GAD vs OCD: Could you have been misdiagnosed with GAD?
Although there may often be similarities between Generalized Anxiety Disorder (GAD) and Obsessive Compulsive Disorder (OCD), there are also some key differences. Both of these disorders include unwanted thoughts; however, thoughts related to a GAD diagnosis are typically more realistic in nature. These thoughts are more likely to involve things that have a higher chance of occurring or a greater relation to someone’s daily life, as opposed to a thought that is illogical, highly unlikely, or generally unrelated to daily life. The latter is a symptom more likely to fall under an OCD diagnosis.
GAD vs. OCD
It is common for people to have worries and feel uneasy at times. Stress is a common emotion and can actually be helpful: for example, if you have a big work project due, stress may actually motivate you to complete the project. Leading up to an important day in one’s life, such as a wedding or the birth of a child, one may have anxious thoughts about what this will look like, and what changes this will bring. It is only when these worries become excessive and start to negatively impact one’s functioning in daily life that there may be an underlying anxiety disorder.
Anxiety disorders, of which GAD is just one, are the most diagnosed mental health conditions in the United States, experienced by roughly 18% of adults in America each year. So what are the key components of GAD? Many report excessive worry, physical symptoms, sleep problems, muscle tension, fatigue, restlessness, irritability, and trouble concentrating. Generally, people who suffer from GAD experience three or more related symptoms and tend to worry about multiple areas of their lives.
OCD tends to look distinct from GAD, once one gains an understanding of OCD and its cyclical nature. In OCD, people experience thoughts, images, urges, or sensations that are intrusive and unwanted—often, they are confusing or disturbing, and do not align with a person’s intentions or values. These are called obsessions, and they can cause a great deal of anxiety and distress in response. When obsessions occur, people with OCD engage in safety-seeking behaviors called compulsions, which are performed either physically or mentally in order to get rid of or avoid the anxiety and distress they feel, or to prevent a feared outcome from occurring. Compulsions provide temporary relief from the anxiety caused by obsessions, but they reinforce the belief that the obsessions pose a real threat, causing them to return again and again.
Let’s consider some examples. Xavier experiences symptoms that are consistent with GAD. They worry frequently about their bills being paid on time. They go to great lengths to track spending and to ensure that they are on track budget-wise. They also spend a great deal of time thinking about their health and worrying about dying. They can spend many hours in any given day hyper-focused on seemingly mundane, everyday problems. They may worry about whether or not their car will break down, they will lose their job, or they may forget to pay an important bill. Although many people who do not meet the criteria for GAD have these same fears, Xavier spends a large part of their time engulfed by these thoughts. They experience impairment in functioning in various areas of their lives.
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Trina experiences some similar symptoms. She stresses a lot about her health. She worries that she will get ill or, even worse, that someone she loves will get sick. Trina can spend hours each day thinking about these things even though she would much rather not. Trina also can be extremely creative when thinking about all of the ways in which she could contract an illness: briefly touching an object, not fully sanitizing a spoon, eating food that was in the fridge overnight. Trina is often well aware that her thoughts don’t make logical sense, and she has a lot of insight into how irrational her thoughts can sound. Yet, Trina is filled with anxiety when she feels uncertain about the possibility of getting sick, and she feels compelled to do things perfectly in order to prevent imagined catastrophes from happening.
Does the diagnosis matter?
The key distinction between GAD and OCD lies in the symptom referred to as compulsions. Compulsions are mental or behavioral actions that an individual takes to prevent real or imagined harm from occurring. These are aimed at neutralizing or reducing the threat of danger. Considering the similarities between OCD and GAD, you may be surprised to hear that OCD is no longer considered an anxiety disorder, as it once was. OCD now falls into its own category in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The change was made to emphasize distinctions in brain chemistry and function in those who experienced OCD and related disorders, as compared to those who met the criteria for anxiety disorders. Various areas of the brain showed different responses in people with OCD than in those with anxiety disorders, including GAD, when anxious feelings are triggered. These differences are important to the understanding and treatment of both conditions.
Receiving the correct diagnosis matters quite a bit, due to the most effective treatment methods for the two conditions. Exposure and Response Prevention (ERP) is the gold-standard treatment for OCD. On the other hand, Cognitive Behavioral Therapy (CBT) is often the treatment of choice for GAD. While ERP falls under the CBT umbrella, it is a very specific and distinct form of treatment. When someone is diagnosed with GAD but really meets diagnostic criteria for OCD, they may be referred for the wrong form of treatment. That is why a correct diagnosis is so critical: the goal of a proper diagnosis is to identify the most beneficial treatment. One study showed that in a primary care setting over half of people suffering from OCD are misdiagnosed.
It is also not uncommon for people to have more than one mental health condition. There is often an overlap in symptoms. It is very possible to be diagnosed with both GAD and OCD. Nevertheless, it is important to have a comprehensive diagnostic picture when beginning treatment.
Is ERP right for you?
ERP therapy can be life-changing for people with OCD. ERP therapy is an active form of treatment and requires intentional buy-in from the member through participation in exposures, a willingness to feel discomfort, and honesty with their therapist about their obsessions and compulsions.
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ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training. If you have questions or think that you may need ERP therapy for your OCD, speak to someone on our care team on a free 15-minute call.
Stacy Quick LPC, is a therapist at NOCD, specializing in the treatment of OCD. She has been working in the mental health field for nearly 20 years. Her goal is to help members achieve skills to help them live a more fulfilling life without letting OCD be in control. Ms. Quick uses ERP and her lived experiences to help her members understand it is possible to live a life in recovery. She is a mother of 3 children, 2 of whom are also diagnosed with OCD. Ms. Quick is also a writer and content creator. Learn more about Stacy Quick on Instagram: @stacyquick.undone
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Licensed Therapist, MA
I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.
Licensed Therapist, LCMHC
When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.
Licensed Therapist, MA
I have personally struggled with OCD and know what it's like to feel controlled by intrusive thoughts and compulsions, and to also overcome it using the proper therapy. I’ve been a licensed therapist since 2017. I have an M.A. in Clinical Mental Health Counseling, and practice Exposure and Response Prevention (ERP) therapy. I know by experience how effective ERP is in treating OCD symptoms.