OCD and eating disorders are mental health disorders that usually develop during adolescence or young adulthood. While they are distinct conditions with different pathologies, they share many characteristics. Co-occurring OCD and eating disorders are also common: many young people with eating disorders also live with OCD, and vice versa.
Co-occurring disorders can make daily life very difficult and complicate treatment processes. But with the right support, young people can recover from both OCD and eating disorders.
Understanding Obsessive Compulsive Disorder and Eating Disorders
Obsessive-compulsive disorders and eating disorders are different types of mental health disorders. Both types of disorder are serious mental health conditions that have a pervasive impact on a person’s daily life.
- Obsessive-compulsive disorder is characterised by patterns of distressing intrusive thoughts, emotions or images (obsessions) and behaviours or rituals that provide short-term relief from obsessions (compulsions). OCD can be connected to anxiety, shame and other kinds of psychological distress.
- Eating disorders are a type of mental health disorder characterised by difficult relationships with food, body shape, and weight. But eating disorders are usually underpinned by deeper emotional and social issues, such as interpersonal problems, low self-esteem or intense emotions.
What Are the Similarities Between OCD and Eating Disorders?
OCD and eating disorders share many similarities, both in the symptoms of the disorders and the personality traits that underpin them. Some of these similarities include:
Intrusive and Persistent Thoughts
Both obsessive-compulsive disorder and eating disorders involve intrusive or persistent thoughts about a specific topic. With OCD, these thoughts might centre around symmetry, contagion, or causing harm. Young people with eating disorders may be preoccupied with thoughts about their body shape or weight, or when and what they will eat.
Harmful and Repeated Behaviours
OCD and eating disorders both involve repeated behaviours that cause long-term harm. People with OCD engage in compulsions to find temporary relief from distressing obsessions, but their obsessions always return. Young people with eating disorders persistently engage in disordered eating behaviours, such as restricted eating, binge eating, or purging, in response to different forms of psychological distress, despite the long-term impact of these behaviours on their mental and physical health.
Impulsivity
Young people with both OCD and binge-purging eating disorders, such as bulimia nervosa or binge-eating disorder, often have higher levels of impulsivity than other people. Impulsivity may be connected to patterns of compulsions that characterise OCD, making it more likely that a person will engage in compulsions instead of choosing to avoid them. People with OCD often experience a sense of “urgency” to perform compulsive rituals, which is an important dimension of impulsivity.
Impulsivity may also underpin some of the mechanisms of bingeing and purging cycles. Young people who are more impulsive may be more likely to engage in these behaviours when they experience emotional distress, even with the knowledge that such behaviours are harmful.
Perfectionism
Perfectionism is another core personality trait of both eating disorders and OCD. Research suggests that perfectionism may be a risk factor and a maintaining factor for obsessive-compulsive disorder that often precedes the onset of the disorder. Obsessions related to tidiness, symmetry and order reflect a need for ‘perfection’ in the surrounding world, while obsessions related to forbidden thoughts and the fear of causing harm may be underpinned by high standards for oneself.
Perfectionism has also been clearly linked to eating disorders, particularly anorexia nervosa. Maladaptive thinking patterns that drive disordered eating behaviours, such as a preoccupation with an ‘ideal’ body shape or weight and body dissatisfaction, may be intensified by perfectionist traits.
Within the broader trait of perfectionism, certain dimensions may have a stronger connection to eating disorders and OCD. For example, different studies have found that “concern over mistakes” is associated with anorexia nervosa, bulimia nervosa and OCD.
Cognitive Flexibility
Cognitive flexibility refers to our ability to switch between different thoughts and cognitive tasks and change our thinking and behaviour to adapt to new circumstances. Research suggests that people with OCD tend to have poorer cognitive flexibility, and studies have found that people with anorexia often have difficulties moving between cognitive tasks (set-shifting).
A lack of cognitive flexibility may make it more difficult for individuals to tolerate intrusive thoughts, making it more likely that they will engage in cycles of obsessions and compulsions. Similarly, difficulties with set-shifting can cause thoughts about food, body shape and weight to take over a person’s inner world.
Understanding Co-Occurring Obsessive-Compulsive Disorder and Eating Disorders
OCD and eating disorders not only share certain similarities, but they also often occur alongside each other. Co-occurring eating disorders and OCD are common among young people and adults, and can complicate both the course of each disorder and the recovery process.
How Common is Co-Occurring OCD and Eating Disorders in Children and Adolescents?
Data suggest that one in three to one in four young people with eating disorders may also meet the criteria for an OCD diagnosis. A study among children with eating disorders between the ages of nine and ten found that 28.8% also had OCD. Another study among children and adolescents with eating disorders found that 20.2% had co-occurring OCD.
Why Do OCD and Eating Disorders Co-Occur?
There are different explanations for why certain disorders often co-occur. Sometimes, two disorders can share underlying mechanisms or be caused by common traits or experiences. This might include childhood trauma, low self-esteem or rigid thinking patterns. Individuals who have these traits are more vulnerable to developing both disorders.
In other cases, one mental health disorder may be a risk factor for another. When this happens, the onset of one disorder is typically earlier than the other.
Most research suggests that OCD usually begins before anorexia nervosa, and often continues even after recovery. However, OCD and eating disorders can also develop at the same time, and, occasionally, OCD can develop after an eating disorder.
Researchers think that both OCD and eating disorders share common risk factors, such as traits of perfectionism and impulsivity that underpin both disorders. For example, a person with perfectionist traits is at a greater risk of developing both OCD and eating disorders. It’s also possible that OCD itself is a specific risk factor for eating disorders.
What Are the Shared Risk Factors of OCD and Eating Disorders?
Some of the most important shared risk factors for OCD and eating disorders are the personality traits associated with both conditions, including perfectionist and impulsive traits. Other shared vulnerabilities may include:
- Childhood trauma or early life adversity
- Experiences of bullying
- Genetic vulnerabilities
OCD and Different Types of Eating Disorders
All types of eating disorders share some features with OCD. But among adolescents and young adults, anorexia nervosa with bingeing and purging behaviours may encompass the most OCD symptoms and traits.
Anorexia nervosa with binging and purging involves a preoccupation with reaching or maintaining a low body weight that can resemble the intrusive thoughts associated with OCD. At the same time, bingeing and purging behaviours are linked to the impulsivity that underpins OCD compulsions and rituals. Bulimia nervosa also tends to involve more OCD symptoms than anorexia.
As young people move into adulthood, the differences between subtypes of eating disorders and their relationship to OCD symptoms become less pronounced, but OCD symptoms become more severe in general.
Treating OCD and Eating Disorders
Young people living with OCD and a co-occurring eating disorder usually benefit from a combination of different treatment approaches that simultaneously address both disorders. While evidence suggests that eating disorder treatments like family-based therapy and cognitive-behavioural therapy also improve some OCD symptoms, they may only address eating-disorder-specific OCD symptoms and not other OCD traits. Equally, while OCD might be considered a risk and maintaining factor for eating disorders, treating OCD alone doesn’t address the complexity of factors that underpin disordered eating behaviours.
There are several different treatment options available for OCD and eating disorders that can support young people in recovery. These include:
Radically Open Dialectical Behavioural Therapy
Radically open dialectical behavioural therapy is a type of DBT that addresses mental health challenges rooted in rigid thinking and over-control. RO-DBT assumes that the psychological and functional difficulties caused by over-control are mostly connected with interpersonal relationships. It supports individuals to develop warmer and closer relationships with others by improving emotional expression, encouraging openness and limiting social comparison.
RO-DBT is a transdiagnostic treatment that can improve symptoms of anorexia nervosa, perfectionism, obsessive-compulsive disorder and other mental health problems. For young people with co-occurring OCD and restrictive eating disorders, it may treat symptoms of both disorders simultaneously, addressing underlying traits that contribute to both conditions.
Dialectical Behavioural Therapy
Dialectical behavioural therapy is a form of cognitive-behavioural therapy intended for people experiencing intense and distressing emotions. It emphasises two core, opposing concepts: the radical acceptance of the parts of our experience that are out of our control, and steps towards positive change. DBT teaches a range of skills, including distress tolerance, mindfulness and interpersonal skills.
DBT is an effective treatment for eating disorders that involve impulsive behaviours, such as binge eating disorder and bulimia nervosa. DBT skills help individuals learn to cope with distressing emotions in healthy ways, rather than using disordered eating behaviours.
Cognitive Behavioural Therapy with Exposure and Response Prevention
Cognitive behavioural therapy with exposure and response prevention is a first-line treatment of OCD. It supports individuals to accept and tolerate intrusive thoughts, rather than fighting or trying to resolve them. It also focuses on delaying or avoiding the rituals that might be used in response.
Exposure and response therapy starts slowly with small steps towards delaying and avoiding compulsions, which gradually build as a person’s confidence and self-belief in their ability to manage intrusive thoughts improve.
MANTRa
The Maudsley Model of Anorexia Nervosa Treatment for Adolescents and Young Adults (MANTRa) is a treatment approach especially designed for young people living with anorexia nervosa. It emphasises the role of interpersonal difficulties and certain cognitive traits in maintaining disordered eating behaviours. Using a combination of CBT skills and writing tasks to develop a range of coping mechanisms that promote positive change.
Pharmaceutical Treatment
Some people with obsessive-compulsive disorder benefit from medication, especially antidepressant medication like SSRIs that help regulate serotonin levels in the brain and body. People respond to medications differently, and there is no single medication that works for everyone. Some people with OCD take medications while others don’t: decisions about medication should be taken collaboratively with a psychiatrist and psychologist.
The Wave Clinic: Transformative Recovery Programs for Young People
The Wave Clinic offers specialist treatment programs for eating disorders, borderline personality disorder and other mental health concerns. We offer a whole-person approach to mental health care, expertly treating complex presentations and co-occurring disorders through combinations of treatment approaches that address the underlying causes of each disorder.
Our programs are family-centred and trauma-focused, emphasising the role of past experiences and social relationships in shaping a young person’s well-being.
If you’re interested in what The Wave has to offer, reach out to us today.
