Is OCD an Anxiety Disorder? How to Tell the Difference

What Is OCD?

OCD is a mental health disorder characterized by a cycle of obsessions and compulsions. Obsessions are unwanted intrusive thoughts, images, or urges that cause extreme distress. The person with OCD performs mental or behavioral compulsions in an effort to neutralize the distress caused by obsessions.

Obsessive compulsive cycles are time consuming and often cause disruption in a person’s social, occupational, and personal life. The World Health Organization lists OCD as one of the top ten disabling conditions.² OCD is generally a lifelong condition which needs management through medication, therapy, or combination treatments.

Is OCD an Anxiety Disorder?

While obsessive compulsive disorder (OCD) may result in symptoms commonly associated with anxiety disorders, people with OCD engage in rituals otherwise not seen in those with anxiety. OCD produces recurring unwanted thoughts, behaviors, or obsessions. The person copes with obsessive thoughts by employing compulsive behavior such as hand washing, checking, and counting that disrupt daily life and functioning.

OCD Used to Be Classified as an Anxiety Disorder But Is Now Its Own Category

Professionals considered OCD an anxiety disorder until the DSM-5 created a separate Obsessive-Compulsive Spectrum Disorders (OCRDs) diagnostic category in 2013. According to identifying criteria, OCRDs exhibit core symptoms of repetitive thoughts and behaviors.³ The impetus of this change includes restructuring classifications and simplifying diagnostic criteria for clinicians.⁴

OCD Vs. Anxiety: Key Differences

A significant difference between OCD and anxiety is that people suffering from OCD experience daily and recurring intrusive thoughts (obsessions) and compulsions. Individuals with anxiety often exhibit ongoing ruminations, usually about future or past events. Both disorders can range in symptom severity.

The Nature of the Thoughts

Anxious thoughts and intrusive thoughts differ in that anxious thinking is usually about the future and real-life events. The intrusive thoughts of OCD are troubling or disturbing images triggered by anxiety about a specific issue, such as leaving the stove on or being contaminated by germs. Often, the more someone pushes aside these thoughts, the more they magnify.⁵ In turn, those with OCD enact compulsions and unwanted actions as attempts to manage these thoughts.

The Presence of Compulsive Behaviors

Behavioral patterns are another distinguishing difference between anxiety and OCD. To be diagnosed with OCD, a person must have compulsions, or repetitive behaviors designed to counteract obsessions. Common compulsions include excessive cleaning, checking, arranging things in a particular order, and compulsive counting. On the other hand, anxiety disorders do not include systematic outward behaviors associated with thought patterns.

Symptoms of OCD Vs. Anxiety

OCD and anxiety frequently co-occur, meaning differentiating the two conditions can be even more challenging. As noted, the primary difference stems from the presence or lack of compulsive behaviors. Additionally, people with OCD report odd, irrational, and sometimes magical thinking compared to those associated with anxiety.

Common symptoms of OCD include:

• Fear of causing harm
• Needing things orderly and symmetrical
• Thoughts about losing control
• Unwanted thoughts
• Avoidance behaviors
• Intense stress

Common symptoms of anxiety include:

• Excessive worrying
• Having a sense of impending danger, panic, or doom
• Trouble concentrating
• Trouble sleeping
• Having difficulty controlling worry
• Feeling agitated
• Avoiding social situations
• Irrational fears

Is OCD a Symptom of Anxiety?

OCD can be a symptom of anxiety in some cases. Sometimes, a person who has GAD can exhibit OCD-like tendencies without qualifying for a true OCD diagnosis. In these situations, OCD behaviors are more symptoms of anxiety. For example, a person with GAD could exhibit fears of contamination and compensatory cleaning behaviors, but they may only experience them 1-2 days of the week, versus the daily impact needed for an official OCD diagnosis.

Is It OCD or Anxiety?

It can be difficult to distinguish between OCD and GAD. Overlapping symptoms like intrusive thoughts, rumination, and excessive doubt can cause you to question which disorder you may be dealing with. A key difference will be the presence of compulsions. It is important to seek the help of a licensed professional to receive an accurate diagnosis. However, some of these questions may be helpful to explore prior to your visit.

Here are some questions to ask yourself if you’re trying to determine whether you have OCD or anxiety:

• When I feel anxious, do I feel the need to do any repetitive behaviors or rituals to calm myself down?
• Do I worry about unrealistic, specific things or is my worry more generalized?
• Do I go to great lengths to suppress, control, or stop my intrusive thoughts?
• Are my worries related to symmetry, order, numbers, or contamination?
• Do I find myself worrying about the same thing over and over?
• Are my worries related to real-life concerns like finances, relationships, or work?
• If I experience compulsions, do I feel very distressed if I’m not able to engage in my behaviors and rituals?
• Do I find myself arranging, ordering, or counting when I am stressed?

Can You Have Both OCD & Anxiety?

OCD and anxiety can occur together, and sometimes anxiety reaches a point where a GAD diagnosis is also appropriate. Research indicates around 30% of people who have OCD also have GAD.⁶ When this happens, a person may engage in more avoidant behaviors and have more severe anxiety symptoms.⁷ For example, they may experience excessive worry about work, relationships, and health that prompts them to use avoidance coping as a compulsion for obsessions.

OCD Vs. Anxiety: Treatment Differences

Anxiety and OCD treatment typically includes a combination of medication and psychotherapy. The main difference in approaches is that clients with OCD learn how to manage compulsions. Studies show that the quality of therapeutic alliance is the best predictor of therapeutic outcomes.⁸

Treatment options for OCD may include:

• Exposure and response prevention (ERP): ERP for OCD exposes the client to triggers that cause compulsions. The therapist helps the client cope with triggers rather than engage in repetitive behavior.
• Cognitive behavioral therapy (CBT): CBT for OCD focuses on changing negative thoughts that fuel behaviors. In CBT, the client addresses the intrusive thoughts that result in compulsive behavior.
• Medication: Medication for OCD can help lessen symptoms, allowing the person to feel more in control of their thoughts and actions.
• Gestalt psychotherapy: Gestalt therapy focuses on examining present situations and clients’ needs and feelings as they develop, particularly the ones resulting in compulsions.
• Acceptance and commitment therapy (ACT): ACT for OCD incorporates mindfulness as clients learn new ways to handle thoughts as they occur.
• Transcranial magnetic stimulation (TMS): TMS is FDA-approved for treating treatment-resistant OCD. During TMS, an electromagnetic coil is placed on the forehead to deliver a magnetic pulse to stimulate nerves in the brain.

Treatment options for anxiety include:

• Cognitive behavioral therapy (CBT):  CBT for anxiety focuses on changing anxious thoughts so clients can feel calmer and at ease.
• Medication: Anxiety medications are an excellent way to lessen symptom severity when used alongside psychotherapy.
• Gestalt therapy: When used for anxiety, Gestalt therapy focuses on gaining self-awareness about anxious thoughts to stop the cycle.

When to Seek Professional Support

People should seek professional support when their anxiety or behavior starts to feel uncontrollable, bothersome, or disruptive. Finding the right therapist can sometimes take work and time, but it is worth the effort. You can ask trusted loved ones for recommendations or search an online therapist directory. If you have been diagnosed with OCD or think you may have it, using an online resource like NOCD can also be a simple way to find an experienced specialist.