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If you've ever had the fear of what if this isn't OCD, but something more serious, Maybe it's psychosis, maybe it's schizophrenia. You're not alone. And often this doubt itself is OCD at work. I'm Dr. Patrick McGrath, the chief clinical officer at NOCD. And before I get into this, I just want to say how serious things like psychosis and schizophrenia really are. And as we talk about it, I'm not having this discussion to in any way kind of decrease anything about psychosis or schizophrenia. But let's face reality. It is one of the big fears that people with obsessive compulsive disorder have is, what if I have another condition instead of ocd? In fact, it can be one of the reasons why people with OCD don't reach out to treatment because they're afraid to hear that it's not OCD and that it might be something else. So we truly understand the seriousness of psychosis and schizophrenia. And nothing I say today is to undercut how serious that is. I'm talking about what happens as one of the obsessions that people with obsessive compulsive disorder have. So a lot of people will reach a point of doubting whether their symptoms are really OCD or not, and they'll start fearing if it's actually psychosis, schizophrenia, or some sign that they're losing grip on reality in some ways. And this can make a lot of sense, right? OCD attaches onto what you can't deal with, right? What is so important to you, what you don't want to be wrong. And if your sense of reality is a high stake thing for you, then, well, there it is. OCD is going to grab onto that. So we want to cover how this fear typically shows up, how OCD actually differs from psychotic disorders. And really what helps when this is the theme that you're stuck on. So how might this look in real life? Well, here are some of the common ways that this shows up. What if my intrusive thoughts aren't really intrusive? What if I actually believe them? What if hearing my own internal voice and I start worrying about it being a hallucination or I'm hearing voices? Yes, I think it's in my voice. But what if it's not briefly imagining a scenario and then worrying that it might have actually happened? This kind of false memory feeling, or did I actually see that? Was that actually a hallucination or something? Feeling spaced out or unreal, like derealization or depersonalization? Assuming that Must mean that I have a psychotic issue. Or what if this recurring. What if I'm losing it or losing my mind and I don't even know that it's happening? These phrases I know can be difficult to hear, but these are the things that we hear all the time from people with OCD who tell us these are the concerns that they have. Often the compulsion around these concerns are mental compulsions, which is part of why it feels like there's nothing to do about these things. But there can be help, and I want to really ensure you that that's the case. If you find yourself constantly checking whether you still feel real, you're mentally testing whether you really believe something like an intrusive thought or image or urge. You try to reassure yourself that you're still you or you're not that kind of person who would do that kind of thing. You're compulsively researching symptoms of serious mental illness and comparing them to your own experience. Or you're even asking other people about what you're describing. And do they think that it sounds like OCD or might it sound like something else? We even know that you might see something on television that talks about people snapping or. Or doing something. And, you know, the neighbors say, oh, they were such a nice person. I can't believe that this happened or those types of things. And people with OCD will even grab onto that, going, what if one day I just become a totally different person? I snap and I do these kinds of things. I've seen it on the news. What if it happens to me? Well, it's the present of doubt itself that I think is a clue that we want to talk about. In ocd, thoughts feel intrusive, unwanted, and ego dystonic. You're aware that you don't really like feeling like you aren't you, and you're aware that these feelings and thoughts themselves or these images or urges don't seem to be you. But for those who experience psychosis, that might evolve more fixed beliefs that they experience actually as being real without the wait, is this me or truly happening feeling that's going on that we see in ocd? OCD compulsions are aimed at relieving anxiety and discomfort. But in psychotic types of experiences, it's not framed that way as relieving some kind of discomfort. In fact, it could just be the experiences they're having are answering other issues going on, like command voices or hallucinations that they may be seeing. The very fact that you're worried and monitoring and seeking reassurance about these things might be a sign that. That things are intact. Like your insight is really working. There's an important caveat here. Only a clinician can really give you a diagnosis, right? But understanding that these distinctions are there can help to take some of the hopeful panic out of the experience and help you recognize what you're actually dealing with. When we're looking at help, the goal isn't to prove this fear wrong. It's to stop treating it like a question that has to be answered. One thing that I've been saying to people lately is my job isn't to give you an answer. It's to help you learn to live with the question. So to me, when we're talking about this theme, what does ERP look like? Well, letting what if I'm losing it sit there without trying to disprove that experience. I'll do that right now as we finish this up. I may not have all of my faculties with me at the moment, and I'm just going to let that be there. I'm not going to try to make that go away. I do want people to learn that you don't have to give in to all of these things. You don't have to do so much research. Right? There's not going to be more things. Probably you're going to find anyway, based on all of the research you've already done, to try to discover what is the true meaning of psychosis, schizophrenia, how does it apply to you? Something of that nature. I want you to work on reducing and resisting this urge to research, because it just isn't going to give you the answer you want. In fact, here's what we know. Trying to fulfill all the research needs that OCD has is trying to fill a bucket that doesn't have a bottom. Everything just keeps going through and going through, and you just need more and more and more to try to get it full. We want people to practice tolerating things like depersonalization or derealization. These sensations can be handled right. You don't have to see them as evidence of something being worse. In fact, there's really good exposure and response prevention exercises for this. We call them interoceptive exposures, where we expose people to symptoms of maybe things like panic or derealization or depersonalization and teach people that they can handle having these feelings without having to do some kind of compulsion or other behavior as a way to neutralize them. Building the willingness to feel uncertain about your own mind and your own mental health. That's exactly what we want you to do, because it's exactly what OCD refuses to do. I have no idea what's going to happen to me tomorrow. I may have some kind of break. I may have a stroke. There could be something mental or physical that happens to me. I don't know. And I accept that. I'm not going to start doing research tonight to try to figure it out. I'm going to just live with it and know that whatever it is, I'll try to figure out a way to handle it. And that's the best that I'm going to be able to do. All of this doubt in your life about these things, that's obsessive compulsive disorder. In fact, OCD's nickname is the doubting disorder. We're not here to win the argument. We're here to just not have it anymore. Even though OCD is going to throw it at us. We don't have to answer. We don't have to participate. Our therapists are really experienced with this theme and they can help guide you through exposure and response prevention therapy. Targets that are specific to whatever compulsions are going on, mental or physical, that you're trying to see if you have all of your faculties, if you're losing it or not, if you are going into a diagnosis that frightens you. If you're looking for help for that, check us out@nocd.com that's n o c d dot com. We have our care team sitting, waiting to chat with you right now. They would be happy to tell you all about our great therapists and the training they have and help you get set up with someone so that you can start to do exposure and response prevention therapy for your ocd. If you want to live that life that you want to live and, and not the life that OCD wants you to live, come check us out. We look forward to hearing from you. Thanks.