If you are wondering if you have (Generalized Anxiety Disorder) GAD vs. OCD (Obsessive Compulsive Disorder) and how to tell the difference, this episode is going to be exactly what you need.
My name is Kimberley Quinlan. I’m a cognitive behavioral therapist. I specialize in all anxiety disorders, and I help people overcome their anxiety in the kindest way possible. Now, I have treated generalized anxiety disorder and OCD for over 15 years, and I want to share with you that it is true—there is a massive overlap between OCD and GAD. They do look very similar. So I’m going to break it down and address the GAD and OCD overlap. Let’s go.
GAD versus OCD. You might know this, but in the world of anxiety disorders, this is actually a very controversial topic right now. I’ve been to conferences and master classes where clinicians will very much disagree on how we differentiate between the two. In fact, some people believe that they are so similar that they should be labeled as the same thing. We don’t all agree, and the reason for that, as I said, is that they do look similar. They do follow a very similar cycle.
My hope is that in order to understand what GAD is and what OCD is, we need to actually go through the diagnostic criteria. And that’s what we’re going to do for you today so that you too can understand the difference between GAD and OCD and determine for yourself what you think will help move you in the right direction. Let’s talk about it.
GENERALIZED ANXIETY DISORDER SYMPTOMS
As I mentioned, in order to get a GAD diagnosis, you do have to have a specific set of symptoms, and we’re going to go through them.
Number one, if you have GAD, the first symptom you need to have is anxiety and worry, and that’s usually focused on everyday events like work, school, relationships, money, and so on. Now, the frequency of GAD needs to occur more days than not for at least six months. The person needs to find it difficult to control this worry and anxiety, and it focuses on areas that are not consistent with other mental health struggles.
What we mean by that is, let’s say the focus was on being judged by other people. Well, that’s better understood as social anxiety. Or if the focus of your worry was on your health, then we would actually be better diagnosing you or understanding your symptoms as health anxiety. If it was focused on a specific thing, like planes, needles, or vomit, we would better understand that as a specific phobia. In order to have the diagnosis of GAD, it needs to not be under the umbrella of a different diagnosis. Other things that we would rule out when we’re thinking about GAD are things like panic disorder, body image, or even a previous trauma.
Now, the fifth symptom is it needs to cause distress and impairment. That’s very, very important here because, again, we’re talking about a disorder. What that means is a lack of order, no order. So what we want to see here is that it’s highly impacting their daily lives, highly impacting their ability to function.
And then the sixth criteria is it has to be ruled out that these symptoms could be from a medical condition or substance abuse. An example of that might be even me with POTS. I have postural orthostatic tachycardia syndrome. A lot of the symptoms of POTS can actually look a little bit like generalized anxiety.
The seventh criteria are the specific symptoms, and this is important to recognize because this might be true of a lot of different situations, symptoms, diagnoses, medical and mental. You need to have symptoms such as restlessness or being on edge. You need to be either easily fatigued, have difficulty concentrating, or have what we call a blank mind. You might have irritability, you might have muscle tension, and you could also have sleep disturbances.
That is the breakdown for GAD. As I said, it’s very easy to mix it up with other mental health disorders, such as OCD, because they can look very, very similar.
OBSESSIVE COMPULSIVE DISORDER SYMPTOMS
Let’s talk about OCD now. What is OCD? Now, in order to understand what OCD is, we need to again address the specific criteria to get a diagnosis of OCD. The symptoms of OCD include the presence of obsessions and compulsions or one. Sometimes, again, you might have obsessions without the compulsions, but usually, at the onset of the disorder, you will have both. You’ll also have intrusive, unwanted, repetitive thoughts, feelings, sensations, urges, or images, and these cause a very high degree of distress and anxiety, as we mentioned with GAD. The individual with OCD will often attempt to avoid or suppress these thoughts, feelings, sensations, or urges, and they will try to neutralize them using what we call compulsions.
Now there are five different types of compulsionS. A lot of you who have followed Your Anxiety Toolkit will know about these compulsions. We’ve talked about them. We actually go over them extensively in our online course for OCD called ERP School. If you’re interested to learn more about that, you can go to CBTSchool.com. We have a whole array of courses there to help you work through this and get help if you don’t have access to treatment of your own.
We do have five different types of compulsions. The first one is avoidance. The second one is mental compulsions. The third one is reassurance-seeking, whether it be from Google or a loved one. The fourth one is physical compulsions, like checking or jumping over cracks or washing your hands, just to give a few examples. The last one is self-punishment. So there are five types of compulsions.
Now, these compulsions are not connected in a realistic way and the way that they’re designed to neutralize or prevent. They’re usually clearly excessive behaviors done repetitively and done usually from a place of not wanting to do them, but more that the person with OCD feels like they have to do them to reduce or remove their obsessions.
Now, obsessions or compulsions are time-consuming. The frequency here is that they need to take up more than one hour per day or cause a significant degree of distress and impairment in their social, occupational, or other areas of functioning in their lives.
The next criteria is that the obsessive-compulsive symptoms are not attributable to physiological symptoms, substance abuse, or a medical condition. Similar to GAD, again, we want to always check for medical and substance abuse issues before we go ahead and get a diagnosis of either GAD or OCD.
And then, last of all, the disturbance is not better explained by another mental health condition. Again, if the worry or the obsession is around needles, like we talked about before, or being judged by somebody else or health conditions—if that were the case, we would give them a different diagnosis. Now, this is also true for trauma. Again, I want to make sure we understand that. Often, this same cycle will play out in different anxiety disorders—PTSD, BFRBs, phobias, health anxiety, BDD (body dysmorphic disorder). Once we have ruled those out, we can then move forward and acknowledge that this might be OCD or it might be GAD.
OCD VS GAD
Now that we’ve gone through all that, we can actually slow down a little and really take a look and talk about OCD versus GAD and how to tell the difference. Let’s break it down.
Both GAD and OCD have intrusive thoughts or what we call obsessions. A repetitive thought. Now, both have the presence of rumination compulsions and reassurance-seeking compulsions. That is true for both conditions.
DIFFERENTIATING GAD FROM OCD
OCD tends to be more on irrational topics and subjects, whereas GAD tends to be more focused on daily stresses and rational actual events in the person’s life, but not always. Again, sometimes the person with GAD may engage in a lot of catastrophic thinking or irrational thinking that can actually make this disproportionate to their daily life stresses.
ARE YOUR FEARS INTRUSIVE AND REPETITIVE?
Questions that you might want to ask yourself when you’re considering how to tell the difference between GAD and OCD are questions like, are your worries related to a daily stressor, or are your fears intrusive and repetitive?
People with OCD tend to identify that their thoughts are very intrusive, that they can’t stop them, they’re relentless, they’re repeating themselves over and over, whereas people with GAD tend to find that these are more preoccupations with problems in their lives, and they’re trying to solve them.
ARE MY FEARS REALISTIC OR ARE THEY IRRATIONAL/DISTORTED?
Another question to ask is, are my fears realistic or are they irrational and distorted? That question too can help us differentiate whether your symptoms are more related to OCD or GAD.
GENETICS AND GAD VS OCD
Another question to ask is, does anyone in your family have GAD or OCD? We know that these conditions are very, very genetic. If you’ve got someone with OCD in your family, it might actually help us to determine, is this something that’s going on for you? Are you better understood as having symptoms of OCD than you are GAD?
GAD TESTS & OCD TESTS
Another question or thing you might want to do is, you can take a GAD test or an OCD test. We have specific diagnostic tests that can help determine these. I strongly encourage, if you’re still having a hard time differentiating after you’ve listened to this episode, please do go and speak to a mental health professional who can help you determine and do those tests so that you can really be clear on what you’ve got and help you get the correct treatment.
CAN YOU HAVE BOTH OCD AND GAD?
Let’s answer some questions about this topic that commonly come up, which hopefully will help you get even more clarity on this topic. One of the most common questions we get asked in this area is, can you have OCD and GAD? Often, some of you are looking at these criteria going like, “Yes, yes, yes, yes, yes, yes, yes.” And the truth here is, yes, commonly, people do have OCD and GAD. There is a very strong GAD-OCD overlap here. So it could be that you have both.
TREATMENT FOR OCD & GAD
The good news here, if that is the case, is that the treatment for GAD and the treatment for OCD are very, very similar. In fact, again, like I said, it’s very controversial. Some clinicians say it doesn’t even matter. We don’t have to differentiate between OCD and GAD because the treatment is going to be so, so similar.
We’re going to use a combination of cognitive behavioral therapy and exposure and response prevention. We call cognitive behavioral therapy CBT, and we call exposure and response prevention ERP for short. Those treatments are focused on reducing those safety behaviors or compulsions, such as rumination, avoidance, reassurance-seeking, physical compulsions, and self-punishment, and also encourage you to identify your fears and learn to face them as much as you can. Learn to navigate those fears by experiencing them, tolerating them, being kind to yourself as you ride the wave of distress, and practice mastering your ability to be uncomfortable. That’s a huge piece of this. Also, master your ability to be uncertain, because in both conditions, they often require you to spend a lot of time trying to seek certainty, to get clarity, to solve the fear, and to prevent the fear. And we actually instead work at reducing that by increasing our willingness to be uncertain.
We also have an online course called Overcoming Anxiety and Panic, and we go through the same steps with that. They’re two separate courses because we want to make sure the person feels very understood and feels like they have a really good plan. Again, if you’re interested in that, you can go to CBTSchool.com. We have two courses for specific diagnoses, and that will help you make a plan for yourself. They are there specifically for people who do not have access to or do not have the means to access mental health services. These are self-led, on-demand courses. You can take them as many times as you want to put a plan together for you.
WHAT ABOUT OTHER ANXIETY DISORDERS VS OCD?
Let’s get back to the questions. What about other anxiety disorders vs OCD? Well, what we’ve talked about already—hopefully, we’ll clear that up—is the real way to determine what your specific problem or struggle is, what is the focus of your intrusive, repetitive thoughts? Again, if it’s on your body and your body image, we would look at an anxiety disorder, an eating disorder, or maybe even BDD. If the focus is on your health, we’re going to look towards health anxiety or hypochondria. If your fear is around being judged, we’re going to look towards social anxiety. If your fear is in response to an actual trauma you’ve been through, we’re going to look at PTSD and other trauma symptoms that you might be having. It’s important to identify the core fear, and that can actually help determine what specific struggle and diagnosis you have.
CAN GAD LEAD TO OCD?
Another important question that people ask is, can GAD lead to OCD? We don’t actually have a lot of research on this, so it’s important that we recognize that yes, they can overlap, that yes, you can have GAD, and then you can proceed into having OCD. But I wouldn’t actually say that GAD leads to it or causes it. Usually, again, we don’t really have a lot of clarity on what causes OCD, but we do know that there is a genetic component and an environmental component that are contributing to having OCD.
Lastly, what’s the difference between having OCD and general anxiety or just anxiety in and of itself? Often, again, we’re going to look at that core fear.
Now the thing to remember here is, everybody has anxiety. Everybody experiences anxiety. It is a normal part of being a human. But if that anxiety is starting to impact the functioning and quality of your life, if it’s starting to take up a lot of time, if it’s starting to stop you from being able to do the things you want to do, that’s usually when anxiety becomes what we call an anxiety disorder. When that happens, I’m going to urge you to seek help. There are treatments, there are solutions, and there are practices that can help you overcome this anxiety and get you back to living the life you want to live. You don’t have to live a life where we just accept anxiety at this rapid rate without getting help, skills, and tools to help you move forward.
The whole reason I created Your Anxiety Toolkit is because there are tools that can help you navigate anxiety in the most effective, wise, and kind way. So my hope here is that today, as we’ve learned to differentiate the difference between GAD and OCD and even other anxiety disorders, you can then go to get resources to help you overcome those specific struggles and challenges.
Again, if you’re interested, please go to CBTSchool.com. We are also here on Your Anxiety Toolkit, where we have over 350 free episodes to help you navigate these conditions. It is an honor and pleasure to help you with these struggles in your life, and I’m so grateful to be able to do that. I hope that’s been helpful. Have a wonderful, wonderful day, and I’ll talk to you soon.