here asking or go to their GPs.


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