OCD vs. GAD and How to Tell the Difference: What You Need to Know

Obsessive compulsive disorder (OCD) and generalized anxiety disorder (GAD) share several similarities, and they can often be confusing to tell apart. OCD is frequently misdiagnosed as GAD because of a general lack of understanding and knowledge of OCD presentations. I have clients who come to me not knowing which they have – or who have been diagnosed with both in the past. Either way, they’re looking for clarity. 

So what is the difference between GAD and OCD, and how can understanding the distinction help get you the treatment you need? Let’s take a look.

OCD vs GAD and How to Tell the Difference

As anyone who specializes in OCD or GAD can tell you, there are many similarities between the two disorders that can make getting a proper diagnosis – and proper treatment – difficult.

One of the biggest similarities? They both revolve around the experience of distressing anxieties that interfere with everyday life.

But there are key differences. Here are four of those differences. 

1. Symptoms

While there are many overlapping similarities between GAD and OCD, there are also several differences in presenting symptoms. Let’s take a look. 

GAD symptoms include: 

• Persistent, excessive worry about everyday situations
• Physical symptoms like irritable bowel syndrome, migraines, and other chronic pain
• Difficulty sleeping
• Fatigue
• Muscle tension
• Restlessness or feeling “cagey”
• Irritability or anger

OCD symptoms include:

• Intrusive and unwanted thoughts (including images and urges)
• A lot of mental and physical energy spent trying to reduce or avoid the intrusive thoughts
• Compulsions, which are attempts to reduce anxiety created by the thoughts
• These thoughts tend to be fixated around a fear that doesn’t align with your values or what you know to be true about the world 

Whereas GAD tends to feel like a general feeling of unease or apprehension, OCD often revolves around a specific fear or set of fears. However, both of these disorders disrupt daily life and can lead to other mental health issues like depression.

2. Type of anxiety

GAD typically consists of distressing anxieties about everyday situations. Think: excessive, perseverating worries about losing a job, relationships, finances, and health. It’s more than just worries, though. GAD can feel like your nervous system is always on high alert mode. The focus of the anxiety tends to jump around frequently, resulting in a constant state of unease.

GAD worries are typically characterized by distorted ways of thinking, such as catastrophizing and all-or-nothing thinking. Imagine it’s the day before a big job interview. If you’re like most people, you’ll experience at least some nervousness. But if you have GAD, you’ve likely been ruminating on this interview since you first scheduled it. You’re probably going over all the worst case scenarios, and being excessively afraid of looking unprepared or messing up.

OCD, on the other hand, involves distressing intrusive thoughts about situations that are specific, out of character, and/or unlikely to occur. For example, someone with OCD might obsess over thoughts of driving their car off a cliff. They don’t want to drive a car off a cliff and there’s no reason they’d actually do that. But once the thought takes hold, they become preoccupied with it and can’t let it go.

One way to understand the difference between OCD and GAD is to consider how “sticky” the anxiety is. While people with GAD do frequently ruminate about the same things over and over, their anxiety is also like a wildfire – it spreads and takes over whatever is in its path. This means the main focus of the anxiety shifts and changes to include any and all parts of someone’s life.

Anxiety latches itself on to people with OCD in a stickier way. Rather than jumping from one anxiety to the next, people with OCD tend to fixate on and obsess over one or a few intrusive thoughts for longer periods of time. Rather than a wildfire, it’s more like a single house burning in a row of houses. And contrary to stereotypes, there are many types of OCD, and they vary widely in form and presentation. 

3. Type of coping

People with GAD tend to use various coping mechanisms to deal with the physical and emotional discomforts of anxiety. These coping strategies can be beneficial or harmful, and they might include things like exercise, journaling, binge eating, watching too much Netflix, or drinking. Their purpose is to soothe or numb the nervous system and decrease anxiety. These coping strategies usually help, at least to a point, even if they stop working or cause harm in the long run. 

In contrast, people with OCD use compulsions, or rituals, to deal with their obsessive thoughts or urges. Coping mechanisms are different from compulsions, and this is a key difference between people with OCD and GAD. 

Compulsions are also used to self-soothe and decrease anxiety, but they very often fuel the very obsessions they’re trying to prevent. 

Compulsions can be mental or physical, and might include:

• Reciting a phrase or mantra aloud or internally over and over
• Knocking on wood
• Counting steps
• Touching or not touching an object
• Frequent hand-washing
• Checking things like doors, the stove, or light switches
• Reviewing and countering their unwanted thoughts

These compulsions can be time-consuming and agonizing for people struggling with OCD. Such rituals are usually unwanted, but not doing them does not feel like an option. It’s important to note that most – but not all – types of OCD include compulsions. 

4. Treatment

Treatment for OCD is often vastly different than treatment for GAD. This is one reason why receiving a proper diagnosis is important. 

Treatment for GAD involves tecnhiques like cognitive restructuring, a form of Cognitive Behavioral Therapy. It consists of becoming aware of your own ways of thinking, realizing there are inaccuracies to your thoughts, and working to change them to reflect a more realistic and compassionate outlook.

But treatment for OCD requires another approach, namely exposure and response prevention, or ERP. ERP involves taking small steps to expose yourself to things that trigger your anxieties and obsessions, and then to start changing your response to these anxieties. 

Medication can also be helpful for either diagnosis, depending on your personal situation. Talk to a doctor or psychiatrist who specializes in OCD or GAD to decide the best route for you.

GAD and OCD Comorbidity: Can I Have Both?

GAD and OCD can and do exist together. It is, however, much more common for someone with OCD to also have GAD than for someone with GAD to also have OCD.

People with OCD may worry about more realistic life situations as well as unlikely situations, and that’s when GAD can become a comorbid factor. And the types of anxieties and symptoms aren’t always clear-cut or consistent. In this sense, GAD and OCD can form a sort of spectrum. 

Both GAD and OCD tend to be exacerbated by stressful life situations. You may notice an influx of anxiety and obsessions during particularly difficult or stressful times (like, oh I don’t know, COVID-19.)

Therapy and Coaching Can Help You Navigate the Difference Between GAD and OCD 

If you’re wondering if you have OCD vs GAD, I can help.

Together, we can work through your challenges and distinguish between GAD and OCD, come up with goal-setting strategies to work on anxiety management skills, and give you tools and skills to reduce your anxiety.

I’m ready if you are. Reach out today to get started.