Breaking the Rules: A Clinician's Guide to Treating OCD

Episode: Navigating the Complexities of Health Anxiety and OCD

Release Date: October 20, 2025
Hosts: Dr Celin Gelgec and Dr Victoria (Tori) Miller

Episode Overview

In this episode, Dr Celin Gelgec and Dr Victoria Miller dive into the intricate overlap between health anxiety (formerly hypochondria) and obsessive-compulsive disorder (OCD). Speaking candidly as clinicians and supervisors, they explore how these conditions intersect, the challenges therapists face in differential diagnosis, and practical approaches to evidence-based treatment. With a blend of clinical insight and personal experience, the hosts normalize the confusion around these diagnoses and offer grounding strategies for effective intervention.

Key Discussion Points & Insights

1. Defining Health Anxiety vs. OCD

• Health Anxiety: Characterized by persistent fears focused on physical health, illness, or bodily functions, often leading to repetitive reassurance-seeking, checking, and avoidance.
  • “Health anxiety, previously known as hypochondria, is really just a fear that is focused on anything health related...” (02:49 - Dr Miller)
• OCD: Defined by intrusive, unwanted thoughts (obsessions) that are inconsistent with personal values, followed by compulsive behaviors (external or internal) to neutralize the distress.
  • “OCD is characterized by obsessions...then followed by a behavior that we do, whether it's internal or external...to alleviate that distress.” (03:21 - Dr Gelgec)

2. The Diagnostic Dilemma

• Health anxiety and OCD have a significant symptomatic overlap—checking, reassurance-seeking, avoidance—making it difficult for clinicians to definitively distinguish between them.
• The hosts debate the importance of precise diagnosis, ultimately agreeing that:
  • “The treatment is almost identical.” (06:17 - Dr Miller)
  • The drive to “get it right” is often more anxiety-provoking for clinicians than necessary, given similar treatment protocols.

3. Subtle Differences in Clinical Presentation

• Health anxiety: Clients are often more easily reassured and may shift focus from one health concern to another, without perseveration.
  • “People with health anxiety are also a bit more able to receive reassurance...then the health anxiety pivots to something else.” (07:04 - Dr Gelgec)
• OCD: Typically features more persistent "what if?" thinking. Reassurance provides only temporary relief, with compulsions growing more elaborate and entrenched over time.

4. Why Health Themes? Existential Roots & Death Anxiety

• Hosts reflect on why health is such a universal theme, citing existential vulnerability and mortality as root drivers.
  • “Ultimately...when we get to a certain point in our lives...we start to feel vulnerable in life...knowing that time is not forever.” (08:36 - Dr Miller)
  • “It comes down to that death anxiety.” (09:02 - Dr Miller)
• Anxiety serves as a defense against more primal feelings of grief and vulnerability:
  • “It's easier to feel anxious than it is to feel sad and vulnerable.” (13:48 - Dr Miller)

5. Impact on Functioning: When Health Anxiety Becomes Clinical

• Functional impairment, not just worry, is key to diagnosis: repeated doctor's visits, excessive money spent on tests, researching, sleep disturbance, and relationship strain.
• Notable behavioral “red flags” include rigid routines for health, inflexibility around food or safety, and significant daily disruption.

6. The “False Security Blanket” of Compulsions

• Compulsions (checking, avoidance, reassurance seeking) offer a false sense of security; the supposed “protection” they bring actually diminishes quality of life.
  • “The thing you're fearful of, which is loss of life, has actually already happened. You might physically be alive, but you're not living. You're just existing.” (27:12 - Dr Miller)

7. Treatment Approaches: What Works?

• Exposure and Response Prevention (ERP): The frontline therapy for both health anxiety and OCD.
• Scripting: Eliciting and writing intrusive thoughts to trigger urges and resist compulsions.
• Delaying or reducing reassurance seeking (with family and health providers).
• Behavioral experiments: Watching medical dramas or reading worst-case scenarios as exposure (e.g., “House,” “ER”).
• Values Work: Reconnecting clients with life goals and meaning outside of compulsions.
• Collaborative care with GPs, especially around medical test referrals.
• Clinicians should acknowledge the anxiety-driven urge to check or avoid and compassionately help clients sit with uncertainty.

Notable Quotes & Memorable Moments

• On the diagnostic overlap:

  “Health anxiety can look almost identical to [OCD]...the reassurance seeking in health anxiety is very common...but they can also be OCD compulsions. So which one is it?” (03:55 - Dr Gelgec)

• On existential roots:

  “It comes down to that. Death anxiety...whether it’s being young and seeing a pet die or a grandparent pass away or a parent...It just cuts deeper.” (09:02, 13:48 – Dr Miller)

• On treatment regardless of label:

  “From a treatment perspective, you’re not losing out and you’re not doing the wrong thing. The treatment is almost identical.” (06:06 – Dr Miller)

• On the ‘preference vs. compulsion’ test:

  “It’s all about flexibility. If there’s flexibility around [health routines] versus rigidity and the impact on daily functioning...that’s when it’s not okay.” (16:35 – Dr Miller)

• On missed life experiences:

  “In attempting to live a longer life, we end up living a less meaningful life.” (27:09 – Dr Gelgec) “You might physically be alive, but you’re not living. You're just existing.” (27:18 – Dr Miller)

• When to actually seek medical advice:

  “If symptoms persist, then you can go [to the doctor]. But if they don’t...” (25:28 – Dr Miller, paraphrasing an old Panadol commercial)

• Clinician anxieties:

  “We want to get it right...give the right diagnosis...but health anxiety and OCD overlap so much that it actually can be really hard to tease apart. And that can generate a lot of anxiety for us as psychologists.” (05:11 – Dr Gelgec)

Timestamps for Key Segments

• [02:13] — Introduction & episode theme
• [02:49 – 03:51] — What is health anxiety? What is OCD?
• [04:06 – 06:18] — Why the diagnosis is tricky and does it matter?
• [06:53 – 07:22] — Subtle distinctions in reassurance-seeking
• [08:14 – 10:54] — Why health? The existential and mortality roots
• [15:14 – 17:36] — Real-life functional impacts: rigid routines, relationships, and daily life
• [18:12 – 20:32] — Do health anxiety and OCD always overlap? Themes, comorbidities, and complexity
• [20:32 – 22:41] — Core treatment strategies and working with GPs
• [22:42 – 24:33] — Exposure ideas: TV, scripting, delaying reassurance
• [25:06 – 26:05] — Facing the “what if” dilemma: when to seek actual medical care
• [26:22 – 27:43] — Integrating values and meaning into treatment
• [27:09 – 27:43] — The paradox: lost life experiences due to compulsive safety seeking

Final Thoughts

Dr Gelgec and Dr Miller candidly validate the clinician’s frustration and uncertainty around distinguishing health anxiety from OCD, citing that treatment ultimately focuses on the same core processes: exposure, response prevention, distress tolerance, and reclaiming life from the grip of compulsions. Their discussion highlights the universal human drive to control the uncontrollable—health and mortality—and how easy it is for that drive to become rigid, limiting, and ultimately self-defeating.

“The thing you're fearful of...has actually already happened. You might physically be alive, but you're not living. You're just existing.” (27:12 – Dr Miller)

By encouraging clinicians and clients alike to return to values and embrace uncertainty, this episode offers reassurance, strategy, and hope.