As if people with schizophrenia aren’t burdened enough by elusions, hallucinations, and thought disorders, some also suffer from obsessive thoughts and compulsions. But is it really a misfortune? Probably for chronic schizophrenic sufferers, evidence suggests, but it may actually be a blessing rather than a curse for recent-onset patients in that it may keep them from plummeting into full-blown psychosis.

This, at least, is the possibility suggested by a study conducted by Israeli researchers and reported in the December American Journal of Psychiatry.

Abraham Weizman of Geha Psychiatric Hospital in Petah Tiqva, Israel, and his coworkers first wanted to see how prevalent obsessive-compulsive disorder is among new schizophrenic sufferers. They focused on 50 patients aged 18 to 45 years of age first hospitalized for schizophrenia, schizoaffective disorder, or schizophreniform disorder between July 1997 and July 1998. All patients were interviewed within the first week of admission by a psychiatrist to determine whether they suffered from obsessive-compulsive disorder—that is, whether they experienced persistent, repetitive, intrusive, and distressful thoughts not related to their delusions or repetitive goal-directed rituals clinically distinguishable from schizophrenic posturing. Seven of the patients (14 percent) were found to have the disorder.

Specifically, schizophrenic symptoms had started in these seven patients at the mean age of 23.4 years, and obsessive-compulsive symptoms at the mean age of 16.6 years. In four of the patients the obsessive-compulsive symptoms were evident before the occurrence of schizophrenic ones; in two, the obsessive-compulsive symptoms occurred after; and in one patient, they took place at the same time. The symptoms ran a gamut—fear of contamination, cleaning rituals, hoarding rituals, arranging rituals, and so forth.

Weizman and his colleagues then attempted to see whether these obsessions and compulsions influenced the patients’ schizophrenia. The obsessive-compulsive patients experienced less thought disruption and expressed emotions more normally than did non-obsessive-compulsive patients, the investigators found. Thus obsessive-compulsive symptoms may protect against psychotic disintegration in schizophrenia, at least during the earlier stages, the scientists speculate.