Understanding OCD – How It’s Different From General Anxiety
Understanding OCD is more than just noticing controlling behavior or preferences for order, and can be more nuanced than we may think. Distinguishing between a normal human emotion and a mental health symptom is ever important, although not always obvious. Below is a comprehensive look from a psychologist’s lens of what OCD is, and what it is not. Also included are how general anxiety differs and signs you may want to request support from a therapist. My hope is that after reading it, you’ll feel more clear in understanding OCD and more confident in evaluating the signals you’re seeing and what they may mean for your life (or the life of someone you love).
Let’s start with the facts as we understand them today. According to the DMS5 (Diagnostic and Statistical Manual of Mental Disorders), OCD is characterized by recurrent and persistent thoughts, impulses, or images (AKA obsessions) that are experienced by the individual as intrusive and inappropriate. These thoughts are not simply excessive worries about real-life problems. Instead they are recognized as a product of one’s own mind having both a thought and action associated with them.
To neutralize the obsessive thoughts, a counter-acting thought, action, or behavior is engaged in as an attempt to minimize the impact of the intrusive thoughts. Many OCD patients organically adhere to rigid rules that are clearly excessive and often not connected in a realistic way with what they are designed to neutralize. This pattern of obsessions and compulsions is unwanted and causes marked anxiety or distress to the person and yet, is very tricky to stop.
As a culture, we understand this and have appropriated the word “obsessive” to mean anything from an intense interest to an anxiety disorder. My daughter and her teen friends used to describe their latest find by saying they were “obsessed” with it. Even the word compulsive has found its way into popular vernacular referencing behaviors that feel unhealthy or like a bad habit (compulsive liar, snacking, shopping etc). The addition of “obsessed” or “compulsive” are almost tools for emphasis these days, like adding an exclamation point to describe something you care about.
To add further nuance to understanding OCD, the disorder is viewed from a clinical lens as both a disorder (Obsessive Compulsive Disorder) and a personality disorder (Obsessive Compulsive Personality Disorder).
Both reference controlling thoughts and behaviors, but OCD itself references a more severe pattern around obsession and compulsions. This includes unwanted, intrusive obsessions and unavoidable, repetitive compulsions that can be mental or physical. The person engaging in these acts feels driven to perform them according to rigid rules in response to an obsession. It’s followed by compulsions (i.e. handwashing, checking, or other mental acts) that are engaged in an attempt to relieve the obsessive thoughts (fears of contamination, catastrophe, or other unwanted outcomes).
OCD personality disorder is different in that it lacks the hallmark compulsions of OCD. Instead, it is characterized by a preoccupation with orderliness, perfectionism, and interpersonal control that tends to be inflexible and pervasive across a range of situations. These patterns cause distress, and negatively impact a person’s functioning and relationships.
Generalized Anxiety & Intrusive Thoughts
When it comes to anxiety in general, intrusive and recurrent thoughts can play a prominent role. Examples include: fear of the unknown, persistent “what-if” thoughts (such as driving off the road, nuclear holocaust, dying from COVID, etc), or needing things to be in a perfect order.
Anxiety can be “intrusive” because the thoughts keep coming and generate similar thoughts. As you ruminate on your worries – even subconsciously – the thoughts continue to intrude on your life. As various “what-ifs” scenarios pierce your mind, you feel more anxious. This intense worry loop leaves people feeling trapped with no solution in sight.
For approximately 3% of the US population, anxiety is experienced as “Generalized anxiety disorder” or (GAD). This form of anxiety is characterized by persistent and excessive worry about a variety of events and activities, that is accompanied by physical symptoms and not easily controlled. Generalized anxiety tends to relate to real life concerns and situations, unlike OCD related anxiety that can be odd, irrational, or even seemingly magical.
As with other anxiety disorders, the intensity, duration and frequency of the anxiety and worry is out of proportion to the actual likelihood of the anticipated event. One interesting fact about GAD is that women’s risk of the disorder is double that of men. The disorder develops gradually and symptoms tend to be chronic, though severity may wax and wane across the life span.
Additionally, dealing with intrusive thoughts about taboo subjects like sex, religion or harm, can cause anxiety too. Clinically, what is seen in practice is the intrusive thoughts fall into a terminal “thought/fear/reaction” loop in your mind with the thought leading to the fear leading to the reaction.
The taboo nature of many topics makes it feel more challenging to discuss honestly, so if you’re dealing with intrusive thoughts of this nature, it’s important to find someone you trust and can confide in.
What Are Thought Distortions?
Anxious thoughts don’t always reflect the realities of what is likely to happen. Most anxious thoughts tend to reference extreme and scary scenarios, rather than the likely ones. Clinically, this is referenced as worrying about the possibilities, rather than the probabilities. Anxiety’s job is to help protect us from danger. Imagining and preparing for threatening situations is how we use anxiety to our advantage.
It takes intelligence to worry, but anxiety can quickly lead us down a primrose path of distorted thinking if we only conjure the most dangerous and least likely situations. A 2019 study at Penn State found over 90% of the predictions made by anxiety sufferers are untrue. Because thought distortions are such a risk when it comes to anxiety, exercising predictive judgment when anxiety strikes can help.
How Anxiety And Intrusive Thoughts Play Together
Obsessive thoughts tend to be negative and catastrophic (people will die, horrible outcomes will transpire, etc), leaving you with a sense of dread whenever you find yourself worrying about something. Likewise, these thoughts tend to be overgeneralized and scary. If a worrisome thought can spark anxiety, an obsessive thought loop can escalate anxiety into something bigger, self-reinforcing, and entrapping. This is how anxiety can start out as something constructive, but then morph into an obsessive anxiety loop that is more symptomatic than helpful.
The more you engage a catastrophic thought loop, the more accustomed your brain is to thinking it. So much so that these thoughts may not even feel voluntary after a while, and even intrude into your consciousness, seemingly out of nowhere. These intrusive thoughts can pop into your head via the most obscure and even imperceivable stimuli, making you feel like you’re crazy. They are unwanted, scary, and impossible to ignore. As such, they tend to maintain obsessive thought loops that become symptomatic and untenable.
Distinguishing Between The Two…
As the world continues to better understand and embrace a wider range of mental health conditions, our collective vocabulary for describing mental health has likewise expanded. Be careful not to overuse this new vocabulary or over-diagnose otherwise commonplace issues so you can preserve your ability to discern your understandable emotions from mental health symptoms.
Everyone feels worry, and worry can feel controlling and even a bit over reactive at times. But consistent worry doesn’t make a mental illness, nor should a diagnosis be used simply for emphasis. (OMG, she’s so OCD…). In better understanding OCD, it’s important to not dilute the suffering of those with clinical diagnoses by overusing the labels to describe everyday stresses.
Understanding OCD: What To Do If You’re Concerned
Sometimes, distracting yourself to substitute the thought helps, but it’s often a short-won war. True solutions to combat intrusive thoughts are found when you work on cultivating actual solutions. When you find yourself thinking about a problematic scenario, it can help to write out your feelings, and come up with plans for how to deal. This is how you can do something with your intrusive thoughts so they can land, and settle.
If you notice obsessive thinking is occupying too much of your time, getting in the way of your life, or leaving you feeling trapped, it may be a sign you could benefit from help. Anxiety disorders are among the most common mental health diagnoses, and also the easiest to treat. Many effective treatments are available, as are practitioners trained to help.
Cognitive Behavioral Therapy (CBT) has been shown to be particularly effective in helping obsessive thinking, and extinguishing the strong association between obsessions and compulsive thinking and behavior that tend to maintain symptoms. Medication can also be effective.
Understanding OCD can be empowering, and the truth is that OCD does not have to rule your life. Help is widely available for anxiety in all of its various forms. If you sense your anxiety has taken a hold on your life, that’s the sign to ask for support. If you are suffering, know that you do not have to do so alone.
If you’re not quite ready for targeted help, but want support, please sign up for my monthly newsletter. I curate articles that speak to the wide range of anxiety challenges and how it impacts relationships, parenting and your selfcare. Similarly, you can get my book Hack Your Anxiety to start your healing journey.