Do I have GAD or OCD? Here’s How You Might Know
Anxiety is worry, nervousness or unease about something that’s on your mind. Everyone worries or feels anxiety at some point in their lives — students on exam day, brides on their wedding day or professionals who sit for a coveted job interview. These temporary anxieties are a usual part of life.
Usual vs. Unusual Worry
But not all anxieties are created equal. Sometimes usual worry becomes unusual, or unmanageable. When the worry you experience is excessive, results in behaviors designed to control anxiety or is irrational, it might be that you are coping with an anxiety disorder. Anxiety disorders are the most diagnosed mental health condition in the United States and affect 18% of adults in America each year. One such anxiety-related condition is generalized anxiety disorder, or GAD for short.
Generalized Anxiety Disorder
Generalized anxiety disorder is excessive worry about multiple life-events or activities that is hard to manage and results in physical symptoms. In 2019, GAD was found to affect 1 in 6 adults in the United States.
Symptoms of GAD include:
- Excessive worry that is accompanied by physical symptoms
- Difficulty concentrating
- Muscle tension
- Sleep problems
Think of GAD as a constant state of feeling apprehensive about something. Maybe you have a performance review at work in two months, and you worry constantly about the results. Perhaps your child is graduating from high school this year, and you worry about what will happen after graduation.
People with GAD worry about many things such as finances, work-related events or activities, family life, health concerns, or other issues. These worries are typically associated with at least three physical symptoms. There is no known cause for GAD, however some research suggests that environment, genetics and biology all play a role in the development of the condition.
GAD is usually diagnosed by a mental health professional, but can also be diagnosed by your general physician. The condition is treatable with evidence-based psychotherapies and medication.
GAD & OCD: Close, but no rituals
People who live with obsessive-compulsive disorder (OCD), also a prevalent mental health condition in the U.S., wrestle with intrusive thoughts and intense feelings of fear, doubt and anxiety. Sounds like GAD, right? Sure. The symptoms of the two conditions can be difficult to distinguish, but there are differences.
It might even surprise you to learn that OCD is not considered an anxiety disorder, even though the symptoms of OCD often include anxiety and other symptoms of GAD. Let’s check out how these conditions differ and why OCD is in a class of its own.
Obsessive Compulsive Disorder
OCD is a mental health condition characterized by persistent and unwanted thoughts, images, urges or doubts (obsessions) that result in significant distress and repetitive behaviors, or rituals (compulsions), to control the distress. These repetitive actions could be physical behaviors or mental actions that are engaged repeatedly to cope with distressing thoughts. While most people have both obsessions and compulsions, it is possible to only have obsessive symptoms without compulsive symptoms.
Symptoms of OCD include:
- Persistent unwanted thoughts, images and urges
- Attempts to control the thoughts with rituals
- Intrusive (unwanted and come out of nowhere) thoughts
- Time spent each day avoiding or preventing thoughts, images, or urges
- Thoughts, images, or urges are patterned around, or fixated on, a particular fear that does not align with who you are or what you know about yourself or the world
OCD can only be diagnosed by a mental health professional. The most effective treatment for OCD is exposure and response prevention (ERP) therapy, however other forms of cognitive behavioral therapy (CBT) and medications are also used in the treatment of OCD.
Why OCD Isn’t an anxiety disorder
OCD was historically conceptualized as an anxiety disorder because of the intense anxiety or fear associated with the symptoms of OCD. However, in 2013 the American Psychiatric Association removed OCD from the anxiety disorders classification and assigned a unique classification to OCD.
The change was made to emphasize distinctions in brain chemistry and function in those with OCD and related disorders, as compared to those with anxiety disorders. Areas of the brain that reveal abnormal results in studies, and that respond when anxious feelings are triggered, are different in those with OCD than in those with anxiety disorders such as GAD. These differences are important to understanding and treating both conditions effectively.
GAD or OCD: How do I know?
Both OCD and GAD are long-lasting, and both involve excessive anxiety, rumination and intrusive thoughts. It can be difficult to figure out which you might be experiencing. While it is possible for people who have been diagnosed with OCD to also have GAD, let’s check out the key differences in symptoms:
- Obsessive (unwanted, persistent and repeated) thoughts, images, urges, and doubts
- Attempt to control/remove anxiety with rituals
- Attempts to suppress, neutralize or replace thoughts
- Unrealistic/hypothetical uncertainty
- Control anxiety with behaviors that are irrational or illogical
- Does not align with values or self-perception
- A single fixation (theme) is not necessarily associated with physical symptoms
- Thoughts or images
- Worrisome (a train of thought that is an attempt to problem-solve)
- No rituals
- Attempts to examine thoughts
- Worry over more than one realistic negative outcome
- Multiple areas of focus, life areas or activities
- Accompanied by at least three physical symptoms
As you can see from above, the presence of obsessions and compulsions (not just worry) are a key distinction of OCD. Repetitive or ritualized behavior (compulsions) is not present in GAD or other anxiety-related conditions. Other key distinctions are that anxiety that is due to GAD is accompanied by physical symptoms, whereas physical symptoms are not often reported in those who experience OCD alone.
The primary feature of OCD is the presence of obsessions and compulsions (repetitive behaviors or mental actions aimed at relieving distress), so if you identify with these descriptions — even if you have been diagnosed with GAD — it is possible that you have OCD.
I think I might have OCD. What now?
After reading the comparisons between OCD and GAD, you might identify with the symptoms of OCD. If that is the case, there are a few steps you can take to find out for sure:
- Talk about your concerns with someone you trust: Sometimes the content of intrusive thoughts can feel scary, embarrassing or even shameful. That can make it difficult to reach out for help. A good starting place is to find someone in your life who you trust to share those concerns with. Perhaps it is a parent, a close friend or a partner, or maybe it’s a member of your local community. The first step to getting help is getting around people who support your efforts.
- Get connected with an OCD specialist for assessment: OCD specialists are expertly trained in the assessment, diagnosis and treatment of OCD. Some even have additional expertise in treating conditions related to OCD, such as trichotillomania, hoarding or excoriation. On the day of your appointment, your specialist will gather brief information about any relevant medical history, past therapy or other diagnoses you might have, and your family and social life. Then they will offer you a chance to share your experience with anxiety and fear, and about how your symptoms have been impacting your life. Assessment sessions can take anywhere from 45 to 90 minutes, and at the end of it, they will tell you if you meet the diagnostic criteria for OCD and offer you resources for getting treatment.
What kind of treatment should I get?
Just as not all anxiety is created equal, neither are all OCD therapies. Now that you have a diagnosis for OCD, finding the right therapy is crucial. Exposure and Response Prevention (ERP) is considered the front-line treatment for OCD and is regarded as the most effective treatment for the condition. Research has found that people with OCD do not experience significant relief with talk therapy, medication alone, or traditional behavior-based therapies such as aversion therapy or systematic desensitization—this means that the therapist you choose must specialize in ERP.
ERP is a form of CBT that teaches you to allow those scary and intrusive thoughts to enter your mind and those anxious feelings to emerge, while refraining from doing something to make the anxiety or discomfort go away. Your specialist will help you to face the fears you feel — safely, in a structured and gradual way — while not giving in to the urge to try to make those feelings or thoughts go away through compulsions.
If this sounds scary to you, don’t fret! You can always begin with CBT without doing ERP right away. CBT helps you identify patterns of thought that create anxiety, or amplify it, and adapt them so that, over time, those anxieties lessen. The CBT therapist can help you to think about yourself, the world (and the things you obsess about) in more healthful ways.
Where to find an OCD specialist:
- NOCD: Our staff is clinically trained to treat obsessive-compulsive disorder by using the gold standard in OCD treatment: ERP. A 15 minute phone call with our staff can explain to you the benefits and the amazing results we’ve seen as a result of ERP therapy.
- International OCD Foundation: The IOCDF is a great resource if you are looking for help in your area. The website offers a resource directory that you can search based on your city, state or treatment interest (e.g., community group, in-person, virtual). Their directory includes providers who have been trained by the IOCDF in the specialized treatment of OCD.
- Psychology Today: Well-known as a source for finding a therapist, this might be a good place to find a provider for OCD. The “Find a Therapist” feature is highly customizable, so you will have better luck finding a therapist who is the right fit.
If you or someone you know is struggling with OCD, you can schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.