Anxiety or OCD? Seven signs side by side
Updated: 7 days ago
If you've ever been told to "just stop thinking about it", usually by someone who can't stop thinking about what's for tea from about eleven in the morning, and you've quietly wondered whether what's going on in your head is anxiety or something else, this one's for you.
I'm Charlotte, an OCD specialist therapist in the UK. Anxiety and OCD can feel very alike from the inside, and they're often mixed up from the outside too, which matters, because the help that tends to work best for each one is a little different.
The sentence I hear most when someone first tells me about their OCD is "I feel like I'm going mad."
First, what's normal
Everyone feels anxious sometimes. A racing mind before a big day, putting off a tricky phone call, asking a friend "do you think that was okay?" or lying awake going over tomorrow are all part of being human, and none of it on its own is an anxiety disorder or OCD.
So when might it be OCD?
OCD is a cycle of obsessions (thoughts, images, urges or doubts that keep coming back, feel unwanted and cause real distress) and compulsions (things you do, out loud or in your head, to make the distress settle or to feel sure).
Clinicians usually start thinking about OCD when that cycle causes real distress, takes up a lot of time, often more than an hour a day, or gets in the way of daily life. A rough way to hold the difference: anxiety tends to spread across lots of worries, while OCD tends to lock onto one doubt and come with something you feel you have to do about it. Only a qualified professional can say which it is, and the two can happen together.
Seven signs side by side
1. Restlessness or a racing mind
With anxiety, this often shows up as a general sense of unease, a mind that won't switch off no matter what you try. With OCD, that same racing quality can settle onto one specific thought or question that keeps looping, rather than skipping between worries.
2. Avoidance
Anxiety might mean putting off a phone call or a difficult conversation. OCD avoidance tends to be more specific, steering clear of a place, an object or a situation because of what it might trigger or mean.
3. Reassurance seeking
Most people ask for reassurance sometimes, and that's simply part of being human. With OCD, the asking can start to repeat, the same question to the same person, or to several people, because the reassurance never quite settles the feeling for long.
4. Physical tension
Anxiety often sits in the body as a tight chest, a clenched jaw or a churning stomach. OCD can bring the same physical sensations, especially in the build-up before a compulsion, with that feeling of pressure easing only once the ritual is done.
5. Difficulty concentrating
Anxiety can pull focus because there's simply too much on your mind. OCD can pull focus for a narrower reason, because part of your attention is quietly busy checking, counting or reviewing something in the background.
6. Sleep disruption
Both can keep you up at night. Anxiety tends to circle general worries about tomorrow, while OCD can keep you up because a thought or a ritual feels unfinished, and unfinished doesn't let you rest.
7. Irritability
Anxiety can leave people feeling on edge and short-tempered simply from carrying so much. OCD can bring a similar irritability, often tied to being interrupted mid-ritual, or having a routine disrupted before it feels complete.
Why the difference matters
OCD is still so under-recognised, and many people are treated for general anxiety before anyone spots the loop underneath. That matters because the approaches that help general anxiety, like reassurance, relaxation or talking a worry through until it feels better, can sometimes feed the OCD cycle, because they work a bit like a compulsion.
The treatment NICE recommends first for OCD is CBT with exposure and response prevention (ERP), where we work together, at your pace, to gently face the doubt while you practise not doing the compulsion. So getting the picture right early can save a lot of time and a lot of going round in circles.
What helps
OCD is treatable and recovery is possible, and anxiety is very treatable too. If you recognised yourself on the OCD side of more than one of these, please take that as a reason to ask a specialist, rather than as an answer.
If you'd like to understand your own loop a little better first, my free guide Is this OCD? walks through the loop, the compulsions people often miss, and where to go next.
Quick answers
Tap a question to open it.
How do I know if what I'm experiencing is OCD?
OCD usually involves unwanted thoughts, images or doubts that feel distressing, and things you do to try to feel better or more certain, such as checking, avoiding, seeking reassurance or going over things in your mind. Only an assessment can tell you whether it is OCD, and you don't need a diagnosis to get in touch.
Does CBT with ERP work for OCD?
CBT that includes Exposure and Response Prevention (ERP) is the treatment recommended for OCD in NICE guidance and by the NHS. Many people find their symptoms reduce with it. Everyone responds differently, so we review how it's going as we work.
How many sessions will I need?
It varies. Many courses of CBT with ERP run somewhere between 8 and 20 sessions, and some people need fewer or more. We'll agree a plan at the start and review it regularly, so you always know where we are.
Do I need a diagnosis or a GP referral?
No. You can contact me directly.
When you're ready
I work with adults online across the UK, and I'm a BABCP accredited CBT therapist with 12 years in NHS and community mental health services. I see people with OCD, anxiety, phobias and trauma, so you don't need to know which one it is before you get in touch.
For bite-sized OCD support most days, come and find me on Instagram at @the_floral_therapist.
Charlotte
If you feel unsafe, or worried you might act on a thought, call 999 or go to A&E, call NHS 111 and choose the mental health option, or call Samaritans free, any time, on 116 123.
This post is educational, not diagnostic, and isn't a replacement for therapy. Only a qualified professional can assess and diagnose OCD. Please speak to an OCD specialist or contact your GP for further support.
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