Obsessive-compulsive disorder (OCD) and anxiety are closely related. Obsessions often provoke anxiety, and compulsions—while done in an attempt to find relief—typically only fuel that anxiety. On the flipside, anxiety can also exacerbate one’s OCD, causing you to spend more time obsessing and compulsing.
If you have both OCD and an anxiety disorder, it’s possible to learn to manage symptoms effectively using exposure response and prevention (ERP) therapy. While some therapeutic approaches meant for anxiety don’t work well for OCD, ERP can address both conditions effectively in tandem.
Read on to get a better idea of how anxiety and OCD are similar and different, and how to treat both conditions.
OCD & anxiety: Similarities and differences
Anxiety disorders are typically characterized by excessive, persistent worry that is difficult to manage and may result in mental and physical symptoms, including:
- Restlessness
- Difficulty concentrating
- Irritability
- Sleep problems
- Heart palpitations
- Shortness of breath
- Nausea
There are currently 11 distinct anxiety disorders recognized by The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include generalized anxiety disorder, panic disorder, agoraphobia, specific phobias, social anxiety disorder, separation anxiety disorder, selective mutism, substance/medication-induced anxiety disorder, comorbid anxiety, other specified anxiety disorder, and unspecified anxiety disorder.
OCD can look very similar to anxiety, but is characterized by two distinct symptoms: obsessions and compulsions. Obsessions are intrusive thoughts, sensations, images, feelings, or urges that are persistent and cause distress, or anxiety. In response to obsessions, people with OCD perform compulsions—physical or mental acts meant to relieve feelings of distress or prevent something bad from happening. Yet, compulsions only provide fleeting relief, exacerbating the cycle. Common OCD symptoms include:
- Unwanted thoughts about violence or hurting yourself or others
- Doubts and fears surrounding relationships
- Recurring doubts about things that happened in the past
- Excessive handwashing and cleaning
- Checking stoves, doors, locks, etc.
- Counting objects, steps, or other things in a certain way
- Avoiding certain places, people, or situations
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Key distinctions
While anxiety and OCD may seem very similar, there are some stark differences that set these conditions apart. People with anxiety and people with OCD may find themselves feeling anxious about similar topics, but someone with anxiety won’t feel the need to perform a compulsion in response. Instead, they’re more likely to engage in a safety behavior—which can look similar to certain compulsions—but are less repetitive and ritualistic.
For example, if you have anxiety, you may pretend to be sick to avoid a presentation you feel anxious about, or you may excessively stock up on first-aid products if you’re nervous about emergencies. But, if you have OCD, you’re more likely to ritualistically avoid a certain part of your workplace or school that you think triggers obsessions, or repetitively check your first-aid box as a response to intrusive thoughts about emergencies. People with OCD also spend at least an hour each day performing compulsions, while people with anxiety may not engage in safety behaviors as often or regularly.
Is OCD an anxiety disorder?
OCD used to be classified as an anxiety disorder, but the American Psychiatric Association re-classified it in 2013 to emphasize distinctions in OCD brain chemistry and function. The most recent edition of the DSM lists OCD under “Obsessive-Compulsive and Related Disorders.”
Still, OCD is sometimes misdiagnosed as an anxiety disorder. It’s worth repeating that ritualized and repetitive behaviors or mental actions aimed at relieving distress are what distinguishes the condition. If you identify with descriptions of compulsive behaviors—even if you have been diagnosed with an anxiety disorder—it is possible that you may have OCD.
Does anxiety trigger OCD?
OCD can cause feelings of anxiety, and anxiety may, in turn, exacerbate symptoms of OCD. Both OCD and anxiety disorders involve rumination and intrusive thoughts. People with anxiety and OCD may try to escape feelings of discomfort by avoiding the people, places or things that trigger these feelings. For instance, people with illness anxiety or obsessions that center on contamination may self-isolate in an attempt to avoid triggering situations.
Can you have OCD without anxiety?
While anxiety is a common component of OCD, there are people who may have OCD without experiencing anxiety. “Instead, they may feel guilt or shame or disgust,” explains Dr. McGrath. In those cases, it’s usually easier to identify the difference between OCD and anxiety.
Can anxiety and OCD be treated at the same time?
It’s common to have an anxiety disorder and OCD. One review of studies suggests that around one-third of people with OCD also have an anxiety disorder, most commonly GAD, phobias, and social anxiety disorder. The good news is that these conditions can be treated together—even if anxiety isn’t a prominent symptom of your OCD.
It’s important to note that typical anxiety treatments like talk therapy aren’t effective for managing OCD symptoms, and OCD requires specialized treatment. “It wouldn’t be enough just to manage the anxiety, because we want to make sure that we’re targeting the obsessions and compulsions in OCD,” Dr. McGrath explains. That’s why experts turn to ERP therapy to handle both conditions at once.
ERP therapy for OCD and anxiety
ERP is a specialized form of cognitive-behavioral therapy designed for OCD. ERP purposely triggers your obsessions, causing you to have to sit with uncomfortable thoughts, images or urges. At the same time, your therapist will teach you response prevention skills, which will eventually replace whatever compulsion you do when experiencing an obsession. “By allowing people to realize that they don’t need to do the compulsion, they learn to handle the discomfort that they’re feeling,” Dr. McGrath says.
By allowing people to realize that they don’t need to do the compulsion, they learn to handle the discomfort that they’re feeling,”
Dr. Patrick McGrath
Luckily, ERP therapy also works for all anxiety disorders. “Just like we do when treating OCD, ERP for anxiety disorders includes facing what makes you anxious, a little bit at a time, and learning that you can tolerate discomfort that arises,” explains Tracie Ibrahim, Chief Compliance Officer at NOCD.
When a therapist is treating OCD and an anxiety disorder together, the focus will depend on what anxiety disorder you’re dealing with. “If you have a panic disorder, I might expose you to uncomfortable physical sensations, and have you not run to the emergency room if that’s what you typically do,” Dr. McGrath explains. “Instead, I will have you sit with those uncomfortable situations, let them pass on their own, and learn that you can handle them.”
Or, let’s say you have a specific phobia like scelerophobia, the fear of thieves. The anxiety caused by excessive worries of being burglarized may cause you to develop checking behaviors. “Instead of doing that behavior, which, for instance might be checking to make sure your doors are locked, I might have you purposely go to bed without checking the locks to learn that you can handle doing that,” Dr. McGrath explains.
Bottom line
Anxiety and OCD are closely linked conditions, but there are some key differences. Still, OCD symptoms can exacerbate anxiety, and vice versa. If you’re dealing with both OCD and anxiety, you can find relief through ERP therapy. In fact, many people report feeling less anxious and/or depressed, even when ERP therapists aren’t specifically targeting depression or anxiety.
“We just know that as people start to see less influence of OCD on their life—specifically through using exposure and response prevention therapy—that they start to feel better overall,” Dr. McGrath says.