Obsessive Compulsive Disorder (OCD) & Anxiety
Clinically reviewed by: Leigh Hall, LMFT
Written by: Casey Clark
Anxiety is multifaceted and affects people in many different ways, potentially showing up in response to specific triggers in some people, while others tend to worry excessively about many topics. There are several recognized anxiety disorders that mental health professionals might diagnose clients with, the most common of which is generalized anxiety disorder (GAD), and it is possible for a person to struggle with more than one anxiety disorder (for example, GAD and social anxiety disorder). It is also possible to have both an anxiety disorder and obsessive-compulsive disorder.
OCD is technically not classified as an anxiety disorder; it’s in the “Obsessive-Compulsive and Related Disorders” section of the most recent DSM. However, people with OCD generally experience a significant amount of anxiety in their daily lives, and may be diagnosed with one or more anxiety disorders, as well. The most common co-occurring condition is generalized anxiety disorder, and the two disorders share some characteristics.
Keep on reading to find out the differences between anxiety disorders, especially GAD, and OCD, and how you can tell if you have one versus the other, or both.
Obsessive-Compulsive Disorder (OCD) & Anxiety
Anxiety disorders (such as GAD) and OCD are separate conditions; however, people with obsessive-compulsive disorder experience high levels of anxiety as well. One of the key differences is that, unlike the “generalized” nature of the worries people with GAD face (usually a broad array of everyday things), with OCD, people are often not worrying about real-life situations or stressors; in fact, many of the intrusive, anxiety-provoking thoughts that people with OCD experience can seem quite outlandish, and often revolve around particular themes, or subtypes.
Most of the time, a person diagnosed with OCD has insight into the irrational nature of their worries, and yet they cannot simply dismiss them, which is part of what makes the disorder so distressing.
What is Obsessive-Compulsive Disorder (OCD)?
Obsessive-compulsive disorder is characterized by repetitive, intrusive, unwanted and distressing thoughts that often revolve around specific themes, and that trigger behavioral or mental compulsions.
Compulsions are actions that are intended to reduce the discomfort and anxiety brought on by intrusive thoughts. The behaviors often become repetitive in an attempt to soothe the discomfort and can be quite time-consuming and disrupt daily activities. Compulsions vary from person to person; however, some of the most common compulsions include hand-washing, checking, and ordering/arranging things.
To receive a diagnosis of OCD, an individual must see a licensed mental health or medical professional and meet several of the criteria listed in the DSM-V over a certain period of time.
OCD Subtypes
Intrusive thoughts OCD
The intrusive thoughts of OCD often center around particular themes, known as subtypes, and there are a number of subtypes that are common among OCD sufferers. Below are a few examples; however, obsessions could revolve around pretty much any topic, and a person may struggle with more than one subtype, or with different subtypes at different times in their lives.
Magical Thinking OCD
Magical thinking OCD involves the belief that thoughts or actions can cause real-life consequences, with no direct, logical connection between them. The thought process with magical thinking OCD is: “I can control X by doing Y behavior.” For example, a person might think, "If I don't text my parents ‘I love you’ before I go to bed, then they will die in their sleep."
Relationship OCD
Relationship OCD is a subtype in which obsessions and compulsions revolve around a relationship – often, though not always, a romantic relationship. This type of OCD usually presents as repetitive thoughts that center on doubts about the relationship and compulsions to check in with a partner in an attempt to relieve the anxiety, even though, as with all OCD compulsions, the relief is only temporary. For example, one might repeatedly ask a partner, "Do you still love me?" or "Are you going to leave me?"
In some cases, this type of OCD is developed from underlying attachment issues that one hasn't worked through.
Contamination OCD
Individuals with contamination OCD experience a great deal of anxiety and distress around the idea of being contaminated by germs or toxins. This could be exhibited by compulsively washing one's hands, throwing things out, avoiding certain places (such as public bathrooms or hospitals) and surfaces, and disinfecting surfaces repeatedly .
Checking OCD
With checking OCD, people feel the need to check something, often a specific number of times until it feels "just right." For example, some individuals might find they need to unlock and lock a door a number of times over before they feel it is completely secure.
Symmetry OCD
Symmetry and order OCD is common for many people with the condition. This usually involves an individual making sure something looks "just right," whether it’s books lined up on a shelf or cans in a fridge. The objects in question don't really matter as much as the symmetry and the visual appearance.
Keep in mind that these aren't the only types of OCD that people experience but some of the more common ones.
What is an Anxiety Disorder
Anxiety refers to the feeling of being worried, uneasy, or tense about something. It is often accompanied by physical sensations that can range from barely noticeable to severe and disruptive, such as rapid heartbeat, sweating, restlessness, muscle tension, and shaking. It is a normal human emotion and can actually be healthy in small amounts. It can keep us alert and motivated in our daily lives to a degree.
For example, a student who is anxious about an upcoming exam may be more likely to study sufficiently than one who isn’t.
However, having too much anxiety, or experiencing it during times when there is no actual threat, can be problematic and in some cases warrant a clinical diagnosis. There are 11 anxiety disorders listed in the current DSM, but among the most commonly diagnosed are generalized anxiety disorder, social anxiety disorder, and panic disorder.
Generalized Anxiety Disorder
Individuals with generalized anxiety disorder (GAD), experience chronic, persistent worry about a variety of topics. These worries are difficult to manage and are accompanied by physical and/or cognitive symptoms, such as irritability, difficulty concentrating, and muscle tension, that can negatively impact the ability to function on a daily basis.
Social Anxiety Disorder
Many people experience social anxiety to varying degrees; however, it becomes a disorder when it is persistent and affects a person’s ability to effectively engage in their life.
Social anxiety disorder manifests as an intense fear of being watched and judged by others. This is often brought to the forefront by situations like going to a party or on a date, giving a presentation, or even minor interactions with strangers, such as at the grocery store. This can particularly be difficult for those in school or jobs in which socialization is necessary to get through the day.
Panic Disorder
Panic disorder causes sudden bouts of intense anxiety, during which the person experiences a rapid heart rate, sweating, difficulty breathing, and/or other intense physical sensations of anxiety, for a period of time, usually out of the blue. In most cases, there's no identifiable trigger for the initial panic attack, and it leaves the person wondering why it happened. People with panic disorder worry about having another attack which perpetuates the cycle.
It's important to distinguish that not everyone who experiences panic attacks has panic disorder.
The disorder component enters the equation when it's significantly impacting one's way of life and happens on a continuous basis.
How are OCD and Anxiety Linked?
Although OCD and anxiety are separate conditions, they are linked and have some overlap. Excessive worry and fear are present in both conditions. Aside from that, anxiety and OCD both involve the presence of intrusive thoughts, the perceived need for control and avoidance.
That said, the way one with anxiety versus OCD tries to manage these uncomfortable thoughts and the associated feelings is different. For example, someone with OCD who experiences an intrusive thought may work to get rid of it, or minimize the effect, by engaging in compulsive behavior. On the other hand, someone who has anxiety might either engage in some type of cognitive reasoning to work through the thought, ruminate about it, or try to suppress, deny, or ignore it – all strategies that might work in the short term but often backfire in the long run.
How to Treat OCD & Anxiety
If you're reading this to learn how to help someone with OCD or maybe you also think you have OCD and anxiety, then you've come to the right place.
There are a variety of available treatments for OCD and anxiety disorders; therapy and medication are two of the most effective.
Therapy
Going to therapy is one of the first lines of treatment for both anxiety and OCD. The specific treatment modality will vary based on person to person and the type of anxiety they are looking to address. With that said, there are some therapy modalities that have been shown to improve symptoms of anxiety and OCD.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is one of the most widely used therapy modalities that works to help individuals recognize and challenge negative automatic thought patterns and change ineffective behaviors. Some forms of CBT rely more on identifying specific types of ineffective thought patterns (such as catastrophizing, the tendency to exaggerate the potential negative consequences of an event), disputing them, and replacing them with more “rational,” balanced thoughts.
Other cognitive-behavioral modalities, such as Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT), incorporate similar awareness of thoughts patterns, while encouraging less engagement from cognitive processes, meaning getting less involved in thoughts and increasing awareness of the present moment.
Exposure Therapy
Exposure therapy can be helpful for those with both anxiety and OCD. The goal of exposure therapy is to slowly expose individuals to their anxiety triggers in a safe and controlled environment. For example, someone with a fear of elevators might go with their therapist to an elevator and start by just clicking the button. At the following session, they might step inside the elevator for a few seconds with the door open. Next, they might ride down one floor, and so on until they are able to ride an elevator without being overly anxious.
The same process would apply to someone with OCD and would be catered to the client’s particular obsessions and compulsions. In essence, exposure therapy is about managing the initial discomfort and working towards acclimating yourself to the situation that provokes feelings of anxiety. For example, if one had symmetry OCD, it could start by making one book crooked on a shelf for a few minutes and then eventually leaving it.
Medication
Aside from therapy, medication can also be a helpful tool for some people in treating both anxiety disorders and OCD. Evidence shows that medications such as selective serotonin reuptake inhibitors (SSRIs), like Lexapro and Zoloft, can help reduce overall anxiety and the severity of symptoms of these disorders.
A higher dose of an SSRI is often required for clients with OCD to experience significant symptom relief, while those with anxiety disorders may feel better on a relatively low dose. A psychiatrist can help a client determine which medication is most appropriate for the treatment of anxiety and OCD.
Conclusion
OCD and anxiety are mental health conditions that are both common and treatable. Here at Octave, we have therapists who specialize in both of these conditions and are trained to help clients manage their symptoms. Get Started with Therapy with one of our licensed clinicians to get more insights into your specific triggers and come up with coping strategies to help you live a better life.
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