Fear of psychosis in an OCD analogue sample: Prevalence and associated factors

Obsessive-compulsive disorder (OCD) includes heterogeneous presentations, despite the disproportionate research and clinical attention on contamination and symmetry symptoms. Colloquially coined "schizophrenia OCD", obsessional fears of having or developing a psychotic disorder (or "going crazy") and associated compulsions have received growing recognition within psychoeducational contexts and patient communities. This preliminary study examined the prevalence and associated factors of fears of psychosis among a university student sample (N = 154). Participants completed an online questionnaire that included symptom checklists assessing psychosis-related unwanted intrusive thoughts and compulsive behaviours, alongside a series of validated measures. Fears of psychosis were commonly endorsed: 77.9% endorsed lifetime unwanted intrusive thoughts, 70.1% endorsed associated compulsive behaviours, and 83.1% reported at least one psychosis-related unwanted intrusive thought or compulsive behaviour. Fears of losing control of your thoughts or actions was the most frequently endorsed intrusive thought (50.6%), whereas fear of developing a psychotic illness (18.3%) was rated most distressing. The most frequently endorsed compulsive behavior was replacing "bad thoughts" with better thoughts (53.2%). Supporting our hypothesis, individuals meeting OCD symptom cut-offs were more likely to endorse psychosis-related fears. Finally, hierarchical regression analyses indicated that health anxiety and negative beliefs about losing control predicted psychosis-related unwanted intrusive thoughts, over and above demographic factors, OCD severity, or other clinically relevant variables. Findings underscore the need for recognition of fears of mental health issues in individuals with OCD and suggest that interventions targeting health anxiety and perceptions of loss of control may be particularly relevant.