Have obsessions related to anxiety disorders ever been known to mimic delusions?

[Tempered Tense]

In times of high stress, when OCD can become pretty severe, have the obsessions and/or phobias ever been known (or is it possible) to become so severe that the individual becomes fully immersed in them to the point that they lose insight and become temporarily psychotic?

If so, does this become a permanent condition? How is it treated? With anti-depressants, or anti-psychotics?

 

[David Baxter PhD]

I don't know of anything to suggest that OCD will "progress" or "evolve" into psychosis, Tempered Tense. Certainly, in the moment OCD thoughts or beliefs can be very intense and very compelling, and at such times the obsessional thought may seem very real. And it's also true that OCD or OCD-like obsessional thinking can co-exist with other disorders like bipolar disorder or schizophrenia.

However, I'm not sure what you mean exactly by

fully immersed in them to the point that they lose insight and become temporarily psychotic

 

[Tempered Tense]

Hi Dr. Baxter,

I ask because one of the hallmarks of OCD is that the sufferer, on some level, always remains aware that their obsessions or fears are irrational, and/or unreal in a sense. But what happens when the sufferer loses this insight, and "really" comes to wholly believe their fears? Have they crossed over to another level of mental illness?

I was trying to keep the question general, but I suppose it may be a follow up to my previous question.

Lately, I have begun to treat my obsessive thoughts as if they were real; particularly the one about my fear of someone trying to poison me. There are times when I really believe that the fear is validated and respond to it as such. It has gotten to the point where I am no longer conscious or even concerned about how I am appearing to others (when I am in the throes of such obsessive thoughts); for example, when I believe that a plate of food I have left out has been tampered with, I will become so stressed and frustrated that I might subtly inquire about it, or make accusations or allusions to someone having messed with it. I will draw on events that have occurred--the fact that someone was just in the kitchen for no real reason, etc. as validation.

Sometimes things will happen to engender my fears; like overhearing bits of a person's conversation on the phone, finding powder-like substances on the counter, people whispering, etc.

I really do believe that all of this is reminiscent of a psychosis more than general anxiety or obsessions. It sounds like a paranoid delusion. I will admit, I realize that delusions are a common symptom of psychosis and not necessarily the defining core feature, but I am curious.

It is something I will certainly bring up in counseling. But one thing is certain, whatever this is, it is severe enough that it is interfering drastically with every aspect of my life. I am going to discuss the possibility of medication with my counselor, but I have fears about that as well.

 

[David Baxter PhD]

one of the hallmarks of OCD is that the sufferer, on some level, always remains aware that their obsessions or fears are irrational, and/or unreal in a sense. But what happens when the sufferer loses this insight, and "really" comes to wholly believe their fears? Have they crossed over to another level of mental illness?

I don't know that your premise here is accurate. When anxiety spikes, individuals with OCD may not always realize that their obsessions or fears are unreal. I recall a client who was afraid she was going to find a way to kill herself despite taking many precautions, all due to intruisive, obsessive, unwelcome thoughts of harming herself in various ways. It took a good while in therapy to get her to the point where she was able to see that her thoughts did not represent suicidal intent but rather safety fears. Another client, a post-partum mother, had similar issues with iuntrusive thoughts of harming her baby, which again had nothing to do with intent to harm but rather fears about the safety of her child.

Sometimes OCD thoughts and worries can feel very real indeed. I think the key is to identify them for what they are. You are not necessarily psychotic because you have vivid, intense obsessional thoughts.

But your best bet if you are having thoughts which concern you is to see a psychiatrist or psychologist who is qualified to diagnose (not all therapists have either the knowledge or the legal authority to do this) in a face-to-face session to review your history and current symptoms and behaviors. As I said earlier, while OPCD does not normally progress into a psychotic illness, having OCD does not preclude the possibility of having a psychotic illness - the two can coexist.