For those trying to discern whether they have an anxiety disorder or obsessive compulsive disorder (OCD), it can be helpful to know the similarities and differences between the two. After you understand the connection between anxiety and OCD, you can better assess what to do next.
Anxiety disorders are relatively common and affect almost one in five adults each year. OCD, despite being less widespread, still affects millions of people in the United States. Here you will learn more about both types of disorder and what treatment might look like for each.
Anxiety
Anxiety disorders exist in a broad category and include General Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, and phobias. For simplicity’s sake, it can be helpful to first explain how many people think of anxiety as a concept more generally.
To avoid confusion, it’s important to understand exactly what is meant when we use the word anxiety, especially as it compares to similar terms like worry and fear. Anxiety has a few specific and distinct components.
The first is that anxiety is future oriented. This means that it is not happening in response to something in the present. Anxiety is one way the brain sometimes responds to potential threats that it anticipates. A second important part of anxiety is that it tends to be enduring, and is not necessarily linked to a specific thing or event. This means that the cause of anxiety can be murky and does not necessarily need to have an identifiable cause. Unfortunately, this in and of itself can be a cause of anxiety. Contrast the vagueness that can exist as part of anxiety with fear, which is an active and acute feeling in the present moment (typically with a known cause). Anxiety might arise from the wind rustling through tall grass. When a rattlesnake slithers out, that’s fear.
Worry, the other similar future oriented feeling, is more specific and temporary. Worry is primarily cognitive, while anxiety has a physical component like sweating or increased heart rate. You might be worried about the math test you have to take next week. Thinking about how you’re going to handle your school work with all of your other life obligations might make you anxious. Persistent worry is a major component of anxiety.
Anxiety can have both mental and physical (or behavioral) symptoms. These include feelings of restlessness, irritability, shortness of breath, racing or pounding heart, muscle tension, and the persistent worry mentioned above. This is really where we begin to see the connection between anxiety and OCD.
Obsessive Compulsive Disorder
OCD also has mental and behavioral components. The mental aspects of OCD are the obsessions. Obsessions refer to recurring intrusive and distressing thoughts or images a person cannot control. These thoughts often center around hygiene, order, symmetry, taboo and harm. To alleviate these thoughts, an individual will have urges, or compulsions which can take the form of repetitive behaviors. These compulsions are the behavioral component that accompanies the obsession. Common behaviors in individuals with OCD include washing, cleaning, and checking, ordering, and arranging objects.
You might think that the mental part of OCD sounds a bit like anxiety, and you would be right. In fact, OCD was once considered an anxiety disorder! Prior to recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) that mental health professionals use to categorize mental illnesses, people categorized OCD differently.
This exemplifies something very important about the flexible nature of DSM diagnoses in general. It is crucial to remember that diagnoses in the DSM are descriptions not explanations. They are constructs, created by committee and subject to change, that are not physical things in the same way as diseases like cancer or the flu are. This in no way diminishes the severity of these disorders, but points more to our limited and still evolving understanding of them.
This is how in the newer editions of the DSM, a new category was introduced called Obsessive-Compulsive and Related Disorders. This category includes OCD along with other related conditions.
Some mental health experts think that OCD should have remained as an anxiety disorder, while others made an argument that it and other obsessive-compulsive related disorders should be in a category of their own. Currently, it is the latter group who won. However, the fact that OCD was once considered an anxiety disorder further demonstrates the connection between anxiety and OCD.
Similarities
While OCD is no longer an anxiety disorder, it is hard to miss some of the common factors. Not only are there commonalities between the disorders, anxiety can coexist with OCD as two distinct diagnoses in what is known as a comorbidity. This is the formal way of saying the two diagnoses are occurring together in the same individual. For a relevant example, some studies suggest that as many as 84% of people with GAD have a comorbid disorder. This could be any other mental health diagnoses, including OCD.
OCD by definition almost always involves some form of anxiety. The degree to which they contribute to or interact with one another depends on the individual. With some comorbidities, there are similar underlying causes. One of the reasons for its new categorization is that OCD has different symptoms and its underlying mechanisms are different fundamentally from anxiety disorders. However, they are still related. One commonality may be the brain detecting “false alarms” in both disorders. All humans try to avoid harm and danger as a function of survival. It is possible that in both anxiety disorders and OCD, our alarm systems malfunction and over react.
Causes
Causes of both anxiety and OCD are complicated. There are biological, social, and cognitive components that can contribute to both the causes and manifestations of each.
While some level of anxiety is normal and healthy, it can become pathological at the extremes. Similarly, many people have OCD-like traits, but these exist on a spectrum where the extreme variations are seen as a disorder.
OCD especially is biological in origin and seems to stem from structural differences in the brain region called the basal ganglia. The basal ganglia is part of the limbic system, which is largely responsible for emotions, memory, and overall regulating our bodies. The basal ganglia itself is specifically related to movement, motivation, reward and pleasure. Another part of the limbic system is one of the more famous parts of the brain, the amygdala. This is the area of the brain that among other things, helps us detect threats and respond to danger. The significance of the limbic system is another connection between anxiety and OCD.
Differences
Despite the similarities between OCD and anxiety disorders like GAD, it is also important to realize how they are different. Thinking patterns regarding what one is specifically anxious about in OCD versus anxiety are unique. People with anxiety disorders typically worry about realistic, possible concerns. However, a person with OCD may have more unrealistic or unlikely concerns that can become obsessions.
In individuals with OCD, the brain can become focused on the risks of actions, fearing potentially bad decisions. The link between this state of mind and anxiety is clear. People with OCD have a tendency to perceive both the past and future in a more negative way. This often leads to not only anxiety, but also potentially depression, or even hostility.
While OCD already has a component of anxiety baked in, additional external anxiety provoking issues, along with accompanying stress, can cause underlying OCD symptoms to worsen even further. What’s more, is that even on their own, OCD symptoms can cause anxiety. This can lead to a vicious cycle of self perpetuating anxiety. This means that individuals with OCD who carry out repetitive behaviors or rituals can become more anxious if they cannot complete them.
Treatments
In treatment, it can be helpful to recognize the adaptive and protective aspects of the traits that underlie anxiety and OCD. For example, while uncomfortable and often seen as negative, fear and worry evolved to keep us safe and help us solve problems. It is only when they are hyper sensitive or cannot be turned off that they become disorders. If someone had no concerns about contamination, past wrongs, or maintaining order, all related to OCD, they might have had a harder time.
Treatment for anxiety disorders and OCD vary case by case and are specific to the individual. Treatment for both disorders often includes cognitive behavioral therapy (CBT) and exploring the use of medications. Treatment for OCD specifically can include exposure and response prevention (ERP).
CBT can help individuals with both disorders by examining the thoughts and beliefs that accompany fears, obsessions, and compulsions. CBT will also address behaviors that the individual wants to change by identifying potential triggers.
A psychiatrist may recommend antianxiety medications in the treatment of anxiety disorders. With OCD, SSRI medications are often used to manage symptoms and assist with therapy. In severe cases, antipsychotic medications could be considered.
Something that has been found to be effective when treating OCD is ERP. ERP therapy helps an individual confront their fear and resist compulsions. This type of therapy may help the brain adjust its threat detection system, with results being supported by neuroimaging studies.
If you’re struggling with an anxiety disorder, OCD, or both and want to learn more about the connection between anxiety and OCD, talking to a mental health professional could help.
