Obsessive-compulsive disorder (OCD) and phobias possess some surface-level similarities, both in terms of how they present and in their treatment. Both OCD and phobias feature strong fears that provoke a significant amount of distress and anxiety, and both feature behaviors that are designed to reduce this distress. Additionally, both OCD and phobias benefit from forms of exposure therapy.
What is OCD?
OCD is a disorder that features a pairing of obsessions with compulsions. Obsessions are experienced as unwanted, intrusive, deeply distressing thoughts. Compulsions are ritualistic, patterned behaviors that an individual feels they must carry out to cope with the intense anxiety that these obsessions generate.
Crucially, obsessive thoughts in OCD are often ego-dystonic, meaning they appear disconnected from one’s reality and run contrary to internalized values, beliefs, and desires. (For example, one might worry they will harm someone, a characteristic theme in harm OCD, even as they have no intention or desire to act on this thought.) For more information on common OCD themes and compulsions, check out my blog.
What is a Phobia?
A phobia, on the other hand, is experienced as a specific fear that causes a great deal of psychological/social/occupational impairment. While people with OCD experience significant distress from thoughts that they aim to neutralize with compulsive behaviors, people with phobias avoid external, fearful stimuli that have the potential to trigger intense anxiety.
Phobias may also feature safety behaviors, which look similar to compulsions, but are designed to deal with an external threat, rather than an internal thought. (For example, carrying bug spray in public to deal with a feared insect.) Phobias are often ego-syntonic, meaning they’re congruent with one’s reality or experiences, as opposed to intrusive or unwanted. (For example, experiencing intense anxiety or panic while looking at a picture of a spider that once caused a bite.)
Some Helpful Examples
One of the most noticeable differences between OCD and phobias lies in how people respond to their fears or obsessions.
For example, consider the following case studies:
Case Study ‘A’
Client A presents with a significant fear of vomiting, which appears to be linked to a previous episode in which they became physically ill and vomited repeatedly. The client spends a considerable amount of time worrying that they will become sick, and as a result, avoids certain foods, smells, and places that trigger their fear. This avoidance behavior has led to some restricted eating patterns when it comes to certain foods, and significant anxiety when exposed to certain triggers.
Case Study ‘B’
Client B also presents with a significant fear of vomiting. To cope, this client spends considerable time seeking reassurance from friends and family to ensure a food is safe to eat, conducting repeated bodily check-ins to ensure no physical symptoms or nausea are present, and spends hours analyzing past meals to ensure no food was consumed that could have been unsafe to eat.
Evaluating the Differences
Client A presents with a significant fear that is causing impairment in several domains, and their primary response to the fear is to avoid external, triggering stimuli. (The client avoids certain foods, smells, and places that trigger their fear/anxiety.)
Client B also presents with a similar fear/obsession causing impairment; however, their response is different: the client engages in compulsive behaviors such as reassurance-seeking (from family and friends), constant checking (of their internal physical state), and rumination (by scrupulously analyzing past meals), the latter of which can be considered a type of mental compulsion.
While both clinical presentations are similar, Client A most directly reflects the diagnostic criteria of a phobia, while Client B exhibits compulsive behaviors more aligned with OCD.
Why the Difference Matters
While the differences are nuanced, they’re also quite meaningful, as identifying compulsive behaviors is essential, not just for accurate diagnosis, but for the most effective, targeted treatment.
For OCD, Exposure Response Prevention (ERP) is a gold standard therapy that involves gradually exposing a person to uncertainty and discomfort while preventing their ordinary compulsive behaviors. In OCD treatment, preventing compulsive behaviors is critical, as these behaviors ultimately reinforce the disorder.
By contrast, people with phobias benefit from a more general form of exposure therapy, where a person gradually, in a safe and client-directed way, confronts their fears so that they can overcome them.
Without proper diagnosis and attention to behaviors, treatment may be ineffective.
Note: If you struggle with unwanted, intrusive, or fearful thoughts, consider reaching out to a licensed professional for assessment and treatment. The content of this article is not intended to be a replacement for accurate diagnosis or mental health treatment. Support, however, is available!
This blog contains the views of Alex Thomson and is intended as educational content. It is not a replacement for therapy or formalized diagnostic assessment. Read full Disclaimer.
Alex Thomson is a licensed associate professional counselor in the state of Georgia and a certified trauma professional. He provides counseling services through Exhale Counseling Services in Acworth.
