How do I know it’s OCD and not just anxiety?
The difficulty of diagnosis
As mentioned in my prior blogs, on average it takes approximately 17 years for someone to get properly diagnosed with OCD. OCD is a sneaky little devil and often masquerades as “just anxiety.”
With all of the feelings of impending doom, intrusive thoughts, hypervigilance, and panic, it’s not hard to see why someone might get misdiagnosed. Even some of the most seasoned therapists can mistake OCD for Generalized Anxiety Disorder (GAD) or Anxiety Not Otherwise Specified– (NOS) as the differentiating characteristics of OCD can be subtle.
OCD thinking patterns follow a very distinctive flow. An inescapable, unwanted, and distressing thought will come to mind. As a result, the victim is overwrought with the intolerance of uncertainty as to whether or not this distressing event will take place. The victim needs to know with 100% certainty RIGHT NOW.
The irresistible itch
OCD presents with an irresistible “itch,” demanding repeated examination of the facts (compulsing/checking) to assure the sufferer of safety. This checking process will indeed lead to resolution, but only temporarily. The OCD mind will then return to checking again. Such repetitive examination leads to a sensation of “spiraling,often eliciting dissociation and paranoia. Many have reported this sensation as feeling like being inside of a “bubble.”
The OCD sufferer has what is known as a “duality of mind.” A part of the mind knows that the fear is unfounded, yet another part continues searching for assurance. While sufferers with both anxiety and OCD are assailed with overthinking and uncomfortable physical sensations and emotions, the non-OCD sufferer will not participate in the same repetitive compulsive behavior as an OCD sufferer. For example, someone with anxiety might worry about getting a cold or the flu, but they will not compulsively wash their hands to the point of bleeding to make 100% certain it won't happen.
Known as the “Doubting Disease,” OCD can be identified by the characteristics of the doubt. Is the doubt obsessional, or is it reasonable? Obsessional doubts cause one to question what one already knows. These questions can involve issues about one’s own identity, wherein one might wonder if they are a “good person” or a “sociopath.” Could they possibly be a child molester and not know it?
Obsessional doubts can question what one experiences in their five senses. Thoughts follow a pattern like this: “I am not sure I can trust that the door is locked. It looks locked. I think I locked it. Maybe it's not.” With a reasonable doubt, new information will help it resolve. For example, “What if I left the light on” will be resolved by checking–once. Obsessional doubts will resurface again, even with new information: “What if I can’t trust what my eyes just saw?”
Obsessional doubts
OCD obsessional doubts can be outlandish and ridiculous such as, “What if I don’t exist,” or “What if I lose control and stab my family?” Someone with GAD may fear bad things could happen; those with OCD fear they are losing their minds.
The need for correct diagnosis cannot be overstated. The simple techniques of checking the facts and Socratic questioning, which are often used to correct cognitive distortions and reduce anxiety, would only serve as compulsions for the OCD sufferer. This sort of cognitive therapy could inadvertently drive someone with OCD deeper into psychosis.
However, under the care of an OCD-savvy therapist, proper treatment such as Exposure and Response Prevention (ERP) will reduce the neural biological activity in the brain and ultimately result in a reduction of intrusive thoughts and compulsive behaviors associated with OCD.
