When Anxiety Is Actually OCD: Why So Many People Are Diagnosed with Generalized Anxiety Disorder First
By Dana Colthart, LCSW | Clear Light Therapy – Englewood, NJ
In my 10 years as a therapist specializing in anxiety disorders and OCD therapy, one pattern shows up again and again: someone comes into my office saying they’ve struggled with generalized anxiety disorder for years, but as we start unpacking what’s really happening in their mind, it becomes clear they are dealing with OCD symptoms.
This is incredibly common.
It is not because therapists are careless. It is not because anyone is incompetent. OCD is simply more complex than most people, including many clinicians, were trained to recognize. And when OCD is mistaken for generalized anxiety disorder (GAD), treatment often misses the mark.
Many of the adults I work with in Bergen County and Monmouth County tell me the same thing:
“I’ve been in therapy before.”
“I learned coping skills.”
“I understand my anxiety.”
“But I’m still stuck.”
They feel heard. They may even like their previous therapist. But nothing actually changed. The intrusive thoughts are still there. The rumination is still there. The fear keeps coming back. When that happens, people often assume they are the problem. They are not. Very often, the issue is not therapy itself, it’s the type of therapy being used.
The Subtle Difference Between GAD and OCD
On the surface, OCD and generalized anxiety disorder can look very similar. Both involve worry. Both involve distress. Both fall under anxiety disorders. But the internal mechanics are different.
With generalized anxiety disorder, worries tend to move around. A person might worry about work one day, finances the next, then their health, then their children. The mind jumps from topic to topic. The anxiety is chronic but fluid. With OCD, the mind tends to get stuck. Instead of bouncing around, it latches onto one question and refuses to let go.
Common OCD themes I see in my practice include:
Relationship doubts (“What if I’m with the wrong partner?”)
Health fears (“What if this symptom is cancer?”)
Moral or responsibility fears (“What if I hurt someone accidentally?”)
Social fears (“What if I said something offensive?”)
Existential questions (“What if nothing is real?”)
The defining feature is not just worry — it’s the urge to solve.
People with OCD feel compelled to:
Analyze the thought repeatedly
Review past memories for evidence
Check their feelings
Seek reassurance from others
Google for certainty
Mentally replay conversations
Try to “figure it out” until it feels resolved
Those behaviors, even when they happen entirely in the mind, are compulsions. This is where OCD is often missed. Mental compulsions don’t look dramatic. They look like thinking.
Why OCD Is So Frequently Misdiagnosed
There are a few reasons OCD gets mistaken for generalized anxiety disorder.
Many therapists are not deeply trained in OCD assessment.
Mental compulsions are subtle and invisible.
Clients describe their experience as “worrying,” which sounds like GAD.
OCD doesn’t always involve obvious behavioral rituals.
If a therapist hears “I worry all the time,” they may reasonably think anxiety disorder. But if that worry involves repetitive, stuck loops and attempts to gain certainty, we are likely looking at OCD symptoms. Diagnosis matters not because labels are everything, but because treatment differs.
Why Treatment Changes Everything
A question I sometimes hear is: “Does it really matter if it’s OCD or anxiety? Isn’t anxiety just anxiety?” It matters because the wrong treatment can strengthen the problem. When someone believes they have generalized anxiety disorder, they often seek traditional talk therapy or general anxiety treatment. That may include:
Reassurance
Cognitive reframing
Challenging irrational thoughts
Relaxation strategies
Breathing techniques
Processing childhood experiences
These tools are not inherently bad. In fact, they can be helpful in many contexts. But for OCD, they often backfire.
The Reassurance Trap
Reassurance is one of the most powerful reinforcers of OCD. Here’s why. When someone feels anxious and receives reassurance, anxiety drops temporarily. The brain learns: “Relief came from getting certainty.” The next time doubt appears, the brain demands reassurance again.
Over time, the cycle strengthens:
Obsession
Anxiety
Temporary relief
Stronger obsession
This is why reassurance feels good in the moment but makes OCD worse long-term.
Example 1: Relationship OCD
A client worries they are with the wrong partner. A non-specialist therapist asks:
What feels off?
What are your doubts?
When did this start?
Are your needs being met?
These questions are appropriate in couples therapy. But if the root issue is OCD, they feed rumination. The client leaves feeling slightly better, then doubt returns, often more intensely. The analysis itself becomes the compulsion.
Example 2: Health Anxiety and OCD
A client fears they have a serious illness. A therapist offers logic:
“You’ve been checked by doctors.”
“There’s no evidence of cancer.”
The anxiety drops temporarily. Then the mind says: “What if they missed something?” Now reassurance is required again. This is why health-related OCD symptoms are often mistaken for generalized anxiety. The compulsive reassurance cycle isn’t recognized.
Why Reframing Thoughts Often Doesn’t Work for OCD
In traditional anxiety treatment, cognitive reframing is common. Clients are encouraged to evaluate evidence, challenge distortions, and replace negative thoughts with rational alternatives. For OCD, this frequently becomes another compulsion.
The person debates the thought. Argues with it. Tries to disprove it. Looks for certainty.
But OCD is not a logic problem. Most people with OCD already know their fear is unlikely. The issue is intolerance of uncertainty. No amount of logic eliminates uncertainty completely. So the brain keeps asking for more. That’s why people often say: “I know it doesn’t make sense, but it still feels real.”
What We Do Differently at Clear Light Therapy
At Clear Light Therapy in Englewood, NJ, our approach to OCD therapy and anxiety disorders is structured and evidence-based. We use:
Exposure and Response Prevention (ERP)
Acceptance and Commitment Therapy (ACT)
These approaches work for both OCD and generalized anxiety without worsening either.
ERP focuses on:
Gradually facing feared thoughts or situations
Resisting compulsions and rumination
Allowing anxiety to rise and fall naturally
Teaching the brain through experience that it is safe
ACT focuses on:
Accepting uncertainty
Allowing uncomfortable thoughts and sensations
Cognitive defusion (separating from thoughts)
Shifting attention intentionally
Moving toward personal values
Instead of trying to eliminate anxiety, we teach clients to change their relationship to it. That is what creates long-term change.
The Core Concepts We Emphasize
Whether someone is struggling with OCD symptoms or anxiety disorders more broadly, the following principles guide treatment:
Anxiety is uncomfortable but not dangerous
Thoughts are mental events, not commands
Uncertainty is part of being human
Rumination strengthens fear
Avoidance maintains anxiety
Reassurance reinforces compulsions
Exposure retrains the brain
Values matter more than fear
These concepts sound simple, but applying them consistently changes lives.
Why High-Functioning Adults Often Slip Through the Cracks
In Bergen County and Monmouth County, I work with many adults. They manage careers, families, and responsibilities. From the outside, they look fine. Internally, they may be spending hours a day in rumination. Because they are functioning, therapists sometimes underestimate the severity of OCD symptoms. Mental compulsions don’t disrupt the outside world in obvious ways, but they can quietly consume someone’s life. Many clients say:
“I didn’t even know mental compulsions were a thing.”
“I thought everyone overthought like this.”
“I thought therapy was just supposed to be talking.”
When treatment shifts toward ERP and ACT, progress often accelerates because we are finally targeting the actual mechanism maintaining the anxiety.
OCD Self-Care Is Not What Most People Think
Many people believe self-care for anxiety means calming down. True OCD self-care looks different. It involves:
Resisting reassurance
Limiting Googling
Reducing rumination
Allowing intrusive thoughts to exist
Continuing activities despite anxiety
Leaning into discomfort gradually
Practicing cognitive flexibility
Self-care for OCD is about building tolerance, not comfort.
If Therapy Hasn’t Worked Before
If you have tried therapy and felt like you were just talking without meaningful change, it does not mean:
You are resistant
You are too complex
You are broken
Therapy cannot help you
It may mean the treatment model did not match the problem. When OCD therapy, OCD counseling, and anxiety treatment are delivered using ERP and ACT, outcomes are significantly stronger than reassurance-based approaches.
Serving Bergen and Monmouth County, NJ
Clear Light Therapy provides specialized OCD help, anxiety disorder treatment, and evidence-based counseling for adults throughout:
Bergen County, NJ
Monmouth County, NJ
Englewood and surrounding areas
Telehealth across New Jersey
Our focus is not simply talking about anxiety, it is helping clients retrain their brains, reduce compulsions, and expand their lives.
FAQ
How do I know if my anxiety is actually OCD?
If you feel stuck on specific thoughts and repeatedly analyze or seek certainty, OCD may be present. You should see a therapist to get an official diagnosis. Please call us for a consultation to start therapy.
Can reassurance really worsen OCD?
Yes. It reduces anxiety temporarily but strengthens the compulsive cycle long term.
Does ERP work for generalized anxiety disorder too?
Yes. ERP reduces avoidance and increases tolerance for uncertainty, which helps both OCD and other anxiety disorders.
Is rumination a compulsion?
Yes. Repeatedly reviewing or analyzing thoughts to feel better is considered a mental compulsion.
Do you provide OCD therapy in Bergen County and Monmouth County?
Yes. Clear Light Therapy specializes in OCD therapy and anxiety treatment in New Jersey, both in person and via telehealth.
