Obsessive Compulsive Disorder (OCD)

Does OCD Always Come with Anxiety?

Is OCD always associated with anxiety? I’m a practicing psychiatrist and I recently evaluated a 10-year-old boy. His behavior doesn’t suggest anxiety, but he’s showing all the other symptoms of OCD.

Since OCD is inherently an anxiety disorder, we wouldn’t typically see it without anxiety. That particular patient may be on the autistic spectrum. Many people with Asperger’s, for example, present symptoms that can appear obsessive-compulsive: they’re very ritualistic and repeat actions without any obvious purpose, but these actions don’t cause the individual any anxiety.

Alternatively, he may have a diagnosis of Obsessive-Compulsive Personality Disorder, or OCPD. The outward signs of OCPD can look like OCD — the individual is very perfectionistic, very ritualistic, and has very precise ways in which they “have to” do things. However, since OCPD is a personality disorder, not an anxiety disorder, it isn’t egodystonic — meaning it doesn’t cause the patient any distress. Someone with OCD will recognize that their behaviors are irrational, and in most cases will wish for them to go away. Someone with OCPD thinks these behaviors are rational, desirable, and an essential part of their personality. When other people confront them about the behaviors, they’ll assume the other person is being unreasonable.

OCD causes distress to the individual. OCPD, in most cases, causes more distress to people around the individual, as they try to navigate around the individual’s strict rules and rituals.