OCD vs. generalized anxiety disorder: Differences explained

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Many of the symptoms people may experience differ between OCD and GAD.

Symptoms of OCD

To receive an OCD diagnosis, a person with OCD must have obsessions, compulsions, or both.

Obsessions are recurrent, unwanted, and persistent intrusive thoughts, urges, or images that cause distress or anxiety. They may attempt to ignore, suppress or neutralize them by performing a compulsion.

Compulsions are repetitive mental acts (such as praying or counting) or behaviors (such as checking and handwashing) that a person feels compelled to perform rigidly in response to the obsession.

These are generally time-consuming or cause significant distress or impairments in their relationships, work, and other areas of functioning.

Learn more about OCD.

Symptoms of GAD

Generalized anxiety disorder (GAD) is a mental health disorder characterized by excessive and unrealistic fear or worry about everyday things.

For a diagnosis of GAD, a person must have excessive worry or anxiety occurring more days than not for at least 6 months. The person must find it challenging to control the worry and must have at least three of the following symptoms:

• restlessness or feeling on edge
• easily fatigued
• mind going blank or difficulty concentrating
• irritability
• muscle tension
• sleep disturbance

A person may also experience nonspecific body complaints such as:

• headaches
• dizziness
• palpitations
• shortness of breath

This typically leaves a person with a constant feeling of being overwhelmed and can cause impairments in their work, relationships, and other areas of functioning.

Learn more about GAD.

The previous versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) classified GAD and OCD as anxiety disorders.

In the DSM-5, experts separated OCD and grouped it with related disorders under a new classification called Obsessive-Compulsive and Related Disorders. The current version (DSM-5-TR) still maintains this separation.

Both conditions generally respond well to treatment. Many of the treatments for each condition overlap.

Cognitive behavior therapy

Cognitive behavior therapy (CBT) is typically effective for both conditions.

It is an effective treatment for GAD, leading to reductions in worry. It has comparable effects to medications. CBT is also the most effective psychotherapeutic method of treating OCD.

While both respond to CBT well, OCD treatment has a more specified treatment regimen, while treatments for anxiety disorders like GAD are broader and less specific. This includes:

• Cognitive restructuring: This involves identifying one’s maladaptive thought patterns and challenging them.
• Exposure therapy: Through imaginal exposure, this makes a person imagine a worst-case scenario or catastrophic outcome and then imagine them undergoing such an experience.
• Mindfulness exercises: This trains a person to have a nonjudgmental and nonreactive awareness of the present moment to help them distance themselves from negative thoughts.

The most essential type of CBT for OCD is exposure and response prevention (ERP). This aims to restructure the mind and change one’s habit of compulsive behavior. It involves exposing the person to their fears and having them resist the urge to perform a compulsion.

Medications

Doctors typically prescribe serotonin-specific reuptake inhibitors (SSRIs) to people with OCD but at much higher doses to see improvements than those prescribed to people with anxiety. But they are also more sensitive to the side effects of the medications.

Other medications doctors may prescribe for OCD and GAD include:

• serotonin-norepinephrine reuptake inhibitors (SNRIs)
• antipsychotics
• benzodiazepines

OCD is a highly misdiagnosed condition. Aside from GAD, OCD can be mistaken for other anxiety disorders, such as social anxiety disorders or specific phobias. It may also have features similar to other OCD and related disorders, such as hoarding disorder.

It is also possible for professionals to mistake OCD for other possible conditions, including:

• major depressive disorder (MDD)
• eating disorders
• tics or Tourette’s syndrome
• psychotic disorders

While OCD and GAD share some features, several characteristics can help distinguish the two conditions.

Behaviors

While both conditions have unwanted, pervasive thoughts, people with OCD generally have a strong drive to engage in compulsions or rituals to prevent or lessen the anxiety caused by obsessive thoughts.

While people with GAD have excessive worry, they do not typically engage in compulsive behaviors to alleviate their anxiety.

Thought patterns

Both conditions have anxiety and distress that root in persistent thought patterns.

Excessive worry is the central feature of GAD. The worries are often about real-life concerns like health, finances, family, or the future.

Compared with everyday worries (nonpathological anxiety), the concerns associated with GAD typically have the following characteristics:

• excessive and significantly interferes with a person’s psychosocial functioning
• more pervasive, pronounced, and distressing
• lasts longer
• occurs without triggers
• accompanied by physical symptoms

Meanwhile, obsessions are the hallmark of OCD. These obsessive thoughts go beyond everyday worries. They may include content that can be considered odd, irrational, or even magical.

Common obsessions with OCD include:

• contamination
• harm
• risk to self or others
• doubt
• symmetry
• aggression

Focus

People with GAD tend to have a general sense of feeling overwhelmed and may worry about several events or activities. In contrast, obsessions in people with OCD tend to have a narrow focus, such as fear of contamination or aggression.

The following are some questions people frequently ask about OCD and GAD.

Can you have both OCD and GAD?

OCD and GAD can co-occur. In a 2021 study, 33.56% of 867 participants with OCD also had GAD.

How common are anxiety disorders and OCD?

Anxiety disorders are one of the most common comorbidities in OCD and can occur in 75.8% of cases. This means that over three in four people with OCD may have a co-occurring anxiety disorder.

OCD and GAD share similar features, but several characteristics can help distinguish the two conditions. Aside from having associated compulsions, thoughts associated with OCD go beyond daily life concerns and may even be considered odd or irrational.

Also, people with OCD tend to have a more narrow focus, while people with GAD may feel more generally overwhelmed and worry about many situations.

Despite this, a person can have both conditions. A person who experiences intrusive and persistent thoughts that affect their life should speak with a healthcare or mental health professional.