How to Know If Your Anxiety Is Actually OCD: The Signs Most People Miss
If you’ve ever wondered, “Is this anxiety, or is this something else?”
…there’s a real chance the answer is OCD.
And no, not the stereotype OCD where someone “likes things neat.”
I mean the intrusive-thought, mental-spiraling, reassurance-seeking, “why won’t my brain shut up?” kind of OCD that most people (and honestly, many therapists) miss entirely.
As a therapist who completed a post-graduate fellowship specializing in anxiety, OCD, and related disorders, trained in evidence-based treatments and the leading exposure and response prevention (ERP) manuals… let me tell you something:
There is A LOT of confusion out there.
Especially in New York City, Hoboken, and Montclair, where highly anxious, high-achieving people often get misdiagnosed for years because their OCD doesn’t look like the stereotypes.
So let’s break this down clearly, gently, and honestly.
Why Anxiety and OCD Get Confused (Even by Therapists)
Most people think OCD is:
hand washing
checking locks
organizing
counting
And yes — those can be compulsions.
But OCD is far broader, and often totally invisible.
Meanwhile, anxiety is everywhere.
So when symptoms overlap, it’s easy to label everything as “anxiety,” especially when:
your thoughts are intense
you’re constantly stuck in your head
you overthink
you fear making the wrong decision
you don’t trust your judgment
you spiral easily
But here’s the key distinction:
Anxiety is fear.
OCD is fear + compulsions (including mental ones).
If you’re doing things (inside or outside your head) to try to neutralize discomfort, that’s not anxiety anymore … that’s OCD territory.
And this is where most misdiagnosis happens.
How OCD Usually Shows Up (Even Without “Classic” Compulsions)
Here’s the part people don’t realize … and the part my fellowship drilled into me:
OCD is obsessions + compulsions,
And most compulsions are mental (which is why an OCD diagnosis often goes missed).
Clients in Hoboken, NYC, and Montclair often don’t realize they’re compulsing because they’re not washing their hands or checking a stove. Their compulsions look like:
Mental loops:
replaying conversations
mentally checking your intentions
reviewing memories to “make sure”
trying to feel certainty about something
Reassurance seeking:
Googling
asking your partner
asking friends
reading forums
checking symptoms
Avoidance:
avoiding decisions
avoiding emotions
avoiding triggers
avoiding situations that might “set off” the fear
Rumination disguised as problem-solving:
This is a big one. People think they’re “thinking it through” — but they’re actually performing a compulsion.
You don’t need visible compulsions to have OCD.
You only need the cycle.
Signs It Might Be OCD, Not Anxiety
Here are the signs I see ALL THE TIME — and why many of my clients were misdiagnosed before landing in my office:
1. You’re searching for certainty
About your health, relationship, choices, safety, identity, morality, etc.
Anxiety asks, “What if?”
OCD says, “I MUST know for sure.”
2. Your thoughts feel intrusive, unwanted, or disturbing
Common themes:
harm
cheating
sexuality
morality
pregnancy / TTC
“what if I’m a bad person?”
“what if I never actually love my partner?”
These are not random — they’re OCD themes.
3. Your brain goes into overdrive after triggers
You spiral for HOURS
…trying to figure out the “meaning” of something
…trying to analyze the thought
…trying to calm the panic
4. You feel panic when you can’t “figure something out”
Especially decisions. OCD HATES uncertainty.
5. You seek reassurance constantly
From Google, from your partner, from your therapist, from yourself.
6. You try to “monitor” your emotions
As proof of something:
“Did I feel attraction?”
“Did I feel anxious?”
“Did I feel guilty?”
This emotional checking is a compulsion.
7. “What if?” loops rule your brain
And no answer ever sticks for long.
If your brain is doing this…
it’s not “just anxiety.”
Relationship Anxiety or ROCD? Here’s the Difference
Relationship Anxiety:
fear of vulnerability
fear of abandonment
fear of conflict
stemming from attachment history
ROCD:
intrusive doubts
compulsive reassurance seeking
checking your emotions
comparing your relationship
obsessing about making “the wrong choice”
analyzing your partner endlessly
If you’re compulsing, it’s ROCD.
This is where specialized training really matters; many therapists mistakenly reassure, which makes ROCD symptoms worse.
Therapist Mistakes I See Constantly (That Make OCD Worse)
Here’s where I get blunt, because your care deserves accuracy:
Reassuring clients
(“I don’t think you’d ever actually do that!”)
Helping them “logic their way out”
(“Let’s challenge the thought.”)
Using talk therapy alone
(OCD does NOT respond to insight-based work.)
Not identifying compulsions
Especially mental ones.
Avoiding exposures
Because the therapist feels uncomfortable.
Mislabeling OCD as GAD, trauma, or perfectionism
Most therapists don’t receive formal OCD training.
I ONLY learned this because of my fellowship, manual-based training, and hands-on ERP work. If you are seeing a therapist for OCD, ask them how they were trained and if they are trained in ERP. If they are not trained in ERP … find a new therapist.
This is why specialized care matters so much.
What Effective OCD Treatment Actually Looks Like (ERP)
Exposure and Response Prevention (ERP) is:
structured
evidence-based
uncomfortable (but so empowering)
skills-based
focused on tolerating uncertainty
ERP helps you break the cycle of:
obsession → anxiety → compulsion → temporary relief → obsession again
By learning to tolerate uncertainty instead of chasing certainty.
This is where real transformation happens.
If you’ve tried therapy before and it didn’t help, it may not have been the right treatment.
OCD requires a completely different approach than anxiety.
With fellowship training in anxiety, OCD, and related disorders, plus ERP and evidence-based practices, I offer therapy that actually targets the cycle, not just the symptoms.