Differences Between GAD and OCD

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Historically, both generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) were considered anxiety disorders. Earlier editions of the Diagnostic and Statistical Manual of Mental Disorders (the DSM), a diagnostic reference guide used by clinicians to classify psychiatric conditions, grouped GAD and OCD within the same section. However, the fifth edition of the DSM published in May 2013, separated these diagnoses into different chapters. While GAD remains in the anxiety disorders section, OCD now resides in a section called Obsessive-Compulsive and Related Conditions. The term “Related Conditions” refers to problems such as hoarding disorder, trichotillomania (aka hair-pulling disorder), and body dysmorphic disorder.

Differences in Behavior

One way to understand the difference between GAD and OCD (as well as the related conditions within that section) is to think about the behavioral component, or lack thereof, to each problem. While people with GAD tend to worry a lot, they don't typically engage in compulsive, ritualistic behaviors to cope with their anxiety. People with OCD, however, commonly use repetitive behaviors—either physical or mental rituals called compulsions—to relieve the stress caused by an obsession. Sometimes OCD compulsions 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. For people with full-blown OCD, compulsions take up a lot of their time—more than an hour a day—and interfere with everyday responsibilities. Even if some repetitive behavior occurs with GAD, such as repeated reassurance-seeking from others, it's highly unusual for it to occur in the rigid, ritualized, or compulsive manner seen with OCD.

Differences in Thinking

The thought patterns characteristic of GAD also distinguish it from OCD. 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, the hallmark thought processes of OCD, are also difficult for people with OCD to control. However, in contrast to GAD, these thoughts or mental impulses extend far beyond everyday worries and problems. Obsessive thinking is more unrealistic and sometimes even has a perceived magical quality. For example, a student with OCD might believe that she has to line up items on her 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 he needs to say a particular phrase repeatedly throughout the day to keep his children safe.

Do These Problems 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.

The treatments for GAD and OCD overlap as well. Many medications are helpful for both problems, as is the cognitive behavioral psychotherapy approach. However, for OCD, a focused type of cognitive behavioral treatment called exposure and response prevention has been shown to work best.

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  • Abramowitz JS, Foa EB. (1998). Worries and obsessions in individuals with obsessive-compulsive disorder with and without a comorbid generalized anxiety disorder. Behav Res Ther, 36: 695-700.
  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders (Fifth edition). Washington, D.C.: American Psychiatric Association; 2013.
  • Newman MG, Crits-Christoph PF, Szkodny LE. (2013). Generalized anxiety disorder. In LG Castonguay & TF Oltmanns (Eds), Psychopathology: From Science to Clinical Practice (p. 62-87). New York, NY: The Guilford Press.