Anxiety and OCD are two of the difficulties I see most often in my practice. If you've been wondering whether what you're going through might be one of them, this article explains what each one looks like and when it's worth reaching out.
What anxiety looks like
Everyone worries from time to time, and that in itself isn't a problem. Worry becomes anxiety when it happens too often, feels too intense, and is hard to turn off. Many of the people I work with already know their worrying isn't helping. They would love to stop, but they can't seem to — and that isn't a failure on their part. It's just how anxiety works.
Anxiety doesn't always look like worry, either. Sometimes it looks like constant problem solving. If you find yourself running through scenarios and planning for every possible outcome, and you can't seem to switch it off, that is often anxiety too.
Underneath most of this is a feeling of uncertainty that's hard to sit with. You may know the thing you're afraid of is unlikely, but the feeling of not being sure is still there, and it's uncomfortable enough that it seems like you have to do something about it.
The question I'd ask you is simple: is it causing you real distress, or getting in the way of your life? If it is, it's worth taking seriously.
What OCD looks like
OCD has a few features that set it apart.
The first is intrusive thoughts. These are thoughts or images that show up uninvited and feel wrong, dangerous, or disturbing, and they're different from ordinary worrying. In a sense, people with OCD are often scared of their own thoughts.
The second is what you do in response — the compulsion. It might be something visible, like checking, washing, or arranging things. It might be a mental ritual, like counting, repeating a phrase, or going back over a memory to make sure nothing bad happened. It might mean asking the people around you for reassurance, over and over. Whatever form it takes, the purpose is the same: to neutralize the thought or get rid of the bad feeling that came with it.
Most people with OCD know, on some level, that the behavior doesn't make much sense. And even so, it's very hard not to give in.
The relief doesn't last, either. A thought shows up and feels dangerous, so you do something to get rid of it or to feel certain. You feel a little better for a short while, and then the thought comes back, often stronger than before.
Here's something I want you to hear clearly: having an intrusive thought says nothing about who you are. Most people have thoughts like these from time to time. The difference with OCD isn't the thought itself — it's how much weight the thought gets, and how hard you end up working to make it go away.
OCD also takes different forms. Some people have relationship OCD, where they feel unsure whether they're in the right relationship and keep searching for certainty about it. Some people have health anxiety, which isn't formally a type of OCD but works in much the same way. And you don't need a full OCD diagnosis for any of this to apply to you. Many of the people I work with have OCD-type symptoms without meeting every criterion, and the same approach helps them.
A note on health anxiety
Health anxiety deserves its own mention, because it can be confusing.
If you have a medical concern, please get it checked by a doctor. That's the right thing to do, and therapy is not a substitute for it.
Therapy is for the worry that continues no matter what the answers are. If you've been checked and told you're okay, and the worry keeps coming back or moves on to a new symptom, that's where counseling can help. At that point the problem isn't the medical question anymore — it's how hard it is to tolerate not being completely sure.
If some of this sounds familiar, there's good news: these are difficulties that respond well to the right approach. In the next article, I explain why the usual ways of handling anxiety and OCD tend to backfire, and what actually helps instead: Why Fighting Anxiety Backfires, and What Actually Helps. And if OCD is what brought you here, there's a page about how I treat OCD.
