A new paper published in the journal Clinical Psychological Science offers insight into why people with obsessive compulsive disorder engage in what psychologists refer to as “catastrophizing,” or the repeated mental simulation of unlikely catastrophic events. According to the researchers, it has to do with a flawed perception of the likelihood of low probability events.
“OCD-related obsessions are largely organized around fears of a specific harmful consequence that compulsions are enacted to prevent,” say the researchers led by Christopher Hunt of the University of Minnesota. “Virtually all common consequences associated with the major OCD subtypes possess two striking commonalities. First, most feared consequences in OCD are objectively catastrophic: the loss of one’s home, health, loved ones, or soul are among the costliest consequences imaginable. Second, the scenarios surrounding these catastrophic outcomes are often highly improbable.”
Examples of highly improbable catastrophic events that pervade the mind of someone with OCD fall into predictable categories, such as:
Contamination/washing (for example, “contracting a deadly infectious disease such as HIV from a public surface or becoming poisoned from contact with a household cleaner”)
Doubting/checking (e.g., “failing to prevent a fire, flood, or burglary after not checking stove tops, water taps, and locks or accidentally hitting and killing a pedestrian without knowing it”)
Aggressive OCD (e.g., “suddenly deciding to jump off a bridge or secretly and intentionally poisoning someone”)
Religious OCD (e.g., “being sent to hell for an immoral thought or trivial act or suddenly shouting obscenities in church”)
Sexual OCD (e.g., “acting on secret incestuous or homosexual desires”)
Somatic OCD (e.g., “failing to catch symptoms of a deadly disease, choking after not chewing food well enough, or going insane from continuously monitoring a bodily function”)
To test the idea that highly improbable events are viewed as more probable than they are by people with OCD, the researchers recruited 78 university students to participate in an in-person experiment. The researchers first measured participants’ levels of OCD using the 18-item OCI-R questionnaire. The OCI-R measures people’s overall levels of OCD as well as the OCD subtypes of washing, checking, ordering, obsessing, hoarding, and neutralizing.
The researchers then requested that participants play a video game in which they were a farmer with the objective of harvesting crops in an unpredictable environment. Participants made decisions in the game such as choosing to take a short, dangerous road versus a long, safe road to start planting their crops. Negative events, such as wild birds consuming one’s crops, were met with small electric shocks to the wrist. Participants’ expectations and reactions to negative outcomes in the game were measured by gauging their startle response (via an EMG electrode placed below the lower eyelid) as well as through self-reported anxiety and threat-probability ratings that were administered at different points during the game.
The researchers found that participants with OCD symptoms were more avoidant of low probability negative outcomes in the game. They state, “OCD did not confer a general tendency to avoid threat but, rather, a specific proclivity to avoid experimental analogues of improbable catastrophes.”
They also found that participants with OCD symptoms showed an increased startle response, as measured by eye-flinching, to low probability negative events. Such results, according to the researchers, offer initial experimental support for the observation that “a variety of common OCD presentations involve concerns with improbable catastrophic consequences and further implicate a more general sensitivity toward improbable threat as a candidate deficit driving this phenomenon.”
“The current study represents the first lab-based test of whether OCD is associated with an underlying sensitivity toward improbable catastrophic threats,” conclude the researchers. “Results show that individuals with higher OCD symptoms were more avoidant of potential threats that were both improbable and highly aversive and were also more expectant of and more physiologically reactive to improbable threats more generally.”
We all experience things like worrying we’ve left an appliance on, or avoiding walking under scaffolding, but for most people, these random stresses and superstitions are short-lived.
Obsessive-compulsive disorder (also known as OCD), however, is a serious anxiety disorder, where worries and urges can have a debilitating effect on a person’s day-to-day, impacting both their mental health and relationships with others.
Misunderstanding and stigma about OCD can make it difficult to reach out – but support is available, and it can make a significant difference for those affected.
What is OCD? “Obsessive-compulsive disorder is an anxiety disorder that causes people to experience a variety of symptoms that typically fall into one of two categories: ‘obsessions’ and ‘compulsions’,” explains Priory consultant psychiatrist, Dr Paul McLaren.
“Obsessions are characterised by persistent and irrational thoughts or urges, and compulsions refer to physical or mental acts that people feel compelled to perform.”
McLaren explains that some people with OCD only experience one type of symptom, whilst others experience both. “These irrational thoughts and behaviours can become extremely time-consuming,” adds McLaren, and the defining factor is that they feel impossible to stop or control.
OCD is ranked by the World Health Organisation as one of the top 10 causes of mental illness-related disability, but misconceptions around the term mean people often don’t treat it with the seriousness it deserves.
It’s often commonly implied that OCD simply means that you like to wash your hands a lot, and it’s not uncommon to hear someone describe themselves as a ‘little bit OCD’ if they like to be very tidy or organised.
Handwashing is a common compulsion if someone has an intrusive thought of being contaminated by germs, but as McLaren explains: “This is not the only form of OCD. Common presentations not only include contamination worries but also double-checking and hoarding behaviour, as well as ruminations and intrusive thoughts and images.
“These obsessions and compulsions can be overwhelming to someone living with OCD, despite their best efforts to avoid thinking and acting in a certain way.”
Why does it happen? No one’s sure yet what causes OCD – but there are lots of different theories, and it’s likely that a number of factors are involved in its development.
“OCD can run in families,” says Glenys Jackson, clinical lead for mental health at Bupa Insurance (bupa.co.uk). “If one of your parents or a brother or sister has OCD, it’s possible you may develop it too. Traumatic life events, social isolation or bullying could trigger OCD or make it worse, and it can also develop during pregnancy.
“The pandemic has put a huge strain on everyone’s mental wellbeing. Factors such as reduced social contact, feelings of isolation and fear associated with contracting or spreading Covid-19 all have strong links to poor wellbeing. These stressors are making OCD symptoms worse in some cases.”
How is OCD diagnosed? If you think you may have OCD and it’s affecting your life, see your GP. Jackson says: “They’ll ask you a series of questions related to OCD to help make a diagnosis. These include how your OCD affects you personally and how it affects your life.
“You may feel embarrassed about your symptoms and it can be hard to talk about them. However, it’s important to be open and honest with your GP or therapist about any obsessions and compulsions you have.
“This will help them make the right diagnosis and recommend the best type of treatment for you.” Your GP may then refer you to a healthcare professional who specialises in mental health for further assessment or treatment.
What kinds of treatment can help? According to Jackson, most people with OCD “spend years struggling with their symptoms” before they seek help.
This is often because of stigma around having a diagnosed mental health condition, they are embarrassed to seek support, or they leave the symptoms to manifest in the hope that they will go away. But as Jackson stresses: “It’s so important to speak up and find a way to treat and manage your OCD.”
When you’re facing obsessive thoughts or compulsions, it can be hard to see them for what they are. “With practice and help, it can become easier to identify when your thinking is affected by the symptoms within OCD and you can build techniques to reduce the impact and bring the symptoms under control,” assures Jackson. “This might include actively exploring and confronting your compulsions or thoughts, maybe through exposure and response prevention where a therapist works with you to challenge the OCD. “It might sound difficult, but it can help you to acknowledge that thoughts and compulsions don’t have power over you. It is important to talk to a professional to determine what pathway is most appropriate for your presenting symptoms.”
Cognitive Behavioural Therapy (CBT) can also help manage symptoms. This form of talking therapy helps you examine in detail how you think about certain situations in your life, how you behave in response to those thoughts, and how your thoughts and behaviours make you feel. “CBT aims to give you the understanding and tools to carry on working towards recovery by yourself,” Jackson says. Your doctor may also prescribe medication if you have severe OCD, or if your symptoms don’t improve with therapy.
Self-care interventions are really important too, and it’s always good to remember that you’re not alone. “OCD is a common anxiety disorder. In fact, a large part of the population may have had some OCD traits at some point in their lives,” says McClaren. “Don’t let it prevent you from talking to people and getting the help you will need. There are online forums and support groups that take place regularly.
“There is a lot of information available online regarding OCD, including testimonies from people with OCD and how they have dealt with it. This can help you put your difficulties into perspective, offer context, and give you more understanding in what may be helpful for you.”
Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are mental health disorders that share similar names, so distinguishing between the two can be challenging. However, the clinical definitions of these disorders are different.
People with OCD have obsessive, intrusive, repetitive thoughts, known as obsessions. They may feel compelled to repeat behaviors, which are known as compulsions. With OCPD, a person may be excessively focused on order and perfection.
Understanding the differences between OCD and OCPD can help determine what treatment is needed.
Symptoms of OCD vs. OCPD
OCD and OCPD may overlap in terms of similar thought patterns and behaviors. They may also share similarities involving order, perfectionism, and organization. However, only OCD is characterized by true obsessions and compulsions.
Traits of OCD
OCD is mainly characterized by obsessions and compulsions that are time-consuming and cause distress to the person with OCD.
Obsessions present as repeating thoughts, worries, or even mental images that are intrusive, unwanted, and unrelenting.
Compulsions present as repeating behaviors that a person feels driven or urged to perform. This repetition is often done to avoid anxiety or a perceived risk, such as excessive handwashing to avoid the risk or fear of germs.
People with OCD are typically aware that they have a disorder, though people with OCPD may not be.
Traits of OCPD
OCPD is characterized differently than OCD. People with OCPD are strongly focused, almost obsessively so, toward a goal of perfection for themselves and others and toward maintaining rules and order in their environment.
People with OCPD may exhibit the following traits:
High-achieving, conscientious, and function well at work
Face challenges understanding others’ points of view
Have difficulty hearing constructive criticism
Look for patterns of control and order
Desire perfectionism to the point that this strong urge interferes with actually completing tasks
May have tendencies toward being unable to discard old or valueless objects
Consistency of Symptoms
OCD is a disorder based on fear, anxiety, and efforts to control uncertainty. The obsessions and compulsions may ebb and flow based on the person’s current level of anxiety or fear. OCPD, however, is a personality disorder, so the behaviors don’t tend to fluctuate. Rather, they occur more consistently over time.
Causes of OCD and OCPD
While the exact causes of both OCD and OCPD are not yet fully understood, there are several possible factors.
OCD Risk Factors
Neurological factors: OCD may result from disruptions in communication between certain regions of the brain. Other studies suggest that abnormalities in neurotransmitters such as serotonin may be a significant factor in OCD.
Genetics: Studies have shown a genetic factor to OCD, in that individuals with a family history of OCD are more likely to have the condition.
Stress and environment: Incidents like brain injury, infection, trauma, and stressful events can contribute to the development of OCD.Stress can both prompt and exacerbate the symptoms of OCD.
PANDAS: A reaction to streptococcal infection (the same type of bacteria that causes strep throat) during childhood can sometimes cause inflammation in the brain which can lead to the development of OCD. These types of cases are called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections).
OCPD Risk Factors
Genetics: OCPD appears to have a genetic component. Studies have found that OCPD is more likely in individuals who have a family history of the condition.
Early attachment: One study indicates OCPD may start in childhood from disruptions to attachment bonds. For example, if a child is unable to form a bond with a primary caregiver during childhood, it can impact later relationships and create attachment difficulties. Personality disorders form to help the person cope with the attachment injury.
To diagnose OCD, a clinician will use the DSM-5 to determine the following:
If obsessions or compulsions (or both) are present
If the obsessions and/or compulsions are occurring because the person is trying to prevent anxiety, distress, or a potential situation
If the obsessions and/or compulsions are excessive, and these thoughts and/or behaviors are taking up considerable time in the person’s life (more than one hour a day) or causing distress
If the obsessions and/or compulsions impair the individual’s ability to function socially or at work
To diagnose OCPD, a clinician will use the DSM-5 to examine the following traits:
A constant pattern of order and control that can come at the expense of flexibility, efficiency, and openness
Perfectionism that may interfere with being able to complete a task, especially when the person’s standards are not being met
A preoccupation with details, rules, order, organization, and schedules to an extreme degree
An excessive devotion to work outside of a financial need, even forsaking personal relationships in favor of work
Significant difficulty with flexibility when it comes to their own ideas and their plan for how to complete tasks
OCD and OCPD are often treated in similar ways. In both cases, medication and talk therapy (or a combination of both) will help treat OCD and OCPD.
People with OCD may be prescribed selective serotonin reuptake inhibitors (SSRIs), which have been shown to help treat OCD. SSRIs are often the first-line treatment for OCD.
Psychotherapy can also be used to treat OCD, including:
Cognitive behavioral therapy (CBT): CBT helps people understand how their thoughts (particularly negative ones) influence their behavior and how to react differently.
Exposure and response prevention (ERP): ERP exposes someone to the triggers causing their obsessions and assists them in overcoming the need for their compulsions.
Treatment for OCPD has not been well-researched, with only a few small studies to date.
At this time there are no specific medications for OCPD, although the same medications that help treat OCD (SSRIs) can also help with OCPD.
Small research studies suggest that CBT is also effective in treating people with OCPD, because it can help them examine their thoughts and the actions that follow.
When biological factors, such as genetics, are at play, it may not be possible to prevent OCD or OCPD. However, there may be some interventions that can mitigate the environmental contributions to these conditions.
Early intervention may also be the key in reducing the severity of the conditions. Education and improving access to effective treatments can help.
People with OCD are frequently distressed by the excessive and repeating thoughts and behaviors they experience. It can be time-consuming to repeat behaviors and can impact a person’s social functioning. These behaviors can affect those around them as well.
There are support groups available for people with OCD and their loved ones. Connecting with people who have similar experiences can help.
Many people with OCPD are not aware that they have a disorder or the effect it has on the people around them. This can make it especially difficult to seek help. If you notice symptoms of OCPD, speak with a mental health professional about a screening.
OCD and OCPD are separate conditions, but both are treatable through similar methods. It’s important to seek help from a mental health professional or healthcare provider when noticing symptoms to achieve an accurate diagnosis of OCD or OCPD.
Frequently Asked Questions
The most significant difference between OCD and OCPD is that OCD is classified as an anxiety disorder and OCPD is classified as a personality disorder.
People with OCD tendencies may experience anxiety. OCD is classified as an anxiety disorder.
A person can be diagnosed with both OCD and OCPD. OCPD occurs in people with OCD 15%–28% of the time.
Many people use yoga to help with their anxiety. There is some evidence to suggest that it is useful, particularly in people living with obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD).
Anxiety is the body’s response to stress and is part of the natural fight, flight, or freeze reflex.
Anxiety might resemble a feeling of distress, unease, or dread. Its intention is to keep a person alert or aware during times of threat.
Sometimes, anxiety can get in the way of everyday life. This is particularly true for people who live with health conditions that can cause excessive anxiety, such as OCD or GAD. Doctors believe that exercise, including yoga, can help people to manage the symptoms of anxiety.
This article looks at why yoga is beneficial for anxiety, which yoga poses may help with anxiety, how to perform them, and the research to support these ideas.
An anxiety rash is an itchy rash that may look similar to hives. It is due to anxiety rather than any other factors, such as certain foods or medications.
Research has found that chronic anxiety increases the sympathetic nervous system response to stress. This response releases histamine, a substance the body usually releases to respond to any injury, inflammation, or allergic reaction. An increased release of histamine may lead to a rash or hives.
Emotional effects of an anxiety rash
Anxiety rash may cause people to feel more anxiety or embarrassment, due to the symptoms or appearance of the rash. Although people may try to hide the rash, covering the rash with makeup, lotions, or tight clothing may worsen the rash.
A rash from stress or anxiety usually resolves in 24 hours, and topical treatments may help to reduce the rash and any uncomfortable symptoms.
Focusing on calming techniques and tools to reduce anxiety may help people feel less anxious, and also help to treat the rash.
Below are some of the treatment options that can help to alleviate debilitating anxiety.
There are a number of different therapies that can help to treat anxiety. The therapy a person receives may depend on the type of anxiety they have, as well as their personal preferences. Some examples include:
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) aims to help people identify and change negative thinking and behavioral patterns that can activate or exacerbate their anxiety.
CBT is a practical, problem-solving therapy. It involves learning and practicing skills, language, and ways of thinking that help empower individuals to have an active role in their treatment. During CBT, a person will work closely with their therapist to:
learn more about their condition and anxiety triggers
learn skills or strategies to help control their anxiety
complete tasks or assignments to practice their new skills and strategies
Exposure therapy involves gradual and controlled exposure to situations that people find fearful. The aim is to assist people in developing healthy coping strategies that will help reduce their fear response.
Exposure therapy can help with the following anxiety disorders:
obsessive compulsive disorder (OCD)
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) teaches people mindfulness and acceptance strategies to help them cope with negative thoughts, sensations, or feelings. This type of therapy can help people:
have better control over their reactions to unpleasant feelings
learn not to avoid potentially negative or stressful situations
accept their thoughts and emotions
feel clarity in their own values
commit to behavioral changes
Dialectical behavioral therapy (DBT)
Dialectical behavioral therapy (DBT) is a complex and multilayered therapy that combines CBT methods with Eastern meditation techniques to focus on both acceptance and change.
DBT uses a combination of group therapy, individual therapy, and additional access to a person’s mental health professional to teach the following:
Eye movement desensitization and reprocessing (EMDR)
Eye movement desensitization and reprocessing (EMDR) originates from the idea that negative thoughts, feelings, and behaviors result from problems with processing information and memories.
During EMDR, a person’s therapist will typically have them recall distressing mental images while they help guide the person to shift their eyes back and forth in a bilateral motion. This is to provide bilateral stimulation, which uses alternating right and left stimulation to activate the brain’s two hemispheres. It may also involve other movements, such as tapping their hands.
EMDR seems to affect how the brain processes information, effectively allowing people to experience disturbing material in a less distressing way.
According to the ADAA, EMDR may work similarly to rapid eye movement (REM) sleep. It may be effective in treating the following anxiety disorders:
post-traumatic stress disorder (PTSD)
Anxiety treatment may involve taking medication on either a short- or long-term basis. Below are some medications a doctor may prescribe for the treatment of anxiety.
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin is a neurotransmitter that has a positive effect on mood, emotion, and sleep. It works by carrying messages between nerve cells in the brain. Nerve cells usually reabsorb the serotonin after the message is delivered.
Selective serotonin reuptake inhibitors (SSRIs) prevent nerve cells in the brain from reabsorbing serotonin. This increases levels of serotonin in the brain, helping to improve mood and relieve symptoms of anxiety.
SSRIs may be an effective treatment for all types of anxiety disorders.
Norepinephrine is a neurotransmitter that plays a role in attention, mental focus, and memory. Selective norepinephrine reuptake inhibitors (SNRIs) work by preventing nerve cells in the brain from reabsorbing serotonin and norepinephrine. This increases levels of both neurotransmitters in the brain, thereby helping to improve mood and alleviate anxiety.
Side effects of SNRIs may include:
minor increase in blood pressure
Benzodiazepines are a type of sedative medication that helps to slow down brain and body functions. They help to treat the physical symptoms of anxiety, such as:
People may take benzodiazepines for the short-term treatment of anxiety, either on their own or in combination with other treatments. However, these medications may be a last-resort treatment, as unlike SSRIs, they are highly addictive.
Tricyclic antidepressants increase levels of serotonin and norepinephrine in the brain, while reducing levels of the neurotransmitter acetylcholine.
Acetylcholine enhances the brain’s sensitivity to external stimuli and increases attention. As such, reducing acetylcholine levels may help to treat certain types of anxiety disorder.
Tricyclic antidepressants can cause the following side effects:
Ir J Psychol Med. 2021 Aug 26:1-7. doi: 10.1017/ipm.2021.57. Online ahead of print.
OBJECTIVE: To assess the mental health of pregnant women, with reference to anxiety, depression and obsessive-compulsive (OC) symptoms, during the COVID-19 pandemic.
METHODS: A cross-sectional survey was conducted in Ireland during the third wave of the pandemic between February and March 2021. Psychiatric, social and obstetric information was collected from pregnant women in a Dublin maternity hospital, alongside self-reported measures of mental health status.
RESULTS: Of 392 women responding, 23.7% had anxiety, scoring 9 for GAD-7 (7-item generalised anxiety disorder), 20.4% had depression, scoring 9 for PHQ-9 (9-item depression screening tool: Patient health questionnaire) and 10.3% had obsessive-compulsive disorder (OCD), scoring 13 for Yale-Brown obsessive-compulsive scale symptom checklist (Y-BOCS). Amongst self-reported OCD symptoms, there was a preponderance for obsessions rather than compulsions. Of 392 women, 36.2% described their mental health as worse during the pandemic, most frequently describing symptoms of anxiety and sleep disturbance. When analysed against test scores, self-reported worsening of mental health was significantly associated with higher scores on the GAD-7, PHQ-9 and Y-BOCS scales. The three scores were positively interrelated. Poor mental health scores were associated with self-reported strain in relationship with the baby’s father, and current or previous history of mental illness.
CONCLUSION: This study found high levels of depression, anxiety and OC symptoms amongst pregnant women during COVID-19. This highlights the vulnerability of this group to mental illness and the importance of enhanced screening and support during pandemics.
Treatment for OCD will vary between people based on their individual symptoms. In some cases, physical pain symptoms may improve or disappear when you receive effective treatment for your symptoms of OCD.
If you have an existing chronic pain condition, like arthritis, it’s important to discuss the best treatments and pain relief options with your healthcare team, too.
Cognitive behavior therapy (CBT). A type of CBT called exposure therapy (ERP) can help. This involves exposing a person to their triggers and working directly with a mental health worker to change their response to the stimuli.
Medication. In addition to ERP, a doctor may recommend you take certain serotonin reuptake inhibitors (SRI) or selective serotonin reuptake inhibitors (SSRIs). Many people find benefits from taking medications in conjunction with ERP therapy as part of a wider treatment plan.
In addition to ERP and medication, you may find that support groups can offer some additional benefit for your symptoms. Support groups can help you connect with other people that are going through similar feelings, struggles, and experiences.
Expect the unexpected. Old thoughts can resurface, and new ones can arise. This is all part of the process.
Acknowledge your thoughts, agree with them, and move on. These thoughts don’t have any true answers, after all.
Avoid trying to “not think” the thoughts. Trying to prevent or block thoughts can often have the opposite effect, leading to more intrusive thoughts.
Accept that slip-ups will happen. Even if you give in to a compulsion, there’s always a chance to interrupt it or to try again next time.
Try to handle your symptoms independently. Relying on other people may not help as much, because they might not always be available. You’ll always be available for yourself.
Move towards the anxiety. The way to overcome a fear is to face it. Working with a therapist can make this possible.
Follow your homework assignments. If your therapist gives you homework, try your best to follow along.
If you’re also living with other underlying conditions, such as arthritis, you can work with your primary care doctor to develop a treatment plan specific to your other condition. This may involve medications, therapies, and lifestyle changes.
If you are seeking treatment for OCD, there are a variety of options. You may benefit from therapy, medication, or a combination of the two. Everyone responds to treatment in different ways.
If you are dealing with sensorimotor obsessions, much of the treatment will involve recognizing the anxiety caused by the sensory input and effectively experiencing the sensation without the resulting worry.
There are several types of mental health professionals who can provide treatment for OCD. Different types of mental health professionals you may look for include:
marriage and family therapist
clinical social worker
Exposure response prevention
Exposure response prevention (ERP) is a type of therapy treatment that helps reduce OCD symptoms. It involves psychoeducation, exposure to the trigger causing the obsessions or compulsions, and finally, a prevention response.
TMS is a type of brain stimulation therapy that uses electromagnetic pulses in the brain to reduce symptoms of OCD. This works by stimulating nerve cells in the brain. TMS is a non-invasive type of therapy.
Usually, TMS is used as a treatment when other treatments aren’t effective.
Some individuals may find relief for OCD symptoms by taking medications. For example, selective serotonin reuptake inhibitors (SSRIs) are usually prescribed for depression and help treat OCD.
Medications aren’t suitable for everyone. However, if you are considering medication to treat OCD symptoms, it is important that you speak with your doctor.
Mental health professionals often prescribed higher doses of SSRIs for OCD than depression. These medications can have side effects, so speaking with a doctor may be beneficial to determine if the medication is right for you.
Feeling down is normal, and everyone feels anxious from time to time. It’s a normal response to stressful situations. But severe or ongoing feelings of depression and anxiety can be a sign of an underlying mental health disorder.
Determining the difference between depression and anxiety is challenging because they can be interdependent, and they share many symptoms, including nervousness, irritability, sleep trouble, and difficulty concentrating.
This article will discuss the differences between depression and anxiety, including symptoms and treatment.
Anxiety may occur as a symptom of depression. It’s also not uncommon for someone with an anxiety disorder to also suffer from depression. Nearly one-half of individuals who are diagnosed with depression are also diagnosed with an anxiety disorder.
Though depression and anxiety share some symptoms, each disorder has its own distinct symptoms that distinguish them as separate mental health conditions.
Despite the relationship between depression and anxiety, each disorder has its own emotional and behavioral symptoms that distinguish them from one another.
These symptoms can include:
Lack of energy
Changes in appetite
Sleeping much more or much less than usual
Feeling empty or numb
Lack of self-esteem
Thoughts of suicide
Loss of interest in daily life
Increased heart rate, blood pressure
Overthinking or obsessing
Although burnout isn’t an official medical diagnosis, what is generally referred to as burnout shares a number of symptoms with depression and anxiety. It can leave people feeling exhausted, empty, and unable to cope with the demands of life. While burnout may be mistaken for depression, they are two separate conditions.
Though there is an association between the two, research has revealed no conclusive overlap between burnout and depression or burnout and anxiety, indicating that they are different experiences.
Types of Depression and Anxiety
Depression and anxiety present in different ways, which are categorized as different types of disorders. These are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the American Psychiatric Association’s reference manual for diagnosing mental illnesses.
Types of anxiety disorders according to the DSM-5 include:
Perinatal depression: A mood disorder that can affect women during pregnancy and after childbirth. Mothers with perinatal depression experience feelings of extreme sadness, anxiety, and fatigue that may make it difficult for them to carry out daily tasks.
Perimenopausal depression: Can occur during the menopause transition and presents with symptoms of irritability, anxiety, sadness, or loss of enjoyment.
Anxiety in Women
Anxiety is more prevalent in women than in men. From puberty until around the age of 50, they are twice as likely as men to have an anxiety disorder.
Effect on Men
Depression may manifest differently in men. Research has shown that some men with depression hide their emotions and may appear angry, irritable, or aggressive, while many women report sadness, weight changes, and sleep disturbance as their main symptoms.
Some men may turn to drugs or alcohol to try to cope with their emotional symptoms.
Studies show that while women tend to experience more suicidal thinking, men are far more likely to die by suicide and use more lethal methods.
Anxiety and depression are caused by a complex mix of environmental, biological, genetic, and situational factors.
Though the exact cause of anxiety disorders is still unknown, researchers suspect a combination of factors, including:
Environmental factors: Experiencing a trauma might trigger an anxiety disorder, especially in someone who has inherited a higher risk to start.
Genetics: If you have a close biological family member with an anxiety disorder, you are much more likely to develop the condition.
Various factors can increase the risk of developing depression, including:
Brain chemistry: Abnormalities in brain chemical levels may lead to depression.
Genetics: If you have a close relative with depression, you may be more likely to become depressed. Estimates suggest that depression is caused 40% by genetics.
Life events:Stress, the death of a loved one, upsetting or traumatic events, isolation, and lack of support can lead to depression.
Medical conditions: Ongoing physical pain and illnesses can cause depression. People often have depression alongside conditions like diabetes, cancer, and Parkinson’s disease.
Substance use: Recreational drugs and alcohol can cause or worsen depression.
Healthcare providers diagnose the many different types of anxiety and depression according to symptoms, causes, and duration. They use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the American Psychiatric Association’s reference manual for diagnosing mental illnesses.
If you have symptoms of depression or an anxiety disorder, talk to your healthcare provider. They will start by taking a complete medical history and conducting a physical examination.
Clinicians use screening tools and questionnaires to assess people for depression. Healthcare providers and mental health professionals are specially trained to administer and interpret the results of these questionnaires.
The different subtypes of depression come with their own sets of diagnostic criteria in the DSM-5. You will be asked if you’ve experienced persistent feelings of sadness, low mood, and loss of interest in your usual activities for at least two weeks. You will also be asked about your sleep, appetite, and if you’ve had any thoughts of suicide.
While there is no definitive test for anxiety, if symptoms are present and persistent, your healthcare provider may conduct a physical assessment and diagnostic tests to rule out potential medical causes.
If no physical illness is found, you will be referred to a mental health professional to be evaluated for an anxiety disorder. They will use the DSM-5 to determine if you have an anxiety disorder. The diagnostic criteria for each anxiety disorder are different.
You may be asked questions about how often you experience feelings of worry or if you’ve noticed any physical symptoms such as restlessness, feeling tired, trouble concentrating, irritability, muscle tension, or trouble sleeping.
Depression and anxiety are treatable, whether they occur together or separately. Most people benefit from psychotherapy (talk therapy), medication, or a combination of these.
For treating depression and anxiety, there are several types of talk therapy.
One of the most researched is cognitive behavioral therapy (CBT), which improves self-awareness of negative thoughts or behavior patterns. CBT is used to treat anxiety and depression, but the treatment itself can vary slightly based on the condition.
In treating anxiety, the goal of CBT is to help the individual change how they react to situations that cause anxiety, and identify and modify thoughts that cause anxiety.
In treating depression, one focus of CBT is on helping the individual become more engaged in activities that they value and have given up since becoming depressed.
If your symptoms are mild, self-help interventions can be a reasonable place to start.
Some self-care tips for people with anxiety and depression include:
Getting enough sleep
Eating healthy foods
Keeping a regular daily schedule
Getting out of the house every day
Avoiding alcohol and recreational drugs
Talking with family or friends about how you are feeling
A combination of medications, self-care, and therapy may be effective for treating depression and anxiety.
Anxiety and depression are not always preventable, but you can take steps to control or reduce your symptoms, and reduce the risk of recurrence. These include getting enough sleep, eating a healthy diet, and practicing regular self-care activities.
Other actions that may help prevent these conditions from developing, or prevent them from getting worse, include:
Limit caffeine: Stop or limit how much caffeine you consume, including coffee, tea, cola, and chocolate.
Seek help: Get counseling and support if you have experienced a traumatic or disturbing event. Doing so can help prevent anxiety and other unpleasant feelings from disrupting your life.
Reducing Mental Health Stigma
People who experience depression and anxiety often face prejudice due to the stigma attached to mental health disorders.
Research has shown that stigma leads to delays in treatment. It also reduces the chance that a person with mental illness will receive appropriate and adequate care.
You Aren’t Alone
It’s important to remember that you aren’t alone, and that there is no reason to feel ashamed or embarrassed for having a mental health condition.
Here are some tips to help address the stigma associated with mental illness:
Show people reliable information to help them understand your diagnosis and to dismiss any myths or misinformation about your condition, including opinions like “depressed people are lazy” or “anxiety doesn’t exist without panic attacks.”
Engage with advocacy/support groups. An advocacy group uses the power of lived experience to influence public opinion and policy. You may even want to become an advocate yourself.
Talk about your experience. Sharing your story can help improve people’s understanding of your condition and change their attitudes.
A Word From Verywell
Depression and anxiety are very common disorders, and they may be mistaken for one another due to an overlap of symptoms. Talk with your healthcare provider if you begin to experience signs of anxiety or depression and these feelings or changes last longer than two weeks. Finding the right treatment may take some time. Your healthcare provider will work with you to find the best option.
Frequently Asked Questions
Who is at risk for depression and anxiety?
Everyone is at risk of experiencing depression or anxiety at some point in their lives, but studies show that women and adults under the age of 35 are more likely to experience anxiety than other groups. The proportion of adults who experienced any symptoms of depression was highest among those ages 18 to 29.
Does medication for depression and anxiety work?
A group of medications known as selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for both anxiety and depression.
Anti-anxiety medications have also been shown to reduce anxiety among patients.
Note that you may need to try medication for six to eight weeks before you notice fuller effects.
How often is anxiety misdiagnosed as depression?
Anxiety disorders can mimic depression, so misdiagnosis is common. The two conditions can also coexist, further confusing the diagnostic process.
A study carried out in a primary care setting found misdiagnosis rates reached 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71% for generalized anxiety disorder, and 97.8% for social anxiety disorder.
Be sure to communicate all your symptoms to your healthcare provider to ensure the most accurate diagnosis is reached.
What does anxiety feel like compared with depression?
Anxiety involves feeling tense, nervous, or unable to relax, with a persistent sense of dread or fear. Physically, you may have a churning feeling in your stomach, feel lightheaded or dizzy, and have rapid breathing or a fast heartbeat.
The classic signs of depression include feelings of sadness, hopelessness, and worthlessness, but some people with depression also feel restless or irritable, have trouble concentrating, and struggle to sleep and eat.
Those looking for free online support might find themselves chatting with a trained volunteer on 7 Cups, a free emotional health service.
Signing up is free and easy. When enrolling, you can create your own username or use one recommended to you by the username generator. This ensures your privacy when chatting with trained listeners, participating in group chats, or posting in the site’s communities.
One of the options when connecting with a trained listener is OCD. This alerts your listener, so you can have pointed support. You can also seek support for loneliness, anxiety, depression, LGBTQ+ issues, and more.
Though 7 Cups offers many free services, the company is also an online therapy provider. Trained volunteers can listen and help users by talking through their concerns, but they aren’t licensed mental health professionals.
If you’re considering online therapy, 7 Cups has paid options.
OCD Peers is a service that offers virtual peer-support groups using a HIPAA-compliant platform.
You can choose from two main group meetings to attend: OCD Support Groups and Community Nights.
OCD Support Groups are more intimate, with an estimated 6 to 10 people at a time (not including group leaders) who come from a variety of backgrounds. These meetings have an agenda but also allow for open discussion.
Community Nights consist of up to 25 people and last for a longer duration. Each person is encouraged to share, followed by discussion as a group.
Compared with other options, OCD Peers isn’t as affordable. Participants pay per group meeting instead of a monthly membership. The company also doesn’t offer free support groups.
To participate, you must register and pay for the meeting in advance, which can be inconvenient for people who don’t have flexible schedules.
With more than 130,000 members, The Tribe is one of the largest online communities for peer-to-peer support.
The OCDTribe is much more than an online support group for people with OCD. It’s a place where you can participate in discussion forums, write blog posts, participate in wellness challenges, and use inspirational wellness tools.
While some online OCD resources might feel impersonal, The Tribe uses social network technology to create online communities of people with shared experiences and feelings.
When you join, you’ll gain access to an activity stream. You can also add friends and join groups, like the one dedicated to OCD support.
Unique to The Tribe is the set of wellness tools. Some allow you to track your mood and overall wellness, while others challenge you to be more mindful or spend time outside.
SupportGroups.com is a free directory of 220+ online support groups, one of which is the popular OCD Support Group with more than 44,000 members.
People with OCD are invited to join this network of people with similar experiences in a safe environment.
When you join the group, you’re prompted to share how you’re feeling. Fellow users can press the heart icon to show support, or leave a comment to initiate a discussion. Private messages are also allowed for one-on-one peer support.
Though some online support groups are associated with bullying and harassment, each group on SupportGroups.com is moderated. If someone is sending you unwanted messages, SupportGroups.com allows you to block them.
HealthUnlocked is an online resource available 24/7 for people going through similar health experiences.
The platform offers online support groups, including My OCD Community with thousands of members. The site gets millions of visitors each month, but some features are only available to registered users.
In My OCD Community, members can start a discussion by writing a post or asking a question, which usually initiates several responses from other members. Users can also like others’ posts to show their support.
Users must comply with the Community Guidelines. The group is moderated by the International OCD Foundation and HealthUnlocked to ensure all members act in accordance with the guidelines.
JUST imagine what would happen if your mind were hooked on a certain thought or image and no matter what you did, this thought or image was replayed in your head over and over again. These thoughts or images aren’t what you desire – they feel like an avalanche. Along with the thoughts or images, come the powerful anxious feelings. It feels like you’re in danger when you’re anxious. Anxiety is a feeling that instruct-ts you to respond, react quickly, defend yourself, and DO SOMETHING, anything. On the one hand, you may know that the fear you are feeling is illogical and unreasonable, yet it nevertheless seems very real, powerful, and true.
The mental health condition known as Obsessive Compulsive Disorder (OCD) is a mental disorder in which the person’s brain produces false alarms about situations that are not at all threatening because its warning mechanism isn’t operating properly. In OCD, your brain tells you that you are in danger when in reality you are not in any sort of danger. Those who suffer from this illness desperately want to escape from the thoughts or images and associated paralysing, never-ending anxiety and in their attempt to do so, they fall trap to various unhealthy mental and physical behaviors such as repetitive checking, repetitive washing, undoing, avoidance etc.
How will I be able to tell whether I have OCD?
OCD can only be diagnosed by trained clinical psychologists/psychiatrists.
They’ll be on the lookout for four things:
The individual has obsessions.
The obsessions produce anxiety
He or she get engaged in compulsive behaviors.
Obsessions and compulsions consume a lot of time and prevent the individual from doing things they consider important and valuable in their life (working, going to school, etc.)
What are Obsessions?
Recurring thoughts, images, or urges that feel out of the person’s control.
The person does not want to have these thoughts.
He or she finds these thoughts, images or impulses unsettling and unwelcome, and he or she is generally aware that they are illogical.
They are accompanied by negative emotions such as fear, disgust, uncertainty, or a sense that things must be done “exactly perfectly.”
They consume a lot of time and get in the way of the person’s important activities of daily life (socializing, working, going to school, etc.).
Common obsessions may include: Fear of contamination, Fear of losing control, perfectionism, repetitive aggressive thoughts or images, unwanted sexual thoughts or images, unwanted antireligious thoughts etc.
What are compulsions?
Repetitive behaviors or thoughts that a person participates in to counteract, neutralise, or eliminate their obsessions and lessen down the feelings of anxiety.
People with OCD are aware that this is simply a temporary solution, but in the absence of a better coping mechanism, they rely on the compulsion as a means of temporary relief.
It may also include avoiding circumstances that stimulate their obsessions.
Time-consuming and create hindrances for the person’s valuable activities in daily life (socializing, working, going to school, etc.).
Common compulsions may include: Repetitive washing and cleaning, repetitive checking, repeating actions unnecessarily, mental compulsions, etc.
At what age does OCD first appear?
OCD may develop at any age, from childhood through adulthood. Although OCD can strike at any age, there are two age groups in which it often manifests. The first occurs between the ages of 10 and 12, while the second is between late adolescence and early adulthood.
Is OCD a hereditary condition?
According to research, OCD runs in families and that genes are likely to have a part in the disorder’s development. However, it appears that genes are only partially to blame for the disease. Nobody knows what additional variables could be at play, but researchers consider variables such as such as sickness or everyday life stressors as factors which could trigger the activation of genes linked to OCD symptoms.
Some researchers believe that OCD that develops in preschoolers is distinct from OCD that develops in adults. For example, a recent analysis of twin studies found that genes have a bigger role to play in childhood OCD (45-65 percent) than in adulthood OCD (45-65 percent) (27-47 percent).
Is OCD a brain disorder?
According to research, OCD is caused by issues in communication between the frontal lobe (the front part of brain) and some deeper parts of the brain. Serotonin is a chemical transmitter used by these brain regions. Images of the brain at action also reveal that with the help of either serotonin medications (also known as Serotonin Specific Reuptake Inhibitors, SSRIs) or cognitive behaviour therapy (CBT), the brain circuits implicated in OCD can become more normal in significant percentage of people affected with OCD.
There are no lab or brain imaging tests that can be used to diagnose OCD. The diagnosis is determined by observing and evaluating the person’s symptoms.
What are some of the most prevalent roadblocks to effective treatment?
According to studies, it takes an average of 14 to 17 years for persons with OCD to receive proper therapy.
Some people prefer to conceal their symptoms out of fear of shame or stigma. As a result, many persons with OCD do not seek assistance from a mental health professional until years after their symptoms first appear.
Because there was a lack of public knowledge of OCD until recently, many patients were unaware that their symptoms were indicative of a treatable condition.
Cultural and religious explanations of the symptoms of OCD which many at times lead to mistreatment of this mental health condition.
Some health practitioners’ lack of adequate training frequently results in incorrect diagnoses. Before getting an accurate diagnosis, some people with OCD symptoms would see multiple doctors and thus it may lead to severity of symptoms.
Finding local therapists who can properly treat OCD is difficult.
Inability to pay for proper psychiatric and/or psychotherapeutic treatment.
How successful are OCD treatments?
For the procedure to be successful, one or more of the following four elements should be included in the treatment of most persons with OCD:
A CBT intervention-Exposure and Response Prevention (ERP),
a properly trained therapist,
and family support and education.
Majority of research suggest that around 70% of OCD patients will improve from either medication or cognitive behaviour therapy (CBT). Patients who respond to medication often have a 40-60% decrease in OCD symptoms, whereas those who respond to CBT typically experience a 60-80% reduction in OCD symptoms. However, in order for the therapies to function, patients must take their medications on a regular basis and actively participate in CBT on weekly basis for atleast two months.
Unfortunately, studies reveal that at least 25% of OCD patients decline CBT, and up to half of OCD patients stop taking their medications owing to side effects or other factors.
How long do these medications take to work?
It’s crucial not to stop taking your medicine until you are not directed to. It usually is a course of 6 months to 2 years (to be decided by the psychiatrist). Many patients have no beneficial benefits during the first few weeks of treatment, but subsequently notice a significant improvement.
The major issue with just taking medications to treat OCD is that if you aren’t receiving CBT, you may not even know if the medication is working. Some people respond to medication without CBT/ ERP, however if OCD has become a habit or a way of life, such patients can have difficulty in understanding how OCD has affected their lives.
One way to look at it is that the medicine may assist to fix the chemical or neurological problem in the brain, but you’ll need Cognitive Behaviour Therapy to help you change the habits that have been established in your lifestyle. As a result, I as a clinical psychologist suggest CBT/ERP for all OCD patients irrespective of the severity of their symptoms. This increases the likelihood of receiving a better response. Medicines can bring a quick relief to a person’s symptoms compared to CBT/ERP, however, CBT/ERP has better impact on lessening the chances of relapse. Thus using combined therapeutic approach (i.e., pharmacotherapy and psychotherapy) is always better than monotherapy alone and the patient may recover with lesser chances of relapse.
What can you do if any of your family members has received the diagnosis of OCD?
Here are a few things you can do:
Learn about OCD.
The first step is education. The more you understand, the more equipped you will be to assist someone who suffers from OCD.
Read OCD literature
Attend OCD support groups
Conduct internet research
Learn to identify and eliminate “Family Accommodation Behaviors.”
Family accommodation behaviors are the behaviors that families engage in that exacerbate OCD symptoms. The demands of OCD have a continuous impact on families. According to research, how a family responds to OCD symptoms may assist to feed OCD symptoms. The more family members understand about their own reactions to OCD and how they affect the person with OCD, the more empowered they are to make a difference! Here are a few instances of these negative behaviours:
Taking part in the behaviour: You take part in your family member’s OCD behaviour along with them. For instance, when they wash their hands, you feel you should wash your hands as well.
Assisting with avoidance: You assist your family member in avoiding things that cause them distress. For instance, washing their clothes for them so that it is done correctly.
Assisting with the behaviour: You provide services to your family member that allow them to engage in OCD activities. Purchasing large quantities of cleaning supplies for them, for example.
Altering Family Routines: For example, you may vary the time of day you shower or when or how often you change your clothes.
Taking on additional duties, such as driving them somewhere when they could normally drive themselves.
Changing leisure activities: For example, a family member may persuade you not to leave the house without them or out of fear of contracting COVID-19 infection. This has an impact on your interest to go to the movies, eat out, spend time with friends, and so on.
Making adjustments at work: For example, you cut back on hours at work to care for a family member.
Learn what to do if a member of your family refuses therapy.
Bring OCD-related literature, videos, and/or audio recordings into the house. Offer the material to your OCD family member or deliberately put it about for them to read/listen to on their own.
Give words of encouragement. Tell the person that with proper treatment, the majority of people have a considerable reduction in symptoms. Tell them there is help available and there are others with the same problems. Suggestions include going to support groups, talking to an OCD buddy through online support groups, or speaking with a specialist at a local OCD clinic.
How does OCD affect lives of children and adolescents?
OCD affects a significant proportion of children and adolescent and thus understanding the disorder’s unique impact on their life is critical to ensuring that they receive the best treatment possible. The following are some of the most prevalent OCD difficulties in children and teenagers:
Disrupted Routines: For children and teenagers, OCD may make daily living extremely tough and unpleasant. They feel that if they don’t get their morning rituals perfect, the rest of the day will be a disaster. They also feel that they must complete all of their obsessive routines before going to bed in the evenings. Because of their OCD, some children and teenagers stay up late and are typically weary the next day.
School Issues: OCD can impact homework, classroom attentiveness, and school attendance. If this occurs, you must be a strong advocate for your child. Under the Individuals with Disabilities Act (in case the disability crosses 40%), you have the right to request adjustments from the school that would help your kid succeed.
Physical complaints: Children might get physically unwell as a result of stress, poor diet, and/or a lack of sleep.
Social relationships: Their friendships are affected by the stress of hiding their rituals from peers, time spent with obsessions and compulsions, and how their friends react to their OCD-related activities.
Self-Esteem Issues: Children and teenagers fear that they are “crazy” because their thinking differs from that of their peers and family. Their self-esteem may be harmed as a result of their OCD, because it has caused them shame or made them feel “bizarre” or “out of control.”
Anger Management Issues: This is due to the parents’ refusal (or inability!) to comply with the child’s OCD-related demands. Even when their parents establish appropriate boundaries, children and teenagers with OCD might become nervous and irritable.
Additional Mental Health Issues: Children and teenagers with OCD are more prone than those without the illness to have additional mental health issues.
Other disorders can sometimes be treated with the same medication that is used to treat OCD. When a youngster takes anti-OCD medication, depression, other anxiety disorders, and Trichotillomania may improve. Attention Deficit Hyperactivity Disorder, tic disorders, and disruptive behaviour disorders, on the other hand, may need additional treatments, including medicines that are not specific to OCD.
Treatment of OCD in Children and Teenagers:
Cognitive-Behavioral Therapy and/or medicines:
Experts believe that for children with OCD, cognitive-behavioral therapy (CBT) is the best treatment option. Children and adolescents with OCD who work with a trained CBT therapist realise that they, not OCD, are in command. Young people can learn to do the opposite of what their OCD instructs them to do by progressively addressing their anxieties in small steps (exposure), rather than succumbing to the rituals by using a CBT approach called exposure and response prevention (ERP) (response prevention).
ERP enables them to discover that their concerns are unfounded, and that they may become accustomed to the frightening sensation, much as they could become accustomed to cold water in a swimming pool. A teenager, for example, who touches items in his room to ward off bad luck will eventually learn to leave his room without touching anything. He may be apprehensive about doing this at first, but as he becomes more accustomed to it, the fear fades. He also discovers that nothing horrible occurs. When children understand how exposure and habituation work, they may be more ready to put up with the initial anxiety that comes with ERP because they know it will get worse before it gets better. Parents must participate in their child’s treatment as well, under the supervision of the therapist.
In addition to CBT, therapists have many other therapeutic modalities available to them that they can use depending on the need in the case.
Medicines may also be needed in cases where the severity of symptoms is beyond moderate level.
The author is a licensed clinical psychologist by profession and works as a child and adolescent mental health therapist at IMHANS-K and can be reached at [email protected]
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