The answer is no, but since there are some similarities between the two conditions, confusion can happen. It’s important to know the difference in order to receive a proper diagnosis and treatment.
History of OCD as an Anxiety Disorder
Historically, both generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) were considered anxiety disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM), a diagnostic reference guide used by clinicians to classify psychiatric conditions, once grouped GAD and OCD within the same section. While GAD remains in the anxiety disorders section, OCD now resides in a section called Obsessive-Compulsive and Related Conditions. Related conditions include hoarding disorder, trichotillomania (aka hair-pulling disorder), and body dysmorphic disorder. This change was made due to research indicating that OCD and related disorders had important commonalities—including obsessive thoughts and repetitive behaviors—that distinguish them from anxiety disorders.
OCD vs. Anxiety: Behavior
The primary behavioral difference between OCD and GAD involves the presence of compulsions. People with OCD engage in compulsive behaviors to cope with anxiety, while people with GAD do not. People with OCD use repetitive behaviors—either physical or mental rituals called compulsions—to relieve the stress caused by an obsession. These compulsive behaviors stem from a belief that the behavior can keep a feared outcome from occurring. An example of this would be handwashing excessively and ritualistically to prevent contamination. In GAD, people tend to worry a lot and sometimes seek reassurance from others. However, they don’t typically engage in compulsive, ritualistic behaviors to cope with their anxiety.
OCD vs. Anxiety: Thoughts
The thought patterns characteristic of GAD also distinguish it from OCD. The primary difference is whether these thoughts can be characterized as worry or obsessions.
Worry
People with GAD tend to worry about real-life concerns. And while these topics are appropriate to worry about, the degree of anxiety is clearly excessive. Concerns may be about major life issues like health, finances, or relationships, but they’re also about many minor, day-to-day stresses that other people wouldn’t tend to perceive as intensely—like giving a work presentation or being unable to predict what their daily schedule will be. Pathological worry, the kind that meets the threshold for a diagnosis of GAD, is pervasive and uncontrollable and tends to involve a lot of catastrophizing (imagining the worst possible outcome) or other distortions in thinking and decision making (aka biased thinking).
Obsessions
However, in contrast to GAD, these thoughts or mental impulses extend far beyond everyday worries and problems. Obsessions are the hallmark thought processes of OCD and are also difficult for people with OCD to control. For example, a student with OCD might believe that they have to line up items on their desk in perfect symmetry and count a specific number of times to keep from failing a test. Or, a parent with OCD might believe that they need to say a particular phrase repeatedly throughout the day to keep their children safe.
How Treatment Differs
The treatments for GAD and OCD overlap as well, although there are also some important differences. Both conditions respond well to cognitive behavioral therapy (CBT).
Cognitive Behavioral Therapy
CBT is a type of therapy that involves learning to identify and change the automatic negative thoughts that contribute to symptoms. The specific CBT techniques used to treat OCD may differ from those used to treat GAD, however. For example:
Cognitive restructuring: People with GAD may benefit from a technique known as cognitive restructuring, where people learn to identify thoughts that produce anxiety, challenge these thoughts, and develop a new perspective. Exposure and response prevention: For OCD, a focused type of cognitive behavioral treatment called exposure and response prevention has been shown to work best. This approach utilizes aspects of exposure therapy to gradually expose people with OCD to the things that provoke their fears and anxieties. Over time, the fear response lessens.
Medications
Many medications are helpful for both OCD and GAD. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are often the first choice for treating both OCD and GAD. They are often most effective when they are utilized in conjunction with CBT.
Medications for GAD: Paxil (paroxetine), Lexapro (escitalopram), Cymbalta (duloxetine), Effexor (venlafaxine) are FDA-approved for the treatment of generalized anxiety disorder (GAD), although others may also be prescribed as well. Medications for OCD: Anafranil (clomipramine), Prozac (fluoxetine), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline) are FDA-approved to treat OCD.
While the treatments for the two conditions often include the use of SSRIs, research suggests that OCD may take longer to respond to these medications than anxiety disorders.
When OCD and GAD Overlap
It’s not uncommon for people with GAD to meet the criteria for another psychiatric diagnosis in the course of their lifetime, or even simultaneously. While the most commonly co-occurring problem is depression, a subset of people struggles with co-occurring GAD and OCD. These statistics suggest that people with OCD may go on to develop GAD in some cases. The co-occurrence of other anxiety conditions is also high. Research also suggests that people who have both OCD and GAD are at a higher risk of developing major depressive disorder (MDD). Researchers also note that in order treat these co-occurring conditions effectively, it is important to get an accurate diagnosis and assessment. SSRIs can be helpful in treating both conditions, but individual responses may vary, so other medications may be prescribed to help manage symptoms. One study suggested that the anticonvulsant valproate could be effective in the treatment of GAD, so it may be useful to prescribe it alongside an SSRI when treating OCD and GAD. Atypical antipsychotics may also be prescribed to augment SSRIs in the treatment of GAD and OCD.
