OCD or obsessive-compulsive disorder has some traditional symptoms which assumes that the patient is aware about the obsessions or compulsions are excessive and they are more than the normal range of feelings. It is often present in the category where the person suffering knows about the condition he is in., i.e. Neuroses. There are some points of contention though. The patients of OCD displays varying degree of insight into their condition. DSM-IV (American Psychiatric Association, 1994) has some mention to this where it is stated that there are cases of people “with poor insight” who “for most of the time” while experiencing an OCD episode do not recognise about their compulsion being excessive or unreasonable. ICD-10 (World Health Organisation, 1992) has no mention of such obsessional symptoms in the presence of schizophrenia.
There are many cases where person suffering from OCD is also diagnosed with some form of borderline Psychosis. Here the OCD is present along with out of touch with reality behaviour. The person suffering is not fully aware about their reactions/behaviour and actions being unreasonable or non-realistic. Psychosis makes anyone think about schizophrenia, although the doctor never mentioned this name. But psychosis in itself is a big symptom of schizophrenia, making things tougher for people who are less aware. The connection of OCD here with psychosis can be described in one line as OCD with poor insight.
People with OCD with Poor Insight
Most of the time people with OCD knows that they are suffering from some kind of obsession which is not normal and there is certain amount of hyper criticality in their behaviour. They are aware that if they tap a wall for 5 times is not going to change anything, but they still do it. They although could not control it, but they are aware about it.
On the contrary if there is OCD with poor insight, such people do not clearly believe that they are irrational or illogical in any way. They think their thoughts and behaviours are not unreasonable, and consider the obsessions and compulsions as normal and stay safe behaviour. The important inclusion in DSM5 says it all. As per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, OCD should be seen with good or fair insight, poor insight, or delusional beliefs.
Why it is important to differentiate OCD with Psychotic Disorders?
The answer to this question lies in the fact that the treatment of Psychotic disorder has some drugs and therapies which enhances the symptoms of OCD. They tend to induce or exacerbate OCD. There are many side effects as well both firm physical and mental aspects.
There is a lot of work for caregivers here to find the comorbid existence of OCD with Psychosis due to obvious readons like the presence of Depression with ADHD. Do not jump to conclusions and specially think about the treatment you think would be suitable for the comorbid conditions. The treatment options of one condition can adversely affect the other condition.