Hi. I have had OCD for a number of years, i got help for it, it went away for a while and now it has come back again. I hear a voice telling me that if i don’t do a particular ritual, i will die (I also have phobias and general fears). As i have had OCD for ages (since i was 11) i can more or less deal with it. However recently, i have experienced new voices. they are telling me that i don’t love my boyfriend. they don’t require any kind of ritualistic behaviour and therefore i cannot make them go away. I constantly have 2 different thoughts and i argue with myself all the time in my head. These thoughts are very painful and disturbing and i do not know how to deal with them. Could they be a different form of ocd? or could it be some form of schizophrenia? either way how can i deal with them and make them go away? thank you very much.

A: The most well-known forms of OCD are things like repetitive hand washing, checking the same thing over and over , or needing things in a certain precise order. However, another form OCD can take is what you may be describing. Often the person experiences it as a verbal “loop” of words or phrases, usually negative, that just won’t stop. It may go away for awhile as mysteriously as it began, only to return later. It’s frustrating and disturbing and can definitely get in the way of functioning in life.

On the other hand, hearing “voices” can also be a symptom of a psychotic disorder. One way to distinguish between the two diagnoses is identifying where you think the voice comes from. If you know it is a thought in your own head, it’s usually thought to be OCD. If you experience the voices as coming from outside of yourself, it is usually a symptom of psychosis. In order to make a correct diagnosis, I’d need to talk with you to learn more details.

Since we can’t do that, my best advice to you is that you confer with an experienced psychiatrist or psychologist. You already had success when you got help before. It’s time to go back for some more. There are medications as well as therapeutic techniques that can help either condition. Find out what your options are so you can make a wise decision about how best to help yourself.

I wish you well.
Dr. Marie