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Looking for Answers... Dealing With Paranoia

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Hi, I'm going to briefly describe my experience and see if anyone can relate or maybe if no one can that can answer my question about whether or not schizophrenia is a possible diagnosis for me. Basically, I have been in and out of therapy since I was 14 (I am now 25). Initially I was in talk therapy for what I perceived as depression. When I was 18 I had a really bad night that felt like it was brought on very suddenly. WARNING: potential triggers; describing paranoia and thoughts of self-harm I became convinced I was going to cut my fingers off. I had been feeling off for most of the night and it came to a head when I lay down in bed to go to sleep. I could not for the life of me get these thoughts out of my head and it was almost like someone was telling me to go ahead and do it. Now, I want to be clear. I did not hear an audible voice. It was much more internalized. However, it did still feel like something was telling me to do that. My mother had previously dealt with an anxiety disorder and continued to take medication for it. I went to her in a panic and told her, embarrassed, that I was sure I was losing my mind and was going to cut all of my fingers off even though I didn't want to. Thoughts along the lines of these ones continued since then. I thought people could magically kill or hurt me simply by touching something I was going to drink or eat. I hated when certain people would touch me and would think a lot of people were out to get me. I went to a psychiatrist since my therapist and mother felt I needed to go, along with myself feeling this way. She ended up diagnosing me with OCD anxiety and later just OCD as I continued to show symptoms involving checking certain behaviors. I went on a low dose of medication and became paranoid about that and discontinued use. Recently my paranoia has been exceedingly bad. I have not been able to sustain a relationship romantically as I always seem to get paranoid about people's intentions and behaviors (i.e. thinking people are obsessed with me, following me, or planning to physically harm me). I do not think my paranoia was totally unwarranted in some cases as some behaviors were unhealthy, but my responses to circumstances were blown up to a big extent. I constantly validate my feelings with others and am often told I am wrong. 

This is my problem. I do not feel like I have OCD. I'm not sure my current psychiatrist does either. We seem to be treating symptoms but don't really have a diagnoses. We have described it as depression, anxiety, paranoia and catastrophizing situations and ADHD. I haven't told her everything I'm feeling yet, but she prescribed me Zoloft and Risperidone since she wants to treat the paranoid thoughts. The Risperidone is at a very low dose and it seems to be doing something although my symptoms are not completely gone. She then added Adderall in the mix to treat my ADHD although she wants to take it slow with all the medications because there are a few different variables at play here.  I am not trying to say I am schizophrenic. I don't necessarily think I am but I do have questions and am trying to learn more since what I describe as anxiety doesn't seem to really line up with how I have seen anxiety portrayed in many other people. I don't seem to have the physical symptoms of anxiety or typical anxious thoughts, but rather just display different forms of paranoia both with potentially realistic situations and very unrealistic situations.. I am just wondering about a couple of things: 

1- I often get trapped in my own head and space out and feel I can't control my thoughts which are often negative in nature and putting me down or telling me someone is going to hurt me or that something in the universe is sending me a sign. That is when I get anxious. What I am wondering is could this be a sign of delusional thinking or does it sound like it could be a form of OCD instead of psychosis?

2- What does it feel like to hear voices? Do you physically hear them in your ears or is it more internalized thoughts that converse with you?

3- Are there warning signs for schizophrenia or related disorders that I could be exhibiting or is it generally pretty clear when someone has the disorder?

I hope none of this is offensive. I am just starting a new mental health journey and am trying to understand the symptoms that I'm dealing with. I was hoping someone could tell me if I'm thinking incorrectly or if I'm possibly heading in the right direction with my thoughts?




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Have you ever heard of pure o? It's  the obsessive part of OCD and it frequently manifests with unwanted obsessive thoughts. I'm not trying to say you have it...but just that OCD like other illnesses has many forms. Does your doc know about all these troubles? Have you discussed not being satisfied with your diagnosis? Does he know the risperdal might be helping, and is it worth trying more? 

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Hey, that could definitely be what's going on! Thank you for your response. My doc does know about these problems to some extent. I was just feeling concerned about possible other diagnoses, but maybe it is pure O OCD. I was just not as familiar with that. 

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I have an internalized voice that comments on things. I used to think it was different people or entities communicating with me through my mind but now it's just 1 person and J know it's not real.

I've also had things like doing something which the normal me wouldn't do and being paranoid about food and people out to get me. It became so bad I wouldn't be able to talk on the phone etc. It was gradual and became worse so maybe worth asking another doc for their opinion before it really gets out of hand.

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That was an excellent description. Everybody has their own experiences. Everybody has variations in onset or progression symptoms. 

Different treatment options apply differently at different times for different reasons for different people. I know that is not very comforting to hear. 

If you have an established relationship with your psychiatrist, my suggestion would be that you take your time and write out what is most concerning and disruptive to you. 

The conversation that follows your disclosure will evaluate potential sources for the symptoms, rule out the alternative possibilities that don't fit, and strategize available options for treatment. 

From your description, I can't shake the feeling that a prescription for Adderall coupled with what might be signs of developing psychotic features could very well be a recipe for disaster. OCD can also manifest with some very irrational thought patterns. 

Although I am no expert, I have done a lot of research of symptomology, illnesses, and treatment options while fighting my way through 15 years of madness. My suggestion is that you familiarize yourself with diagnostic criteria so that you are more able to have an open conversation with your psychiatrist. 

A lot of the different symptoms overlap. A lot of the different treatments overlap.

But, a proper diagnosis is very important to avoid potential complications. 

In the OCD spectrum your description of irrational thoughts is referred to as 'insight' and can be classified anywhere from 'good' to 'absent' depending on how aware you are of what you perceive to be reality.

Although the symptoms mimic psychosis, the treatment options contradict each other depending on the root cause. 

Antipsychotics would likely exacerbate symptoms of OCD.

The first line prescription option to treat OCD (SRI meds) will likely exacerbate psychosis.

So, with this in mind, there is added pressure to be very thorough when discussing symptomology with your psychiatrist. 

For the sake of credibility, I will try to find the article I read a while ago and edit this with a link for your review. It was very detailed and descriptive. 


In case the link does not work properly, drop 'ocd with psychotic features treatment' in any search engine box. 


Edited by Lms-Kaz
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I apologize.. in my long reply, I didn't specifically address your questions.

1. "What I am wondering is could this be a sign of delusional thinking or does it sound like it could be a form of OCD instead of psychosis?"

-- OCD can sometimes manifest with variations of psychosis. Anxiety is a separate spectrum. The provided examples of your 'irrational thoughts' are leaning more towards schizo than OCD. I am NOT a trained professional. That is merely my opinion. 

2. What does it feel like to hear voices? Do you physically hear them in your ears or is it more internalized thoughts that converse with you?

--- psychosis has different qualities for different individuals. Hearing voices is literally hearing voices. They intimidate, they encourage, they provoke, they comfort, they argue,. Only the person afflicted can hear them. Psychosis can imitate any of the 5 senses. Hallucinations can be seen, heard, felt, smelled, and tasted. Internalized thoughts is.. having a conscience. Applying a rational lesson learned. If a stove is hot, internally we remind ourselves not to touch it. Or, it can be irrational.. constantly remembering regrets or mistakes made. Re-living past occurrences as if we can go back in time to change the outcome.

3. Are there warning signs for schizophrenia or related disorders that I could be exhibiting or is it generally pretty clear when someone has the disorder?

--- As stated in my reply above, there is a lot of symptomatic overlap across the spectrums of afflictions. With schizophrenia, I think it is one of the more pronounced (easier to identify) disorders when it reaches its full extreme. Lack of personal hygiene traits, and the strength of the belief in the delusions (can feel aliens swimming in veins.. praying to a toaster because Jesus lives inside it..) Well, things like that do not typically overlap to other afflictions. An extreme manic episode can get very close though. The Bipolar spectrum has its own unique identifying characteristics. 

Yes, my (unprofessional) opinion is that you have legitimate concerns based on the description in your post.

The important thing is finding a proper diagnosis/treatment plan to get on the path towards a more stable future. 

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