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Difference Between Anxiety and OCD

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Edited & medically reviewed by THE BALANCE Team

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CONTENTS

It is common to feel anxious or worried at some point in life. However, for people with an obsessive-compulsive disorder (OCD), the anxiety related to these intrusive thoughts may force them towards persistent compulsive rituals that may make life difficult. Such people commonly believe that they must perform these rituals or else something terrible will happen, which only leads to the generation of intense feelings of anxiety. So does this mean that OCD is a type of anxiety disorder? If not, how are they different from one another?

Despite sharing a close relationship, OCD and anxiety are two different disorders. This article will explain the difference between anxiety and OCD, why they are separately categorised, and what happens when they overlap.

From a historical point of view, both obsessive-compulsive disorder (OCD) and generalised anxiety disorder (GAD) were categorised as anxiety disorders. As per the Diagnostic and Statistical Manual of Mental Disorders (DSM), experts’ diagnostic reference guide to classify psychiatric disorders once grouped both the issues in the same section. However, in 2013, the fifth edition of DSM separated them into different chapters.

So far, this categorisation remains the same in the most recent edition of DSM-5. While GAD continues to be in the anxiety disorders section, OCD is now present in a section termed “obsessive-compulsive and related conditions.” Some other issues that share the section include body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder), and hoarding disorder. The reason for these changes was that despite the shared commonalities, OCD and GAD had some key differences in symptomatology. These fundamental differences are explained in the following sections.

The nature of thought involved is one of the two essential differences between OCD and GAD. While unwanted thoughts form the main symptom of diagnosis in both issues, the ones associated with GAD focus on real-life concerns, such as family, school, work, health, relationships, and finances. These issues are the ones that almost all people worry about, but people with underlying anxiety do so to the extent that it significantly disrupts their daily functioning.

While the GAD thoughts revolve around reasonably plausible concerns, those with OCD obsess about less common and somewhat unrealistic issues. These issues have been developed into a colloquial shorthand for easier description and may include:

Contamination OCD, in which people obsess about germs and dirt and their effect on their health. For example, they may fear catching an infection by coming in contact with the suspected contaminant
Hit and Run OCD, in which the sufferer obsesses over the fear of running over people with their vehicle
Harm OCD, forces sufferers to obsess about accidentally or intentionally causing harm to themselves or others
Relationship OCD, in which the focus of obsessions is the fear of not loving one’s partner or not being sexually attracted to them
Scrupulosity OCD characterises obsessions of not living according to one’s spiritual beliefs. It focuses less on religious obsessions and more on the worry of failing to live in a manner that meets their personal moral standards.

Remember that the abovementioned list is not an exhaustive compilation of the different OCD variants. It only means demonstrating some of the prevalent types of this condition. That said, remember that OCD can make people obsess about anything around them and usually focuses on highly improbable things based on insubstantial evidence.

The second key difference that separates obsessive worrying related to GAD from OCD is the behavioural response of a person to their obsessions. In anxiety disorder, the primary behavioural response includes worrying excessively about the issues, making them anxious. Such people spend a lot of time contemplating these issues but do not exhibit the classic compulsive symptoms characteristic of OCD, such as door checking or hand washing. Instead, anxiety disorder takes worrying as both an obsession and compulsion.

For instance, someone with GAD may repeatedly panic over thoughts like, “what if I lose my job and end up going broke?” As a response to this thought, they may compulsively ruminate about the possibility of getting fired and going broke in an attempt to manage their anxiety.

On the other hand, people with OCD have different compulsive behavioural responses to their unwanted obsessions or thoughts. While most of these responses are overt and obvious, like lock checking, others may not be so apparent. Irrespective of their nature, the compulsive behaviours in OCD are an attempt to eliminate or reduce anxiety associated with unwanted obsessions.

The treatment modalities for anxiety and OCD overlap significantly, despite having some critical differences. For example, both conditions respond well to psychotherapy called cognitive behavioural therapy and a particular class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

Cognitive Behavioral Therapy (CBT)

CBT refers to a type of behavioural therapy that encourages people to identify and change the negative thoughts contributing to the symptoms. While this therapy generally performs well in managing OCD and GAD, the specific techniques used may differ. For example:

People with GAD generally respond better to cognitive restructuring, a sub-type of CBT in which they learn to identify thoughts provoking anxiety and challenge them to learn new perspectives.
People with OCD usually undergo exposure and response prevention therapy, a sub-type of CBT that gradually exposes them to things that provoke obsessions and compulsions. Over time, effective use of this therapy leads to lessening the fear and reducing compulsive acts.

Medications

Many medications are beneficial for treating GAD and OCD. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the drugs of choice for treating these issues. Combining these medications with a suitable subtype of CBT is common for more effective outcomes.

The approved medications for GAD typically include paroxetine, escitalopram, duloxetine, and venlafaxine.
The approved medications for OCD include sertraline, clomipramine, fluoxetine, and paroxetine.

While SSRIs form a common treatment element for OCD and anxiety, research suggests that the former may take a bit longer to respond to them than the latter.

It is not uncommon for individuals with anxiety to simultaneously meet the criteria for another type of psychiatric issue. While depression is most commonly associated with anxiety, a small subset of people may develop OCD concurrently. Some evidence suggests that the prevalence of the two mental disorders is relatively high in the general adult population. According to some, up to 30 per cent of adults with OCD are bound to have GAD at some point in their lives. Experts also speculate that such people are at a higher risk of acquiring a major depressive disorder later in life.

An accurate diagnosis and assessment hold the utmost importance in effectively treating co-occurring anxiety and OCD. As discussed previously, SSRIs can be beneficial in managing both simultaneously; however, individual responses may vary. Hence, using other medications may also be considered, such as sodium valproate, a drug used for treating epilepsy. Similarly, some experts may add an atypical antipsychotic medication to augment the effects of SSRIs to manage OCD and GAD together.

Distinguishing between OCD and an anxiety disorder can be challenging, given the commonalities in their symptoms. However, some key differences may aid in establishing an accurate diagnosis and commencement of suitable treatment.

Whether it is an anxiety disorder or OCD, excessive fears and intrusive and persistent thoughts can make anyone uncomfortable. However, remember that it is still possible no matter how difficult recovery may seem. All you need to do is get in touch with a suitable rehabilitation centre that deals with both disorders. The experts in these rehabs are highly-trained to assess the patients and establish an accurate diagnosis, following which an individualised treatment plan can be curated.

You do not need to suffer anymore. Contact a rehab centre today to begin healing.

FAQs

What do you mean by obsessions in OCD?

Obsession refers to ideas, thoughts, or mental images that are unwanted, persistent, and cause undue distress. Obsessive thinking is usually unrealistic and may have a perceived magical quality. For example, a student with OCD-related compulsions may believe they must line up all items on their desk in perfect symmetry and count them every day to prevent failing a test. Similarly, a parent may believe they have to say a certain phrase at certain times to protect their children from harm.

What are some common examples of compulsions in OCD?

Compulsion refers to a repetitive ritual or behaviour that forces people to act in response to an unreasonable obsession. Some common compulsions related to OCD include ensuring that things are in order, constantly seeking reassurance, cleaning all the door handles multiple times a day, checking if the stove is off, or repeating word sequences throughout the day based on an unreasonable and illogical obsession.

Is OCD an anxiety disorder?

Due to the close similarities in anxiety and OCD symptoms, experts initially believed the latter to be a part of a generalised anxiety disorder (GAD). However, experts have recategorised OCD due to research that highlights the differences in neurological causes of both issues. While OCD and anxiety have a lot of commonalities, there are marked differences in the thoughts of each.

How do you treat OCD and GAD?

Treatment modalities for both conditions are similar and usually involve medications and psychotherapy. Cognitive behavioural therapy and SSRI antidepressants are particularly effective in managing OCD and GAD, primarily when used together. Despite similar treatment plans, anxiety usually responds better to cognitive restructuring, whereas OCD requires exposure and response prevention therapy for adequate management.

Are OCD and anxiety similar to any other psychiatric issue?

OCD may have similar traits to other conditions that one can easily confuse. These conditions include:

olfactory reference syndrome
body dysmorphic disorder
hoarding disorder
body-focused repetitive disorder

Despite the similarities in symptoms, such as obsessions and repetitive behaviours, some critical key differences differentiate these diseases from OCD, like the behaviours related to physical appearance only. Similarly, people can confuse OCD with agoraphobia and separation anxiety disorder because specific symptoms, such as avoiding certain situations or places due to fear, are common in all three.

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