When Your Worry is Really OCD

Almost everyone worries from time to time about stressful, real-life concerns like financial troubles, performance at work or at school, health problems, and relationship issues. Such stress and worry can become a more significant anxiety problem when the worry and anxiety get to be out of proportion to the real risk and when the worry and anxiety occur most every day and disrupt quality of life. Obsessive-Compulsive Disorder (OCD) can look and feel quite similar to general anxiety, yet there are differences.

Everyday Concerns and Not So Everyday Concerns

With both general anxiety and OCD, the person feels anxious much of the time, exaggerates the perceived level of threat, and experiences a disruption to their quality of life. That being said, one important indicator that distinguishes generalized anxiety from OCD is that people with generalized anxiety focus more on everyday concerns, whereas people with OCD focus on concerns that are more unrealistic and not as relatable for family, friends, and co-workers.

For example, a person may become fearful that they ran over a pedestrian each time they drive over a pothole or bump in the road. For people with OCD, their worry about these unrealistic concerns often goes to the next level and becomes obsessive in terms of its repetitiveness, intensity, and intrusiveness in their daily thoughts and mental images.

Fear That is Relentless and Repetitive

With generalized anxiety, the person can often distract themselves for a while more easily. They can turn their attention to another task for a while without the worry or fearful thought pushing its way back into the forefront of their mind.

OCD thoughts and images have a more persistent, “in-your-face” aspect to them. When they do subside for longer than several minutes or hours, the break in fearful thought, while welcome, often seems to occur more by chance, rather than something the person does to distract their attention.

Common Themes for OCD

Common themes for OCD include fear of contamination or germs, fear of physically harming others or self, unwanted sexual thoughts or images, fear of not following one’s ethical code or religious values with exactness (known as scrupulosity OCD or perfectionism OCD), and excessively high need for symmetry and order (ICD-11, World Health Organization, 2019).

Another frequent indicator for OCD is that the person may have more than one of these themes (unrealistic fears), either at the same time or across the lifespan. For instance, a 30-something woman who lives in a low-crime area may currently obsessively fear that an intruder will kidnap her young children, and yet she may also have had an obsessive fear of germs and contamination for a few years when she was a teenager.

Also know that the person with OCD experiences these fearful thoughts and images as unwanted, and the thoughts and images often violate their personal value system and sense of identity. It almost seems that OCD “chooses” some of the person’s deepest fears to create emotional upheaval in the person, and then the catastrophizing ensues, even if the fear is unrealistic and has a low probability of occurrence.

The irrational and obsessional thoughts and images are often accompanied by a demand for 100% certainty to make sure there is no risk of the irrational fear actually happening. That demand for certainty then leads to what is probably the most distinctive sign of OCD: compulsions.

Compulsions: Rituals, Reassurance-seeking, and Other Things Too

Compulsions involve rituals, behaviors, or reassurance-seeking; all of which the person uses to reduce their distress from the obsession-related anxiety. For example, the person with the fear of running over pedestrians each time they encounter a bump in the road may drive back once, twice or even several times to check to make 100% certain that they did not actually hit a person.

While these compulsions reduce the anxiety for a short time; sometimes the relief lasts only for seconds or minutes. Even more importantly, engaging in compulsions/rituals only makes the problem worse in the long run. In other words, the compulsions – that is; doing the physical behaviors, thinking the mental rituals, or avoiding the feared situations – leads to an increase in the frequency and intensity of the obsessional fear in the long run.

What’s more, the person may have frequent feelings of excessive anxiety or inappropriate guilt when they resist or try to abstain from the compulsive ritual or behavior. Over time, the person with OCD will engage in compulsions more often and with an even greater sense of urgency, unless the person learns the how OCD works and how to manage it. Know that with proper treatment, the person can become the master rather than remain a slave to the OCD.

Compulsions Commonly Seen in OCD

Compulsions – the rituals and behaviors the person uses to reduce the anxiety – may include:

1. cleaning and washing rituals; checking that no harm came to others;
2. risk-reducing behaviors (such as checking locks, doors, ovens);
3. repetitive confessing for minor mistakes made either recently or long ago;
4. seeking reassurance from others or self or the internet that the fear is irrational and unlikely to happen;
5. arranging and rearranging items such as clothes or desk items to their proper place or order if disturbed (DSM-5-TR; American Psychiatric Association [APA], 2022).

The amount of time spent on these compulsive rituals and behaviors can be significant and take up a few hours or more each day.

Mental Compulsions

Also, know that for some people with obsessional worry that their anxiety-reducing efforts (compulsions) are not observable in terms of visible rituals or behaviors. For them, they have limited their compulsions to efforts to reassure themselves that the feared risk will not happen. Some people refer to this type of OCD as pure obsessional OCD, though technically the person still has compulsions. The compulsions are simply mental in nature and not able to be seen by family, friends, or co-workers.

Yet another example of a mental compulsion is the use of a safety phrase that is repeated in the mind over and over again when the fear comes to mind. For instance, a young mother may say to herself “Everything will be okay” several times when she has fear that her children will come to harm even though, logically, the safety phrase has no real connection to whether the feared outcome will occur. Another mental compulsion is frequent review of past thoughts, actions, or conversations to reduce fear and uncertainty. There are other forms of mental compulsions as well.

Thought-Action Fusion

Another sign or common feature seen in OCD is what is known as thought/action fusion. In other words, people with OCD are more likely to believe that thinking the irrational thought will make the feared outcome (action) happen. To refer back to the example of the driver with fear-of-harming-others OCD who fears running over a pedestrian, the driver may believe that having the fearful thought or image will make it occur at some point in time. They just don’t know which time it will be.

Conclusion

In summary, the main differences between general anxiety and OCD are in OCD the person:

1. focuses on more unrealistic concerns that are hard for others to relate to,
2. struggles more to shake off the fearful thought even after acknowledging the thought is irrational or not likely to occur, and
3. engages in compulsions: repetitive rituals, behaviors, or mental phrases designed to reduce their distress about the obsessional thought.

While OCD can certainly rob a person of much of their quality of life and sometimes even bring an occasional bout of depression, relief is available through proper treatment that may sometimes also include the use of medication. Research suggests that the most effective form of treatment for OCD is exposure and response prevention (ERP). Dr. Craig specializes in treating OCD with this treatment approach, and he would be happy to help you restore your quality of life and get back your peace of mind.