OCD or Anxiety? It's Not a Black and White Question
Breaking the Rules: A Clinician's Guide to Treating OCDShow Notes
OCD or Anxiety? It's Not a Black and White Question
The question has been coming up in supervision a lot lately. Is this OCD — or is it GAD? Specific phobia? Health anxiety? Social phobia? It sounds like a simple diagnostic question. It isn't. In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller dig into one of the most common and most confusing clinical challenges in the OCD space — differentiating OCD from anxiety disorders that present in similar ways. They explore why OCD and anxiety so frequently co-occur, how anxiety disorders can morph into OCD over time, and why we're increasingly seeing subclinical OCD presentations in the clinic — and why that's actually a good thing. They also talk about what to do when you genuinely can't tell. Why the DSM is a guide, not a definitive answer. And why the most important thing you can do is take your client along with you through the process — because a diagnosis that happens to someone, rather than with them, rarely lands the way it needs to. Celin also shares a story about a client who'd worked through most of her trigger list — and then asked if she had to do the rest. What Celin said, and why, is one of the most honest things we've put in an episode about what it actually means to be done.
In this episode, you'll learn:
Why OCD was only separated from the anxiety disorders in DSM-5 (2013) — and what that tells us about how much they overlap The anxiety disorders most commonly confused with OCD: GAD, health anxiety, specific phobia, and social phobia Why untreated or poorly treated anxiety disorders can morph into OCD over time — and what to watch for Why subclinical OCD is showing up more often — and why that's worth treating early The key diagnostic features that separate OCD from GAD in practice How scrupulosity OCD gets missed as social phobia — and why it matters Why you don't need to know the answer straight away — and how to take your client through the process What discharge from OCD treatment actually looks like — and who gets to decide
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More from Breaking the Rules: A Clinician's Guide to Treating OCD
This one's for the parents. In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller tackle one of the most common questions they hear from families - I think my child might have OCD. Where do I even start?
ERP is the gold standard for OCD. But what happens when it's not enough on its own? In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller explore one of the most important — and least talked about — questions in OCD treatment: when and how to bring in other therapeutic modalities, and how to do it without abandoning the principles that make ERP work. Tori shares what traditional manualized ERP actually looked like in the early days of her career — rate your SUDS, watch the clock, wait for the anxiety to come down — and how the field has shifted since the inhibitory learning model changed the way we think about exposure. Celin reflects on her experience of always working in an integrated way, and why the principles of ACT have always felt like ERP to her — because they are. They also get honest about the moments when ERP becomes a battle. When the exposure menu turns into a war. When a client has every reason in the world not to engage — and what to do instead. Whether you're a clinician looking to expand your toolkit or someone living with OCD who's wondered why their therapist keeps talking about values and mindfulness - this episode will change how you think about what treatment can look like.
Four years in, and we're going back to basics. In this episode of Breaking the Rules, Celin and Tori walk through the full OCD assessment process from the ground up - because with new listeners joining and so much focus on treatment in recent episodes, it felt like the right time to start at the beginning.
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