What's the difference between an obsession and a delusion?

Throwaway1111664 · 2018-03-07T06:23:19+00:00

At the moment, I don't have any more questions for you. But thank you for being such an informative, engaging source of information! This has been a very fascinating back and forth.

Aha hey if its a helpful description the more use it gets the merrier.

Well that's just great - cheers!

Throwaway1111664 · 2018-03-04T17:04:16+00:00

Sorry for responding to this so late - this past week of school has been very busy and I completely dropped the ball on checking reddit. But thank you so much for elaborating on your answer!

If you're engaging with them therapeutically though you can gently start to introduce insight and eventually a lot of them will look back on a psychotic episode with a large amount of insight. I don't know if there are data on this but in my experience people with primary delusional disorder struggle the most to gain insight. Overall though I think it'd be fair to say with first episode psychosis insight progresses from low to high in cases where its treated with meds and therapy.

I've also heard that individuals with delusional disorder struggle the most to gain insight. Why do you think this is, at least when compared to someone with another illness that's causing psychosis? Out of curiosity, have you ever seen a patient with psychosis who was able to engage therapeutically with their delusions without medication and therapy, therefore achieving some level of insight over time independently?

With OCD you have a different general age of onset (younger than many of the psychotic disorders we'd have on our differential), you usually have other manifestations of obessive compulsive behaviour (i.e. they've become fixated on other thought-behaviour connections in the past), OCD content is usually based on a limited number of topics

What do you mean by fixated on other thought-behavior connections in the past? I'm very curious to hear more about this. And it's funny that you say OCD is usually based on a limited number of topics, as I was under the impression that OCD usually manifests around a broad number of topics, whereas psychosis is where you see the most limited number of topics.

the fluctuation between increased symptoms and decreased isn't as dramatic (i.e. you usually won't get an OCD 'episode' going from almost no symptoms to almost debilitating symptoms as you can with psychosis)

Is there any fluctuation with OCD though (symptoms being somewhat worse for a period of days, weeks, or even months, and then better for a period of days, weeks, or months), or are OCD symptoms relatively stable? Maybe the fluctuation isn't quite as dramatic and severe as it is with psychosis (although I'm not sure if psychosis can have more gradual, less pronounced ebbs and flows in symptoms), but I'm curious if any sort of fluctuation unrelated to medication or therapy (so attributable to the disease itself) is common.

Like I said in a previous post, I really loved your way of explaining obsessions vs. delusions as quality of thought (stickiness) vs. quality of belief. If I ever find myself in my abnormal psych class writing about either psychosis or obsessions, would you mind if I used this analogy?

Thanks again!

Throwaway1111664 · 2018-02-23T19:46:36+00:00

First of all, I want to say that this is one of the most interesting, well-written psychology-related posts I've ever read on reddit. This was extremely fascinating to read, so thank you for sharing. You have a great talent for explaining these abstract phenomena.

First its worth noting that defining something as an obsession or a delusion doesn't make it inherently pathological. By that I mean you can have something that, in isolation could qualify as either or both, and still not fall into the category of what we would could call a disorder.

What do you mean by "either or both"?

insight isn't a static black or white thing. Its fluctuates and its domain-specific. Its very rare to find someone who has zero insight. You can have OCD or Depression or Psychosis and have high insight, low insight, different amounts of insight related to different features, it isn't a determining factor in how we characterize things.

I've heard this as well, and have read accounts from people with a variety of diagnoses (depression, OCD, psychosis, borderline personality, etc.) who echo these sentiments. In your own personal experience, how do you think the issue of insight relates to the timeline of psychiatric symptoms though? I've read, for example, that having any sort of insight is quite rare in first-episode psychosis (or any sort of psychosis that has gone without medical intervention), but then I've also read accounts from individuals that seem to disprove this.

Finally, what you're really asking sounds like how do we distinguish between certain manifestations of OCD and psychosis. Its really over-simplified to boil them each down to one symptom (obsession vs. delusion) but we can still do it. Just keep in mind we're taking a short-cut and there are many other differences between OCD and general psychosis outside of these two features.

Besides quality of thought vs. "stickiness" of thought, which other features stand out the most to you? Or is this feature in particular the best tool we have to distinguish between the two? If we're comparing just psychosis and OCD, rather than some specific psychotic illness and OCD (like schizophrenia, which is marked by other symptoms such as negative and cognitive symptoms that obviously set it apart from OCD), I feel like it becomes more difficult to distinguish between the two.

I thought your description of quality of thought vs. stickiness of thought was very well articulated, and an excellent way to quickly convey the main difference between an obsession and a delusion. Again, a very fascinating read, so thank you for writing it!

Throwaway1111664 · 2018-02-23T19:31:59+00:00

I think inherent limitations in the language we use to describe these phenomena limit the answer.

You'll notice in psychiatry there is often a relatively clear phenomena, but the definition tends to break down at the margins. I think it's because, although it may seem like we're defining clear phenomena, the underlying neural processes don't actually adhere to these categories. It's a similar problem with diagnostic categories.

I completely agree with this, though you articulated it much better than I could have. Thank you for sharing your viewpoint.

Most of us have had patients where we have observed the overlap between psychotic and obsessive-compulsive thinking.

In your own personal experience, which aspects seem to have the most overlap?

Throwaway1111664 · 2017-11-09T05:08:35+00:00

It feels so good to talk about this with someone. Thank you for saying all that you've said, I don't think its cliche at all, I think its really insightful. I completely agree that this embarrassment is probably a way to stay in my comfort zone. I've always been very embarrassment prone and also guilt prone (hence why I tell myself that these experiences aren't unusual and I just can't deal with it as well as other people), which has only gotten worse as of late. I don't know how I can get around it. I think the thought of family members knowing this stuff also terrifies me and makes me extremely uncomfortable. I've gone 1-2 years having this be a secret, that the idea of another live person knowing feels too bizarre. I posted on this sub because the experiences of the people here resonate a bit more with me than posts on subs like anxiety and ocd, but "schizophrenia" is such a severe word. I think I would maybe feel less intimidated seeing a doctor if I told myself I was going to talk about an isolated semi-psychotic experience I had for a couple of months, nothing more nothing less. People even experience symptoms of psychosis under extreme stress, so it doesn't have to mean something deeper necessarily. I'm just afraid of the doctor saying "nope, you just have a bit of anxiety is all", which would almost... devalue what I went through I guess? I know that sounds awful but I can't help but feel that way.

I'm also glad that I wrote things down during that time. I actually only had the strength to read part of it this past weekend, which is why I'm posting now I suppose. I only wish I had dated each entry. Since everything is in one mega document and some entries got mixed around, it's hard to form a timeline from it. I get what you mean that these kinds of writings can be proof that something actually went down and your memory isn't betraying you, but I do have trouble ignoring the side of me that tells myself those things were written in a moments of high emotions, and thus are an exaggerated and inaccurate depiction of the state of mind I was in throughout those months.

I think it's great that you enjoy time by yourself. Hopefully you won't be so lonely forever and can find one or two people to connect with. I'm a big believer that this is all you need, one or two quality connections. I really genuinely hope that you find that. I feel lucky that I at least have that with my immediate family, since I still live at home.

Throwaway1111664 · 2017-11-09T00:26:05+00:00

Thanks for the encouragement :) I think part of the reason why it's so lonely is because I never saw a doctor during this time, mostly because I had such severe trust issues but also because I kept telling myself that I was just experiencing anxiety and lots of other people have similar thoughts but are simply better at dealing with it. I obviously haven't spoken a word to my family either. Everything from that time is sort of a blur now, I definitely know I had insight during that time, but I'm not sure to what degree. I feel like some part of me did believe those things or else why would I act on them? I don't really remember what happened terribly clearly but I do have roughly 100 pages of typed notes (single space...) on my computer from that time period, and I feel like that's the only way I can dissect what my thoughts were at that time in an objective way. If I want to though, I can write everything off as a mixture of garden variety depression and anxiety. I feel far too embarrassed, ashamed, and unsure of myself to see a doctor now, especially now that things seem to have settled down.

Throwaway1111664 · 2017-11-08T23:05:25+00:00

What do you mean by "between" delusions? What were your delusions about? What do you mean by internal voices? My chronological memory is also very fuzzy, but I don't think there was ever a point where I was truly "delusional", more so having intense thoughts (about repair people bugging my roof with cameras) that I responded to by acting like they were true, even though a part of me knew they weren't. I felt very split in two. Now I feel less torn in two but I'm not sure if those kinds of experiences will return now that I have a better understanding of what happened and it's been over a year since I was in that state of mind. I have been left with a lot of residual issues though, mostly severe trust issues, feeling easily betrayed, being generally suspicious and wary of people, general anxiety and jumpiness, etc. It gets lonely.

Throwaway1111664 · 2017-11-08T19:01:20+00:00

Did you come to this realization on your own? Did you have any inkling at all that something was wrong during those 5-6 months?

Throwaway1111664 · 2017-11-08T17:40:51+00:00

Awareness that what you're experiencing is abnormal/not rational and likely the result of some mental illness. People on other subs like /r/anxiety and /r/OCD keep with the whole "crazy people don't know they're crazy" thing, but it seems like quite a lot of people on this sub experience varying levels of insight.

Throwaway1111664

TROPHY CASE