As an OCD specialist, there’s a question I hear even from people who have lived with OCD for years: What’s the difference between anxiety and obsessive-compulsive disorder (OCD)? It may seem like a technicality, but the answer actually gets at the heart of both conditions.
OCD and anxiety definitely share commonalities. Both are mental health conditions that revolve around distress, but a major distinction with OCD is that there are several other key components. Most notably, you engage in compulsive behaviors over and over again to try to tamp down the distress that you feel about your obsessions, according to Tracie Ibrahim, LMFT, CST, Chief Compliance Officer at NOCD.
On the other hand, if you have anxiety and not OCD, you may desperately want to escape your distress, but you don’t necessarily partake in compulsive rituals as a result.
Can OCD and anxiety disorders occur together? They sure can. In many cases, they’re even treated in the same way. Let’s take a closer look at OCD, anxiety, how they’re related, and what sets them apart.
What is Anxiety?
Anxiety is an umbrella term for a number of different disorders, and it’s very prevalent. In fact, according to the National Institute of Mental Health, anxiety affects more than 19% of the United States population every year, making it the most commonly diagnosed mental health condition in the country.
A subtype of this condition is generalized anxiety disorder, or GAD, which involves ongoing and excessive worry that lasts for more than six months. It is accompanied by at least three symptoms that might include:
- Restlessness
- Fatigue
- Irritability
- Muscle tension
- Trouble concentrating
- Trouble sleeping
Aside from GAD, there are other anxiety disorders, such as:
- Panic disorder: People with panic disorder often have panic attacks—sudden bouts of intense fear, discomfort, or loss of control—out of the blue.
- Social anxiety disorder: People with social anxiety disorder have a persistent, intense fear of being judged by other people. They’re often deeply uncomfortable in social situations.
- Phobias: People with phobias are intensely afraid of or averse to specific situations or objects—and to a greater extent than rationally makes sense. They try to avoid the situation or object, and when they can’t, they suffer severe anxiety. Some common phobias include fear of flying, heights, blood, injections, or animals like dogs.
- Separation anxiety: People with separation anxiety have extreme anxiety when they’re apart from their loved ones, often worrying that something bad will happen to them.
Is OCD a form of anxiety?
Notice what isn’t included in the list above: OCD. That’s because OCD falls into an entirely different category. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)—the medical reference guide used by clinicians—gives OCD a category of its own: obsessive-compulsive and related disorders.
With OCD, you often experience obsessions like unwanted thoughts, urges or impulses that lead to compulsions you do to try to reduce the distress from your obsessive feelings. For example, if you have OCD, you may have obsessive thoughts about getting sick when you come into contact with others. To cope with your anxiety, you may wear protective gloves everywhere you go, and compulsively take showers or wash your hands after being in public.
Other conditions under the umbrella of “obsessive-compulsive and related disorders” include:
- Hoarding disorder: People with hoarding disorder spend a lot of time preoccupied with collecting or arranging items, which is a common compulsion among people with OCD. But unlike people with OCD—who are distressed by their compulsions—people with hoarding disorder don’t see a problem with it.
- Body dysmorphic disorder (BDD): People with BDD may check their bodies repeatedly. This condition is more focused on physical appearance than OCD typically is.
- Body Focused Repetitive Behaviors (BFRBs): People with BFRBs perform repetitive behaviors involving their bodies. For example, those with trichotillomania pull out their body hair. But while people with OCD don’t enjoy their compulsions, people with BFRBs often get a good feeling from doing these repetitive behaviors, even if they don’t like the side effects.
How OCD and anxiety are different
Here’s an interesting fact: OCD was once considered an anxiety disorder. But the DSM-V put it into its own category in 2013.
So why was OCD once thought to be an anxiety disorder—and what changed? Well, the intense distress present in OCD can feel similar to an anxiety disorder. There may be a lot of overlapping symptoms such as a persistent fear and worry. This isn’t always the case, though. Anxiety isn’t a necessary part of OCD. As Patrick McGrath, PhD, Head of Clinical Services at NOCD, points out, “There are people who may have OCD without experiencing anxiety. Instead, they may feel guilt or shame or disgust.”
Some experts believe that, instead of being a core part of OCD, anxiety is a common side effect of it. “The anxiety that many OCD patients experience is now thought to be a secondary part of their condition, brought on by recognizing that they are unable to control repetitive behaviors,” reports the University of Michigan.
What’s more, OCD is different from anxiety because it involves obsessions and compulsions. “You can be anxious about something without obsessing and having compulsions,” explains Ibrahim. “That’s what makes OCD different from just anxiety.”
Another reason OCD is considered a separate diagnosis is that research has found that there may be differences in brain chemistry and function. But while anxiety and OCD can affect the brain differently, when it comes to figuring out which one you have, it all comes down to your symptoms.
How to know if you have OCD or anxiety
One factor that helps differentiate between OCD and anxiety is the content of your fears. Anxiety disorders are often focused on daily life stressors and life events, says Kimberley Quinlan, LMFT, who specializes in OCD, anxiety, and OCD-related disorders. If you have anxiety, you may worry about things that could possibly happen—like losing your job, facing financial hardship, or having other stressors in your everyday life. But OCD, she says, tends to present as more repetitive, or irrational.
In other words, fears related to OCD are often less realistic. With OCD, you may recognize that your fears aren’t based on a true threat, but feel distressed about them anyway. “Usually with anxiety, fears are blown out of proportion, but with OCD, sometimes the fear is a completely wild thing that makes no sense,” explains Ibrahim.
For example, people with social anxiety may feel extremely anxious around others, worrying that others think poorly of them. They might blush, sweat, and tremble whenever they have to talk to people, but they’re not necessarily bombarded with irrational thoughts that they can’t fight with logic. On the other hand, a person with OCD might be preoccupied with the idea that they will blurt out something offensive in public, even when there’s no reason to believe they would do that.
While a person with social anxiety disorder may engage in safety behaviors such as ruminating and avoiding social settings, they may not feel the need to perform compulsive rituals over and over again if they don’t have OCD. According to Quinlan, compulsions more likely to occur in OCD than anxiety disorders include:
- Reassurance seeking
- Confessing
- Checking
- Washing
- Compulsive prayer
Take the example of a person with OCD who’s obsessed with the thought they have offended people, even when there’s no clear indication they have done so. As a compulsion, they might feel the need to repeatedly seek reassurance from others that they’ve behaved appropriately. Of course, this is just one example of how obsessions and compulsions might manifest—they’re different for everyone with OCD.
If you have excessive worry, but don’t have obsessions and compulsions, you may be experiencing anxiety, rather than OCD. Ultimately, the only way to know for sure whether you have OCD or anxiety is to see a licensed mental health provider and get a diagnosis.
Can you have both OCD and Anxiety?
The short answer is yes. It’s possible to have both anxiety disorders and OCD. “It’s so, so common,” says Ibrahim.
One review of studies suggests that around one-third of people with OCD also have an anxiety disorder. The most common were GAD, phobias, and social anxiety disorder. Experts aren’t sure why there’s so much overlap, but Ibrahim says that it makes sense that people prone to anxiety related to OCD may be more likely to have anxiety disorders as well.
When OCD is accompanied by anxiety disorders, it is often more severe, persistent, and disruptive. That’s because the disorders can feed into each other. “Let’s say harm OCD is telling you that you’re going to hurt people in public, and then you also have social anxiety,” Ibrahim explains. “So you’re like, ‘Oh, I’m not going out there. I might stab people.’ And so now each disorder is making the other worse.”
The good news is that OCD and anxiety disorders are treatable—even at the same time.
How OCD and anxiety are treated
If you believe you might have OCD or an anxiety disorder, seek the guidance of a trusted professional and take that first step to getting the help you need.
The most successful treatment for OCD is a form of behavioral therapy called exposure and response prevention (ERP). It’s also commonly used to treat anxiety disorders. “So if somebody’s coming in with, for example, social anxiety disorder and OCD, we’re going to treat those both at once with ERP,” says Ibrahim.
During ERP, you discuss your symptoms with a trained therapist and then rank your fears or triggers from least to most stressful. First, your therapist may ask you to face a fear that ranks low on the list. You may feel some distress, but instead of doing compulsions, you’ll learn tools to help you tolerate the discomfort. As you tackle your fears and see that nothing bad happens, you realize you had nothing to fear in the first place. When you become more comfortable, you take on bigger fears and triggers.
“For example, if your fear is that you’re going to embarrass yourself and people will laugh at you, that could fall under OCD, or it could fall under social anxiety, and we treat it the same,” notes Ibrahim. “We’re going to make a hierarchy about that. You’re going to think about going outside and being social. Next you might actually go outside and walk two blocks and come back. Then you’re going to go to the grocery store and make eye contact with somebody, and you might even say ‘Hi.’”
Eventually, you will no longer feel riddled with distress from your anxiety or obsessions. Ibrahim has seen this with so many of the people she treats. For example, she has one woman who’s in recovery from OCD and GAD. Her ERP has involved exposures to fears sparked by both her disorders. Since receiving treatment, she’s been more successful at work, with her anxiety and compulsions no longer getting in the way of her sleep and work attendance. “Now she’s gotten all patched up and she’s using all of her ERP tools to stay well,” says Ibrahim.
While ERP is the main treatment for OCD, and a common treatment for anxiety disorders, other forms of treatment can also be helpful, either as a supplement to ERP, or—in the case of some anxiety disorders—as an alternative. These might include medication or cognitive behavioral therapy (CBT) to teach you how to change your thoughts and behaviors to relieve the distress your anxiety or obsessions bring.
Talk therapy can help process fears related to certain anxiety disorders—so you realize that your fears aren’t rational. But talk therapy isn’t shown to be effective for OCD because, unlike certain anxiety disorders, OCD typically doesn’t respond to logic and reasoning.
Ultimately, anxiety disorders and OCD are distinct, but they often go hand in hand. In any case, all of these conditions are manageable. With proper treatment, you can enjoy a life that’s not plagued with anxiety or distress.
