Do I have OCD or Anxiety? Learn with an OCD Therapist in San Francisco
If you’ve ever wondered whether your symptoms are OCD or Anxiety, you’re not alone. Both Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD) involve worry and fear so it can get confusing. In this blog, I will address some of the differences between these two mental health conditions. Let’s start by first breaking down the basics for each.
What is OCD?
Obsessive Compulsive Disorder (OCD) is a mental health condition in which individuals experience recurring and unwanted thoughts, urges, images, or sensations, known as obsessions. These obsessions are ego-dystonic (they go against the person’s character and values) and feel distressing and threatening. The obsessions typically feel urgent and like they require immediate attention and action. Individuals will OCD will perform repetitive physical or mental behaviors called compulsions to bring down the distress. The urge to engage in compulsions can be gripping and powerful. Completing the compulsion brings temporary relief, but in the long run, keeps individuals stuck in an OCD cycle. These symptoms interfere with daily functioning.
What Is Anxiety?
Let’s start by acknowledging that anxiety is a normal human response that we all experience when confronted with a perceived danger. Our body activates this natural response to fight or escape a threatening situation and ensure safety. In other words, we need anxiety, it is like our security alarm. However, it can become problematic when this anxiety response becomes too pervasive, feels uncontrollable, and affects one’s daily functioning. This is like our security alarm going off at the slightest movement, even when there is no threat. This can end up developing into an anxiety disorder, such as Generalized Anxiety Disorder.
Generalized Anxiety Disorder (GAD) is a mental health condition in which individuals experience excessive and chronic worry for six or more months. The worry is difficult to control and encompasses many things (finances, health, relationships, work, school, etc.) Other symptoms of GAD include ongoing restlessness, irritability, muscle tension, difficulties concentrating, and disturbed sleep.
GAD is often referred to as ‘Anxiety’ in casual talk. But it is important to make the distinction between the occasional anxiety that we all experience versus the clinical diagnosis of Generalized Anxiety Disorder that can impact an individual’s quality of life. In this blog, I’ll be using both GAD and ‘Anxiety’ interchangeably to refer to the clinical diagnosis.
What is the difference between OCD and Anxiety?
One difference between OCD and Anxiety is in how the worries present and the nature of the concerns:
OCD worries come from obsessional fears and latch onto specific things (i.e. contamination, harm, symmetry/ordering, and taboo themes.) They tend to feel out of place, feel more extreme than an individual’s normal worries, and have an illogical feel. So someone with Harm OCD may be fearful that they might become a serial killer, even though they have never been violent or had any desire to hurt anyone in their lives. They may be completely fine so long as their obsession with becoming a serial killer doesn’t get triggered. Obsessive thoughts are often related to some commonly seen themes, but not always.
Many people with OCD have some level of insight and in their calmer moments can acknowledge the element of irrationality with their obsessions. But during those triggered moments, the obsessions feel so convincing and intense. Clients often tell me “I know this doesn’t make sense, but in those moments it feels so real.”
GAD worries tend to be more constant and about everyday concerns in one’s life (work, health, finances, relationships, friendships, etc.) They tend to feel more rational and possible. So, someone with GAD will experience worries throughout the day that shift from one issue to another. They might worry excessively about work performance, being late, their health status, financial stability, purchases they need to make, what to make for dinner, etc.
GAD worries are not usually tied to one specific thought or fear, as they are with OCD. Many of my clients with GAD identify themselves as “worriers.” They often notice that their worries about everyday things tend to be more intensified and exaggerated compared to others. Others in their lives may also notice this as well.
Another difference between OCD and Anxiety is in the behavioral patterns related to the worries/fears (compulsions versus safety behaviors):
One of the key ingredients of OCD is the presence of compulsions. Individuals with OCD engage in compulsions in response to the anxiety or distress caused by their obsessions. Compulsions are physical or mental behaviors individuals engage in to reduce the distress caused by their obsessions. There is usually a sense of urgency and insistence to complete the behavior before the individual can move on to the next thing. Compulsions also tend to be specific and can be repetitive and ritualistic. Sometimes they can be illogical.
Individuals with GAD do not typically engage in compulsions. But they may engage in safety behaviors that are also meant to help reduce anxiety. These safety behaviors are not tied to an obsession, as with OCD. Some common safety behaviors include avoidance, distraction, and mental ruminations. These can also be seen with OCD, but again, usually in a more repetitive manner and in direct response to an obsession.
It’s important to note that the presence of compulsive behaviors does not immediately equate to an OCD diagnosis. Compulsive behaviors can be related to many other diagnoses. A thorough assessment is important to get a good idea of what is happening. Additionally, individuals may sometimes have more than one thing going on and those symptoms may overlap. It can get a little murky trying to sort it out. An OCD specialist will explore the function of your behaviors and work on differentiating the potential diagnoses.
How can you tell if you have OCD or Anxiety?
It can be tricky to tell the difference between OCD and GAD because they both involve worry and fear. While there isn’t an OCD test or Anxiety quiz that can provide a diagnosis, below are some questions that could help guide you. It’s always a good idea to seek the help of an OCD and anxiety therapist to get assessed for an accurate diagnosis and proper treatment.
Are my worries focused on specific, intrusive thoughts that come back regardless of what I do? If yes, it could be OCD.
Do I engage in specific actions or rituals to make the anxiety go away? Are the actions repetitive and sometimes seem like they don’t make sense? If yes, it could be OCD.
Do I experience excessive worries that shift from one thing to another without any specific intrusive thoughts? If yes, it could be GAD.
Do I excessively avoid situations or try to control my worries without performing specific rituals? If yes, it could be GAD.
What is the treatment for OCD and Anxiety?
Both OCD and GAD are treatable with therapy, medication, or a combination of both. The OCD and Anxiety cycles are very similar but it’s important to note that not everything that works for GAD will work for OCD. Some techniques can be harmful and worsen OCD.
OCD Treatment in San Francisco
The most effective treatment for OCD is Exposure and Response Prevention (ERP), which is a type of Cognitive Behavioral Therapy (CBT). ERP involves gradually exposing yourself to the things that trigger your obsessions while resisting the urge to do compulsions. This helps weaken the OCD cycle over time.
Medication could also be used alone or in combination with therapy. Selective Serotonin Reuptake Inhibitors (SSRIs) could help reduce symptoms. Medication can often make it easier for individuals to engage in therapy when symptoms feel too overwhelming.
Anxiety Treatment in San Francisco
Cognitive Behavioral Therapy (CBT) is a treatment modality that is effective for treating GAD. CBT helps identify unhelpful thought patterns and learn how to challenge and reframe them into more helpful thinking. ERP can also be effective in reducing safety-seeking behaviors.
Relaxation techniques, breathing exercises, and mindfulness practice can be good tools to help maintain overall anxiety at a lower baseline without intensifying it.
Medication, such as SSRIs or anti-anxiety medications, can be helpful alone or in combination with therapy.
So while both OCD and anxiety can seem very similar, there are some important differences. OCD involves specific obsessions and compulsions, while anxiety tends to be more general and widespread. It’s also possible for OCD and Anxiety to co-exist and for individuals to meet criteria for both.
If you're unsure about what you might be dealing with, connect with an OCD and Anxiety therapist to help you sort it out. You don’t have to figure it out alone!
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