The Difference Between OCD, GAD, and Phobias

Anxiety is a common mental health condition and is usually characterized by excessive worry, fear, and nervousness. Anxiety has both emotional and physical symptoms associated with it.

Common Anxiety Symptoms

Emotional symptoms might include: 

• Feeling overwhelmed, tense, or edgy
• Excessive worry about normal, everyday situations
• Difficulty making decisions
• Difficulty concentrating
• Irritability or restlessness
• Feeling a sense of impending doom or disaster

Physical symptoms might include:

• Rapid heartbeat or palpitations
• Sweating or trembling
• Shortness of breath
• Muscle tension or aches
• Nausea or intestinal distress
• Difficulty sleeping 

Usually, these symptoms lead to some type of avoidance of the situation or triggers that are causing the anxiety. Anxiety can be caused by genetics, life experiences, and stress. But not all anxiety needs to be treated professionally. Sometimes, when the stressor is relieved, anxiety symptoms will also lessen. 

Sometimes and if left untreated, anxiety can grow into obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), or phobias. Because all of these diagnoses fall under the anxiety umbrella, it can be difficult to get an accurate diagnosis. For example, research shows that it can take people up to 7 years to get an accurate diagnosis. Which is frustrating because therapy is not cheap and prolongs people’s suffering. 

In this post, we will take a more in-depth look at these disorders, what to look for, and when to get help. We hope that by understanding these differences, we can equip you to ask the right questions of your therapist and get the right help sooner rather than later. 

Understanding Obsessive Compulsive Disorder (OCD)

OCD involves persistent, intrusive thoughts (obsessions) that create intense distress, coupled with repetitive behaviors or mental acts (compulsions) performed to reduce that distress. Unlike normal worries, OCD thoughts are often irrational, and the behaviors become time-consuming rituals. Just as the name suggests, a diagnosis of OCD includes obsessions and compulsions.

Obsessions

Obsessions are recurring, persistent, and unwanted thoughts, urges, or images that cause significant anxiety, fear, or distress. They are so disturbing because they go against everything a person stands for or values. Unlike anxiety, which is usually related to real-life problems, obsessions are disturbing in their very nature. 

Common themes include: 

• fear of germs, dirt, or disease
• thoughts of accidentally or intentionally harming oneself or 
• a need for things to be “just right,” balanced, or even (people typically prefer odd numbers because there is a definite middle)
• forbidden thoughts related to religion, aggression, or sex
• repeated doubts even when things were turned off or doors were locked

Compulsions

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The hope is that by performing these acts, it will reduce the anxiety that is caused by the obsession or prevent an undesirable outcome. 

Common compulsions include:

• repeatedly checking locks, switches, or appliances
• excessive hand-washing, showering, or cleaning to neutralize fears of contamination
• counting objects or repeating words a specific number of times
• arranging items in a specific or precise way
• constantly asking others for reassurance that these things are okay
• trying to neutralize “bad” thoughts with “good” thoughts or prayer

Understanding Generalized Anxiety Disorder (GAD)

GAD is characterized by excessive, persistent, and usually uncontrollable worry and anxiety about a variety of everyday events. GAD does not involve rituals or compulsions to neutralize them like OCD. 

Emotional Symptoms

• Excessive, persistent worry about multiple topics (health, money, work, family, world events)
• Difficulty controlling the worry – it feels uncontrollable
• Anticipating disaster or worst-case scenarios
• Constant feeling of being “on edge” or restless
• Difficulty concentrating or mind going blank
• Irritability
• Indecisiveness or difficulty making decisions
• Worry that feels disproportionate to the actual situation

Physical Symptoms

• Muscle tension (especially neck, shoulders, jaw)
• Fatigue or feeling easily tired
• Sleep disturbances (difficulty falling asleep, staying asleep, or restless sleep)
• Headaches
• Stomachaches or digestive issues
• Restlessness or feeling keyed up
• Being easily startled

Understanding Phobias

A phobia is an intense, irrational fear of a specific object, situation, or activity that can cause significant distress or avoidant behavior. Unlike OCD, doing a specific ritual alleviates anxiety. And unlike GAD, it is usually related to a specific situation or object (e.g., small spaces, public spaces, spiders, needles). With a phobia, the fear is specific and isolated. 

Emotional Symptoms

• Intense, irrational fear of a specific object, situation, or activity
• Fear is immediate and automatic when encountering (or anticipating) the phobic stimulus
• Recognition that the fear is excessive or unreasonable (in adults; children may not recognize this)
• The feared object/situation is actively avoided or endured with intense distress
• The phobia significantly interferes with normal routine, work, relationships, or causes marked distress

Physical Symptoms When Exposed to Phobic Stimulus:

• Rapid heartbeat or palpitations
• Shortness of breath or feeling of choking
• Trembling or shaking
• Sweating
• Nausea or stomach distress
• Dizziness or lightheadedness
• Chest pain or discomfort
• Fear of losing control or “going crazy”
• Fear of dying (especially with blood-injection-injury phobia, which can cause fainting)

Common themes include:

• Animal/insects: Spiders, dogs, snakes, insects, birds
• Natural environment type: Heights, storms, water, darkness
• Blood-injection-injury type: Needles, medical procedures, seeing blood, injuries
• Situational type: Flying, elevators, enclosed spaces, driving, bridges
• Other types: Choking, vomiting, loud sounds, costumed characters (in children)

Key Differences Between Conditions

OCD vs. GAD

OCD is characterized by obsessions (intrusive thoughts) and compulsions. GAD involves excessive, uncontrollable worry about various everyday situations, but without the specific compulsions of OCD. It’s important to note that you can have both conditions.

OCD vs. Phobias

While both can cause distress, OCD is a cycle of obsessions and compulsions, while phobias are intense, irrational fears of a specific object or situation.

Misdiagnosis

It can be difficult to get the right diagnosis, especially when so many of the physical symptoms overlap between OCD, GAD, and Phobias. A misdiagnosis can be frustrating for everyone involved because it can cost valuable money and take longer to feel better. For additional information on how to track some of these behaviors, as suggested below, check out our blog post found here. 

Here are some ways that you can help avoid a misdiagnosis:

• AI, social media, and the Internet can be helpful to give you a direction, but we would caution you to seek a professional for an accurate diagnosis
• Be honest with your therapist about the frequency, intensity, and duration of your symptoms
• Before your first appointment, identify how these symptoms are impacting your daily life (you can easily use a 1-10 scale with 1=least distress, 10=most distress)
• Be as detailed as possible
• Be honest about how symptoms are affecting your ability to function at work, school, and in social situations

It’s important to get the right diagnosis so that you can get back to your normal life as quickly as possible. 

Peace Family Counseling is Here to Help

If you’re not sure whether or not you or someone you love has an anxiety disorder, we’d love for you to reach out. We have therapists who specialize in anxiety-related disorders such as OCD. We have several therapists at Peace Family Counseling in Greenwood, Indiana, and the greater Indianapolis area who can provide you with the support you need in person or via telehealth.

We’d love to walk alongside you and help you find hope and healing in your lives and relationships. Please feel free to contact us here. We can help you find the right counselor. Explore our team page and request a specific therapist. You can schedule directly with one of our therapists online, or you can book a call with our intake coordinator.