Is OCD a Form of Anxiety? An OCD therapist explains

If you’re familiar with obsessive-compulsive disorder (OCD), and know the anxious feelings that accompany the condition, you might be wondering: What’s the difference between anxiety vs OCD? And could OCD just be a form of anxiety? Is OCD a Form of Anxiety? An OCD therapist explains

As a therapist who treats OCD, I’ve encountered this question from patients many times. The fact is, while OCD and anxiety definitely share some commonalities—worry is a part of both mental health conditions—they are not the same. One distinction is that people with OCD don’t just feel anxious; they engage in compulsive behaviors to try to tamp down the anxiety they feel. People who have anxiety but don’t have an OCD diagnosis may also feel like they want to escape their distress, but they don’t partake in compulsive rituals as a result. 

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. Symptoms may include feeling nervous, irritable, or on edge; breathing rapidly, hyperventilating or trembling; gastrointestinal problems; and increased heart rate, just to name a few.

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. For example, someone with OCD might have obsessive thoughts about getting sick if they come into contact with other humans. This thought makes them very anxious. To cope, they wear gloves everywhere they go and obsessively take showers after being out in public.

For comparison’s sake, while someone with anxiety might be irrationally worried about getting sick when they leave the house, they typically don’t engage in compulsions like avoiding people or repetitive showering. While the feeling of anxiousness might be similar, only in OCD does the anxiety lead to repetitive behaviors (compulsions).

Why OCD is no longer considered 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. 

How to Know if You Have OCD or Anxiety

As previously mentioned, someone with anxiety experiences excessive worry, but doesn’t perform compulsive acts to reduce their distress. In addition to the presence of compulsions in OCD, the nature of OCD thoughts and anxiety thoughts can be a distinction between the two diagnoses. People with anxiety may worry about things that technically can happen—like the loss of a job, financial hardship, and any number of other stressors in everyday life. The intrusive thoughts suffered by people with OCD tend to be more irrational, focused on outcomes that are not likely to happen.

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.

Can you have both OCD and Anxiety or GAD?

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 OCD and anxiety are treated

Getting the right diagnosis from a trusted profession is the first step to finding the right help. The good news is that both OCD and anxiety are treatable—even at the same time. 

For OCD, traditional talk therapy is unlikely to be effective. So what does help? Exposure and response prevention (ERP), which is the gold standard treatment for OCD, backed by rigorous clinical research. In ERP, you work with a therapist who has received specific training in this form of treatment. It’s not about finding the root cause of your worries and fears but about allowing these thoughts to exist without engaging in compulsive behaviors.

ERP is also a highly effective form of treatment for anxiety disorders such as GAD, but these conditions can also be treated with other types of therapy, such as cognitive behavioral therapy (CBT), or with medication management.

Let’s take a specific example to see why the appropriate therapy is key. For some people with OCD, reassurance seeking can be a compulsion that’s used in an attempt to soothe oneself from the discomfort of obsessive thoughts. In other words, if you’re obsessively worried about something, you might repeatedly ask the people around you to tell you that you’re okay and that nothing bad will happen. This is the type of behavior you’d work to stop engaging in in ERP therapy. In ERP treatment, the goal would be to avoid this reassurance and manage the discomfort.

Where exactly to find help 

Living with OCD, an anxiety disorder, or both conditions can be incredibly difficult, but effective treatment for both conditions is available. You can work with a qualified professional and start feeling better.

NOCD Therapists receive specialized training in treating both OCD and anxiety disorders with evidence-based ERP therapy. If you think you may be struggling with OCD or anxiety, I strongly encourage you to learn about NOCD’s treatment for both conditions.