Obsessive-compulsive disorder (OCD) and anxiety are separate mental health conditions that have distinct symptoms but overlap in their causes and treatment. A person can have OCD and anxiety at the same time.

Although OCD is not a type of anxiety disorder, people with OCD experience very regular intrusive thoughts that can cause anxiety and interfere with everyday life.

Individuals may carry out repetitive behaviors or rituals and become more anxious if they cannot complete them. Common behaviors include washing, cleaning, and checking, ordering, and arranging objects.

While they are distinct mental health conditions, OCD and anxiety can overlap in their causes and treatment. The authors of the recent 2022 anxiety overview state that anxiety is underdiagnosed, despite being one of the most prevalent mental health conditions in the general population.

In addition, a 2022 overview of OCD states that the condition is undertreated.

This article considers the link between anxiety and OCD, discusses whether a person can have both OCD and anxiety, and provides information on the symptoms and treatment of OCD.

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OCD and anxiety can overlap. However, they are separate mental health conditions.

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) classified OCD as an anxiety disorder.

However, the most recent edition — the DSM-5TR — classifies OCD as a separate mental health disorder under the Disorder Class “Obsessive-Compulsive and Related Disorders.” This section also includes body dysmorphic disorder, hoarding disorder, and a hair-pulling disorder called trichotillomania.

There is a wide range of anxiety disorders that are classified separately from OCD, which include:

Characteristics

A 2022 overview of anxiety describes it as a “future-oriented” mood state, meaning those with anxiety disorders are often psychologically and behaviorally preparing for future events they anticipate may be a threat.

While people with OCD and anxiety can feel intense fear about certain situations or objects, those with OCD are more affected by recurrent thoughts, images, or behavioral urges that cause them anxiety.

They will respond to these recurring thoughts or urges by repetitively performing rituals such as handwashing or ordering objects.

A person with OCD may not be able to control their urge to engage with compulsions, and they may not enjoy performing them.

People with anxiety disorders typically will not feel the need to carry out these compulsions.

Causes

Scientists do not know what causes OCD. However, the mental health charity Mind in the United Kingdom lists the following as potential causes:

  • Personal experiences: These may include childhood trauma, abuse, or bullying, or parents or carers that showed similar compulsive behaviors, which may lead to OCD stemming from learned behavior. Stressful events, chronic anxiety and stress, and pregnancy and childbirth may also play a role in the development of OCD.
  • Personality traits: OCD may develop in people who hold themselves to high standards and are very neat and methodical. However, this is not true for everyone.
  • Genetics: There is some evidence to show that people can inherit OCD from parents. However, studies often carry limitations. Overall, more research is needed.

The causes of anxiety are diverse and may include:

  • Past experiences: Stressful experiences, including abuse, violence, prolonged illness, and the death of a loved one may, lead to anxiety. Experiencing difficult situations in childhood or adolescence may also cause anxiety. This can include neglect, bullying, social exclusion, and racism. Learn more about racism and mental health.
  • Stress: Prolonged stress can cause anxiety. This can be stress from work or school, having challenges with finances or housing, or going through a period of significant change or uncertainty.
  • Health conditions: Living with serious and long-term health conditions can cause anxiety. Other mental health conditions may also cause a person to develop anxiety.
  • Medication side effects: Certain medications, including psychiatric medication, can list anxiety as a side effect.

The symptoms of OCD include a combination of obsessions and compulsions.

Obsessions include:

  • recurring intrusive and distressing thoughts, urges, and images a person cannot control
  • the urge to stop intrusive thoughts, urges, and images with another thought or action

Compulsions include:

  • responding to obsessions with repetitive behavior or mental patterns
  • performing repetitive behaviors or mental patterns to reduce anxiety or prevent a perceived threat or negative consequence

Compulsions may not always clearly relate to the negative consequence a person is trying to avoid, and the action may seem excessive to other people. They can take up a lot of a person’s time.

Common compulsions stem from fears about contamination, aggression or harm, sex, religion, and keeping their environment exactly as they want it.

A person only needs to show one compulsive behavior for a diagnosis. Some examples of compulsions include:

  • repeatedly checking things, such as ensuring their door is locked
  • frequent, excessive handwashing
  • counting or tapping objects
  • engaging in rituals such as prayer or repeating specific phrases

2019 and 2022 research state that OCD and anxiety can put a person at higher risk of suicide.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

A person should speak with a doctor to discuss diagnosis and treatment if they are experiencing symptoms of OCD or anxiety.

Some people can have both OCD and an anxiety disorder.

For instance, in a 2021 study, 33.56% of the 867 participants had both OCD and GAD.

This study found that people with OCD and GAD were more likely to have the following symptoms:

A person with OCD and GAD will typically have OCD symptoms and anxiety symptoms, such as:

A person may also have anxiety disorders, such as post-traumatic stress disorder (PTSD) and social anxiety disorder.

A person should work with a doctor to discuss their symptoms and understand whether they may have OCD, an anxiety disorder, or both.

The International OCD Foundation notes that CBT and medication are the most effective treatments for OCD.

Exposure and response prevention (ERP) therapy is a type of CBT.

2019 research states ERP is the first-line treatment for OCD. The authors write that up to 50% of people who have ERP on its own or in combination with medication will have a significant improvement in their symptoms. However, it does not work for everyone.

ERP involves a person working with a mental health doctor to talk about their compulsions, the fears or anxiety that might trigger them, and discuss the relationship between the two. A person may also share what they fear will happen if they do not perform their compulsive behaviors.

A person will then rank different situations from least distressing to most distressing.

After this, they will confront these situations with the support of the clinician and try to hold back from engaging in their compulsive behaviors or rituals. A person will do this in real-world settings and by imagining the situation.

The aim of ERP is to help a person learn that engaging in the situations or tasks they find distressing and refraining from performing their compulsive behaviors will not lead to the negative consequences they fear.

Other treatment options include:

  • Medication: Selective serotonin reuptake inhibitors (SSRI) medications are common treatments for OCD. A person may take a higher dose for OCD than for anxiety.
  • Deep brain stimulation: When medication and therapy do not work, deep brain stimulation may help with OCD. This involves using an electrode to send out impulses that change the behavior of the brain. However, it is expensive and not often used.

Treatments for anxiety also include therapy and medication.

A doctor may prescribe:

CBT is one of the most effective types of therapy for anxiety. It aims to help a person identify negative thought patterns and beliefs that trigger and sustain their anxiety and adapt them to reduce their symptoms.

A person may also try exposure therapy for anxiety, which helps a person confront situations that cause them anxiety.

A person can work with a doctor to discuss which treatment is best for them.

While fear and anxiety play a role in both OCD and anxiety disorders, they are distinct mental health conditions.

The main difference between OCD and anxiety is that those with OCD will experience strong urges to carry out repetitive behaviors or mental patterns to reduce anxiety about a specific situation or fear. They will also feel anxious if they do not perform these actions. People with anxiety will typically not have these urges.

Medication and therapy can treat both anxiety and OCD.

Anyone living with OCD or anxiety should speak with a doctor to discuss treatment.