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OCD vs Anxiety Disorder: How They Are Related?

Written by:
Dorianne Green
MD
Medical Reviewer:
Dr. Michael Chichak
MD
The medications listed on this website are provided for informational purposes only.
Their inclusion does not guarantee they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. Healthcare providers may prescribe other medications or recommend non-pharmacological treatment based on the patient’s unique health circumstances and needs. Read more

Highlights

  • Anxiety disorders and OCD are distinct mental health conditions, although they do have overlapping symptoms such as intrusive thoughts, significant distress, and avoidant behavior.
  • People with OCD can experience anxiety because of the distress caused by their obsessions and compulsions.
  • 90% of individuals with OCD [1*] have at least one other co-existing mental health condition; often, this is an anxiety disorder.
  • People with OCD experience repetitive thoughts that are unrealistic and take up more than one hour a day. In contrast, thoughts in anxiety disorders relate to overwhelming fear and worry, often about realistic circumstances.

You’re having recurring upsetting thoughts that are starting to get in the way of your daily routine. You’ve done some research, and two mental health conditions are coming up in your results: OCD and anxiety. But this is where you’re getting stuck: how do you differentiate between them and better explain your experiences to a healthcare provider? This article will discuss these two conditions, compare them in detail, answer your questions, and tell you what you can do next.

Get an accurate diagnosis from a licensed medical provider. Book a video visit in a few clicks.

What Is OCD?

OCD is short for obsessive-compulsive disorder. It is a mental health condition characterized by:

  • repeated intrusive thoughts, urges, or mental images called obsessions that might lead to
  • repetitive actions or mental images called compulsions.

What are intrusive thoughts? They are unwanted thoughts that are difficult to control, have no clear purpose, and cause distress.

The compulsions are usually a reaction to the person’s obsessive intrusive thoughts. With the help of these repetitive behaviors or mental images, people with OCD try to: 

  • Take away the distress caused by the obsessions
  • Prevent a feared consequence

It is estimated that an average of 2 people per 100 [1*] worldwide will have OCD in their lifetimes.

OCD Diagnosis

In order to be diagnosed with obsessive-compulsive disorder [2*] , according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must:

  1. Have either obsessions, compulsions, or both.
    1. Obsessions are defined as:
      1. Recurrent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
      2. The individual attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some thought or action (i.e., by performing a compulsion).
    2. Compulsions are defined as:
      1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly.
      2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
  2. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The disturbance is not better explained by the symptoms of another mental disorder.
"Patients often find these behaviors embarrassing even though they perform them themselves. The compulsions associated with OCD are so strong, that patients are often unable to resist and find themselves performing these repetitive behaviors. Because of the embarrassment, social anxiety and generalized anxiety can be found as comorbidities."
Dr. Michael Chichak, MD
Medical provider at MEDvidi

Examples of obsessive thoughts [3*] :

  • Fear of contamination
  • Fear of being harmed by loved ones
  • Fear of harming loved ones
  • Fear of losing something important
  • Fear of crime
  • Blasphemous thoughts
  • Inappropriate aggressive or sexual thoughts
  • Meaningless images, sounds, words, or music

Examples of compulsive behaviors (all repetitive):

  • Handwashing
  • Showering
  • Checking locks and windows
  • Arranging things
  • Seeking approval
  • Counting in sets
  • Mental rituals
Only a qualified healthcare provider can diagnose OCD and anxiety disorders. Book an online consultation if you have bothersome symptoms.

What Is Anxiety?

Anxiety is a common mood state that is related to fear [4*] . Fear is your body’s automatic reaction when it believes it is in danger, and it might trigger the fight-or-flight reaction. The threat could be real or imaginary.

Anxiety is normal to experience; it is your brain and body’s way of keeping you on your toes and safe. Usually, anxiety is mild and passes quickly, but when intense feelings of fear and worry are crippling and affect your everyday life, it could be part of an anxiety disorder.

Anxiety Disorders

Anxiety disorders are the most common mental health conditions, with up to 30% of adults [5*] affected at some point in their life. There are many types of them:

  • Generalized anxiety disorder (GAD) is one of the most common mental health conditions. It manifests as a constant feeling of being overwhelmed by worry about everyday things [6*] like relationships or work. 
  • Social anxiety disorder manifests as an intense feeling of fear about being judged in social situations.
  • Panic disorder occurs when people have repeated and unexpected panic attacks and frequently worry about having another panic attack.
  • Specific phobias occur when a person fears a specific object or situation, such as spiders, heights, or confined spaces.
  • Other anxiety disorders caused by specific medications or medical problems.

So, where does the confusion between OCD and anxiety come in?

Can OCD Be Mistaken for Anxiety?

In the past, the American Psychiatric Association (APA) classified OCD as a type of anxiety disorder [7*] . That’s how similar they are.

"Many mental health conditions often get misdiagnosed as anxiety at presentation because it is common that other mental health conditions can cause a patient to have anxiety. That's not to say that anxiety is not coexisting, however, anxiety may not be the only diagnosis. As such, be sure to discuss this with your healthcare providers so that they can make an accurate diagnosis and cater a treatment plan to your unique situation."
Dr. Michael Chichak, MD
Medical provider at MEDvidi

Under the new 2013 DSM-5 guidelines, obsessive-compulsive disorder patients now fall under a distinct category, the obsessive-compulsive and related disorders (OCRDs), which includes [1*] :

  • OCD
  • Body dysmorphic disorder (BDD): A mental health disorder where the person is obsessed with perceived flaws in their physical appearance, leading to distress and dysfunction.
  • Hoarding disorder: It prevents people from throwing away objects or possessions, resulting in excessive clutter and impaired daily functioning.
  • Trichotillomania: It is also known as a hair-pulling disorder; it’s caused by an uncontrollable urge to pull out one’s hair and can result in hair loss and distress.
  • Excoriation or skin-picking disorder: It leads to compulsive picking, scarring, and consequent distress.
  • Substance or medication-induced obsessive-compulsive and related disorders.

Let’s take a closer look at the link between OCD and anxiety disorders.

Shared Symptoms

OCD and anxiety disorders have overlapping symptoms:

  • The distress caused by obsessions and compulsions can result in anxiety symptoms. 
  • People with anxiety disorders may experience intrusive thoughts, which is one of the classic OCD symptoms. Although these unwanted thoughts may upset them, they are not repeated and time-consuming as they are in OCD.
  • In both OCD and anxiety, people have difficulty concentrating and mood swings.
  • Avoidance of triggering situations is common in both these mental health disorders.

Can You Have Both?

Believe it or not, it is common for people with obsessive-compulsive disorder to have a co-existing anxiety disorder [8*] . This is true for 2 to 6 out of 10 individuals.

What Else Could It Be Other Than OCD or an Anxiety Disorder?

Other psychiatric disorders might also cause intrusive thoughts, significant distress, and avoidant behavior. These might include depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD). In addition, medically-related disorders such as thyroid problems, vitamin deficiencies, and brain disorders might cause symptoms that mimic OCD and anxiety.

This is why it is essential to see a healthcare provider for a diagnosis; online research is not enough when one’s daily life is affected.

Have an appointment with a licensed medical provider from the comfort of your home and get personalized treatment.

Key Differences Between OCD and Anxiety Disorders

So, if they are so similar, how do you tell whether you have OCD or an anxiety disorder? Actually, you can’t tell it by yourself — only a qualified healthcare provider can assess your symptoms and make a diagnosis. However, it can be helpful to learn more about the differences to have a more detailed discussion during the consultation.

Let’s break it down into manageable pieces.

Nature of Thoughts

Although both conditions might cause intrusive thoughts, if we compare their basic nature, it comes down to this:

  • People with OCD have two types of thoughts:
    • Obsessive thoughts that are repeated, continuous, and unwanted, while also being unrealistic or irrational. A person may try to ignore or get rid of those thoughts through compulsions.
    • Compulsive thoughts or mental acts that they feel driven to have in response to an obsessive thought.
  • People with anxiety disorders have distressing thoughts related to excessive worry or fear. Often, they are related to a real-life experience.

Next, let’s look at behavioral differences.

Behaviors

OCD is characterized by compulsive behaviors. These are repetitive behaviors that one feels driven to perform in response to an obsessive thought. A person believes that such actions will ease distress or prevent a dreaded outcome; however, they are usually unrealistic and excessive.

On the other hand, behaviors that result from anxiety disorders stem from a response to worry or fear. This might be avoidance of anxiety-provoking situations, such as parties in social anxiety, and confined spaces or heights in phobias. Anxiety disorders might manifest with behaviors exhibiting physical symptoms like panic attacks triggered by the fight-or-flight response.

Triggers

The triggers for each condition can be divided into factors that provoke specific thoughts and behaviors and triggers that make the overall condition worse.

Obsessive-Compulsive Disorder (OCD)

Anxiety Disorders

Triggers of obsessions:

  • Dirty environments
  • Specific places
  • Certain numbers
  • Fear of a lack of safety

Triggers of excessive worry:

  • Poor health
  • Stressful events and traumatic experiences
  • Financial troubles
  • Social events (social anxiety disorder)
  • Specific situations (specific phobias)
  • Troubled relationships

Triggers that make OCD worse:

  • Emotions such as guilt, anger, or sadness
  • Change in routine
  • Lack of sleep
  • Major life events

Triggers that make anxiety worse:

  • Lack of sleep
  • Stress from being overworked
  • Caffeine
  • Lack of exercise
  • Lack of support

Is Overthinking a Sign of OCD or Anxiety?

Overthinking is a broad term that could apply to both OCD and anxiety disorders. In OCD, it relates to repeated obsessive ideas that make one feel the urge to perform compulsions to calm down. In anxiety disorders, one may overthink and worry about potentially realistic things, but they find it challenging to stop or even control such thoughts for a long time.

Summary Table: OCD vs Anxiety Disorders

 

Obsessive-Compulsive Disorder (OCD)

Anxiety Disorders

Key Symptoms

Obsessions (intrusive thoughts) and compulsions (repetitive behaviors); time-consuming

Excessive worry and fear related to specific situations depending on the type of anxiety disorder

Prevalence 

Approximately 1-3% of the global population will be affected in their lifetime

Up to 30% of adults, at some point in their life

Gender Ratios

Females are 1.6 times more likely to be affected

Higher prevalence in females, especially in disorders like GAD

Common Co-existing Mental Health Conditions

Often occurs with anxiety disorders (up to 60% of cases), depression, and tic disorders

Frequently comorbid with depression, OCD, and substance use disorders

Shared Symptoms

Anxiety, distress, intrusive thoughts, and avoidant behavior

Anxiety, distress, intrusive thoughts, and avoidant behavior

Key Differences

Characterized by specific obsessions and compulsions. Anxiety is a result of these obsessions or compulsions

Primarily characterized by overwhelming anxiety without compulsive behaviors. The worries are often more generalized or realistic

Treatment Options

There is some overlap in OCD and anxiety treatment, like the use of cognitive-behavioral therapy or medications called SSRIs for both of them in some cases. However, the recommendations within these two broad categories of treatments are different. That is why it is essential to consult a healthcare professional for an accurate diagnosis and a personalized treatment plan.

For Anxiety Disorders

If worry affects your daily functioning, it is time to consult a doctor. They might recommend therapy or prescribe medication.

Cognitive-Behavioral Therapy

This is a type of talk therapy that centers around recognizing and changing thought patterns that trigger anxiety and, by doing this, modifying behaviors. Some techniques that might be taught are mindfulness and progressive relaxation.

Medication

Your healthcare provider might prescribe medication as part of your anxiety disorder treatment plan, such as:

  • Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, citalopram escitalopram, fluvoxamine, and paroxetine; serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine and venlafaxine. These two classes are considered first-line maintenance treatment for anxiety disorders.
  • Benzodiazepines like diazepam and clonazepam are helpful in an anxiety crisis but should only generally be used short-term because of the risk of addiction.
  • Beta-blockers block adrenalin and prevent physical symptoms caused by the fight-or-flight response, such as sweating, flushing, palpitations, and tremors.
See a healthcare provider online to learn what treatment for anxiety can be right for you.

Note that booking an appointment doesn’t guarantee obtaining a prescription. The decision is at the discretion of your healthcare provider.

For OCD

Treating OCD might require a combination of therapy and medication.

Exposure and Response Prevention Therapy

Exposure and response prevention therapy, a type of cognitive behavior therapy, is first-line [3*] OCD treatment.

During this therapy, individuals with OCD are gradually exposed to the obsession trigger (e.g., dirt) and then a licensed therapist helps them not to perform a compulsive ritual or response (e.g., hand washing). After a while, they realize there is no dreaded outcome when they don’t follow the compulsive behavior.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are the first choice if medication is needed for OCD. SSRIs available in the U.S. that work for OCD are fluoxetine, sertraline, escitalopram, fluvoxamine, and paroxetine. Another SSRI commonly used for anxiety and depression, citalopram, is not used for OCD because the dose required is too high.

Compared to SSRI treatment for anxiety disorders, much higher doses [3*] are necessary to control OCD, and they take longer to start working (six to twelve weeks). If you are prescribed medication for OCD treatment, always follow your provider’s recommendations, never exceed the dosage, and notify them about any side effects.

In Summary

The distinction and relationship between OCD and anxiety disorders is complex, and to get you onto the correct treatment plan, it is essential to get a professional opinion.

Book an online appointment at MEDvidi in a few clicks and get connected with a licensed medical provider soon.

Sources

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8 sources
  1. Brock H, Rizvi A, Hany M. Obsessive-Compulsive Disorder. [Updated 2024 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
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  2. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison.
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  3. Geller J. What Is Obsessive-Compulsive Disorder? American Psychiatric Association. Published 2022.
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  4. Chand SP, Marwaha R. Anxiety. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
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  5. American Psychiatric Association. Anxiety disorders. Psychiatry.org. Published 2019.
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  6. Munir S, Takov V. Generalized Anxiety Disorder. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
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  7. APA PsycNet.
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  8. Sharma E, Sharma LP, Balachander S, Lin B, Manohar H, Khanna P, Lu C, Garg K, Thomas TL, Au ACL, Selles RR, Højgaard DRMA, Skarphedinsson G, Stewart SE. Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis. Front Psychiatry. 2021 Nov 11;12:703701. doi: 10.3389/fpsyt.2021.703701. PMID: 34858219; PMCID: PMC8631971.
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Written by:
Dorianne Green
MD
Medical Reviewer:
Dr. Michael Chichak
MD
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This article contains scientific references. The numbers
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