Do I have GAD, Generalized Anxiety or do I have OCD?

That’s a recent question I had from Brendan. He told me his therapist diagnosed him with GAD Generalized Anxiety Disorder, but he thinks he has OCD. And he thinks that explains why the talk therapy was not very helpful for him. I thought it might be helpful to point out the differences between GAD, Generalized anxiety disorder and OCD, Obsessive compulsive disorder.

Hi. I’m Paige Pradko. I am a therapist that specializes in anxiety disorders and OCD. Welcome to Therapy for a Better Life.

Today, I am going to compare what people experience with GAD, generalized anxiety disorder compared to what people experience that have OCD, because there are some similarities and some differences. It is important to know the difference because it will affect your treatment choices. Before I get into the meat of the video, I left you a GIFT in the description. First, there is a PDF called, “Why do I feel that in my Body: Explanations of bodily symptoms due to anxiety, stress and panic.” And a free assessment for OCD as well. First, people with generalized anxiety disorder typically experience excessive worry and anxiety about several different topics and events and activities going on in their life. Not only is there constant anxiety and worry that is out of proportion to the topic, but there are often physical symptoms too, like feeling tense and an inability to relax, a restlessness, nervousness, or trembling. They can have symptoms like sweating and ibs (irritable bowel syndrome), nausea, muscle tension, irritability and trouble sleeping. People with GAD have difficulty setting aside worries, and concentrating, and sometimes they may fear making the wrong decision. They often overestimate the danger or threats and underestimate their ability to cope. They are overthinkers and often excessive planners, trying to cover all their bases. They often are perfectionists as they tend to over prepare and overdo and want to please and strive for approval. Yet, they may lack confidence even though they overdo and over prepare. Many of these behaviors are done in attempt to gain certainty and control, as they have a very difficult time with uncertainty. What other conditions have difficulty with uncertainty and overthinking? Hmmmm. Did you guess OCD? Yes, there are lots of similarities between GAD and OCD. People OCD also have worries and anxiety and rumination and catastrophize and run through what-if scenarios. And they also are overthinkers and have difficulty tolerating doubt and uncertainty. There is an overlap in symptoms between people with GAD and people with OCD, but I want to point out some key differences so that you know the difference as that affects your treatment. 1. First, people with OCD have what we call “sticky thoughts”. The thoughts, images or sensations can get stuck and become obsessive. People with GAD have worries that jump around from one topic to the next. And although the worries may be excessive, they are not the same worry, repeatedly. I have heard it described that people with GAD feel more frantic and people with OCD feels more like they are spiraling in loops. 2. That brings us to the content of thoughts. People with OCD experience obsessive thoughts that are the opposite of their character and opposite of who they are and what they value. We call this ego dystonic. They are having thoughts about things that they absolutely do not want to be thinking about. And the thoughts tend to be more irrational, sometimes magical and very specific. “If I have that thought, I have to hold my breath and tap 3 times or something bad will happen to my parents.” OCD is not logical, but it has a way of attacking people with their deepest, darkest fears and makes them doubt themselves. People with GAD typically have worries surrounding what they are doing or going to do. Their worries are real life concerns, although blown a bit out of proportion. “What if I don’t get that job, or what if I fail that test?” 3. And the third difference concerns rituals and compulsions. People with OCD may do physical compulsions and rituals like washing, blinking, checking door handles, tapping, re-doing things to get a just-right feeling, etc. They may also have mental compulsions like ruminating, analyzing, replaying things, repeating things, counting, neutralizing bad thoughts with good thoughts. The purpose of the compulsions is to self soothe, and lower their anxiety and discomfort, although the behaviors actually feed the OCD cycle. For people with GAD, they typically do no perform rituals and compulsions like in people with OCD, but they can have some of those behaviors. And they often do have avoidance behaviors and ruminate and do other behaviors that may maintain their anxiety cycle as well. It is important to know whether you are experience GAD or OCD, because this ultimately affects your treatment. A trained therapist is going to interview you to review your symptoms and history and include assessments like Yale-Brown obsessive compulsive scale and the DASS and other measures before giving a diagnosis. And, to make things a little more complicated, it is possible to have both conditions. As far as treatment goes, the gold-standard treatment for OCD is ERP, Exposure and Response Prevention as a first line of treatment. There are other therapies like ACT and mindfulness, and medications that may be added to the treatment as well. For GAD, ERP can also be effective for some, and other therapies focused more on thoughts like CBT’s cognitive restructuring or ACT therapy using cognitive defusion along with acceptance and mindfulness-based therapies. Don’t forget, I left you a gift in the description of the video. Until next time, I will see you in session.