Obsessive-Compulsive Disorder and Eating Disorders: Understanding the Intersection
By Rebecca Jaspan, MPH, RD, CDN, CDCES
When you have an eating disorder, it is not unusual for you to also struggle with other mental health issues. These may include depression, generalized anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.1 Studies show that about two-thirds of individuals with eating disorders also have a co-occurring anxiety disorder. Studies also show that those diagnosed with anorexia nervosa or bulimia nervosa are anywhere from 11 to 69% more likely to develop OCD. It is believed that eating disorders and OCD share traits that contribute to their development and account for the high rate of comorbidity.2
As its name implies, those who have obsessive-compulsive disorder struggle with either obsession, compulsions, or more commonly both. Obsessions are recurrent and frequent thoughts and impulses that intrude on your daily life and often cause distress and anxiety.3 An individual usually attempts to ignore, suppress, or stop the thoughts by doing another action or thought, which becomes the compulsion. Compulsions are repetitive behaviors or mental acts that are performed in response to an obsession.4 Common compulsions are hand washing, repeated checking, counting, or repeating words.
People with eating disorders can present with many similar symptoms that are characteristically similar to the symptoms of OCD. Specifically, people with eating disorders may experience repetitive thoughts about food and body engage and engage in ritualistic behaviors that may cause distress if they do not engage in the behavior. Common ritualistic behaviors in eating disorders include body checking, weighing frequently, avoiding foods associated with fear of weight gain, and engaging in rituals around food intake, such as cutting food into tiny pieces or eating foods in a certain order.
The important distinction between OCD and eating disorders lies in the relationship that the individual has with their thoughts and actions. A person with OCD finds their obsessions and compulsions in conflict or aversive to their identity and values. In an eating disorder, the person typically feels aligned with their thoughts and behaviors. Individuals with OCD are typically highly interested in stopping their obsessions and compulsions, where someone with an eating disorder may feel more tied to these thoughts and behaviors and have more trouble uncoupling them from their identity. Losing these thoughts and behaviors may feel extremely distressing and like a part of their identity is being taken away. This distinction is imperative as it drives the difference in the treatment process.
Because both eating disorders and OCD share some overlapping diagnostic characteristics, treatment for both in the form of exposure therapy is helpful. Exposure therapy involves exposing the client to the feared stimulus, for example, a food that is feared, having dirty hands, or not getting on the scale, in order to help them gradually build a tolerance to their fear and develop a new association. In eating disorder treatment, the client is mainly exposed to food or stressful situations surrounding food. In OCD treatment, the client would not only be exposed to food, but also would be coached through refraining from any rituals around food in which they may compulsively engage.
Additionally, cognitive treatment varies across the disorders. Individuals with OCD recognize that their obsessions are irrational, but have difficulty coping with these thoughts. Conversely, individuals with eating disorders tend to struggle to see the distortions in their thinking. Cognitive behavioral therapy (CBT), which includes identifying and challenging cognitive distortions, is commonly used in the treatment of eating disorders. Acceptance and commitment therapy (ACT), which focuses more on changing the person’s relationship to their thoughts and feelings, is more appropriate for a person who struggles with OCD. It is important to note that both types of therapy can be used in either disorder as well.
Working together, the therapist, dietitian, and psychiatrist on the treatment team can identify the overlap of these disorders and help the client recognize their behavior patterns. Identifying the similarities, differences, and interventions is an important aspect of treatment for both disorders.
References:
- Anxiety and Depression Association of America. Anxiety, depression & obsessive compulsive disorder.
- Neziroglu F. International OCD Foundation. The relationship between eating disorders and OCD part of the spectrum.
- Anxiety and Depression Association of America. Obsessive-compulsive disorder (OCD).
- American Psychiatric Association. What is obsessive-compulsive disorder?.
