Is It OCD or Anxiety? How to Tell the Difference

Everyone experiences alarming thoughts and waves of panic, especially during hard times. But when racing thoughts turn into extreme hyper-vigilance and the need to perform rituals to regain control, it can be difficult to tell the difference between OCD vs. anxiety.

On the surface, both conditions may look similar or even identical. However, it’s important to get an accurate diagnosis to receive the appropriate treatment. This article will explain the key differences between obsessive-compulsive disorder and anxiety and outline the various available treatment plans.

OCD and Anxiety Can Look Very Similar

Obsessive-compulsive disorder (OCD) and anxiety are frequently confused because they both trigger spikes in adrenaline, avoidance, worrying, and physical distress. Both conditions may result in someone becoming hypervigilant, avoidant of their triggers, or often in high distress.

The key difference lies in what happens after the initial thought or trigger. People with anxiety experience a linear escalation. They encounter a trigger, become increasingly worried, experience stress, and gradually become calmer once the concern is resolved or the situation passes. On the other hand, people with OCD often experience their obsessions and compulsions randomly.

OCD vs Anxiety: The Key Differences

The key distinctions between OCD and anxiety are the source and response to the trigger. Below, we outline how the OCD and anxiety loops differ.

What OCD Typically Looks Like

OCD manifests as obsessions and compulsions that manifest as such:

• Obsessions: These are the recurrence of intrusive thoughts often involving hygiene, religion, mistake-related fears, or needing things to be organized in a specific manner.
• Compulsions: These are repetitive behaviors that you may feel are uncontrollable. Common repetitions include hand-washing, repeatedly checking various appliances, counting or repeating phrases, and touching things multiple times. These compulsions may provide temporary relief, but they don’t address the core problem.

Someone with OCD may take significantly longer to complete daily tasks, such as washing the dishes or preparing to drive to work. Children with OCD might demonstrate symptoms such as constantly needing reassurance from a parent or rewriting/erasing homework until it looks “right.”

Individuals with OCD may hide their symptoms from family members and friends due to shame and even delay seeking treatment for years.

What Anxiety Typically Looks Like

Unlike OCD, anxiety is less likely to “happen out of nowhere.” Here’s what it might look like:

• Somatic symptoms: Individuals with anxiety may experience stomachaches, headaches, muscle tension, and shortness of breath.
• Behavioral changes: A person might avoid certain activities because of a fear of failure, struggle to control anxious thoughts, or become socially withdrawn to avoid disappointing their friends and family.
• Psychological symptoms: Individuals display excessive worry, tend to jump to conclusions, struggle to concentrate, and feel constantly on edge.
• Panic attacks: Excessive worrying may cause intense surges of discomfort that affect someone’s breathing and can cause chest pain.

Anxiety may impair a person’s daily life through poor sleep quality, increased stress, and constant negative thoughts. It can also impact a person’s relationships, especially if they are highly irritable, frequently experience social burnout, and need a lot of reassurance.

Diagnosing OCD and Anxiety

OCD is a relatively rare condition. Roughly 1% to 3% of people receive a diagnosis [*]. To diagnose OCD, specialists facilitate a detailed psychological evaluation that involves taking your medical history, interviewing family members, and noting your symptoms.

A diagnostician may also ask you to answer a questionnaire—either the Y-BOCS (Yale-Brown Obsessive Compulsive Scale) for OCD and the GAD-7 (Generalized Anxiety Disorder Assessment) to assess the severity of symptoms.

Diagnosing OCD can sometimes be challenging because its symptoms may overlap with those of anxiety, depression, and other mental health conditions.

Can anxiety be misdiagnosed as OCD?

Yes, it’s possible for anxiety to be misdiagnosed as OCD, though it’s more common for OCD to be misdiagnosed as anxiety. Misdiagnosis is common for someone likely to have generalized anxiety disorder (GAD), as they might frame fears about their job or relationships as obsessive.

Roughly 50% of OCD cases are initially misdiagnosed as GAD or depression, and this is often the case when clinicians mistake compulsions for worrying [*].

Can you have both OCD and anxiety?

Yes, it’s possible to have both OCD and anxiety. Roughly 33% of individuals diagnosed with OCD are also diagnosed with anxiety [*]. When an individual has both conditions, they experience a constant baseline of hypervigilance and sudden spikes of panic.

Fortunately, both disorders respond exceptionally well to targeted behavioral therapies. Completing regular evidence-based treatment can help individuals regain full daily functioning.

OCD and Anxiety Treatment

There is no definitive cure for OCD, but treatment can reduce symptoms and help restore daily functioning and quality of life. The most effective treatments for both conditions are therapy and medication together.

When someone has both OCD and anxiety, treatment must be tailored. Psychotherapy is commonly used to treat both conditions, with cognitive-behavioral therapy (CBT) being a popular option to eliminate intrusive and negative thoughts. Specialists may recommend exposure and response prevention (ERP) to help individuals overcome fears of certain objects and minimize the need to perform compulsive rituals [*].

Certain psychiatric medications can help control or minimize compulsions, including antidepressants, such as Prozac, Luvox, or Paxil. Your doctor may rotate medications to find out what works best for your specific treatment.

In severe cases, specialists might recommend deep brain stimulation (DBS), which implants electrodes into certain areas of the brain to control impulses [*].

It’s important for individuals to develop relapse-prevention skills, especially during periods of major life transitions.

The Bottom Line

Both OCD and anxiety can cause significant distress and take a heavy mental load. Learning how to cope with stressors and triggers is the key to retaining executive functioning and a positive environment. Explore more helpful resources from our collection of anxiety worksheets.

Sources:

1. Cervin M. “Obsessive-Compulsive Disorder.” Psychiatric Clinics of North America, 2023.
2. Perez MI, Limon DL, Candelari AE, et al. “Obsessive-compulsive disorder misdiagnosis among mental healthcare providers in Latin America.” Journal of Obsessive-Compulsive and Related Disorders, 2022.
3. Sharma P, Rosário MC, Ferrão YA, Albertella L, Miguel EC, Fontenelle LF. “The impact of generalized anxiety disorder in obsessive-compulsive disorder patients.” Psychiatry Research, 2021.
4. Simpson Hb, Hezel D. “Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.” Indian Journal of Psychiatry, 2019.
5. Mar-Barrutia L, Real E, Segalás C, Bertolín S, Menchón JM, Alonso P. “Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years.” World Journal of Psychiatry, 2021.