How Do I Know If I have GAD or OCD?

A question I notice that comes up quite often from clients and other therapists is how to differentiate between generalized anxiety disorder and obsessive compulsive disorder. If you do a quick google search, you are likely to find differing criteria and opinions from professionals in the field. I will go into the DSM-V criteria below but some of the main differences include: the presence or absence of compulsive behaviors and thoughts rooted in daily life activities versus more ego-dystonic topics. Ego-dystonic means thoughts that don’t align with your personal value and belief system. Compulsions are behaviors that are used in attempts to reduce anxiety, guilt, and disgust and can include rituals, physical compulsions, mental compulsions, reassurance-seeking, and avoidance. Clients can often have both diagnoses and it is important to examine the dynamics of both.

The DSM criteria for generalized anxiety disorder includes but not limited to:

The presence of excessive worry and anxiety about a number of topics. The worry occurs more often than not for at least 6 months. The worry is very clearly excessive.

1. The worry or anxiety is hard to control and may jump around to different topics.

2. The anxiety and worry are present alongside at least 3 of the following symptoms: (In children, only 1 is needed)

   1. Tired or easily fatigued

   2. Restless

   3. Difficulty with concentration or having a feeling of your mind going “blank”

   4. Irritability

   5. Muscle tension or aches

   6. Trouble with sleep

   7. Nausea, vomiting, or diarrhea (GI symptoms)

3. Someone who struggles with GAD will spend a high percentage of their time awake worrying about something. The person make seek reassurance from friends or family. In adults, the worry can focus around a job, health, finances, or other everyday life topics.

4. The worry will make it difficult for the person to function in daily activities including work or social life.

The DSM criteria for obsessive-compulsive disorder includes:

The presence of both obsessions and compulsions. Obsessions include images, thoughts, or impulses that feel outside of the person’s control. The obsessions will come up frequently and most people feel anxiety, shame, or disgust by the thoughts. Most people realize that the thoughts are not logical. The obsessions and compulsions that people engage in typically last more than 1 hour per day and will interfere with work, school or social life. Compulsions are the behaviors that follow the obsession which try to reduce the anxiety, disgust or shame felt by the obsession.

Examples of obsessions include, but are not limited to:

• contamination obsessions

• violent obsessions

• responsibility obsessions

• perfectionism-related obsessions

• sexual obsessions

• religious or moral obsessions (scrupulosity)

• identity obsessions

  Examples of compulsions include, but are not limited to:

• washing/cleaning

• repeating

• checking

• mental compulsions

• avoidance

• reassurance seeking

Both diagnoses can be treated similarly with exposure and response prevention. However, there are other subtypes of cognitive behavioral therapy that can also be used with anxiety. Top treatments for OCD include the gold standard of exposure and response prevention and a newer treatment of inference-based cognitive behavior therapy which you can learn about here.

Feel free to check out my podcast episode with Julie Hilton, LCSW on Outside of Session. We cover OCD in greater detail. You can find the episode here.

Ultimately, if you are concerned about either, you should seek help from a trained mental health professional and specifically one who has been trained to work with OCD. OCD can be a tricky disorder to spot and having the knowledge of how to properly assess and treat OCD is pertinent. IOCDF has a great provider directory you can access here.