If you know or suspect you have anxiety, chances are your friend, neighbor, teacher, or coworker knows exactly how you feel.
That’s because anxiety is the most common mental illness that affects Americans. About 20 percent of U.S. adults (which is 40 million people) have an anxiety disorder, according to the Anxiety & Depression Association of America (ADAA). If you feel besieged by the symptoms of anxiety—irritability, feelings of dread, headaches, insomnia, digestive distress—then know that there is very effective treatment for anxiety to help you feel more like yourself again.
But mental health is complex, and it’s crucial for treatment to address everything that’s impacting your life—just as doctors would treat medical conditions. One of the most common conditions that occurs alongside anxiety disorders is obsessive-compulsive disorder, or OCD, a disorder that’s often misdiagnosed as anxiety and treated incorrectly.
Misdiagnosis is just one barrier to finding the right mental healthcare. Both access to therapy and financial struggles can also affect someone’s ability to seek out treatment, says April Kilduff, MA, LCPC, LMHC, therapist and clinical trainer at NOCD, and finding appropriate treatment for two conditions at the same time is a daunting task.
On top of that, finances can be the biggest issue of all, says Kilduff, if your insurance plan does not cover mental healthcare. Paying out of pocket can be expensive, and many people feel as if they’re priced out of therapy.
You do have options, though—especially if you have OCD and/or anxiety. Here’s what you need to know about why OCD and anxiety are often confused, how to seek out the right diagnosis, and what to know if you’re seeking effective treatment for both conditions.
What is the difference between OCD and anxiety?
Both OCD and anxiety are mental health disorders, but they have distinct defining characteristics, and it’s important not to conflate one with the other. Here’s a crash course:
OCD
If you have OCD, you experience a persistent a cycle of obsessions (unwanted, intrusive thoughts, images, feelings, sensations or urges that are distressing) and compulsions (repetitive mental behaviors or physical actions done in order to neutralize and quickly reduce this distress, gain reassurance or certainty, or prevent something bad from happening), says the International OCD Foundation. People who are diagnosed with OCD spend a significant amount of time during the day engaged in obsessions and compulsions—at least one hour—experience significant distress when their obsessions are triggered, or find that these symptoms interfere in the way they live their lives.
Anxiety
Anxiety disorders may be at play when feelings of fear and distress become so potent that they impact your ability to live your life, according to the National Alliance on Mental Illness (NAMI). Everyone feels some anxiety—it can be a natural, helpful part of life, and you don’t want to eliminate all of it—but if you have an anxiety disorder, these thought patterns reach an overwhelming pitch. It’s like you’re always on edge, trying to figure out and prevent bad things from happening, often avoiding things you love or find important.
At one point, OCD was actually considered an anxiety disorder. In the previous Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which serves as an authoritative guide to diagnosing mental health disorders, per the American Psychiatric Association, OCD was listed among other anxiety disorders. When the latest iteration of the Manual was published, however, OCD was moved to its own class: Obsessive-Compulsive and Related Disorders.
So, it’s true that both anxiety and OCD have similarities, but misconceptions about how the two disorders are linked persist. “OCD is often misdiagnosed as an anxiety disorder,” says Kilduff. “In large part this has to do with therapist training. Therapists as a whole are not reasonably educated on OCD or its proper treatment during graduate school,” she explains. Given that OCD can look similar to anxiety, anxiety is often the default diagnosis—but this can lead to serious issues.
One thing that differentiates the two mental disorders is intrusive triggers. Intrusive triggers are thoughts, feelings, urges, sensations or mental images that you don’t want running through your head. Oftentimes, they just pop in unannounced, while other times intrusive thoughts are triggered by something specific.
Intrusive thoughts are present in both anxiety and OCD. But with anxiety, those intrusive thoughts simply create fear and worry. I’m worried that my kids aren’t safe at school. I’m worried that I’m going to get into an accident on the way to work. In OCD, on the other hand, intrusive thoughts cause intense fear or worry, which in turn leads you to perform compulsions. “The thing that makes OCD different from most anxiety disorders is the presence of compulsions, which can be both behavioral or mental,” says Kilduff.
For example, you worry about your kids’ safety at school, so you repeat prayers or certain phrases a specific number of times when you drop them off. You feel as if you can’t go back home until you’ve said this prayer 12 times in the exact “right” way, or until you’ve waited well past they go through the front door. Or, perhaps, you worry about getting into an accident on the way to work, so you “test” your vision, coordination, and balance every morning, just in case (a very common phrase in OCD) something could be wrong with you. It’s these ritualistic behaviors or mental routines that exist in OCD and distinguish it as its own disorder.
If you’re not sure whether or not you have anxiety or OCD, that’s okay—a licensed mental health professional with specialized training and experience with OCD can help you with diagnosis (it’s not on you to figure it all out!), but a good thing to ask yourself is if you perform compulsions, and to be open and honest about these behaviors, mental and physical, when you’re being evaluated for a mental health disorder.
One more thing to keep in mind: OCD and anxiety commonly coexist with each other. In a review on studies over a 40-year span that included more than 15,000 people with OCD, 69% had another mental health or developmental disorder, according to a 2021 issue of Frontiers in Psychiatry. (The presence of two conditions is called a comorbidity.) Among those with OCD who had comorbidity, one in three had anxiety.
“Anxiety often comes out in a lot of different ways. And OCD involves being anxious. It’s kind of rare that I see someone with only OCD and that’s it,” says Kilduff. Part of OCD is that your obsessions trigger a great deal of uncomfortable feelings, including anxiety. This is the reason why you feel driven to perform a compulsion—you want to relieve yourself of the anxiety and distress they cause. And being stuck in this perpetual cycle, it’s no surprise that so many also have an anxiety disorder.
What treatment is effective for OCD and anxiety?
There are two important points to keep in mind when we’re thinking about treatment. One: Treatment for both OCD and anxiety will involve a type of cognitive behavioral therapy called exposure and response prevention, or ERP. This is considered the first-line treatment for OCD, according to research, and it’s extremely effective in treating many anxiety disorders, as well.
ERP is used for OCD because this type of therapy asks you to face your fears and change the way you respond to them. Your therapist will actually work with you gradually, carefully trigger your obsessions. Once you feel that wave of anxiety and distress, you’ll feel a strong urge to perform a compulsion. But here’s where therapy comes in: You will actively resist doing your compulsion.
Yes, this is difficult. Yes, it can be scary. But that’s why this isn’t something you confront on your own; it’s something that you do together with a licensed professional who’s trained in OCD and treating it with ERP. As you resist compulsions and sit with the distress they cause, you learn that you can tolerate those feelings without having to rely on a compulsion to chase them away. As a result, you feel less distress when facing similar situations in the future, and you gain greater confidence in yourself as you move through your life.
In addition, ERP can also help treat anxiety, says Kilduff. In a study on patients who were using NOCD, published in the Journal of Medical Internet Research in 2022, ERP treatment decreased anxiety symptoms by 48%. Another study in Psychiatry Research found that ERP was more effective in decreasing anxiety in OCD patients compared to a control group.
When you treat OCD, the anxiety that rides on the coattails of the disorder is treated, too. To begin treatment, “I ask clients what’s causing the most impairment and distress in their life, and we’ll focus on that area,” says Kilduff. If you have anxiety and OCD that appear separate from each other—such as social anxiety and contamination OCD, then you can work on both at the same time in therapy. For instance, they explain, you might do a contamination exposure in a therapy session for the OCD and talk about being more assertive at work to hit on the social anxiety piece. But both aspects would involve intentional exposure to discomfort.
Questions to ask a therapist before they start treating you for OCD or anxiety
If you have OCD or OCD with anxiety, it’s important to seek out a therapist who is knowledgeable in the treatment of OCD and who specializes in ERP. That’s because there is a real risk involved in receiving the wrong treatment.
If your OCD is misdiagnosed as anxiety, you may receive treatment that can work against you and make your OCD symptoms worse. “When someone with OCD is in distress, many non-ERP-trained therapists will provide coping and relaxation exercises. They might also try to provide a sense of certainty or answer the question their client’s OCD poses, which by default is unanswerable. By engaging with their client’s OCD, this only encourages OCD behaviors in the client,” says Kilduff. This comes from a well-meaning place, and the therapist doesn’t realize they’re causing harm—but it can feed the OCD cycle even further.
Here’s an example, says Kilduff: Let’s say that someone who has sexual orientation OCD sees a therapist, and they explain that they’re worried that they’re actually a lesbian—even though they’re set to marry their boyfriend. If they have been diagnosed with OCD, ERP treatment will not try to answer the sexual orientation question. Instead, in ERP, you’ll actually explore and sit with that uncertainty, learning to accept the “what ifs” that come with being a complex individual. You won’t try to use coping mechanisms to deal with it—like endlessly taking sexuality quizzes, checking your attraction every time you’re around your partner, or being reassured every week in your therapy session—because those can quickly become twisted into compulsions. Learning to face that uncertainty is what will actually give you the ability to live with confidence in the relationships that matter to you.
Finding the help you need
If you think you may be struggling with OCD and anxiety, you will want to find a licensed therapist who specializes in treating OCD and anxiety disorders using ERP therapy, so that both conditions can be effectively treated together. When meeting any therapist for OCD and anxiety, ask them questions to determine if they’re the right fit, such as:
- How long have you been treating OCD?
There is no “right” number here, but you should feel confident in their background and specialty. Therapists who treat anxiety are easier to find, but you want to make sure that yours also has experience with OCD so you can access the right treatment.
- What type of OCD have you treated?
There are many subtypes of OCD, all of which are treated using ERP, but it helps to know if they are familiar with your subtype.
- What type of treatment do you use?
It should be ERP. Acceptance and commitment therapy (ACT) can also be added on to help people with OCD.
- How would you describe your therapy style?
Do you like someone more direct or would you prefer a gentler, friendly approach? Determine who you will best fit with; ERP is typically a more directive approach that involves homework between sessions.
If you’re interested in starting your journey to recovery, Kilduff recommends learning more about NOCD’s evidence-based, holistic approach to treating OCD and anxiety—an approach that has been backed by rigorous scientific research.
Above all, please know that while struggling with OCD and anxiety can be daunting or even debilitating, effective treatment for both conditions is available. You can work with a qualified professional, and get on the road to feeling better.