Obsessive-Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD) can be difficult to distinguish. After all, there is often such a huge overlap between the two which can make diagnosis tricky. Both can come with worrying, distress, and unwanted thoughts. So then, what are the differences?

Side note: It is possible have both GAD and OCD comorbidly.

OCD vs. GAD

Let’s start with some brief definitions.

Generalized Anxiety Disorder (GAD) is a mental health condition characterized by persistent and excessive worry and anxiety that is difficult to control.

Obsessive-Compulsive Disorder (OCD) is a mental health disorder characterized by frequent unwanted thoughts (obsessions) that cause one to perform repetitive behaviors (compulsions).

In GAD, we are looking at the presence of persistent feelings of worry that are difficult to control. With OCD, we are looking for the presence of obsessions and compulsions.

What are obsessions and compulsions? Find out more on my blogpost here: The Basics of OCD

Anxious Thoughts vs Obsessions

Although some anxious thoughts are obsessions and a lot of obsessions are anxious thoughts, there are key differences between GAD and OCD. GAD tends to focus on every day worries that are more generalized such as school, work, finances, health, etc. OCD thoughts and obsessions tend to revolve around fears that are often irrational and more specific. You can think of obsessions as things that most people don’t worry about. Although some people may worry in general about driving, most people don’t worry accidentally hitting someone or something while driving and not being able to remember it. Although some people may worry about grades in general, most people don’t worry about if their grade will suddenly change because of a random error.

Ego-Syntonic vs Ego-Dyntonic Thoughts

Ego-syntonic refers to behaviors, thoughts, or feelings that align with one’s personal goals, values, or beliefs (or one’s sense of self aka the ego). Ego-dystonic, on the other hand, refers to behaviors, thoughts, or feelings that are in conflict with the ego, and do not align with one’s personal goals, values, or beliefs.

With GAD, the worry tends to be focused on the future and often feels rational. The person genuinely believes they need to “worry” and think through their worries to prevent the feared outcome. They may overthink and ruminate on what-if questions such as “What if I get a bad grade?” or “What if I make a mistake?” Therefore, these thoughts feel ego-syntonic and aligned with their values.

With OCD, these intrusive thoughts and obsessions are unwanted and distressing. These thoughts become so distressing that they lead to an urge to engage in a compulsion. They may think other what-if questions such as “What if I do something bad and forget it?” or “What if I don’t wash my hands and get someone sick and they die?” These thoughts are therefore ego-dystonic and in conflict with their values.

Behaviors

When is a behavior a compulsion vs a a way of coping? Although those with GAD may develop some coping behaviors such as worrying and overthinking, a key difference is they do not perform compulsions. Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession, or to reduce the anxiety or distress caused by an obsession. The individual feels as if they must perform these compulsions, but often does not actually want to do them. These compulsions can involve hand-washing, counting, checking, re-doing things multiple times, etc.

If-Then Relationship

A key importance that distinguishes a behavior from a compulsion is the if-then relationship that exists between the obsessive thought and the compulsive behavior. Those with OCD often engage in a compulsion to prevent something from happening. While someone with GAD may also experience if-then statements, those with OCD experience if-then statements that are often specific and lead to a terrible, irrational outcome. Although someone with GAD may engage in behaviors such as overthinking or worrying to help them manage their feelings and prevent a generally negative outcome, it is not necessarily to prevent something irrational from happening. With anxious thoughts, the behaviors aim to prevent general negative outcomes such as being perceived poorly or getting a bad grade. With obsessions, the compulsions are aimed to prevent specific, terrible things from happening such as death, getting others sick, having a bad day, etc.

The Anxiety Cycle vs The OCD Cycle

The OCD Cycle. Learn more on my blog post: The Basics of OCD

Examples

While someone with anxiety may worry or what their peers may think of them and may end up overthinking, someone with OCD may fear that they may be perceived as offensive/a bad person and therefore may need to replay past memories over and over again to make sure they did not do anything offensive.

While someone with anxiety may worry about getting sick, someone with OCD may fear that they will die from contracting germs/getting sick and therefore may engage in excessive hand-washing or mentally keeping track of what is clean vs dirty.

While someone with anxiety may worry about things not being clean or organized, someone with OCD may feel as if things are off or may experience discomfort from the mess and therefore may need to clean until it feels “just right” or organize things in a certain way/symmetrically/in a way that feels correct.

While someone with anxiety may worry about bad things happening in general, someone with OCD may fear having a bad day that could lead to death and therefore may avoid stepping on cracks or making sure to do things in even numbers.

Defining Features

As presented in the examples above, the key differences between OCD and GAD lie in the presence of compulsions, the if-then relationship between statements, and the content of the anxious thought/worry/obsession.

OCD THERAPY WITH CZARINA DE JESUS, LMFT

Helping clients learn the difference between anxiety and OCD is one of my favorite things to do together in therapy!

-If you’d like to learn more about how I do OCD treatment, you can visit the following page: OCD THERAPY

-If you’d like to reach out to me, you can follow the directions on this page: SCHEDULE A SESSION

OCD vs Anxiety: What’s the Difference?