Is OCD a Form of Anxiety? Here’s the Key Difference Between Them

Everyone experiences anxiety or worry at some point in their lives. For people who have  obsessive-compulsive disorder OCD, the anxiety of intrusive thoughts is what compels them toward compulsive rituals and/or avoidance. It often feels like they must do these things or else something bad will happen, which can lead to strong feelings of anxiety. But does that mean OCD is a type of anxiety disorder? If not, what’s the difference, and how are they connected? 

Though OCD and anxiety are closely related, OCD is a separate diagnosis. In this article, we’ll discuss the key distinctions between OCD and anxiety disorders, why they are separate diagnoses and in what ways they overlap. We’ll also talk about why OCD is treated differently from anxiety.

How OCD and anxiety are different

To start, it’s helpful to define these two diagnoses. 

Anxiety is an umbrella term for multiple anxiety-related disorders. Anxiety affects 18% of the United States population, making it the most commonly diagnosed mental health condition in the country. A common diagnosis within the anxiety umbrella is generalized anxiety disorder, or GAD, which is characterized by “persistent and excessive worry” about multiple issues, which lasts for over six months and is accompanied by at least three physical symptoms, according to the Anxiety & Depression Association of America. 

Some anxiety symptoms include: 

• Feeling nervous, irritable or on edge
• Breathing rapidly, hyperventilating or trembling
• Experiencing gastrointestinal problems
• An increased heart rate

OCD, on the other hand, is a condition where a person experiences unwanted thoughts, urges or impulses that are obsessive and lead them to compulsive actions in an attempt to reduce the distress that comes with these thoughts. 

Some symptoms of OCD are: 

• Persistent unwanted thoughts, images or urges
• Attempts to control the thoughts with rituals
• Time spent each day avoiding or preventing thoughts, images or urges

History of OCD as an Anxiety Disorder

You might be interested to know that, historically, both GAD and OCD were indeed considered anxiety disorders. But as of the 2013 publication of the fifth edition of the DSM (The Diagnostic and Statistical Manual of Mental Disorders), a diagnostic reference guide used by clinicians, that’s no longer the case. Now, GAD is considered an anxiety disorder, while OCD falls under its own category: Obsessive-Compulsive and Related Conditions. These related conditions include body dysmorphic disorder, hoarding disorder, and trichotillomania (aka hair-pulling), to name a few.

OCD was historically conceptualized as an anxiety disorder because of the intense anxiety or fear associated with persistent and unwanted thoughts, images and urges. However, the American Psychiatric Association reclassified OCD as a separate diagnosis because there are significant differences in brain chemistry and function for each of these disorders. 

Why OCD is no longer considered an anxiety disorder 

Though distressing thoughts are a big part of both generalized anxiety disorder and OCD, the key difference is that OCD is characterized by intrusive, obsessive thoughts that trigger this anxiety, and are followed by compulsive actions done to relieve it. In contrast, someone with more general anxiety will experience worries without necessarily taking compulsive actions. Additionally, GAD is generally characterized by physical symptoms of anxiety, such as hyperventilation, while physical symptoms are not a requirement for an OCD diagnosis, according to therapist Davida Vaughn, M.S., Ed.S., LPC.

It is possible to have both generalized anxiety and OCD, but one does not require the other — and it’s also important to mention that anxiety is not a necessary part of OCD. Dr. Patrick McGrath, Head of Clinical Services at NOCD, points out in a recent video that sometimes compulsions are motivated by other equally intense and uncomfortable emotions, like disgust, shame, or guilt, rather than anxiety. 

How treatment for OCD and treatment for anxiety differ

There are similarities in treatment for OCD and anxiety, but they may in some cases differ or be contradictory. 

Both OCD and anxiety can be treated with a form of cognitive behavior therapy. CBT is an umbrella term to describe types of evidence-based therapies that are rooted in the idea that the way a person behaves and feels is influenced, at least in part, by their thoughts. Anxiety disorders such as GAD are usually treated with a combination of CBT and medication.

The standard treatment for OCD, on the other hand is a very specific form of CBT called exposure and response prevention therapy, or ERP. ERP specifically focuses on targeting the obsessions and compulsions the patient is experiencing. During treatment, a patient works with a therapist to slowly expose themselves to the source of their obsession—without performing a compulsive action. The idea behind ERP therapy is that when a person realizes that they don’t need to follow an obsessive thought with a compulsion and that they’re able to handle the discomfort of their thoughts, they learn they can overcome their OCD. 

One major reason that the proper treatments for OCD and GAD can differ is when a person seeks reassurance as a compulsion. For some people with OCD, reassurance seeking can be a compulsion meant to soothe or solve obsessive thoughts. In ERP treatment, the goal would be to avoid this reassurance and manage the discomfort that comes as a result. However, when treating GAD, it may be a helpful part of treatment for individuals to examine evidence and challenge their thoughts or to get feedback about specific anxieties.