OCD, Anxiety, or Both?
September 15, 2026
Feeling Like You’re in the Arena?
The first day of college, a new job, or another important life event can feel like stepping into an arena. Your mind may warn you: You can’t do this. You’re not ready. Get out while you can.
Fortunately, you’re not actually facing a fierce opponent. These alarms are coming from a mind that is trying—sometimes too hard—to protect you.
Why Does This Happen?
Anxiety is a normal part of being human. When we perceive a possible threat, our natural stress response prepares us to respond. Anxiety becomes problematic when it is excessive, persistent, out of proportion to the situation, or begins interfering with daily life.
Anxiety Can Be Misunderstood
Consider Ross.
As a child, Ross frequently complained of stomachaches before school. His parents initially kept him home because he appeared genuinely ill. Yet his symptoms often subsided once the pressure of attending school was gone.
Over the years, Ross was treated for severe anxiety. Despite receiving help, his symptoms increasingly interfered with school and daily life.
Eventually, Ross met with a clinician experienced in anxiety, OCD and other obsessive-compulsive related conditions. During a comprehensive assessment, the clinician discovered something Ross had never shared: he was experiencing distressing, unwanted thoughts.
Ross had kept these thoughts secret because he feared others would judge him or misunderstand what the thoughts meant about him. Further assessment revealed OCD symptoms that had previously gone unrecognized.
With an appropriate diagnosis, Ross was able to begin evidence-based treatment, including Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT) and if needed Inference-Based Cognitive Behavioral Therapy (I-CBT). Treatment also helped him reconnect with what mattered most to him (his values) in the areas of life he cared about such as relationships, education, health, leisure, and spirituality.
Why OCD Is So Easy to Miss
OCD does not always look like the stereotype of excessive handwashing or fear of contamination. Some people experience compulsions that are largely internal and therefore difficult for others to see. These can include rumination, mentally reviewing past events, repeatedly trying to “figure something out,” or seeking certainty.
People may not recognize these mental behaviors as compulsions and therefore may not report them. Clinicians who are unfamiliar with the many ways OCD can present itself may consequently overlook them.
Shame and stigma can create another barrier. Intrusive thoughts may be frightening or inconsistent with a person’s values, and someone may fear being judged if they disclose them. These concerns can contribute to people withholding symptoms and experiencing delays in appropriate recognition and treatment.
There Is Effective Treatment
If you or someone you care about has been struggling with persistent or “severe anxiety,” particularly when previous treatment hasn’t brought the expected improvement, a comprehensive evaluation by a clinician trained in both anxiety disorders and OCD may be helpful.
OCD is a complex and treatable condition. Evidence-based approaches such as ERP, ACT, and I-CBT can help people learn new ways of responding to intrusive thoughts and uncomfortable feelings while moving toward a meaningful life.
We don’t believe in one-size-fits-all care. Every treatment plan starts with a thorough evaluation that looks at OCD, anxiety, and any co-occurring mental health conditions or life factors. By identifying and treating co-morbidities from day one, we ensure your care is as complete and targeted as possible.
You don’t have to keep struggling in silence. Reach out to learn more about assessment and evidence-based treatment for anxiety, OCD and other conditions.
References
Abend, R. (2023). Understanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum. Neuroscience & Biobehavioral Reviews, 152, Article 105305. https://doi.org/10.1016/j.neubiorev.2023.105305
Ferrão, J. V. B., do Rosário, M. C., Fontenelle, L. F., & Ferrão, Y. A. (2023). Prevalence and psychopathology features of mental rituals in patients with obsessive–compulsive disorder: A descriptive exploratory study of 1001 patients. Clinical Psychology & Psychotherapy, 30(6), 1520–1533. https://doi.org/10.1002/cpp.2890
Robinson, K. J., Rose, D., & Salkovskis, P. M. (2017). Seeking help for obsessive compulsive disorder (OCD): A qualitative study of the enablers and barriers conducted by a researcher with personal experience of OCD. Psychology and Psychotherapy: Theory, Research and Practice, 90(2), 193–211. https://doi.org/10.1111/papt.12090
Semenya, A. M., & Bhatnagar, P. (2024). Diagnosis and management of obsessive-compulsive disorder in the primary care setting. American Family Physician, 110(4), 385–392.
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. https://doi.org/10.1016/j.jaac.2020.05.008
By Annabella Hagen, LCSW
