Anxiety itself is not a mental illness. It is a normal, adaptive emotion that helps us respond to perceived threats.
Anxiety is the automatic reaction that makes you jump back when you think you’ve seen a snake while walking in the bushes – before realizing it’s a stick.
It’s also (uncomfortably) the sweaty palms and shaky voice you notice before a presentation or a first date, or the circular thoughts that keep you awake at 3am.
Most of us have ways to deal with anxious thoughts and feelings that can give us a greater sense of control. This could be checking and double checking that we have the right room for our presentation or seeking reassurance from someone we love.
But when might these behaviors fit the diagnosis of an anxiety disorder? And when could they really be a sign of obsessive-compulsive disorder (OCD)?
As clinical psychologists, we find these questions come up a lot, perhaps prompted by a recent surge in interest in OCD for social media. So what is the difference between anxiety and OCD? And how are they treated?
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When is anxiety something more serious?
“Normal” anxiety can become an anxiety disorder when the fears or worry are persistent, intense, and begin to interfere with daily life.
For one in three people will develop an anxiety disorder at some point in their lives.
Among the most common are social anxiety disorder (fear of social situations), panic disorder (frequent panic attacks and fears of having another) and generalized anxiety disorder (persistent and excessive worry).
These disorders have slightly different symptoms. But they all share excessive and persistent fear or worry that causes distress or leads people to avoid important parts of life, such as work, study, or social activities.
So what about OCD?
Although OCD includes anxiety, it is actually considered a separate disorder in the diagnostic manual used by mental health professionals.
It is possible to have both – around half to three quarters of people with OCD also meet criteria for one or more anxiety disorders.
OCD includes obsessions, compulsions, or both. These cause significant discomfort or interfere with daily functioning.
Obsessions are disturbing, unwanted thoughts, images, or urges. This could mean an intense fear that your food is contaminated, a sudden vision of hurting someone, or a nagging feeling that you’ve made a serious mistake.
Compulsions are the repetitive behaviors (or mental rituals) that people feel compelled to perform to relieve this distress, such as checking, repeating phrases, excessive hand washing, or reassurance seeking.
Many of us will occasionally experience unwanted thoughts or go back to check that the oven is really turned off. Keeping things tidy or being specific about routines may just be habits that don’t cause concern.
But what makes OCD different is its severity and impact.
If obsessions or compulsions take up a lot of time, cause you significant distress, or interfere with daily life, it may be a sign of OCD.
You can’t “diagnose” OCD from behavior alone. OCD can also be invisible because many compulsions occur mentally, such as repeating phrases or counting. People with OCD may also try to hide their symptoms out of shame.
Are OCD and anxiety treated differently?
While anxiety disorders and OCD share some similarities, including recurring disturbing thoughts, the patterns and beliefs that drive them are different. This means that how they are treated will also differ.
Cognitive behavioral therapy (CBT) is one of the most effective treatments for both anxiety disorders and OCD.
For OCD, treatment often includes a specialized form of CBT called exposure and response prevention (ERP). It involves gradually dealing with situations that trigger anxious thoughts while resisting the urge to perform compulsions.
For example, someone with fears of contamination may gradually reduce the number of times they wash their hands before eating. Over time, people learn that the dreaded effect doesn’t happen, that they can tolerate their discomfort without the ritual, and that the stress goes away on its own.
Treatment for anxiety disorders focuses on the specific fear. For generalized anxiety, for example, it involves understanding patterns of worry, challenging beliefs that maintain worries, and developing more helpful ways of responding to problems, such as brainstorming and taking small actions.
Antidepressant medications (particularly selective serotonin reuptake inhibitors, or SSRIs) can be an effective component of treatment for both anxiety disorders and OCD. A combined treatment approach of medication (SSRIs) and therapy (CBT) often leads to better treatment resultsespecially for severe OCD.
One final note
While great mental health is discussed more openly online and stigma is reduced, social media can also blur the line between personal experience and evidence-based information.
If something you’ve seen online has made you curious about your mental health, the best next step is to talk to a qualified professional who can help you understand what you’re experiencing and what support can help.
For more information and resources about anxiety and OCD, visit Black Dog Institute or Beyond the Blueand ReachOut or Headspace for young people.
There are many online evidence-based treatment programs for anxiety disorders and OCD that you can access for free or at low cost, such as This way up, MyNewWay or Mindspot.
There are also online treatments for microcosm and teens with OCD and worry.
You can also ask your doctor about a Mental Health Care Plan for Medicare discounted psychology sessions.
