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Generalized Anxiety Disorder vs. Obsessive Compulsive Disorder

I’ve been a therapist more than 20 years, and I can still get tripped up teasing out generalized anxiety disorder from obsessive compulsive disorder (and many times people have both). Functionally GAD and OCD are very similar and for clinicians who specialize in treating anxiety disorders and OCD, we often consider them part of the same continuum.

Make no mistake, however. These are two different disorders.

Before I proceed, it’s essential to note that the only way someone knows whether or not they have an anxiety disorder is to be diagnosed by a trained, licensed professional. These articles are helpful in giving you a basic overview, but they’re never meant to diagnose, treat and/or replace your current mental health plan.

What Is Generalized Anxiety Disorder?

Persistent and excessive worry about many different things describes generalized anxiety disorder, or GAD. This is worry that’s causing physical symptoms, disrupting your life in some way and has been going on for at least 6 months. This is not just being a “worry wart” or anxious about an upcoming event. An estimated 5.7% of U.S. adults experience generalized anxiety disorder at some time in their lives, according to the National Institute of Mental Health.

I often talk about anxiety being a process. Something triggers your worry. You then do something to try and get rid of that discomfort. You may feel better — temporarily — but in the long-term, you’ve taught yourself that the trigger is dangerous and something to be escaped.

What Is Obsessive Compulsive Disorder?

Obsessive compulsive disorder (OCD) is comprised of obsessions, distressing intrusive thoughts, and compulsions or behaviors to relieve the distress. Again, we’re not talking about washing your hands a little longer right after you touched raw chicken. The person’s life or functioning is disrupted and/or they’re spending more than an hour a day engaging in compulsions for at least 2 weeks. In[MOU1]  terms of prevalence, OCD is the 4th most common mental illness with 1–3% prevalence rate in the general population.

Generalized Anxiety Disorder and Obsessive Compulsive Disorder

Because Generalized Anxiety Disorder and Obsessive Compulsive Disorder may be conceptualized on the same continuum, it makes sense for there to be similarities between them. Both are disorders marked by excessive anxiety and worry where the individual attempts to control the worry.

In OCD, the anxiety is called an obsession, and in GAD, it’s called a worry. In OCD, the attempt to control it is called a compulsion. In GAD, the behavior may be called a safety-seeking behavior, worrying or overthinking (though there are many more). Both can be fueled by avoidance and maintained by negative reinforcement, and both are internalizing disorders.

In GAD, the worry tends to be about typical things such as money, health, kids and aging parents. Lots of people with OCD have the same fears, but their appraisal of the fear is often excessive and irrational. Take getting sick, for example. Someone with GAD may worry excessively about getting sick, if they’re sick, how long they’ll be sick, how sick they’ll be and so on. They may visit their real doctor a lot as well as Dr. Google to get reassurance. The person with OCD, however, may equate getting sick with missing work, all their colleagues talking about them, losing their job, not being able to pay their bills and becoming homeless. The behaviors they’ll do to relieve the distress (compulsions) may have a superstitious element (if I only do things in sets of 3, I’ll be ok), may have to be done in a ritualized order and may take up more time and energy. In OCD, you may also see more taboo themes like sex, religion and harm.

What’s important to remember is that both can have distressing worrisome thoughts; we all have those. What differentiates someone with OCD is often the degree to which they’ll go to get certainty around the content of their obsession.

In GAD, the feelings we hear the most are worry and fear. In OCD, we’re likely to hear worry and fear but also doubt, responsibility, shame, disgust and guilt.

In GAD, the anxiety reducing behaviors are primarily mental—worrying, overthinking, ruminating, excessive planning and checking. In OCD, there will definitely be mental rituals and potentially some overt ones, too.

Diagnosing Generalized Anxiety Disorder and Obsessive Compulsive Disorder

It generally takes people well over a decade from symptom onset to diagnosis to getting into effective evidence-based care, a sobering statistic from the International OCD Foundation. A primary reason for this delay is misdiagnosing OCD as GAD. Interestingly, the inverse is NOT true. Those with GAD are not getting misdiagnosed as having OCD.

Adding to the potential for confusion, the co-morbidity for someone with OCD also having GAD is over 30%. This means more than 30% of the time, someone with OCD also has GAD. Since they are functionally similar, it’s easier to appreciate how OCD can get missed and lumped under GAD. In addition, clinicians aren’t well trained to spot OCD.

Generalized Anxiety Disorder and Obsessive Compulsive Disorder Treatment

And why does any of this matter anyway?

I’m not a big believer in diagnoses and labels but diagnosis-guided treatment. If you’re getting misdiagnosed, you may not get the right (evidence-based) treatment, which is what happens with people with OCD all the time. Not all treatment models work with everything and just because your therapist “knows CBT” doesn’t mean they’re specially trained to treat anxiety disorders. Ask questions, do your research, know what the evidence-based models are. If you need a place to start here are some great places to start:

https://iocdf.org/ the ultimate OCD resource

https://contextualscience.org/ to find an ACT therapist

https://adaa.org/ to learn more about GAD, find a therapist

https://www.abct.org/  CBT resource, evidence-based with a therapist directory