OCD is rare. OCD is all about cleanliness. OCD is an anxiety disorder. These are just a few of the many myths that surround obsessive-compulsive disorder (OCD).
OCD, in fact, is not an anxiety disorder—which can be a bit confusing to some. After all, “every person with OCD experiences anxiety,” according to Tracie Ibrahim, LMFT, CST, Chief Compliance Officer at NOCD. “No one with OCD has ever escaped the feeling of anxiety—that’s the whole problem—that you feel so anxious that you engage in compulsions to try to get rid of the discomfort of the anxiety.”
That said, there are still a lot of differences between OCD and an anxiety disorder—and they’re worth getting an understanding of.
Does the DSM consider OCD an anxiety disorder?
No. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the handbook clinicians use for diagnoses—updated the classification for OCD and no longer puts it in the category of anxiety disorders.
Earlier editions of the DSM classified OCD as an anxiety disorder, but as researchers learn more about mental health disorders, the DSM evolves, too. OCD’s new classification—in the category of Obsessive-Compulsive and Related Disorders—acknowledges what makes OCD distinct.
Key difference between OCD and an anxiety disorder
Anxiety can be a factor in OCD, but there are several other key components besides anxiety.
Most notably, OCD involves a very specific cycle. This is a loop of four components: an obsession or intrusive thought; feelings of distress or anxiety; compulsions in an attempt to neutralize or escape the obsession; a temporary sense of relief.
People with anxiety disorders may tend to overthink and worry—sometimes about the exact same concerns that someone with OCD has—but they aren’t locked into this same pattern, where they need to perform a compulsion to cope with their distress.
“There’s only one thing that makes OCD and anxiety different and that’s obsessions and compulsions,” Ibrahim adds.
Let’s look at one example. Someone may have an anxiety disorder that causes them to worry excessively about getting a serious illness. The fears may persist even when they’re reassured by professionals that nothing is wrong.
Likewise, someone with Health OCD, a common subtype of OCD, can become preoccupied with the fear of having a serious illness, despite medical reassurances that they are healthy. But to cope with this fear, they engage in compulsions—such as repeatedly checking their body for signs of illness.
“With OCD, you’ll see very ritualistic kinds of behaviors,” says Dr. Patrick McGrath, psychologist and Chief Clinical Officer at NOCD. “They may have to do something exactly the same way or check it a certain number of times.” With an anxiety disorder, such as illness anxiety disorder, “they might just run to the bathroom and check quickly to see if that spot of concern on their body has got any bigger. They’re not taking any kind of ritualized approach to doing something about it. They’re just assessing to see what, if anything, has changed.”
Signs you may have OCD
With OCD, obsessions and compulsions cause marked distress, are time consuming (take more than 1 hour a day), and significantly interfere with your life, work/school, and/or relationships.
Signs you have obsessions:
• You have regular intrusive thoughts that are often troubling and cause a lot of distress
• You feel you can’t do anything to stop these thoughts, and this bothers you
• You can’t shake the feeling that something bad will happen as a result of your thoughts
• You feel an outsized responsibility for what happens to others
• You feel a strong urge to do something when an intrusive thought arises
• Your intrusive thoughts often (although not always) center around a theme—such as:
- Fear of harming yourself or others (Harm OCD)
- An extreme need for perfection, symmetry, or things to be “just right” (Perfectionistic OCD)
- Fears and doubts about one’s “true” sexuality (Sexuality Orientation OCD)
- Intense fear about contamination or becoming ill (Health and Contamination OCD)
- Consisting worry about violating religious, moral, or ethical beliefs (Religious or Scrupulosity OCD)
- Fixations on bodily sensations or involuntary bodily functions (Sensorimotor OCD)
- Doubts and fears surrounding relationships—most often the intimate ones (Relationship OCD)
- Recurring doubts about things that happened in the past (False Memory and Real Event OCD)
Common OCD Compulsions:
- Checking (i.e. seeing if the stove is off or if the door is locked)
- Tapping/Touching (i.e. tapping something three times in order to feel okay or “just right”)
- Reassurance-seeking (i.e. asking a loved one, “Did you see me push anyone when we were walking down that busy street?” or “Do you really love me?)
- Avoidance (i.e. refusing to go places or be in situations that might trigger intrusive thoughts)
- Excessive washing/cleaning (i.e. handwashing, showering, or disinfecting surfaces multiple times a day)
- Rumination (i.e. thinking something over and over in your mind, even for hours a day)
- Mental reassurance (i.e. giving yourself reassurance as “I would never do anything awful like that because I’m not a bad person”)
- Thought-neutralization(i.e. replacing a bad thought in your head with a good one)
Signs you may have an anxiety disorder
There are several types of anxiety disorders. While all feature a primary symptom of anxiety, they’re all a bit different. Here are a few of the common diagnoses:
Generalized Anxiety Disorder (GAD): Involves ongoing and excessive worry about everyday things. You may view problems more intensely than those who don’t have GAD, overthink your decisions, view events as critical even if they’re not of significant importance, and regularly fall into the trap of worst-case scenario thinking. You may experience restlessness, fatigue, difficulty concentrating, irritability, or sleep problems (among other symptoms) for at least 6 months.
Panic disorder: People with panic disorder often have panic attacks—sudden bouts of intense fear, discomfort, or loss of control—out of the blue. As a result, they become fearful of having panic attacks in various places.
Social anxiety disorder: People with social anxiety disorder have a persistent, intense fear of being judged by other people. They’re often deeply uncomfortable in social situations.
Phobias: People with phobias are intensely afraid of or averse to specific situations or objects—and to a greater extent than rationally makes sense. There are many types of specific phobias, such as fear of heights and fear of animals.
Can you have both OCD and anxiety?
Yes. It’s possible to have both anxiety disorders and OCD. “It’s so, so common,” says Ibrahim.
One review of studies suggests that around one-third of people with OCD also have an anxiety disorder. The most common were GAD, phobias, and social anxiety disorder. Experts aren’t sure why there’s so much overlap, but Ibrahim says that it makes sense that people prone to anxiety related to OCD may be more likely to have anxiety disorders as well.
When OCD is accompanied by anxiety disorders, it is often more severe, persistent, and disruptive. That’s because the disorders can feed into each other. “Let’s say Harm OCD is telling you that you’re going to hurt people in public, and then you also have social anxiety,” Ibrahim explains. “So you’re like, ‘Oh, I’m not going out there. I might stab people.’ And so now each disorder is making the other worse.”
The good news is that OCD and anxiety disorders are treatable—even at the same time.
How OCD and anxiety disorders are treated
Your treatment plan will depend on the exact disorder you have and your unique needs.
Typically, treatment for anxiety disorders includes an element of therapy and possibly medication. Cognitive behavioral therapy (CBT) is a type of therapy that’s often used, as the goal is to recognize and identify thought patterns and behaviors that lead to anxiety—so you can change them.
In some cases, the recommended form of therapy for anxiety disorder isn’t CBT, however, but Exposure and Response Prevention (ERP)—the exact treatment that’s used for all types of OCD.
“Just like we do when treating OCD, ERP for anxiety disorders includes facing what makes you anxious, a little bit at a time, and learning that you can tolerate discomfort or anxiety that arises,” Ibrahim said.
In fact, ERP is the gold-standard treatment for OCD, as it’s backed by decades of clinical research.
Someone with OCD tries to avoid situations that trigger their obsessions, but ERP carefully exposes them to the very thing that ignites the intrusive thought. Only by doing this—with the help of a trained OCD specialist—can you then learn how to respond without compulsions.
The bottom line: OCD and anxiety disorders have their differences—and understanding them is key. But once you make a decision to reach out for help, freedom becomes not only possible, but probable.
