Tag: generalised anxiety disorder

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Is It Anxiety or OCD? 2 Psychology Experts Explain the Difference

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Photo by Joice Kelly on Unsplash

Emily Upton, UNSW Sydney; Black Dog Institute and Kayla Steele, UNSW Sydney

Anxiety itself is not a mental illness. It’s a normal, adaptive emotion that helps us respond to perceived threats.

Anxiety is the automatic reaction that makes you jump back when you think you’ve seen a snake while bushwalking – before realising it’s a stick.

It’s also (inconveniently) the sweaty palms and shaky voice you notice before a presentation or a first date, or the circling thoughts that keep you awake at 3am.

Most of us have ways to cope with anxious thoughts and feelings that can give us more of a sense of control. This could be checking and double-checking we’ve got the room right for our presentation, or seeking reassurance from someone we love.

But when might these behaviours fit a diagnosis of an anxiety disorder? And when could they actually be a sign of obsessive compulsive disorder (OCD)?

As clinical psychologists, we find these questions come up a lot, perhaps spurred by a recent surge of interest in OCD on social media. So what’s the difference between anxiety and OCD? And how are they treated?

Social media is full of content ‘diagnosing’ OCD and explaining how it’s different to anxiety. TikTok

When is anxiety something more serious?

“Normal” anxiety can become an anxiety disorder when fears or worry are persistent, intense and start interfering with everyday life.

About one in three people will experience an anxiety disorder at some point in their lifetime.

Among the most common are social anxiety disorder (fear in social situations), panic disorder (frequent panic attacks, and fears you’ll have another) and generalised anxiety disorder (persistent and excessive worry).

These disorders have slightly different symptoms. But all share excessive and persistent fear or worry that causes distress or leads people to avoid important parts of life including work, study or social activities.

So, what about OCD?

Although OCD involves anxiety, it is actually considered a separate disorder in the diagnostic manual used by mental health professionals.

It is possible to have both – around half to three-quarters of individuals with OCD also meet criteria for one or more anxiety disorders as well.

OCD involves obsessions, compulsions, or both. These cause significant distress or interfere with daily functioning.

Obsessions are intrusive, unwanted thoughts, images or urges. This could mean an intense fear your food is contaminated, suddenly visualising hurting someone, or a feeling that keeps entering your mind that you’ve made a serious mistake.

Compulsions are the repetitive behaviours (or mental rituals) people feel driven to perform to ease that distress, such as checking, repeating phrases, excessive hand-washing or seeking reassurance.

Many of us will occasionally experience unwanted thoughts or go back to check the oven is actually off. Keeping things tidy or being particular about routines can simply be habits that don’t cause distress.

But what makes OCD different is its severity and impact.

If obsessions or compulsions take up large amounts of time, cause you significant distress, or interfere with daily life, it may be a sign of OCD.

You can’t “spot” OCD from behaviour alone. OCD can also be invisible because many compulsions happen mentally, such as repeating phrases or counting. People with OCD may also try to hide their symptoms out of shame.

Are OCD and anxiety treated differently?

While anxiety disorders and OCD share some similarities, including repetitive distressing thoughts, the patterns and beliefs driving them are different. This means the way they’re treated will also differ.

Cognitive behavioural therapy (CBT) is one of the most effective treatments for both anxiety disorders and OCD.

For OCD, treatment often involves a specialised form of CBT called exposure and response prevention (ERP). It involves gradually facing situations that trigger distressing thoughts while resisting the urge to perform compulsions.

For example, someone with contamination fears might gradually reduce the number of times they wash their hands before eating. Over time, people learn the feared outcome does not occur, that they can tolerate their discomfort without the ritual, and that the anxiety passes on its own.

Treatment for anxiety disorders focuses on the specific fear. For generalised anxiety, for example, it involves understanding patterns of worry, challenging beliefs that keep worries going, and developing more helpful ways to respond to problems, such as brainstorming solutions and taking small actions.

Antidepressant medication (particularly selective serotonin re-uptake inhibitors, or SSRIs) can be an effective component of treatment for both anxiety disorders and OCD. A combined treatment approach of medication (SSRIs) and therapy (CBT) often leads to the best treatment outcomes, especially for severe OCD.

A final note

While it’s great mental health is being discussed more openly online and stigma is reducing, social media can also blur the line between personal experience and evidence-based information.

If something you’ve seen online has sparked curiosity about your mental health, the best next step is to talk with a qualified professional who can help you understand what you’re experiencing and what support might help.

For more information and resources about anxiety and OCD, visit the Black Dog Institute or Beyond Blue, and ReachOut or Headspace for young people.

There are lots of evidence-based online treatment programs for anxiety disorders and OCD you can access for free or low-cost, such as This Way Up, MyNewWay or Mindspot.

There are also online treatments for kids and teens with OCD and anxiety.

You can also ask your GP about a Mental Health Care Plan for Medicare-rebated psychology sessions.

Emily Upton, PhD Candidate in Psychology, UNSW Sydney; Black Dog Institute and Kayla Steele, Postdoctoral Research Fellow and Clinical Psychologist, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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New Research Sheds Light on the Biological Roots of Anxiety

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The largest genetic study of anxiety disorders to date has identified 58 genetic variants associated with anxiety, most of which have not been identified before now.

Photo by Joice Kelly on Unsplash

In the largest genetic study of anxiety disorders to date, new research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, in partnership with Texas A&M and the Institute of Psychiatric Phenomics and Genomics (IPPG) at LMU Munich, has identified 58 genetic variants associated with anxiety, most of which have not been identified before now.

The research, published in Nature Genetics, confirmed that, rather than being driven by a single “anxiety gene”, anxiety disorders are influenced by numerous genetic variants from across the genome, with each contributing a small effect.

The researchers compared the genetic data of 120 000 people diagnosed with an anxiety disorder to almost 730 000 people without.

Their analysis of the data notably highlighted the role of several genes involved in GABAergic signalling; a key system that regulates brain activity.

“Anxiety disorders arise from the interplay of genetic vulnerability and life experience. At a time when rates of anxiety are rising rapidly in our young people, by identifying robust genetic signals offering novel insight into the biological foundations of these debilitating disorders, this research helps move the field toward more precise and effective approaches to prevention and care.” 

Professor Thalia Eley, Professor of Developmental Behavioural Genetics at King’s IoPPN and one of the study’s senior authors

While the research provides a biological basis for anxiety, the researchers do not advocate for the use of genetic testing to diagnose anxiety.

Professor John Hettema, from the Department of Psychiatry at Texas A&M University Naresh K. Vashisht College of Medicine, another of the study’s senior authors said, “Anxiety disorders and their underlying sources of genetic risk have been understudied compared to other psychiatric conditions, so this study substantially advances this critical knowledge.”

Prof Jürgen Deckert, Julius Maximilians University, Würzburg, Germany wrote “The results of the study provide evidence for a role of several previously unknown molecular pathways in the etiology of anxiety, beyond the previously identified GABAergic system. They will provide the basis for future studies in cell culture, animal models and humans which will contribute to a better understanding of the neurobiology of anxiety and as a consequence to innovative and individualized therapies.”

Genome-wide association study of major anxiety disorders in 122,341 European ancestry cases identifies 58 loci and highlights GABAergic signaling (DOI 10.1038/s41588-025-02485-8) (Eley, Mattheisen, Hettema et al) was published in Nature Genetics.  

Source: King’s College London

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A Connection Between Mental Health and Heart Disease, Increased Mortality Risks

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Every 34 seconds, someone in the United States dies from heart disease. As nearly half of the country suffers from some form of cardiovascular disease (CVD), another 1 in 4 adults experience a mental health disorder in their lifetime, signalling an inevitable overlap.

Now, a new report from Emory University shows that certain mental health conditions escalate the risk of developing heart disease by 50–100% – and adverse outcomes from existing heart conditions by 60–170%.

The report, published in The Lancet Regional Health-Europe, summarises cardiovascular health disparities among those diagnosed with depression, anxiety, schizophrenia, bipolar and post-traumatic stress disorders (PTSD). The article is part of a series aiming to raise awareness around disparities in CVD health in four populations: women, the elderly, racial minorities and those with mental health conditions.

Emory University professor Viola Vaccarino, MD, PhD, led this metareview linking mental health conditions to CVD, along with co-authors Amit Shah, MD, and Douglas Bremner, MD, also Emory professors.

The report associated the following conditions and their corresponding risks of developing CVD:

  • Major depression, 72%
  • PTSD, 57%
  • Bipolar disorder, 61%
  • Panic disorder, 50%
  • Phobic anxiety, 70%
  • Schizophrenia, nearly 100%

The research also shows that these conditions are associated with a poorer prognosis, greater risk for readmission and higher mortality from existing heart conditions. For example, major depression more than doubles the mortality rate in those with existing CVD.

Additionally, the report emphasises a bidirectional relationship. “More than 40 percent of those with cardiovascular disease also have a mental health condition,” adds Vaccarino.

The physiology of stress

According to the report, a well-documented relationship exists among depression, schizophrenia, PTSD, and abnormal stress responses in the autonomic nervous system (ANS) and hypothalamic-pituitary adrenal axis (HPA).

The former allows the brain to manage involuntary responses, such as functions of the liver, heart, sweat glands, and eye muscles. ANS also manages both acceleration and deceleration of these functions, regulating inflammatory responses. Since most major organs have ANS nerve endings, this system impacts most bodily functions.

The hypothalamic-pituitary adrenal axis (HPA) also influences immune response and metabolism, which can impact cardiovascular function.

According to the report, dysregulation of these systems creates “adverse downstream effects that can affect cardiovascular risk chronically, including increased inflammation, metabolic abnormalities, high blood pressure, enhanced systemic vascular resistance and autonomic inflexibility.” Inflammation has also been implicated in both the development of heart disease and mental health conditions.

Social determinants and quality of care

The role of social determinants of health in CVD disparities is critical. Those with mental health conditions may face disruptions and barriers in the continuum of care, such as affordability and accessibility. Compromised health literacy or communication can also impede access to health screenings and treatment.

Clinicians could also be challenged to care for patients with certain mental conditions, which can be compounded by stigma and existing models that fragment mental and physical health care. Stigmas are also present in the field of clinical research, where having a mental health condition is often an exclusionary criterion in randomised trials.

Moreover, according to the report, current prediction models don’t account for mental health disorders when forecasting the risk of developing heart disease.

Next steps toward a healthier future

To address the disparities of CVD among people with mental health disorders, the authors recommend an integrated approach with interdisciplinary care encompassing behavioural, mental and cardiovascular health.

“The tight connection between cardiovascular and psychological health warrants changes in the health care system that are more amenable to patients with comorbidities,” says Vaccarino. “A clinical team would be ideal for the care of these patients – a team of specialists, social workers, and nursing staff who work in collaboration to provide multidisciplinary care and resources.” 

The report concludes that closing the health disparity gap upholds the rights of those living with a mental health condition to achieve the highest level of health and fully participate in society. 

Source: Emory University

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Abnormal Heart Reaction in Generalised Anxiety Disorder

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Photo by Joice Kelly on Unsplash

In women with generalised anxiety disorder (GAD), researchers using functional magnetic resonance imaging (fMRI) have identified an abnormal link between the heart and the prefrontal cortex.

The researchers were seeking to determine whether individuals suffering from GAD show dysfunction in the neural circuitry underlying cardiovascular arousal, and if it is associated with certain disorder-related symptoms such as anxiety and body sensation. To conduct the study, they completed a randomised clinical trial of 58 adult female participants (29 with GAD and 29 healthy controls).

During the study, they stimulated the cardiovascular system using isoproterenol, which mimics the effects of adrenaline but, unlike adrenaline, cannot cross the blood-brain-barrier to directly impact brain activity. Intravenous infusions of isoproterenol or saline were administered during fMRI, allowing them to assess whether the brains of patients with GAD differ in the processing of information received from the body, a function known as ‘interoception’. The main findings were that patients with GAD perceived their heartbeats to be more intense and had relatively higher heart rates and lower neural activity in the ventromedial prefrontal cortex. However, these were only observed during the lower of two dosages of isoproterenol: a key finding. Self-reported anxiety was higher only for those with GAD compared to healthy participants in response to either dose. 

The findings were published in JAMA Psychiatry.

Lead author Adam Teed, a postdoctoral associate at Laureat Institute of Brain Research, said “administering isoproterenol allowed us to provide causal evidence that an abnormally sensitive cardiovascular system and an abnormally insensitive frontal cortex in GAD patients lowers their ability to regulate bodily arousal. This could help to explain why they experience anxiety so frequently and in a wide variety of contexts.” The authors hope that their study prompts further research into the ventromedial prefrontal cortex as a therapeutic target for novel treatments helping individuals with GAD to regulate physiological and emotional responses to stress. 

In addition to this link, the observation of cardiovascular hypersensitivity in GAD patients was also noteworthy. This is because the DSM-5 describes autonomic symptoms such as sweating, rapid heart rate, or shortness of breath, as being less prominent in GAD than other anxiety disorders, such as panic disorder. As senior author Sahib Khalsa, MD, PhD, a psychiatrist and principal investigator at LIBR explains, “this study shows us that anxiety is not only something that happens within our brains but within our bodies as well.” 

Thus abnormal autonomic nervous system functioning is not only a factor in GAD, but it occurs in combination with abnormal functioning of certain areas of the brain. Dr Khalsa believes that this finding is the most important research outcome: “it is the interaction between our brain and body that may be essential for determining whether an innocuous situation creates a state of fear in individuals with GAD. We need to better understand how this abnormal physiological response relates to the functional impairments that commonly interfere with the daily lives of such individuals.”

Source: Laureate Institute for Brain Research