What Is the Difference Between GAD and OCD?

Features of generalized anxiety disorder versus obsessive-compulsive disorder.

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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, for short), 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 (i.e., DSM-5) 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 (i.e., 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. Though individuals with GAD tend to worry a lot, they do not 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 stress caused by an obsession. Sometimes OCD compulsions result out of 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 (e.g., > 1 hour/day) and interfere with everyday responsibilities. Even if some behavioral correlate to the worry seen in GAD is present, like repeated reassurance-seeking from others, it is highly unusual for it to occur in a rigid, ritualized or compulsive manner.

Differences in Thinking

The thought patterns characteristic of GAD also distinguish it from OCD. People with GAD tend to worry about real-life concerns; these topics are by-and-large appropriate to worry about, though the degree of worry is clearly excessive. Worries may be about major life issues – such as health, finances, or relationships – but they are also about many minor, day-to-day stresses that others would tend not to perceive as intensely – such as giving a work presentation or not being able to predict what one’s 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 or otherwise biased thinking.

Obsessions, the hallmark thought processes of OCD, are also difficult for the afflicted individual 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 magical quality.

For example, a student with OCD might believe that items on her desk must be lined up in perfect symmetry and counting a specific number of times to prevent her from failing a test. Or, a parent with OCD might believe that they need to say a particular phrase repeatedly throughout the day to keep their children safe.  

Do These Problems Overlap?

It is not uncommon for individuals with GAD to meet criteria for another psychiatric diagnosis in the course of their lifetime, or even simultaneously. The most commonly co-occurring problem, however, is depression. However, a subset of individuals struggle with co-occurring GAD and OCD.

Of note, 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 the strongest evidence base.).

References

Abramowitz JS, Foa EB. (1998). Worries and obsessions in individuals with obsessive-compulsive disorder with and without 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.

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