Severe obsessive compulsive symptomatology may mask underlying schizophrenia. Clinical observation indicates the process begins with ego crippling and distortion from invasion by the id. This results in destructive and self-destructive compulsions which represent the id taking over some of the ego functions. They express both drive and defense. The disturbed functioning may be due to a split in the ego, to the amount of cathexis spent in maintaining the psychotic ego nuclei and their introjects, and to the countercathexis needed to maintain isolation.