How do I know if it’s OCD or Anxiety?
(No artificial intelligence (AI) was used in the creation of this article.)
Clients often ask whether they are experiencing OCD or “just” anxiety. Sometimes there’s a simple answer, a sort of “hack.” But usually it’s more nuanced. We can always make sense of it when we work together with the right tools.
The tools are evidence-based models of therapy and scientific study. Until about 10 years ago, OCD was considered and anxiety issue. More recently, through the use of brain imaging technology, scientists agree there is a strong neurological component to OCD—that it happens more in the brain that in in the mind. Having OCD definitely causes anxiety, but the anxiety itself is not the key component. Rather it’s the misinterpretation of data combined with reinforcing behaviors which create a loop in the brain. When I work with folks in my therapy practice in Colorado, I strive to make them experts, like Jedi Knights, of OCD. Armed with the right knowledge and tools, people can gain a solid grasp on what is anxiety, and what’s “just” OCD.
Here are some tips about anxiety vs OCD. *
*This article is not meant as therapy or a replacement for therapy. If you think you may have OCD, please reach out to a qualified mental health professional for a full assessment.
Anxiety vs OCD: Anxiety itself is not inherently bad and can even serve a healthy purpose. Problematic anxiety is an “outsized” response to a situation or a worried thought, where the level of distress is not matching the level of threat. Anxiety like this is made of thoughts, feelings and body sensations that typically respond to relaxation techniques, self-compassion, distraction/refocussing and various forms of CBT and psychodynamic therapy. OCD is a self-reinforcing cycle of thought+anxiety+behavior+relief which does not respond to the tools listed above. OCD can be described as responding to imaginary stimuli as if it is real. The content of an obsession might be technically real (like germs are real), but the thought that causes us to ritualize—to seek relief from the stressful thought—is not rooted in evidence (like the belief that the germs remain after one good handwashing.) But of course they feel real enough to cause severe impact. Obsessions and compulsions require special skills taught in Exposure and Response Prevention (ERP) and Inference-based Cognitive Behavioral Therapy (I-CBT).
Shame and Embarrassment. People struggling with OCD often report shame and embarrassment about their obsessions that is not present regarding their anxiety and anxious worries. For instance, if you’re worried about the medical test results while waiting for lab results, you might share that with a friend and not feel too bad about that. That’s anxiety. But if you’re waiting on elective test results that were not recommended by a doctor and it’s the second or third time you’re getting these tests done, you might feel some hesitation or embarrassment about sharing those worries with a friend. That’s a huge clue that you may be struggling with OCD.
Is it making you do something? Anxiety doesn’t ask much of you—maybe just to worry and avoid things. With plain old anxiety you might even say to yourself, “I can’t do anything about it, and that’s problem!” But OCD tells you that you must do something, usually something specific. And when you do that thing (sometimes in a very particular way) you feel relief. Sometimes OCD tells you that you have to do something in your head like “figure it out” or “plan for every contingency,” which is different that just worrying. An OCD therapist can help you identify the difference.
What if you don’t? Since we know that Anxiety doesn’t ask you to do much, and OCD does, a great follow-up question to see if it’s really OCD is, “What if I don’t do anything about it?” What would happen if you did not engage in any compulsions or rituals (even in the mind)? If the answer to that question is “something bad will happen.” Then you’re probably looking at OCD at work. If the thought of that question brings more anxiety, then you’re also likely dealing with OCD.
I hope that these tips spark more questions and inspire curiousity about your mind and how you’re thinking and behaving. This brief article is not meant as a diagnostic tool; it’s not meant to give a conclusion to someone who is wondering if they have OCD. If you’re reading this, I hope these ideas give you more ways to talk about your experience when you discuss it with a qualified OCD-trained therapist.
OCD frequently gets mistaken for other issues because of its similarities with anxiety. Related issues that get misdiagnosed or missed include social anxiety, phobias, panic disorder, body focused repetative behaviors (like skin picking and hair pulling), and body dysmorphia. Missing OCD can delay really helpful treatment and prevent people from living their best lives—sometimes for a decade or more. That’s too long to suffer when help is available.
