Understanding the difference between anxiety and OCD can be challenging. After all, both disorders affect the mind and body. Those with anxiety or OCD can experience physical, mental, emotional, and spiritual distress. Let’s start by looking at the symptoms of each disorder.
Common Symptoms of Generalized Anxiety:
- body tension
- increased heart rate
- frequent worry
- difficulty concentrating
- feeling edgy
- difficulty sleeping
At a basic level, anxiety occurs when your internal fear response kicks in when it’s not needed. Our fear response is a good thing, given to us by God to keep us safe. The problem is that our brains and bodies are imperfect. Thus, the fear response can get turned on in response to something that is not actually going to hurt us. As an example, let’s say that you have generalized anxiety and get nervous when put in new situations. Your brain has made a connection somewhere along the way that new situations are potentially dangerous and must be avoided or engaged in with extreme caution.
Today, you are meeting your new male coworker. You may have worrisome thoughts. What if he’s mean or rude? What if he doesn’t like me? I’m always so awkward in these types of situations. What should I say? Your body starts to get hot and a little sweaty. You notice your heart has started beating a little faster. You take a few deep breaths, wipe your sweaty palms, and tell yourself everything is probably going to be fine with the coworker. You’re still a little edgy, but have calmed yourself down enough to meet him. Meeting a new coworker is not a life or death situation, but your body may be so worked up that it feels like it is.
OCD involves the presence of both obsessions and compulsions. An obsession is an intrusive thought that feels real, doesn’t respond to logical reasoning, and often creates internal doubt. While obsessions are a thought process, they are accompanied by distressing emotions and body sensations that are similar to what a person with anxiety experiences. This is the part that is confusing and often leaves the OCD undiagnosed for years. Compulsions are a behavior that someone feels compelled to engage in as a way to satisfy the obsession. Like scratching an itch, there is temporary relief, but in the long term, engaging in a compulsion strengthens the obsession, starting the whole obsession/compulsion cycle over again. Obsessions and compulsions can vary widely, but I have listed some common examples here:
Examples of common obsessions:
- Offense: I must have hit someone with my car while driving. I offended my coworker. I have sinned or offended God.
- Cleanliness: I have touched something that caused me to be contaminated. I’m dirty. This surface is dirty. I’m going to throw up.
- Harm: You may picture yourself harming yourself or someone else. You may be concerned about harming yourself, spouse/loved one, or child.
- Relationships: Am I destined to be with my boyfriend/girlfriend? Maybe I married the wrong person.
- Just so: Something doesn’t feel right, so I have to keep focusing on this aspect until it feels “just so.”
Examples of common compulsions:
- Checking: Checking the appliances multiple times before you leave the house or turning your car around to see if you hit someone
- Counting: completing actions according to a certain number such as flipping the light switch 3 times, avoiding certain numbers
- Repeating: re-doing schoolwork because you didn’t like your handwriting, repeating certain words in prayer or repeating a prayer a certain number of times
- Reassurance seeking: Asking your boyfriend multiple times if everything is OK between the two of you, asking your boss if you have done the right thing, asking for permission to do something you don’t need to ask permission for, asking someone questions a different way until they give you a desired response.
Let’s circle back to the example of meeting the new coworker, looking at it from an OCD lens. You have obsessive thoughts you can’t seem to get out of your mind about potentially harming the coworker. You picture yourself spilling coffee on him or accidentally tripping him. You put your coffee cup back on your desk. Your body starts to get hot and a little sweaty. Your heart has started beating a little faster, but you’re too consumed with your thought process to notice. Please don’t let me be awkward, you pray internally. It doesn’t feel right, so you say it two more times. Please don’t let me be awkward. Please don’t let me be awkward. You feel a small sense of relief, but then wonder if you should find the boss to get more information about the coworker in order to make sure you don’t offend him or harm him in some way.
The importance of determining if you have anxiety or OCD:
Why does it matter anyway? The key to effective treatment is proper diagnosis. If you see a therapist who practices Cognitive Behavioral Therapy for anxiety, they may teach you to challenge the anxious thoughts like you are in a court of law, looking at contradictory evidence. This would only seek to strengthen OCD, causing more distress. You may see a kind therapist who misses the OCD and provides reassurance that everything is going to be OK. You see the therapist every week, feeling a little better, but after six months of therapy, you’re not any better than when you started. You still have tremendous struggles outside of session. OCD treatment involves increasing one’s ability to tolerate distress. This can be done through several different therapies: Acceptance and Commitment Therapy (ACT), Exposure and Response Prevention (ERP), or Eye Movement Desensitization and Reprocessing (EMDR).
In my experience, EMDR is a great treatment for both anxiety and OCD. Unlike other forms of talk therapy, EMDR works at a brain and body level to help reduce uncomfortable body sensations. Clients defeat the avoidance that anxiety and OCD bring by learning mindfulness and distress tolerance skills. Present behavior is traced back to past learned experiences. After processing, clients may notice some obsessive thoughts, but they are now in the background instead of the foreground. Clients are able to experience the obsession without engaging in the compulsion. If you are in TN and interested in EMDR therapy, click here.
Carrie Bock, LPC-MHSP of By The Well Counseling is a Licensed Professional Counselor who specializes in helping clients with trauma, anxiety, and OCD get to a deeper level of healing through EMDR via in person and online counseling across Tennessee and EMDR intensive therapy sessions. Carrie is the host of the Hope for Anxiety and OCD podcast, which is a welcome place for struggling Christians to reduce shame, increase hope, and develop healthier connections with God and others.