Running head: SCHIZOPHRENIA AND OCD 1

Reaction Paper Two

The Relationship Between Schizophrenia and OCD

Aaron W. Whiteman

Ball State University

PSYSC 100:08
SCHIZOPHRENIA AND OCD 2

Hypothesis:

Schizophrenia and Obsessive Compulsive Disorder (OCD) show positive

correlation in presence in adults.

My Initial Hypothesis

In considering mental disorders among adults, many associate with certain

diagnoses a stigma: all those with mental diseases are all crazy, dangerous people. This

allowed me to think of whether there are similarities between some of these diseases

which would make such a generalization possible. Of course many of these connections

are falsely relayed as truth via social media, but having obsessive compulsive disorder

myself, I wondered how many individuals were affected by not only this, but also the

more serious schizophrenia. Two commonly misinterpreted diseases such as these may

surely have some binding traits. Given this idea, I assumed that perhaps those with either

disease may be inclined to also have the other. This would perhaps support the

generalization so adamantly represented in the minds of many groups of people and also

prove an interesting phenomenon to study (one with two such debilitating diseases).

The Empirical Evidence

According to Mayo Clinic Staff (2010a), obsessive-compulsive disorder is “an

anxiety disorder characterized by unreasonable thoughts and fears (obsessions) that lead

[one] to do repetitive behaviors (compulsions).” The definition of schizophrenia is “a

group of severe brain disorders in which people interpret reality abnormally,” (Mayo
SCHIZOPHRENIA AND OCD 3

Clinic Staff, 2010b). Given these two very different definitions, it is hard to see how

either condition would have much in common, but both disorders may affect an affected

individual’s ability to function properly in their everyday life. Both disorders are

disorders which affect the way the mind works, but one, obsessive compulsive disorder,

works with the affected individual’s knowledge, wherein the individual knows that what

they are doing is not healthy or rational, whereas schizophrenia isn’t as easily known by

those affected, changing the way they think, not just what they think.

These diseases have quite a few differences between them, but what they have in

common is that they are mental disorders which affect the lives of those who have them.

There are some scientific similarities between obsessive-compulsive disorder and

schizophrenia, with very similar parts of the cortex of the brain being dysfunctional when

either disease is diagnosed. The orbito-frontal cortex is largely affected by impairment in

obsessive compulsive disorder in-patients, and the dorso-lateral prefrontal cortex is

largely impaired in instances of schizophrenia in in-patients, all shown by poor

performance by the former group in a study on the object alternation test, and poor

performance on the Wisconsin card sorting test on the latter, with each performing

normally on the alternate test (Abbruzzese, Ferri, & Scarone, 1997). Both of these areas

of the brain are in the frontal lobe, and both have Brodmann areas in the cognition areas

of the brain (Dubin, n.d.; Van Hoesen, Parvizi, & Chu, 2000; et al., 2005). These

associations show similarities in the ways in which the diseases work with the brain, and

thus affects the way the brain works. Additionally, Abbruzzese, Bellodi, Ferri, and

Scarone (1995) found more evidence to support that there are connections in frontal lobe

damage and both diseases, finding similar results in association with the dorso-lateral
SCHIZOPHRENIA AND OCD 4

prefrontal cortex in schizophrenia patients and the orbito-frontal cortex in obsessive-

compulsive disorder patients when using “Weigls Sorting Test and the Word Fluency

Test to assess global frontal functioning.” There is evidence, as noted in a study by

Elbert, Perlstein, and Stenger (2001), that there is an inverse correlation between the

activities in the orbito-frontal cortex and the dorso-lateral prefrontal cortex: when activity

in one cortex goes up, the other goes down. As this evidence shows, there is little doubt

that these areas in the frontal lobe are directly connected to an individual’s possession of

either disease.

There have been many studies done on the associations between schizophrenia

and obsessive-compulsive disorder, particularly in cases of individuals with

schizophrenia also having obsessive-compulsive disorder. There seems to be a relation

between the two diseases, considering the rates of obsessive-compulsive disorder

between those with schizophrenia and those in the general population. There are many

conditions commonly associated with obsessive-compulsive disorder: Major depressive

disorder (45%), separation anxiety (34%), dysthymia (29%), suicidal ideation (15%), and

phobia (8%) were the diagnoses most frequently comorbid with OCD,” (Addy et al.,

1994). Given that there is no mention of schizophrenia among these, it’s surprising,

perhaps, to note that while only 3% of individuals have clinical obsessive compulsive

disorder in the general population, a significantly larger, more concentrated 25% of

individuals diagnosed with chronic schizophrenia also showed significant obsessions and

compulsions directly related to obsessive compulsive disorder, as found by Berman et al.

(Addy et al., 1994; Beer, Eisen, Pato, Rasmussen, Venditto, 1997). This is a very large

difference (23%) in occurrence between individuals with chronic schizophrenia who also
SCHIZOPHRENIA AND OCD 5

have obsessive compulsive disorder, and in fact in a similar study by Fenton and

McGlashan, showed that upon closer evaluation (as Berman’s study dealt with therapists

and not actual patients directly), still 12.9% of individuals with schizophrenia also had

obsessions and compulsions closely associated with obsessive compulsive disorder. This

lower number still gives a near 10% lead over non-schizophrenic patients with a

diagnosis of obsessive-compulsive disorder.

These results have been repeatedly found with results of 25% by Chue, Kroetsch,

Tibbo, and Warneke (1999), and 14% in a study by Fuchs, Poyurovsky, and Weizman

(1999). In addition, all of the patients in the study by Fuchs et al. were shown to score

“significantly lower than schizophrenic patients without OCD on the formal thought

disorder subscale of the [Schedule for the Assessment of Positive Symptoms].” Chue et

al. (1999) also found that such patients diagnosed with both disorders scored

“significantly higher on the Y-BOCS, Hollingshead scale, and GAF; plus significantly

lower PANSS negative symptoms and a trend in increased Parkinsonian symptoms

compared with individuals with schizophrenia alone.” This data shows that not only are

schizophrenic patients more likely to have obsessive compulsive disorder, but those who

do also show stronger symptoms and are more negatively affected by such afflictions

than their solely schizophrenic counterparts, and it may be assumed that they are much

more negatively affected than those individuals without either disease.

My Current Opinion

Based on the significant and reliable (based on repeated results) empirical

evidence found, I have come to the conclusion that my hypothesis may be plausible.
SCHIZOPHRENIA AND OCD 6

Though there were no directly mentioned correlations between obsessive-compulsive

disorder and schizophrenia, there is a much greater chance of an individual being

diagnosed with obsessive-compulsive disorder if they already suffer from schizophrenia.

From this, we may make an assumption that there is a positive correlation between the

existence of schizophrenia and the existence of obsessive-compulsive disorder. It is more

likely that an individual will obtain a diagnosis of obsessive-compulsive disorder if they

are also diagnosed with schizophrenia, and this is evident of a positive correlation. There

is an interesting aspect implied by the evidence, that I would like to study further that is

not directly related to my hypothesis or research: if there is an inverse correlation in brain

activity among the dorso-lateral prefrontal cortex and the orbito-frontal cortex, depending

on the existence of either disorder mentioned, then what are the activities like in

individuals who have diagnoses of both obsessive compulsive disorder and

schizophrenia? This would be interesting as a study so the results may be examined. Most

of the experiments done referred to possible implications in the medicine field for

treating either disorder, and such a study may help further such implications and,

hopefully, results.
 SCHIZOPHRENIA AND OCD 7

References

Abbruzzese, M., Bellodi, L., Ferri, S., & Scarone, S. (1995). Frontal-lobe dysfunction in

schizophrenia and obsessive-compulsive disorder - A neuropsychological study. Brain

and Cognition, 27 (2), 202-212.

Abbruzzese, M., Ferri, S., & Scarone, S. (1997). The selective breakdown of frontal functions in

patients with obsessive–compulsive disorder and in patients with schizophrenia: A double

dissociation experimental finding. Neuropsychologia, 35 (6), 907-912.

Cannon, T., Glahn, D., Kim, J., Van Erp, T., Karlsgodt, K., Cohen, M., et al. (2005). Dorsolateral

prefrontal cortex activity during maintenance manipulation of information in working

memory in patients with schizophrenia. Arch Gen Psychiatry, 62, 1071-1080.

Dubin, M. (n.d.). [Diagram of the Broddmann areas and their categories.]. Brodmann areas in the

human brain with an emphasis on vision and language. Retrieved from

http://spot.colorado.edu/~dubin/talks/brodmann/brodmann.html

Eisen, J., Beer, D., Pato, M., Venditto, T., & Rasmussen, S. (1997). Obsessive-compulsive

disorder in patients with schizophrenia or schizoaffective disorder. Am J Psychiatry, 154,

271-273.

Mayo Clinic Staff. (2010a, December 15). Obsessive-compulsve disorder. Retrieved April 12,
 SCHIZOPHRENIA AND OCD 8

2011, from Mayo Clinic: http://www.mayoclinic.com/health/obsessive-compulsive-

disorder/DS00189

Mayo Clinic Staff. (2010b, January 30). Schizophrenia. Retrieved April 12, 2011, from Mayo

Clinic: http://www.mayoclinic.com/health/schizophrenia/DS00196

Perlstein, W., Elbert, T., & Stenger, V. (2002). Dissociation in human prefrontal cortex of

affective influences on working memory-related activity. Proc. Natl. Acad. Sci. USA, 99

(3), 1736-1741.

Poyurovsky, M., Fuchs, C., & Weizman, A. (1999). Obsessive-compulsive disorder in patients

with first-episode schizophrenia. Am J Psychiatry, 156.

Tibbo, P., Kroetsch, M., Chue, P., & Warneke, L. (2000). Obsessive-compulsive disorder in

schizophrenia. Journal of Psychiatric Research, 34 (2), 139-146.

Valleni-Basile, L., Garrison, C., Jackson, K., Waller, J., McKeown, R., Addy, C., et al. (1994).

Frequency of obsessive-compulsive disorder in a community sample of young

adolescents. J Am Acad Child Adolesc Psychiatry, 33 (6), 782-791.

Van Hoesen, G., Parvizi, J., & Chu, C.-C. (2000). Orbitofrontal cortex pathology in alzheimer's

disease. Cereb. Cortex, 10 (3), 243-251.