“We suffer more often in imagination than in reality.”

-Seneca

Anxiety is an umbrella term for multiple anxiety-related disorders. Anxiety affects nearly 30% of the United States population. It is the most commonly diagnosed mental health condition in the country. Anxiety is, in its essence, an over-estimation of risk and an under- estimation of our ability to cope with that risk. It can target any aspect of our life but commonly affects social/family relationships, school/work functioning and future oriented doubts. Below is a list of the most common symptoms of anxiety:

  • Feeling nervous, irritable or on edge

  • Difficulty eating or sleeping

  • Frequent worry

  • Breathing rapidly, hyperventilating or trembling

  • Experiencing gastrointestinal problems

  • An increased heart rate

Everyone experiences anxiety or worry at some point in their lives. It is the level of impact and impairment in daily living that causes most to reach out for treatment.

Is it anxiety or OCD?

What is Anxiety?

Distinguishing the difference between OCD and an anxiety disorder comes down to how the individual comes to the conclusion (the reasoning process) to worry about their fear. In OCD, possibilities that are imagined are treated as more important than realities that are known. In other words, an OCD sufferer is dismissing relevant information in the here and now and treating a remote possibility that is imagined as evidence their fear is happening. In an anxiety disorder, the individual is using relevant information in the here and now to conclude a risk but may be over-emphasizing the risk. For example, an OCD sufferer would conclude they have cancer despite no relevant information indicating they should worry about this beyond an imagined possibility. In an anxiety disorder, there would be relevant information and true uncertainty (e.g. a doctor taking a biopsy that is concerned there is cancer) the individual may then begin to ruminate about catastrophic outcomes. It is important to distinguish between the two because appropriate treatment approaches differ for each disorder. When starting therapy, a thorough assessment will be done to identify this distinction.

What is OCD?

Obsessive compulsive disorder (OCD) has been named the “doubting disease” because it makes us question the things that matter most to us. It is a mental health disorder that affects people of all backgrounds and identities. It is estimated that about 1 in 100 adults (between 2 to 3 million adults in the United States) currently have OCD. OCD is diagnosed when a person gets caught in an unending cycle of obsessions and compulsions that impacts and impairs ones ability to function. Obsessions are doubts that cause unwanted thoughts, images or feelings that can cause intense fear and distress. Compulsions are attempts to get rid of or disprove these doubts through behaviors, thoughts or avoidance. Most basically, OCD is diagnosed when a person experiences:

  • Persistent ego-dystonic (meaning, unacceptable or inconsistent with one’s self concept) thoughts, images or urges

  • Attempts to disprove the doubts with rituals

  • Considerable time is spent each day avoiding or preventing thoughts, images or urges the person worries might prove their doubts true

OCD is the bully that tells you that you are both incapable and your worst case scenario is right around the corner. That your only defense is to stay alert and track your every thought, feeling, action or even past. It is the feeling that relief or safety is one action, thought, answer, google search, body scan, conversation or expert away. Yet you also know that the cycle of repetitive mental reviewing, cleaning/fixing, checking, reassurance seeking and avoidance is only causing you to feel more stuck and helpless. That relief lasts mere seconds before the next “what if” or “how do I know for sure” slams back into your mind.

OCD causes the agony of daily doubts around the things that matter most to you in this world. Below is a list of common OCD themes. Keep in mind that OCD can target any topic and often bounces around so this list will not include every OCD obsession.

  • Contamination obsessions / washing compulsions

  • Morality / religious OCD (obsession or fear with being “bad” or immoral)

  • Gender identity OCD (fear of being in denial about your gender identity)

  • Sexual orientation OCD (fear of being in denial about sexual orientation)

  • Harm OCD (violent obsessions, hit-and-run OCD, fear of causing harm)

  • Symmetry / “just right” OCD (Fixing or doing something until it “feels” right)

  • Health anxiety (fear of having / getting illnesses)

  • Real event / False memory OCD (excessive concern about things that may or may not have happened in the past and what impacts they may have had)

  • Hyper-responsibility OCD / checking compulsions (fear of making a mistake, making the right decision)

  • Pedophile OCD (fear of inappropriate sexual thoughts about children)

  • Relationship OCD (obsessions related to being in the right relationship)

  • Hyper-awareness OCD (fear of noticing your swallowing, breathing, blinking, itching, etc.)

  • Obsessing about obsessing (fear of having OCD forever, doubts around whether you even have OCD)

  • Existential OCD (obsessions about meaning of life, existence, purpose) 

  • Perinatal / Postpartum OCD (fear of harm related to newborn)

The truth is, you are not alone and it is not that you are broken, but that the tools your mind uses again and again to solve this unsolvable puzzle are just simply not sufficient. Everyday I help others to break free from the grip of OCD and reengage in the things that matter most to them in their lives. OCD is highly treatable and freedom is attainable.

There is hope.