One of the most commonly heard questions on internet anxiety-support forums is some variation of: “Is this Generalized Anxiety or Panic Disorder?” Much discussion revolves around the diagnoses and their symptoms, yet the most important thing you will ever learn about your diagnosis is this: it’s largely irrelevant. Aside from the insurance companies and the FDA’s medication standards, your diagnosis has little bearing on your recovery.

The anxiety disorders fall on a spectrum and there is rarely an individual who shows signs of one without showing signs of another. Many people ultimately diagnosed with Generalized Anxiety Disorder (GAD) typically show signs of Obsessive-Compulsive Disorder (OCD). For example, many GADers experience chronic, nagging fears about their health (mental or physical); this is sometimes referred to as hypochondriasis or “health anxiety.” You may not realize it, but your constant thinking and analyzing of physical or mental symptoms is actually a ritual. So is your constant need for reassurance. If you find new symptoms and then rigorously search for relief from Dr. Google, then you’re performing a ritual. We often know this ritual won’t help much, but we can’t help it, we just have to know about the disease we fear so much.

When people think of OCD, they usually think of the Hollywood version: a quirky guy or gal who repeatedly locks his door or who obsessively avoids stepping on cracks in the sidewalk. While this image is true for a lot of OCD sufferers, the vast majority of individuals with OCD do not perform rituals of this type. In fact, according to Dr. Jonathan Grayson and Dr. Lee Baer (and others), most people with OCD do not use any form of “obvious” ritualizing. This is sometimes referred to as “Pure-O” OCD, meaning “pure obsession.” Mental rituals are also common in people with GAD. Analyzing oneself in circles to the point of exhaustion is quite obviously a ritual in which the individual hopes to find relief by thinking about the problem, as if it could be somehow solved through rigorous analysis. (You’re not going to prevent death or illness by thinking about it, I promise you.)

In his book Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty, Dr. Grayson notes that individuals with anxiety disorders are almost always obsessive about their fears and they perform rituals without ever recognizing that they’re doing so. There’s a thin line between “coping technique” and “ritual.” Unfortunately, doctors are reluctant to make an OCD diagnosis unless the rituals are bizarre. According to some doctors, if you search the internet for comfort, that’s GAD; but if you spin in circles, that’s OCD.

One of the largest problems facing people with anxiety disorders is this concern with diagnosis. Far too much emphasis is placed on diagnosis and too little is placed upon the common factors that unify all anxiety disorders. Many people don’t realize that fear is fear, despite whether it’s called “GAD,” “OCD,” or “happy monkeys.” In most cases, the course of treatment is the same for all anxiety disorders (including simple phobias): exposure, deconditioning, medication, therapy, stress reduction, maintaining a healthy lifestyle.

This isn’t to say that there are no differences between the disorders, but these differences are not clear-cut and relate almost exclusively to the source of the fear. For those with GAD or OCD, the source of fear may be anything that causes unrelenting anxiety, such as health worries, or worries about children or family-members. For Social Anxiety Disorder (SAD), the source of fear is limited to social situations or public speaking, although most people with anxiety disorders fear public places and public speaking. For PD, the fear revolves around panic attacks themselves, although almost everyone with an anxiety disorder experiences panic attacks regularly; and people with PD usually develop obsessive fears of panic attacks that leads to all sorts of behaviors. If you think about all of the “althoughs” that we could place into this paragraph, you’d soon realize that the disorders are more alike than they are different. Their common denominator: extreme, unremitting fear.

Another difference that is of a bit more significance is how one deals with the anxiety. A GADer and OCDer will respond similarly with some sort of ritual behavior that alleviates anxiety. For PDers, SADers, and PTSDers, the primary response is usually one of avoidance. But here again, GADers and OCDers also use a lot of avoidance behaviors to cope. Finally, there is one major difference that must be considered. Biology plays an undetermined role in all anxiety disorders, but research has shown that severe OCD may be more “biological” than was previously thought.

I have long wished that anxiety support groups (including internet groups) would stop separating individuals by diagnosis. This segregation by diagnosis is counterproductive and causes confusion. There are a few exceptions to this, as there always are exceptions, but by-and-large, all people living with chronic anxiety can learn from one another despite the source of the fear. And the most under-recognized and under-diagnosed of the anxiety disorders, OCD, is probably the one that we could learn the most from.

So leave the diagnosing to the doctors, the insurance companies, the FDA, and to academia. You should be focusing on recovery. If that means “crossing over” into the foreign territory of another disorder, do it. You might find that territory to be more familiar than you expected.

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