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As a therapist specializing in OCD and anxiety, I often have clients ask, “Wait, this isn’t what everyone else experiences?” when discussing both conditions. I’d like to take a moment to break down the differences between the two. This is not for diagnostic purposes, but I hope it provides insight into how your brain works and offers some validation for how we all experience life in our own unique ways.

Clinical Anxiety

I use the term “clinical anxiety” instead of just “anxiety” because everyone experiences anxiety. It’s an adaptive skill that keeps us safe. However, anxiety becomes less helpful when it turns into “clinical anxiety.”

To explain this, let’s look at the difference between anxiety and fear. When we experience fear or anxiety, we have both cognitive (thoughts) and emotional (feelings) symptoms. If you think, “Oh no, there’s a bear right in front of me” (cognitive) and your body tenses up (emotional), that’s fear. If you think, “I could run into a bear while hiking, so I should pack bear spray” (cognitive) and feel the urge to prepare (emotional), that’s anxiety. Fear is the response to a present, imminent threat. Anxiety is the response in anticipation of a potential threat.

Anxiety helps us prepare for future challenges in a calm yet motivated way. Fear, on the other hand, prompts us to react to an immediate danger—often not so calmly. Clinical anxiety begins when we confuse anxiety with fear. For instance, if the thought “I might see a bear while hiking tomorrow” triggers bodily sensations similar to fear (fight or flight, racing heart, hyper-focusing on the threat), then we’re entering the realm of clinical anxiety.

You might ask, “Wouldn’t being hyper-prepared for a bear make you safer?” Yes, it might. But you have limited cognitive and emotional resources each day. If you only have $10 of mental energy, and you spend $8.50 preparing for a bear, you won’t have enough left for other daily needs like feeding yourself or your family. So, while you’re more prepared for the bear, is it worth the cost?

OCD

I wanted to explain clinical anxiety first because OCD and anxiety can look very similar on the surface: anxious thoughts, over-preparing, and spending mental resources in ways that don’t feel purposeful. However, beneath the surface, different systems are at play.

OCD is caused by genetics. If you have the gene for OCD, it usually activates around age 10 (plus or minus a few years). Less commonly, it may activate closer to age 18. If untreated, OCD symptoms can worsen over time, as shown by brain scans. In childhood, OCD might look like fears of getting sick or a parent being in a car accident. As we age, the fears become more complex—doubting memories, feeling unsure about relationships, or fear of religious punishment. These fears come with compulsive behaviors, like hand washing, counting, or checking things repeatedly. Sometimes the behaviors aren’t directly related to the fear, such as counting to 7 to prevent illness. As adults, compulsions may become more covert, such as overthinking or ruminating on past scenarios. So in summary, OCD is categorized as specific fears (obsessions) that come with specific behaviors to soothe that fear (compulsions).

Key Differences

  • Cause: Clinical anxiety can stem from trauma, learned behaviors, or difficult life experiences. OCD is caused by genetics. Note that in rare cases, OCD can be triggered by health issues, such as strep or childbirth, but that’s another conversation. While almost anyone can experience clinical anxiety, not everyone can develop OCD.
  • Focus of Stress: Clinical anxiety causes generalized stress that can affect multiple areas of life with multiple dynamic fears. OCD, however, involves very specific obsessions—such as illness, harm, or perfectionism. OCD fears can change over time, but most people have one or two “big ones” that dominate.
  • Treatment: Treatment for OCD is highly regimented and direct. If you use the same approach for generalized anxiety, it might help, but it’s like cutting butter with a battle axe—it’s over the top. Anxiety treatment requires more personalized care, focusing on the life circumstances that contributed to the anxiety (e.g., trauma or learned behavior).

What Should You Do Now?

If you’ve read this and thought, “Oh no, this sounds like me,” reach out! If you want to learn more about yourself and how to manage your mental resources purposefully, contact us. You can call or text us at (615) 570-1190, or email us at intake@workscounselingcenter.com.