Do I have anxiety, OCD, or both?

Instead of focusing on life, individuals with obsessive-compulsive disorder (OCD) are often dragged into obsessive loops. Despite knowing that their worries aren’t logical, they can’t stop themselves from ruminating about them anyway.

Generalized anxiety disorder (GAD) also involves excessive worrying, so it’s no wonder that many people think that anxiety is at the root of OCD. While the two are related, their relationship isn’t straightforward. Here’s the lowdown on OCD vs. anxiety.

Are OCD and anxiety different?

OCD and anxiety might seem like they’re two peas in a pod, but they’re not the same thing. OCD used to be categorized as an anxiety disorder, but in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was moved into its own category.

Despite this, both conditions involve unwanted thoughts or feelings that cause distress or anxiety. This is a big thing to have in common, and social phobia may also occur with OCD or anxiety, but that’s where the similarities end.

OCD compels those experiencing it to respond to their upsetting and obsessive thoughts with compulsive behaviours. One example of an OCD ritual could be someone who worries that if they don’t clean their room perfectly, someone close to them will die. They know that their thoughts and actions are odd, irrational, and in the realm of magical thinking.

Despite this, they still feel compelled to complete the room cleaning ritual for fear of what might happen if they don’t. Luckily, individuals experiencing OCD typically only have a few different topics that result in these loops.

With GAD, anxiety instead stems from a variety of different topics. You might find yourself worrying about your performance at work, or what you said to someone in a social situation like a party. Individuals experiencing GAD find that their anxiety darts from subject to subject throughout the day. While their worrying is usually outsized given the circumstances, it’s not out of the realm of reality.

Additionally, they don’t feel the need to participate in rituals in order to “neutralize” their thoughts. Instead, individuals with GAD are more likely to simply avoid the things that spark their anxiety.

Is anxiety the root of OCD?

While anxiety is often a feature of OCD, that’s not always the case. You might believe, for example, that failing to check all the light switches and electrical appliances in your home will cause a fire. While anxiety might spur you to engage in the ritual or compulsion, a lack of control or stress can also trigger your OCD.

How do I know if I have OCD?

You’ve likely heard someone talk about how “OCD they are” because they’re super neat or can’t stand having things be out of place. But being conscientious or having perfectionistic tendencies doesn’t mean you have obsessive-compulsive disorder.

Things like counting your steps or engaging in repetitive or compulsive ritualistic behaviours are actually quite common. Maybe you grew up with the fear that stepping on a sidewalk crack would break your mother’s back and you can’t stand to do it to this day. Or perhaps you run to wash your hands every time you’re around someone who’s sick. Neither of these means you have OCD.

To be diagnosed with OCD, your symptoms have to cause distress or impair your social, occupational, or other important daily functioning in some way. Alternatively, they must take up an hour or more a day. Without meeting one of these criteria, you don’t have it.

Signs and symptoms of OCD

Symptoms of OCD fall on a scale and can range from mild to extreme. They include:

Recurrent, intrusive thoughts, images, or urges that you can’t control
The need to engage in rituals or compulsions as a response to minimize the intrusive thoughts

Obsessions and compulsions can take a variety of forms, but some common themes include:

A fear of contamination — this often leads to excessive self-cleaning
Fear-related obsession, surrounding fire or burglary, for example. This often triggers compulsive checking — making sure the door is locked or the stove is off.
Fear that if things are not neat or orderly something bad might happen — this may result in complex cleaning rituals or manifest as a need to organize certain items

It’s also important to note that OCD and specific phobias are two different things. While those with OCD develop compulsions to reduce anxiety, people with specific phobias — such as a fear of spiders, heights, or enclosed spaces — are usually only triggered by their fear if they’re exposed to it. So if you experience certain phobias, it doesn’t necessarily mean you have OCD.

Signs and symptoms of anxiety

Everyone feels anxious or nervous sometimes, but if you’re experiencing an anxiety disorder these feelings are extreme. Mental and physical symptoms of GAD may include the following:

Persistent feelings of anxiety or dread that occur more days than not for at least six months and cause distress or reduced functioning
Difficulty controlling your anxiety
Irritability
Muscle tension
Feeling keyed up or on edge
Difficulty concentrating
Difficulty sleeping
Being easily tired

How common are anxiety and OCD disorders?

Anxiety disorders are the most common mental health disorders in Canada. About one in 10 Canadians will experience one at some point in their life.

Anxiety is a normal part of life. Despite its unpleasantness, everyone feels it, and it serves a function. A certain amount of anxiety is adaptive — it ensures you’re on your best behaviour at the office party, or prompts you to prepare for an exam.

In these cases, the anxiety is proportional to the situation. For someone with an anxiety disorder, however, these feelings of apprehension are with them all day.

When it comes to obsessive-compulsive disorder, about 1% of the Canadian population will experience an episode in their lifetime. Like anxiety, however, almost everyone will experience aspects of OCD at some point. But counting your steps or having the occasional intrusive thought aren’t enough to receive a diagnosis. For you to be diagnosed with OCD, your symptoms must either cause distress or must be time-consuming — taking up one hour of your time or more.

Can you have OCD and anxiety?

Yes, it’s possible to have both OCD and anxiety at the same time. In fact, it’s quite common. Up to 90% of individuals diagnosed with OCD meet the criteria for at least one other mental health disorder — many of which are anxiety disorders.

You can distinguish between the two conditions in a couple of important ways. The intrusive thoughts or anxieties that you experience with OCD tend to be more “out there.” That means that the person experiencing the disorder likely knows that the worries they have aren’t realistic. They may know there’s no real need to wash their hands fifty-plus times a day, but they feel compelled to nonetheless.

When it comes to GAD, the anxieties you feel are usually rooted in your daily experience — things like worrying about whether you offended someone accidentally in a conversation, for example. While the anxiety you experience tends to be more amplified than it “should” be, it’s not totally out there.

Another difference between the two that’s worth noting is the subject of that anxiety. With GAD, you’ll likely experience apprehension about a number of different things — work, interpersonal interactions, driving — the list is endless. With OCD, your anxiety is more likely to revolve around one or two specific themes instead.

What causes OCD and anxiety to get worse?

Dealing with the effects of anxiety and OCD is already difficult enough, but an increased level of stress can cause anxiety and OCD tendencies to get worse. Experiencing a stressful situation could make someone with anxiety or OCD feel like they can’t control or cope with even the smallest tasks — this can trigger even more intense feelings of anxiety or OCD routines.

Treatment for OCD

Many people with OCD experience recurrent episodes of the disorder throughout their life. And, since stress can often precipitate an episode or make symptoms worse, ongoing stress management is a key component of managing the disorder.

When it comes to treating OCD, selective serotonin reuptake inhibitors (SSRIs) are quite effective. If you have OCD, your doctor may prescribe fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft) as part of your treatment. While they do work on their own, the success rate of SSRIs often increases when used with other treatments like exposure and response prevention (ERP).

ERP involves gradually exposing the affected individual to their fear. For example, if your compulsion is to engage in a counting ritual while you get ready for bed, your therapist will give you activities to help break that pattern. They might ask you to count to the wrong number or to sing a song instead.

Alternatively, they might ask you to imagine the worst-case scenario if you don’t count instead of counting. The idea is that replacing the compulsion with an alternative narrative makes you feel less compelled to practice it.

In severe, treatment-resistant cases of OCD, neurosurgery may be recommended. This involves targeting, neutralizing, or stimulating the parts of the brain involved in producing OCD symptoms. Neurosurgery for deep brain stimulation is a controversial and serious procedure, however. It isn’t recommended for everyone with extreme OCD symptoms.

Treatment for anxiety

Medication is often a helpful tool for treating anxiety. You might be familiar with benzodiazepines — a class of drugs that includes clonazepam or lorazepam — for treating anxiety or panic attacks. While effective, benzodiazepines can cause physical dependence, as well as other side effects like drowsiness, or memory or attention problems.

To minimize the risk of physical addiction, your healthcare provider may instead prescribe a non-benzodiazepine anti-anxiety medication like buspirone hydrochloride (Buspirone), or venlafaxine (Effexor). Alternatively, the same SSRIs used for treating OCD can also be helpful in treating anxiety. Whichever medication you and your provider choose, combining it with therapy may make it more effective.

For anxiety treatment, this usually means cognitive behaviour therapy (CBT). This can involve identifying anxiety-provoking thoughts and replacing them with more realistic ones. It may also involve practicing breathing techniques, and incorporating progressive muscle relaxation — tensing and relaxing various muscle groups.

How Maple can help

If you’re looking for help mapping out your mental health strategy, make seeing a mental health physician your next step. A mental health physician can diagnose and help manage your condition by prescribing the right medication for OCD or anxiety, if necessary. They can also guide you in determining your next best steps, helping you figure out if counselling or psychotherapy is right for you.

If you’re looking to make CMT or ERP a part of your treatment, speaking to a therapist online can start you on that journey. With Maple, you can make an appointment to see a therapist at the time of your choosing from the comfort of your home.

Anxiety and OCD can shrink your world. Work, school, and even leaving the house can all feel overwhelming when you’re grappling with intrusive thoughts from OCD and anxiety. If you’re feeling overwhelmed by these thoughts, reach out today for help putting them to rest.