OCD symptoms can be so intense and consuming that other conditions occurring alongside it get missed during diagnosis. Anxiety or depression sitting alongside OCD can be overlooked entirely, both by clinicians and even by the person living with it.
But this works the other way too. Anxiety, for example, shares enough features with OCD that it sometimes gets identified and treated first, leaving the OCD unrecognized.
The point is that OCD is commonly comorbid with other mental health conditions, and understanding how common this link is can help you get the right treatment. To help with this understanding, this page will cover:
Obsessive-compulsive disorder (OCD) is a mental health condition that comprises two different parts that feed into each other, known as obsessions and compulsions:
OCD has different presentations depending on what the obsessions focus on. Research finds that OCD symptoms in general have four main themes:[1]
Regardless of the theme, the underlying mechanism is the same: an obsession creates distress, the compulsion temporarily relieves it, and the cycle continues.
A comorbidity is when a person experiences more than one physical or mental health condition at the same time. In terms of OCD, it means that the person experiences another mental health condition alongside OCD.
Comorbid OCD is actually a lot more common than most people expect, with some research showing that 90% of people with OCD also meet the criteria for at least one other psychiatric condition.[2]
These pairings can take many different forms, and there doesn’t seem to be a limit on which ones can co-occur. Conditions can also interact, sometimes exacerbating both sets of symptoms.
For example, a person with obsessive-compulsive disorder may develop depression because of how tough living with OCD can be. Someone with both OCD and anxiety can also be stuck in a spot where both conditions feed into each other and make both the OCD and the anxiety worse.
What all this shows is that if you’ve been diagnosed with OCD, or you suspect you have it, there may be a strong chance that something else is present alongside it. Recognizing this is the first step toward getting the correct treatment.
This is a complex question, especially as there isn’t a blanket answer that’s applicable to everyone. However, the research does point toward a few explanations that overlap and build on each other.
Research on OCD and anxiety has found that the two share a common genetic and neurobiological background. This means there are traits like a tendency toward negative emotion or difficulty tolerating uncertainty that appear in both.[3]
Studies of twins show a shared genetic foundation, which helps to explain why anxiety, specifically, is so consistently found in those with OCD.
As anyone living with OCD will know firsthand, OCD is exhausting to live with. The constant intrusive thoughts and the rituals that follow can wear a person down, and that wear and tear can potentially open the door to other problems.
Depression is a clear example, as spending hours each day managing exhausting OCD symptoms can affect your mood and sense of hope.[4] It also becomes harder to maintain the ordinary things like relationships and routines that support mental health.
Many conditions that co-occur with obsessive-compulsive disorder share some of the same features. For example, repetitive thinking and perfectionism are notable across several disorders. In the next section, we explore these overlapping features in more depth.
OCD has high comorbidity rates across a wide range of conditions, some with more evidence behind them than others. The five below are among the most commonly seen. Each interacts with OCD in its own way, sometimes intensifying symptoms, sometimes complicating treatment.
Depression is the most common single comorbidity in OCD. Research found that between 41% and 70% of people with OCD also met the criteria for major depressive disorder.[5] That’s a wide range, but even the lower end is a significant proportion.
This raises the question of which came first. Was the depression already there before OCD, or was it the other way round? The link is generally understood as depression being secondary to the distress of OCD. As explained above, when intrusive thoughts and rituals take over hours of the day, exhaustion, both mentally and physically, can pull a person’s mood down into a depressive episode.[4]
Anxiety disorders are another common pairing with OCD, with research finding that 33.5% of people with OCD also had generalized anxiety disorder.[6]Â
Results also showed that for those with OCD and comorbid generalized anxiety disorder (GAD), there was an increased number of participants who showed:[6]Â
In other words, having both OCD and GAD tends to come with a more complex clinical picture than having either condition alone.
Both conditions involve chronic worry and difficulty tolerating uncertainty, which makes it easy to see how the two feed into each other. Anxiety can drive the obsessive thinking, and the obsessions push anxiety back up.
Body dysmorphic disorder (BDD) is the preoccupation with perceived flaws in appearance, usually paired with repetitive behaviors like mirror checking. Research finds that around 10% of people with a primary OCD diagnosis also meet the criteria for BDD.[5]
BDD and OCD share obsessive-compulsive features, which is why the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) places them both in the same category. Both involve intrusive thoughts that drive repetitive behaviors with the aim of finding relief from their distress.
The main difference is that BDD is centered specifically on appearance. A person with BDD isn’t worried about contamination or harm, but that something is wrong with the way they look. No amount of reassurance or checking can resolve those worries.
A meta-analysis found that neurodevelopmental conditions, like attention-deficit hyperactivity disorder (ADHD), are one of the more common comorbidity groups in OCD, especially in those whose OCD started early in life.[7]
Living with both conditions can be incredibly tough as the two are in a constant battle with each other. For example, OCD pulls toward rigid and repetitive routines, while ADHD makes focus and follow-through harder. This daily battle can make life difficult to manage.
The same research also shows the clear overlap between autism and OCD.[7] For example, repetitive behaviors and preferences for certain routines are commonly seen in both conditions. This can make it difficult to understand if a particular behavior is being influenced by autism or OCD. The distinction matters for treatment because the same behavior might need a very different response depending on its source.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
OCD is already a complex disorder, and when it’s paired with another complex condition, the situation becomes even more difficult.
Diagnosis becomes challenging as the symptoms from different conditions can merge together. For example, depression can change how OCD presents, and anxiety symptoms can look similar to the worry that fuels the obsessions. Neurodiverse conditions, such as ADHD, can influence OCD in ways that look very different from textbook descriptions.
This means a thorough assessment from a clinician who knows OCD is vital to make sure nothing important gets missed.
It also means that a more tailored treatment plan needs to be discussed and put into place. Research on comorbid depression found that people with both OCD and depression sometimes improve more slowly than those with OCD alone.[8] It’s important that the treatment plan accounts for both conditions from the start.
A common concern is whether having two conditions means two completely separate treatment paths. In most cases, that isn’t necessary. There’s a lot of common ground when it comes to treatment, so the approaches can fit together well.
For depression and anxiety, talk therapies such as cognitive behavioral therapy (CBT) are well established and usually paired with selective serotonin reuptake inhibitors (SSRIs) whenever necessary.Â
OCD therapy also relies on a form of CBT, known as exposure and response prevention (ERP), and SSRIs, so there’s a natural overlap that makes treating both at once more workable. You’re not starting from scratch for each condition and can build on shared foundations.
BDD is treated with a tailored form of CBT and SSRIs, much like OCD, which makes sense given how closely the two are related.
ADHD treatment usually combines medications with practical strategies and CBT, which is aimed at everyday challenges like focus and organization.
Autism is supported differently, since it isn’t something to be treated or cured. Support here might focus on adapting therapy and surroundings to suit the person and treating any co-occurring conditions with a version of CBT adjusted to fit.
Residential OCD treatment generally suits people with treatment-resistant OCD, whose symptoms haven’t responded to outpatient care, or those whose comorbidities make outpatient treatment difficult.
This type of setting means the focus is entirely on OCD recovery. The person can receive daily psychotherapy, with integrated treatment for any comorbid conditions. This is all delivered by a team that fully understands both OCD and co-occurring conditions. Inpatient OCD treatment also offers help around the clock, meaning there’s support ready and waiting for moments where an extra helping hand can make all the difference.
Research supports residential-level programs at OCD treatment centers well. One study found that for those with severe OCD receiving intensive residential treatment, severity scores dropped by an average of around 30% from admission to discharge.[9]
A separate study found nearly 61% of participants at mental health treatment centers achieved a meaningful and measurable improvement in OCD severity.[10]
A Mission For Michael (AMFM) provides treatment for adults experiencing various conditions. OCD support is a phone call away – call 866-478-4383 to learn about our current treatment options.
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If you’ve recognized obsessive-compulsive disorder in yourself, along with the signs of another condition occurring alongside it, then treating both together is what gives you the best chance at lasting recovery.
At AMFM (A Mission For Michael) Mental Health Treatment, our treatment programs work exactly in this way. Rather than treating OCD in isolation, our expert clinical and psychiatric teams address both at the same time. We aim to manage the symptoms and possible triggers of each condition through evidence-based therapeutic methods like CBT and ERP.Â
Our multidisciplinary treatment team is led by a board-certified psychiatrist present on-site to conduct a comprehensive evaluation and meet with you one-on-one every week so that any medication can be reviewed and adjusted as your treatment progresses. This matters with comorbid conditions because the medication picture can make treatment more complex.Â
AMFM Mental Health Treatment provides the full spectrum of care, including residential and outpatient treatment programs. We offer an intimate, focused mental health treatment experience for adults in home-like settings that are carefully maintained to be peaceful, comfortable spaces.Â
Our locations in California, Minnesota, and Virginia accept insurance and are in-network with most major providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form or call us at 866-478-4383.
Reach out to us if you would like to start the admissions process or learn more about how we can support your mental well-being. Our compassionate team is available 24/7 to answer your questions and provide guidance with no obligation.
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