Are they the same?
As a therapist specializing in treating obsessive-compulsive disorder, one of the questions that I hear the most is in regards to the differences between having an anxiety or OCD diagnosis. The way that I like to describe it will take us back to second grade for a second. All squares are rectangles, but not all rectangles are squares. I see OCD as existing under the umbrella of anxiety disorders that holds multiple diagnoses, such as specific phobia, generalized anxiety disorder, panic disorder, and of course the aforementioned obsessive compulsive disorder. But not all anxiety is OCD. Here we will go into some of the key differences between the two.
When working with OCD I often use the words OCD and anxiety interchangeably. I might ask the question, "What does your OCD have to say about this?" and in the next breath ask, "How is anxiety playing a role here?" This might seem like we haven't landed at clear spot, but describing a square as a rectangle is not inaccurate.
OCD Symptoms
The first indicator that a diagnosis of OCD might be present is the presence of obsessive thoughts. This might also take place in another type of anxiety disorder, but this is our starting place for OCD. In this, the intrusive thoughts come on without notice or warning and may stick around for hours, days, or weeks on end. These unwanted thoughts cause significant distress to the person experiencing them and are usually associated with real-life concerns. As we dig deeper, we will generally see that compulsive behaviors are also present in response to the obsessions. There is a faction of people in the OCD community who say that compulsions do not need to be present in the symptoms of OCD. Others state that though the compulsions may not be visual ritualistic behaviors, they could be mental and compulsions are always present in OCD. I tend to align with the latter on this debate and when there is a complete lack of compulsions, either mental or behavioral, I might begin to explore different types of anxiety disorders.
This next thing I am going to say will sound like it comes from an unprofessional and non clinical manner. However, I guarantee that any good OCD therapist would agree with the following: OCD has a certain flavor to it. I know that isn’t helpful for reading a blog, as there’s really no way I can describe that flavor very effectively to you. It would be like trying to explain the flavor profile of a complex dish that you've never tasted before. But if I were to try and explain it, I would say that OCD tends to take root in a few different themes. It would be too hard to describe all of them, but when you see a specific diagnosis continue to show up in the same ways over and over again, you start to pay attention.
What can make this difficult to understand from the perspective of the public, is that a lot of obsessions take place in persistent thoughts centering around ideas that are very upsetting. People do not tend to be as vocal about the presence of obsessions that they are having when the fear is that they would violently attack a loved one or impulsively sexually violate a minor. But these are themes that I hear time and time again, and so when those types of intrusive thoughts are present my mind quickly moves to exploring OCD ahead of just checking for the symptoms of anxiety. This is where our square/rectangle analogy is helpful. Perhaps this is meeting the criteria for being an anxiety disorder and we should look at that. Well, that would be like asking somebody if they have considered that the square that is being inspected could in fact be a rectangle. Classifying something as a square confirms that it is in a rectangle, it is implicit.
The Blur
As we begin to cross the line out of OCD territory, I would like to take a quick stop at social phobia. This is when people have certain fears about being in a social situation and it causes extreme distress to even think about doing so. The reason that I would like to take a quick pit stop here, is because this can look very much like OCD. There are generally intrusive and obsessive thoughts about appearing weird or doing something embarrassing, avoidance tendencies certainly always exist within this diagnosis, and there might even be checking behaviors associated with the fear, such as texting friends are a social gathering to check if anything "odd" happened or was portrayed.
Either way, the excessive worry that comes from social anxiety disorder is going to be treated the same way that OCD is treated. Exposure and response prevention is the first-line treatment when it comes to treating OCD and will often be the center of a treatment plan. There are other diagnoses that will also utilize this modality as the most effective treatment, such as specific phobia. I wish that I had some sort of shape to work this into our square/rectangle analogy, but my google search produced the fact that there are only two types of rectangles. Oh well, every analogy falls apart eventually.
Anxiety
As we make our way towards the other side of fence, we explore how sometimes the feelings of anxiety are not necessarily better explained by OCD. One thing that I find present in anxiety that is often not the case with OCD is that there is not a poignant cause of the anxiety symptoms that are occurring. People might describe feeling just generally anxious and feeling all of that anxiety in their body, without the ability to pinpoint exactly where is is coming from. At times, they are able to vocalize the sources of their anxiety but it does not come from as narrow of a focus that happens with OCD. It might an amalgamation of the general worries that exist in everyday life. OCD does not tend to show it's face with five small things that are causing anxiety and combining themselves into the physical symptoms that show up in association with anxiety.
Additionally, people suffering from more general anxiety disorders are often more likely to be excessively distressed by more occurrences. During the pandemic I found it very interesting to hear how my clients with OCD were handling the concern around COVID. What I most often saw was that unless their OCD took some root in contamination, illness, or disease in some way, they were no more anxious about the possibility of contracting COVID than the average person I was seeing for therapy at the time. It was the people with anxiety disorders who were more likely to engage in more avoidance or compulsive behaviors. People with OCD tend to dislike uncertainty around specific themes, where as people with anxiety disorders latch on to uncertainty in a variety of areas of their lives.
Language
At the end of the day, I like to help people understand that what we are really talking about is the language that we use to categorize a particular mental health disorder. And language is extremely important as it helps us navigate how to interact in the world and having an accurate diagnosis is massively influential in how to approach treatment. But there are certain cases when I tell my client that we aren't going to get wrapped up in the specific diagnosis as we are going to end up utilizing the same treatment either way to address the behaviors and thoughts they are exhibiting. As always, you should talk with a therapist about what you are experiencing. I always recommend talking with a trained OCD therapist if you are suspecting that you might have OCD. Unfortunately, OCD often goes undetected and it will not get better if you are not engaging in specific OCD treatment.
The international OCD foundation is a great resource to help you find a list of therapists in your area. If you are in Arizona, we are of course happy to help you with navigating this journey as well.
Resources
We hope you are leaving this blog with a bit of new information for your OCD journey, whether it is for you or a loved one. OCD is a diagnosis that isn't a quick thing to arrive at, or work through and we hope we have been a small support to you. We have more resources for you available not only in our blog, but also our online membership. Thrive+ features a library of psychoeducation classes for you to learn more about yourself and enhance your healing journey. If you are looking for in person treatment for OCD we have both an Intensive Outpatient Program specific to OCD, and a weekly ERP Group. If you have questions about our service options, don't hesitate to reach out!
