Do I Have Anxiety? Or OCD?
Clients and therapists alike can find the line between anxiety and OCD a little hazy. This can be frustrating for clients who hope to have a clear diagnosis, or even confusing when they walk away from a session with a different diagnosis than what was given by their prior therapist.
The reason for this fine line can be attributed to both disorders sharing a core fear of uncertainty.
In OCD, this manifests as intrusive thoughts that compel individuals to perform rituals or repetitive actions to alleviate perceived threats, while in anxiety disorders, it shows up as persistent and uncontrollable worry about potential negative outcomes. Both conditions share a deep-seated fear that something bad may happen, and the inability to sit with the ambiguity of not knowing the future fuels these cycles. The struggle with uncertainty leads individuals to seek reassurance, control, or predictability, but this only reinforces the anxiety, creating a vicious cycle that can be difficult to break.
While OCD and anxiety disorders share similarities, particularly in their core fear of uncertainty, they do have some differences in the way they manifest. One key distinction is in the nature of intrusive thoughts. People with OCD experience obsessions—unwanted, distressing thoughts, images, or urges, often centered on fears like contamination, harming others, or making mistakes. To reduce this distress, they engage in compulsions or rituals, which, though aimed at preventing feared outcomes, rarely have any real impact. In contrast, anxiety disorders, such as Generalized Anxiety Disorder (GAD), involve excessive worry about a wide range of everyday concerns, from work to health. The worry in GAD is not usually tied to specific, irrational fears as it is in OCD.
Another difference is the role of compulsions. OCD is characterized by repetitive behaviors or mental acts that are performed to alleviate the anxiety caused by obsessions. For example, someone with OCD might repeatedly check if a hair curler is turned off out of fear it could cause harm. In GAD, the focus is more on the mental process of worry rather than performing specific actions to reduce anxiety.
The triggers for OCD and anxiety disorders also differ. OCD triggers are often specific, such as germs, harm, or symmetry, leading to compulsive behavior in response to particular situations or objects. In contrast, anxiety disorders like GAD involve broader, more diffuse worries, which can be triggered by a variety of factors, from social interactions to future uncertainties.
So, does it matter? Not much, really.
Here’s the thing: While there are these diagnostic differences, they don’t necessarily change the treatment plan. Whether it’s OCD or another anxiety disorder, the symptoms can overlap significantly, and the key to managing them lies in understanding how the brain reacts to fear and distress.
ERP: The Common Ground
Exposure and Response Prevention (ERP) is a form of Cognitive Behavioral Therapy (CBT) that has been proven to be incredibly effective for both OCD and anxiety disorders. In fact, it's one of the most researched and evidence-based therapies available today.
No matter whether you’ve been diagnosed with OCD or generalized anxiety, ERP might be part of your treatment plan. ERP helps you face the thoughts, feelings, or situations that trigger your anxiety or compulsive behavior. Then, instead of giving in to the compulsion to engage in a safety ritual, ERP teaches you to resist it. Over time, you get better at tolerating anxiety without the need to act on those urges, which leads to less anxiety overall.
