Anxiety disorders and OCD share overlapping symptoms, such as excessive worry and intrusive thoughts, but OCD is defined by compulsive behaviors. Both conditions can be managed effectively through exposure and response prevention (ERP) therapy, alongside lifestyle changes like improving sleep hygiene and staying sober.
Everyone worries or feels anxious at some point in their lives—whether you’re a student studying for an exam, or a bride getting ready for your wedding. These passing concerns are a typical part of life, but sometimes anxiety can become more persistent, impacting sleep, work, relationships, or daily tasks.
If you’re finding yourself consumed by worries that are affecting your ability to function, you may be dealing with a larger mental health condition—such as an anxiety disorder, or obsessive compulsive disorder (OCD). Anxiety and OCD have a lot of overlapping symptoms, so it can sometimes be challenging to figure out what you’re dealing with, and how to get help.
Read on to learn more about the signs of anxiety and OCD, how these conditions interact, and the best strategies for managing symptoms.
What is anxiety?
Anxiety disorders are typically characterized by excessive, persistent worry that is difficult to manage and may result in physical symptoms. Generalized anxiety disorder refers to a constant feeling of overwhelm, while more specific disorders—such as social anxiety disorder or separation anxiety disorder—are typically defined by anxiety in specific situations, such as social settings or during times of separation from loved ones.
Anxiety is common; anxiety disorders are the most diagnosed mental health condition in the United States, affecting 18% of the adult population. There is no known cause for anxiety, however some research suggests that environment, genetics and biology all play a role in the development.
Common symptoms of anxiety:
- Excessive worry
- Restlessness
- Difficulty concentrating
- Irritability
- Sleep problems
- Heart palpitations
- Shortness of breath
- Nausea
It’s typical to experience bouts of anxiety during life, but if the worry you experience is excessive, based on irrational fears, or results in behaviors designed to control your surroundings, you may be navigating an anxiety disorder.
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What is OCD?
OCD is a complex, but treatable, mental health condition characterized by two key symptoms: obsessions and compulsions. Obsessions are intrusive thoughts, sensations, images, feelings, sensations, or urges that are persistent and cause distress, or anxiety. In response to obsessions, people with OCD perform compulsions—physical or mental acts meant to relieve feelings of distress or try to prevent something bad from happening. However, compulsions only provide temporary relief, exacerbating the OCD cycle.
Common symptoms of OCD:
- You experience persistent unwanted thoughts, images and urges.
- You attempt to reduce anxiety with rituals or repetitive behaviors that may be irrational.
- You obsess about ideas that do not align with your values or sense of self, such as intrusive thoughts about harming others or yourself.
- You spend at least an hour each day performing compulsions.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
How anxiety and OCD interact
Both OCD and anxiety disorders involve excessive anxiety, rumination and intrusive thoughts. According to Tracie Ibrahim, LMFT, CST, and Chief Compliance Officer, “anxiety and OCD have a lot of overlap in symptoms, including physical symptoms.” Ibrahim explains that people with anxiety and OCD often try to escape feelings of discomfort by avoiding the people, places or things that trigger those feelings. For example, people with social anxiety or obsessions that center on relationships may self-isolate in an attempt to avoid triggering situations.
Anxiety vs. OCD
While anxiety and OCD may seem very similar, there are some key differences that set these conditions apart. OCD used to be classified as an anxiety disorder, but the American Psychiatric Association re-classified it in 2013 to emphasize distinctions in OCD brain chemistry and function. “People with OCD [experience] neurological false alarms that send urgent messages of fear or doubt,” Ibrahim explains. “Then, a variety of chemicals are released into the body to prepare it to escape from the anxiety and fear, which leads to compulsions.”
The presence of compulsions, rather than just worry, is a key characteristic of OCD. People with anxiety may engage in what Dr. Patrick McGrath, chief clinical officer at NOCD, calls “safety behaviors”—pretending to be sick to avoid a speaking engagement, or overstocking a pantry in case of a natural disaster, for example—but, don’t engage in repetitive or ritualized behaviors.
OCD is sometimes misdiagnosed as an anxiety disorder, but the presence of repetitive behaviors or mental actions aimed at relieving distress distinguishes it. If you identify with descriptions of compulsive behaviors—even if you have been diagnosed with an anxiety disorder—it is possible that you have OCD.
Can OCD cause anxiety?
According to Ibrahim, “anxiety is just one of the many symptoms of OCD.” OCD obsessions are typically fear-inducing, and can trigger anxiety. For example, if your obsessions center on close interpersonal relationships, you may find yourself excessively anxious about a partner leaving you—even if there is no clear cause for concern.
Some people with OCD also experience anxiety about the perceived implications of their intrusive thoughts. For example, let’s imagine you’re dealing with harm OCD, a subtype of OCD characterized by obsessions about harming yourself and others. Perhaps you experience frequent intrusive thoughts about driving your car off the road, every time you pick up your child from school. You might begin to experience anxiety about secretly wanting to harm yourself or your child, when, in fact, your obsession says nothing about who you are. OCD obsessions are ego-dystonic, meaning that they tend to seize on the things you care most about but do not reflect your values or true intentions. Still, they can be anxiety-inducing.
It’s not uncommon to experience OCD and an anxiety disorder together, since OCD can heighten feelings of anxiety—and stress can exacerbate OCD symptoms. If you’re battling one or both of these conditions, know that you’re not alone, and that relief is within reach.
Getting help for anxiety and OCD
Living with anxiety and/or OCD can be challenging, especially if you’re going it alone. Reaching out to a mental health professional is an important first step for getting accurately diagnosed, and accessing treatment. “Never try to diagnose yourself,” says Ibrahim. “A trained professional knows how to look at the whole picture of your presenting symptoms and…piece together what categories of disorders make the most sense.”
Read on to learn more about ways to manage anxiety and/or OCD.
Exposure and response prevention (ERP) therapy
Fortunately, both anxiety and OCD can be approached using the same, highly-effective and evidence-based treatment: exposure and response prevention (ERP) therapy. ERP works by having you gradually confront your fears, while refraining from immediately reacting or engaging in compulsions.
“It makes no difference if you have an anxiety disorder and OCD, we still do the same treatments,” Ibrahim explains. “ERP helps people learn how to face their fears, and tolerate uncertainty—allowing them to live lives where they are in control of their choices and their behaviors.”
According to McGrath, the essential part of ERP—for both anxiety and OCD—is response prevention. Exposing yourself to fears won’t help you heal, unless you and your therapist are able to establish new ways of responding. For someone with social anxiety, this might look like using mindfulness techniques to begin gradually re-engaging in social situations. For someone with harm OCD, who fears driving, this might involve starting by sitting in your car, but not going anywhere.
ERP can also be used to help you tolerate the physical sensations of anxiety. Interoceptive exposures refer to a type of exposure meant to mimic the feelings of anxiety in the relative safety of a therapy session, so that you can slowly become more comfortable facing these sensations. “We’re going to run in place, hyperventilate, breathe through a straw, or spin in a chair,” Dr. McGrath explains. “We’re going to learn we can handle all of the bodily sensations that are thrown at us, and that we don’t need to run away or avoid them.”
If these treatment approaches sound intimating to you, don’t worry. ERP therapy can be difficult, but the results are worth it—and your therapist will guide you every step of the way. With the right treatment, you can find relief and regain control over your life.
Lifestyle changes
In addition to ERP therapy, adjustments to sleep hygiene and substance use can help ease anxiety, and improve your chances of succeeding at ERP therapy. “If you’re not getting good enough sleep, then it’s easier to give into safety behaviors or compulsions,” Dr. McGrath explains. Consider putting your phone away at least an hour before bed, trying to keep a regular schedule, and avoid checking the clock when you wake up in the middle of the night.
Dr. McGrath also notes that sobriety can be important for managing symptoms. Substance use can numb you, making it harder to learn to sit with feelings of discomfort and learn new responses. This process can feel uncomfortable at first, but is necessary for growth. “You really want people to put their whole mind-body into the treatment,” says Dr. McGrath.
Key Takeaways:
- Anxiety disorders and OCD can look similar, but OCD is characterized by compulsions—physical or mental acts meant to relieve negative feelings.
- OCD can cause feelings of anxiety, and anxiety may, in turn, exacerbate symptoms of OCD.
- Both anxiety and OCD are most effectively treated through ERP therapy.
- Getting enough sleep and staying sober can help reduce anxiety and help make ERP treatment more effective.
