OCD or Psychosis? Yes: A Case Study of a Diagnostic Conundrum and the Caregiver Role

Obsessive-compulsive disorder (OCD) and schizophrenia spectrum disorders, while distinct phenomena, have considerable overlap in their presentations which can present a challenge in their approach to diagnosis and treatment. The changes in the DSM-5 bring these challenges to light, in allowing OCD to be specified as having absent insight or delusional beliefs. This can be especially distressing for caregivers, who play a major role in treatment, especially among youth. We present a case of a 16-year-old male presenting to care in his first episode of psychosis with overlapping obsessive-compulsive features, later found to have OCD. We discuss diagnostic and treatment approaches for someone presenting with overlapping psychotic and obsessive-compulsive features and highlight the underrecognized, but indisputably important role of caregivers throughout the process.