OCD or Anxiety? Here's How to Tell the Difference

What feels like classic anxiety might actually be something else entirely. Experts explain how OCD hides in plain sight, and why getting the diagnosis right matters.

You may not know this, but what you thought may be a classic case of anxiety may actually be signs of an obsessive-compulsive disorder (OCD). There is a distinction, and it matters because treatment varies accordingly.

"OCD is like anxiety on steroids," says Simone Leavell-Bruce, PsyD, a psychotherapist who specializes in OCD. A person who has OCD, according to Leavell-Bruce, has “really horrible, intrusive thoughts and images” that repeatedly enter one’s head.

These intrusive, unwanted thoughts, or obsessions, are often rooted in some form of doubt. According to Levi Riven, PhD, a psychologist based in Ottawa, this is followed by the compulsion to pacify that doubt or relieve the distress they cause, through certain behavior or rituals.

These rituals can be either physical, like repeatedly washing one’s hands for fear of the presence of germs, or mental, like mentally listing reasons why something they fear isn’t true.

Anxiety, like OCD, involves excessive worry, but this does not typically result in compulsive behavior.

One key difference between the two is in how the worries feel. Anxiety usually stems from everyday concerns like work or health. OCD obsessions are often more unusual and typically described as "ego-dystonic," a term referring to something that contradicts norms, values, morals, or the sense of self. "That's what makes OCD so scary: it hits you with something you just don't recognize in yourself," Leavell-Bruce says.

That being said, OCD is not an anxiety disorder and cannot be classified as one. This is because in OCD, the anxiety is the side effect of the obsessive thoughts, while anxiety is the problem itself and not a result of some other condition.

There are different approaches to treating anxiety and OCD. With anxiety, talking to someone during therapy sessions can help. But this cannot be said for OCD, because talk therapy tends to worsen its symptoms. Instead, exposure and response prevention therapy (ERP) is considered the best way to address OCD, according to experts.

Because these two conditions tend to overlap, about 75 percent of people with OCD also have an anxiety disorder. If you suspect you may have either, a licensed mental health professional is the only one who can provide an accurate diagnosis. (Talkiatry)