OCD vs anxiety — what’s happening in your head?

OCD vs anxiety: what’s the difference? Many people mistake obsessive-compulsive disorder (OCD) as a type of anxiety. It’s even more confusing because some OCD symptoms are similar to symptoms of anxiety, including tension and rumination about worries. They’re so similar that OCD was once professionally categorized as an anxiety disorder.

However, OCD and anxiety are distinct disorders that require distinct types of treatment. It’s essential to understand what symptoms you’re experiencing because OCD is often misdiagnosed. And if you’re misdiagnosed, you risk getting the wrong treatment.

Here, we do a deep dive into the differences and similarities between OCD and anxiety, including case examples of how to tell the difference.

OCD vs anxiety: similarities 

OCD and generalized anxiety disorder have many similarities. In fact, until its most recent edition, OCD used to be categorized as an anxiety disorder in the Diagnostic Statistical Manual (DSM). We now know that anxiety and OCD are separate disorder types with unique traits that can look alike at first glance.

Both anxiety and OCD cause people to have excessive worry. Although the nature of the worries differs between anxiety and OCD, many people (including professionals) find it difficult to tell the difference between anxiety-related worrying and OCD obsessions. People with anxiety and OCD find it difficult to stop ruminating on these thoughts, which causes them a great deal of fear and unease.

Fear and uneasiness can be accompanied by physical symptoms both in anxiety and OCD. For example, people with anxiety or OCD can become so anxious that they experience:

• Gastrointestinal discomfort
• Rapidly heartbeat
• Sweating
• Muscle tension
• Insomnia
• Headaches

Misdiagnosis: ways anxiety disorders and OCD are confused

OCD is often mistaken for generalized anxiety disorder or other types of anxiety disorders (or other conditions). People with OCD can be misdiagnosed for an average of 10 years before getting the right diagnosis.

Although OCD has some things in common with anxiety, it’s essential to understand how OCD is unique from any type of anxiety disorder. OCD is not anxiety and requires unique treatment.

The following table lays out the similarities and differences between OCD and 4 common anxiety disorders.

OCD vs anxiety: differences 

Since the latest edition of the DSM, OCD has been placed in its own category, separate from anxiety disorders, named obsessive-compulsive and related disorders. Understanding how OCD and its related disorders differ from anxiety disorders is key to getting the right treatment.

Worries vs obsessions

Both anxiety and OCD can cause fear and excessive worrying about certain subjects. In OCD, these worries are called obsessions. Obsessions include feelings of fear and worry, but can also include feelings such as disgust, shame, and guilt. 

Obsessions differ from anxiety-related worrying in subtle but important ways. First, people with anxiety tend to have a range of concerns about things that could actually happen. For example, someone with anxiety may have worries like, “What if I get fired today?,” “I don’t think my friend even likes spending time with me,” or “I’m going to fail this exam.” These thoughts are usually irrational, but they’re still based on reality.

OCD obsessions, on the other hand, tend to revolve around one or a few themes. These themes may or may not have anything to do with daily life. For example, a new mom with OCD may have obsessions about harming her baby. She might have a repeated violent image of hurting her baby even though she loves her baby and has never acted violently toward anyone. Obsessions are often completely removed from reality in this way.

In addition, people with anxiety may have worries that jump from topic to topic. But people with OCD usually get stuck on one specific obsession for hours, days, or weeks. The “stickiness” of the thoughts differentiates OCD obsessions from anxious worries.

People with OCD may not worry at all about the general things in life that people with anxiety do. For example, someone with OCD could feel completely confident in professional and social settings and have no worries about finances (topics that people with generalized anxiety may worry more about), but become suddenly overwhelmed with the fear that they’re secretly a pedophile or a sociopath.

Ego-syntonic vs dystonic worries

Anxiety worries and OCD obsessions also differ in the ways they relate to the self. Anxiety worries are ego-syntonic, while OCD obsessions are ego-dystonic. In simple terms, this means that people with anxiety tend to have worries that are reflective of how they see themselves, while people with OCD have obsessions that are contrary to how they see themselves (which is why they’re so distressing).

For example, someone with anxiety may worry, “What if I never achieve my goals and I’m stuck behind my peers forever?” The way they see themselves is aligned with this worry — they view themselves as unambitious or unable to meet their goals. This lack of self-esteem may not be based on logical evidence, but is consistent with their sense of self.

On the other hand, someone with OCD has worries that aren’t aligned with how they see themselves. For example, they could have the obsession, “What if I lost my mind and killed someone?” This is at odds with how they see themselves — they know they aren’t violent, and the idea of suddenly becoming violent doesn’t align with their sense of self. This causes intense feelings of shame, guilt, and fear.

Presence of compulsions

The most critical difference between anxiety and OCD is the presence of compulsions in OCD but not anxiety. Compulsions are repetitive or ritualistic behaviors that people with OCD feel they must perform to drive away intrusive thoughts (obsessions). They’re a necessary component of OCD; you can’t be diagnosed with OCD if you don’t experience compulsions.

Compulsions are what make OCD so debilitating. Everyone, including people with anxiety, gets intrusive thoughts sometimes. But people with OCD have a unique relationship with their thoughts — they feel the need to perform repetitive or ritualistic behaviors to ward them off. This is the key difference between anxiety and OCD.

For example, someone with anxiety and someone with OCD could both have the worry, “What if I got sick from eating that undercooked chicken?” The person with anxiety would probably ruminate on the thought for a while, but move on once it becomes clear that they didn’t actually get sick.

A person with OCD would obsess about this fear. They would perform compulsions, which could be anything from mentally reviewing their memories over and over to recall how the chicken was cooked, asking others for reassurance, or performing “cleansing” rituals to protect themselves from disease. Whenever they eat chicken in the future, they would need to perform these compulsions to ward off their fears.

How to know if you have anxiety vs OCD

The only way to know for sure whether you’re living with anxiety or OCD is to get a professional assessment and diagnosis from a licensed mental health provider. The right diagnosis is critical because treatment for OCD is different from anxiety treatment. However, certain symptoms may help you tell the difference.

Here’s a breakdown of the specific symptoms of OCD vs anxiety and how each can manifest.

What OCD looks like: symptoms

According to the DSM, the symptoms of OCD are:

• The presence of obsessions, or intrusive thoughts, images, or urges that cause significant distress
• The presence of compulsions, or repetitive/ritualistic behaviors meant to reduce stress and prevent a feared event
• Both obsessions and compulsions are time-consuming and can take hours every day
• Obsessions and compulsions have a significant negative impact on daily functioning

Case vignette: Natalie

Whenever Natalie drives, she’s overcome by the fear that she’s run someone over without noticing. She doesn’t remember hitting anyone with her car, but she fixates on the thought: “What if I did hit someone but was so scared that I blocked out the memory?” She finds herself distracted at work all day when she has these worries. She’s overwhelmed with guilt.

Natalie retraces her steps and mentally reviews any moment when she could have hit someone. She asks all of her colleagues questions about how she seemed when she walked into the office — did she seem dazed or confused? She can’t take her eyes off the news, where she is watching closely for stories about hit-and-run drivers.

Natalie lives with OCD. Hit-and-run fears are a common theme of OCD obsessions.

Case vignette: Jesse

Jesse is generally a friendly person and has many close relationships. But Jesse has a secret fear of saying offensive things that insult the people he loves most. When he’s with his friends, he has intrusive images of yelling out slurs, even though he loves his diverse friend group and holds no prejudices against them. He sometimes has urges to slap friends, even though he isn’t violent and doesn’t want to hurt anyone. 

Jesse is overwhelmed with guilt and shame when he thinks of these images. He thinks: “What does this say about me? Am I an evil person?” He tries to compensate by repeating “good” thoughts about his friends in his head. For example, he thinks, “Sam is a wonderful human being.” 7 times every time he has these urges. He feels that this “neutralizes" the evilness of his thoughts.

The presence of obsessions and compulsions shows that Jesse has OCD about harming his loved ones.

What anxiety looks like: symptoms

There are many different types of anxiety disorders, including generalized anxiety, social anxiety disorder, and specific phobias. Some of the symptoms of anxiety disorders include:

• Recurrent and persistent worries about a variety of topics (or specific topics like social humiliation or heights, if one lives with social anxiety disorder or specific phobia)
• Avoidance of the people, places, or things that trigger the fear
• Physical symptoms include sleep disturbances, muscle tension, and chest pain.

Case vignette: Laura

For years, Laura has been terrified of driving. She’s well-versed in the statistics of car fatalities and worries she could die or be injured. She tries to avoid driving as much as possible, choosing to walk instead. This causes problems in her social life. In a car, she feels her muscles tense up and like she might throw up. She tries to take slow, deep breaths until she can get out of the car.

Laura likely has an anxiety disorder (a specific phobia of driving and cars). Unlike Natalie, she doesn’t have intrusive thoughts, take undue responsibility, or engage in compulsive behaviors.

Case vignette: Jordan

Jordan becomes very anxious in any social situation. He worries that he’ll make a fool of himself and that everyone will laugh at him or talk about him behind his back. These worries make him sweat and blush, which makes him feel even more embarrassed. This significantly impacts his social life, and he doesn’t have many friends. He avoids social situations as much as possible.

Jordan likely has social anxiety disorder, not OCD.

Can you have anxiety and OCD at the same time?

You can have both OCD and an anxiety disorder, which makes a diagnosis even more complex. Studies show that 20 to 50% of people with OCD also have anxiety. If you have both OCD and anxiety, it’s important to get a mental health professional’s help in separating the symptoms, so you get the right treatment.

Find out for sure with a professional diagnosis

The only way to know for sure whether you have OCD and/or an anxiety disorder — or another condition entirely — is to get a diagnostic assessment from a licensed mental health provider. 

There are several formal diagnostic tools that a professional might use to make a diagnosis. The most commonly used assessment in OCD diagnosis is the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). This instrument measures the intensity of your OCD symptoms as well as the specific types of obsessions and compulsions you experience.

In addition, most professionals use informal diagnostic assessments to aid their evaluation. They may observe you in sessions and ask you questions about your symptoms and how they impact your life. These answers can help them determine whether you live with anxiety, OCD, or another condition.

How OCD and anxiety are treated

The reason it’s so critical to know the difference between OCD and anxiety disorders is because the treatments are different — and treating OCD like anxiety can make OCD symptoms worse. 

Similar treatments for OCD and anxiety

OCD treatment and anxiety treatment do share some commonalities. The first-line treatment for both is a combination of therapy and medication. Some broad treatment methods used for both anxiety and OCD include:

• Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medications, are used to treat both OCD and anxiety disorders. Specific types include fluvoxamine (Luvox), sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro).
• Various types of cognitive-behavioral therapy (CBT) are used to treat both OCD and anxiety, although the although the types of CBT used for OCD and anxiety are unique.
• Benzodiazepines are sedative medications that are sometimes used for anxiety and OCD.
• Beta-blockers and buspirone, an anxiolytic, are also sometimes used for anxiety and OCD.

Unique treatments for OCD and anxiety 

It’s important to understand the key differences between OCD and anxiety treatment, and the specific treatment methods that are used for each.

• Exposure and response prevention (ERP) is a specific type of CBT that’s used in OCD treatment. It may not be helpful for anxiety disorders and other types of CBT (that are used to treat anxiety) may be ineffective for OCD.
• Fluvoxamine (Luvox) is a type of SSRI medication that’s only approved to treat OCD, although it can be helpful for some people with anxiety as well.
• Transcranial magnetic stimulation (TMS), a brain stimulation therapy using electromagnetic coils, is Food and Drug Administration (FDA)-approved to treat OCD. It may be helpful for anxiety as well but is not approved to treat anxiety.

Key takeaways

• OCD and anxiety are distinct disorders that require distinct treatments.
• The main symptom that differentiates OCD from anxiety is the presence of compulsions or ritualistic or repetitive behaviors that a person feels driven to perform to prevent or ward off anxiety and feared events.
• OCD and anxiety can sometimes look alike leading to OCD being frequently misdiagnosed.
• Only a licensed mental health provider can provide clear answers about whether you live with OCD, anxiety, or another disorder.

Find a therapist for OCD or anxiety on Klarity

Whether you live with OCD or anxiety — or are looking for answers on which you’re experiencing symptoms of — find a licensed mental health provider on Klarity who can help. Klarity makes it easy for you to connect with a licensed therapist or psychiatrist who can help you overcome whatever you’re going through. Mental health recovery is within your grasp. Find the provider you need on Klarity today!

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.