When OCD and Panic Disorder Occur Together: What You Need to Know
TL; DR
Obsessive-compulsive disorder (OCD) frequently co-occurs with panic disorder, affecting about 15% of those with OCD. Panic disorder is characterized by panic attacks and a persistent fear of future attacks, leading to avoidance behaviors. It's important to distinguish between panic attacks and high anxiety episodes related to OCD, as they differ in onset, duration, and behaviors.
OCD can trigger panic attacks, complicating treatment. Fortunately, both conditions are effectively treated with exposure therapy, which helps individuals confront anxiety rather than avoid it. This therapy may include interoceptive exposures for panic disorder and exposure and response prevention (ERP) for OCD.
Treatment for OCD and panic disorder together is available, using structured, evidence-based approaches like those implemented at Leap Counseling. Reclaiming your life from these conditions is possible!
Do OCD and Panic Disorder Commonly Occur Together?
Obsessive-compulsive disorder (OCD) often does not occur in a vacuum; There are other disorders that can be present at the same time as OCD. One common co-occurring disorder is panic disorder. It is estimated that about 15% of people with OCD also experience panic disorder. If you have OCD and experience panic attacks or panic disorder, you are not alone.
What is Panic Disorder?
Panic disorder is a mental disorder characterized by panic attacks and ongoing concern about having another panic attack, usually leading to a lot of avoidance. Panic attacks can arise when calm or when feeling anxious, and they build to a peak within just a few minutes. To be diagnosed as a panic attack, there must be at least four of a list of symptoms that include physical symptoms of fear, as well as fear of dying and fear of going “crazy” or losing control.
People can have panic attacks in the context of another disorder, but panic disorder is diagnosed if there is a persistent concern of having another panic attack and significant avoidance. Panic disorder is often described as “fear of fear” because the core fear is of the symptoms of anxiety themselves, and what they might mean. For example, some people with panic disorder fear that an increased heart rate means they are having a heart attack.
Is it OCD or Panic Disorder?
The term “panic attack” is often used incorrectly by the general public! Often, folks will say they had a panic attack when they were experiencing a period of very high anxiety, but high anxiety does not necessarily mean it was a panic attack. The distinction is not meant to invalidate how severe a person’s anxiety is or was. Instead, it is important to understand the type of anxiety the person was experiencing so that proper diagnosis and treatment can be provided.
Folks with OCD can experience episodes of very high anxiety, caught up in compulsions that keep them hurtling down into an OCD spiral. In these moments, it is common for there to be multiple symptoms of anxiety, such as a rapid heart rate or feeling lightheaded. For some, the spirals can last all day or even seem to last multiple days. For others, it might last one evening, for a few hours, and go back to baseline symptoms of OCD. These spirals are different from panic attacks for a few reasons:
How long does it build?
In a panic attack, symptoms peak within minutes. They are experienced as an abrupt surge of fear and can even start when a person is calm. When they start when a person is already anxious, the panic attack still rises from that baseline level of anxiety and peaks at an intense level of fear very quickly. When a person experiences an OCD spiral, it can come on relatively quickly, but it usually doesn’t go from 0 to 100 as fast as a panic attack. OCD spirals can also build for hours before they get at their worst.
How long does it last?
Typically, panic attacks last from 5 to 20 minutes. They can last longer in rare cases, but most panic attacks are relatively short. This is, in part, because our bodies cannot keep up that extreme level of fear for very long. OCD episodes can last all day, often with fluctuations in the level of anxiety throughout the day. However, panic attacks cannot last that long, although a person can have multiple distinct panic attacks in a single day.
Behaviors
There are differences in the type of safety-seeking behaviors that are performed due to OCD vs panic disorder. For panic disorder, safety behaviors are much less widely varied and are primarily focused on preventing another panic attack from occurring. These may include carrying around “safety signals” (i.e., items or people that make a person feel safe) such as PRN medication, a water bottle, or a phone; avoiding places they previously had a panic attack; avoiding experiencing physical sensations (e.g., by avoiding exercising); and checking one’s heart rate repeatedly. When a person is experiencing a panic attack, typical behaviors include going to an ER, escaping the situation (e.g., leaving the room), or calling a loved one.
For people with OCD, safety signals are less common. However, any behavior can become a compulsion in OCD. During an OCD spiral, folks are typically doing the same compulsions they are doing when not in a severe spiral. However, they are likely doing them more quickly/frequently, repeating them more, or doing more intense versions of their compulsions during an intense episode.
OCD Can Trigger Panic Attacks
Just to complicate things further, OCD symptoms can also trigger panic attacks, especially for people who have both panic disorder and OCD. Through treatment with an experienced OCD therapist, clients can begin to identify specific triggers for panic attacks. Usually, the trigger is some physiological symptom associated with anxiety/fear, such as an increased heart rate. Since OCD often involves anxiety, symptoms of OCD can then trigger panic attacks, like falling dominoes.
George has relationship OCD. When his mom asked him when he and his partner were going to get engaged, he became anxious and started feeling a little lightheaded as he tried to push his intrusive thoughts away. Without consciously noticing the lightheadedness and thinking “what if I faint and humiliate myself,” his mind immediately interpreted the lightheadedness as dangerous. Suddenly, George was sweating, feeling hot, lightheaded, and his heart was pounding as his fear shot up, and he experienced a panic attack.
How Are OCD and Panic Disorder Treated Together?
Here’s the good news: The treatment for OCD and for panic disorder is essentially the same. Both are very effectively treated with exposure therapy. The goal of exposure therapy is to change a person’s relationship to anxiety. As humans, our typical response to anxiety is to try to find safety and avoid feeling that way again. The function of anxiety is to protect us! But when it gets out of whack in OCD and anxiety disorders, we need to find a different way to relate to it. Instead of avoiding anxiety, exposure therapy teaches folks to approach anxiety. In doing so, folks are able to learn new information (e.g., that you won’t die if you don’t go to the ER during a panic attack), and anxiety tends to decrease in the long run.
One difference is the type of exposures that might be done. For panic disorder, it is important to introduce a type of exposure called “interoceptive exposures.” Interoceptives involve intentionally inducing certain physical sensations, such as increased heart rate, feeling short of breath, chest pressure, and even derealization/depersonalization. These exposures work by getting the person used to experiencing those feelings without avoiding them. This way, they are less threatening when they are experienced naturally in one’s life.
ERP Considerations
Exposure and response prevention (ERP) for OCD also involves identifying triggers and intentionally exposing oneself to those triggers, without any safety behaviors. It is important to note that resisting compulsions in the course of ERP can increase one’s anxiety in the short-term. Since physical symptoms of anxiety are the main triggers for panic attacks, doing an OCD-related exposure and resisting compulsions can trigger a panic attack. While there’s nothing dangerous about panic attacks, every OCD exposure can become a double exposure - exposure to the OCD trigger and to a panic trigger.
For some clients, this can lead to lower willingness to engage in exposure work, especially if they are not prepared for dual exposure. Thus, when both OCD and panic disorder are at the forefront, I sometimes recommend starting with interoceptive exposures first, then adding OCD-related exposures as treatment progresses. This is consistent with recommendations to combine exposure triggers only after first completing exposures for each trigger separately.
Final Thoughts From an OCD Therapist in Wauwatosa, Wisconsin
When OCD and panic disorder overlap, anxiety can feel constant and confusing. Intrusive thoughts trigger physical fear. Physical fear triggers panic. It can start to feel like both your mind and body are working against you. Help is available, and the treatment for both problems is exposure therapy. Both conditions are highly treatable.
Exposure-based therapy with Leap Counseling can help you change your relationship to anxiety rather than trying to eliminate it. Whether treatment starts with interoceptive exposures, ERP for OCD, or a combination depends on which fear is most disruptive. Panic sensations are not dangerous. Intrusive thoughts are not dangerous. And with structured, evidence-based treatment, it is absolutely possible to step out of the cycle and reclaim your life.
Work Through Triggers With Support Through OCD Treatment in Wauwatosa
Dealing with OCD and panic disorder at the same time can feel like fighting on two fronts, but with the right support, it doesn't have to stay that way. OCD therapy that addresses both conditions together can help you untangle the cycle, reduce the grip of fear, and start building a life that isn't ruled by anxiety.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in OCD and anxiety disorders, including panic disorder. Dr. Wood offers personalized, evidence-based care designed to help clients understand what's driving their anxiety and develop real, lasting strategies to face it. Taking that first step is easier than you might think:
Reach out to schedule a free 15-minute consultation
Work one-on-one with an experienced OCD therapist in Wauwatosa
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Other Online Services LEAP Counseling Offers in Wauwatosa, WI, and Beyond
When OCD and panic disorder show up together, therapy can show you how to manage symptoms while learning to trust yourself again in the moments that feel most overwhelming. With consistent, targeted support, many people find they're able to move through fear rather than around it, and reclaim parts of their life they thought anxiety had taken for good.
OCD and panic disorder aren’t the only challenges I work with at my Wisconsin-based online therapy practice. Anxiety has a way of showing up in many different forms, and you may be dealing with more than one. In addition to OCD treatment, I offer therapy for a range of anxiety disorders, including Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Phobias. As a licensed psychologist in Wisconsin and all PSYPACT states, I'm able to work with clients across many locations online.
No matter how long anxiety has been part of your story, it doesn't have to define what comes next. Browse my mental health blog for more insight into OCD, panic, and anxiety treatment, and when you're ready to get started, reach out to schedule an appointment.
About the Author
Dr. Johanna Wood earned her PhD in Clinical Psychology from Northern Illinois University and completed her doctoral internship at Rogers Behavioral Health in the OCD and Anxiety Adult Residential Program, where she also went on to supervise clinical staff. That immersive training in some of the most complex OCD and anxiety cases laid the foundation for the focused, evidence-based practice she runs today. But Dr. Wood's understanding of OCD and anxiety doesn't stop at her credentials. She has lived experience with intrusive thoughts and the anxiety spiral of relationship OCD, and knows what it's like when fear and doubt feel impossible to escape.
Her own ERP treatment taught her to face triggers head-on rather than avoid them, a "leap of faith" she now helps her clients take as well. That combination of clinical depth and personal insight is especially relevant when OCD and conditions like Panic Disorder overlap, as she understands both the professional and human sides of navigating compounding anxiety. Dr. Wood is a Wisconsin-based clinical psychologist licensed in Wisconsin and authorized in all PSYPACT states. She is an active member of the International OCD Foundation and contributes to national education efforts on scrupulosity OCD, bringing the full weight of her training and lived experience to her ERP-based OCD therapy practice.
