Understanding the Overlap Between Anxiety and OCD
If you experience anxiety or unwanted, repetitive thoughts, you may sometimes wonder: Is this anxiety, or could it be OCD? The two can look similar on the surface, and there is meaningful overlap between them. At the same time, anxiety and obsessive-compulsive disorder (OCD) are distinct conditions with important differences.
According to the International OCD Foundation (IOCDF), OCD Awareness Week is held internationally during the second week of October every year. In recognition of OCD Awareness Week, which is October 11–17 this year, the similarities and differences between anxiety and OCD, as well as why distinguishing between them is not always straightforward, are described below.
Anxiety and OCD can both involve worry
Everyone experiences worry from time to time. It is a normal part of being human and can even be useful when it motivates us to prepare for something important.
For example, you might worry about missing a train, feel concerned that your children do not have enough friends, or feel nervous about making a mistake at work. These thoughts can be uncomfortable, but they may reflect ordinary experiences of worry rather than a mental health disorder.
When anxiety becomes excessive, persistent, difficult to control, or significantly interferes with someone's life, it may be part of an anxiety disorder.
OCD can also involve significant anxiety or distress. However, OCD is characterized by obsessions, compulsions, or both. Obsessions are intrusive and unwanted thoughts, images, or urges that are difficult to control. Compulsions are repetitive behaviors or mental acts that a person feels driven to perform, often in an attempt to reduce distress or prevent something feared from happening.
This can create a cycle in which an intrusive thought produces distress, a person performs a compulsion to obtain relief or certainty, and the temporary relief reinforces the urge to perform the compulsion again.
Where anxiety and OCD can overlap
The overlap between anxiety and OCD can be especially confusing because many of the thoughts themselves may sound similar.
For example:
Is this the right relationship for me?
What if I made the wrong decision?
Did I lock the doors? I can't remember.
What if something goes wrong?
These kinds of thoughts do not automatically indicate OCD, or even an anxiety disorder.
The same thought can occur for very different reasons. Someone might occasionally question whether they made the right decision, worry about something going wrong, or double-check that they locked the door without having a mental health disorder.
For someone with an anxiety disorder, these concerns may become excessive, persistent, or difficult to control. For someone with OCD, similar thoughts may function as obsessions and become connected to compulsive behaviors or mental rituals.
And sometimes, a person may experience both anxiety and OCD.
The examples in the overlap portion of the diagram should therefore be understood as examples of experiences that can occur across different conditions, not as indicators of a particular diagnosis. Depending on the broader context, a symptom in this area could be associated with an anxiety disorder, OCD, both, or neither. More information would be needed to understand what is happening for an individual.
What can make OCD different?
One important distinction is the presence of obsessions and compulsions.
For example, someone with OCD might feel that they must touch a light switch seven times. They may believe that if they do not choose the "right" option, something bad will happen to their family. They may feel compelled to check a lock repeatedly, even after they know they have already checked it, because they cannot tolerate the uncertainty that something might go wrong.
Compulsions can take many forms. They may be visible behaviors, such as checking, washing, counting, or arranging things. They can also be mental compulsions, such as repeatedly reviewing memories, seeking reassurance, mentally repeating phrases, or trying to achieve a feeling of certainty.
Importantly, compulsions are not always performed because someone genuinely wants to do them. A person may recognize that the behavior seems excessive or unreasonable and still feel unable to resist the urge to perform it.
Why the distinction matters
It can be tempting to focus on the content of a thought, for example, "I'm worried about my relationship, so I must have relationship OCD." But the content of a thought alone does not determine whether someone has OCD.
Clinicians consider the larger pattern: How frequently does the thought occur? How intrusive or distressing is it? Does the person feel driven to perform behaviors or mental rituals in response? How much time does it take? Does it interfere with daily functioning? Is the person engaging in avoidance or reassurance-seeking? And are there other symptoms that provide important context?
This is one reason it is generally not helpful to diagnose yourself based on a single symptom or example.
A note about the examples in the diagram
The examples in the accompanying Venn diagram are intended for education and illustration, not diagnosis. Experiencing one of these thoughts or behaviors is not, by itself, sufficient to meet diagnostic criteria for OCD or an anxiety disorder. A comprehensive evaluation by a qualified mental health clinician would be necessary to determine whether symptoms meet criteria for a diagnosis and, if so, which diagnosis or diagnoses best fit the person's experience.
It is also possible to experience distressing thoughts or repetitive behaviors without meeting criteria for a mental health disorder.
If you are unsure whether it's anxiety or OCD
If you find yourself spending significant amounts of time worrying, checking, seeking reassurance, avoiding situations, or trying to get rid of unwanted thoughts, it may be worth talking with a mental health professional.
You do not need to figure out the diagnosis on your own. A clinician can help you understand the patterns underlying your thoughts and behaviors and determine what type of support or treatment may be appropriate.
Understanding the difference between anxiety and OCD can be an important first step; but perhaps more importantly, you don't have to have the perfect label for your experience before reaching out for help.
