When OCD and Eating Disorders Collide: Understanding and Managing the Co-Occurrence

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From their symptoms to their associated behaviours, consequences, and underlying causes, many eating disorders share traits with OCD – and these two families of anxiety disorders may feed into one another when they co-occur. Dual diagnosis from a treatment centre that understands both conditions from a deep professional standpoint is the most sustainable pathway to treatment for young people looking to recover from these complex diseases.

Identifying OCD, Identifying Eating Disorders

Obsessive Compulsive Disorder and eating disorders are two very distinct health conditions that can share a lot of overlap. OCD is an anxiety disorder characterised by obsessions and compulsions that can interfere with daily life. Eating disorders are illnesses that involve disordered eating patterns, such as restricting food intake, bingeing, purging, or other extreme behaviours, often related to body image concerns.

Signs of OCD

Obsessive-compulsive disorder (OCD) is a mental health disorder characterised by intrusive thoughts that cause anxiety, repetitive behaviours and rituals, and an inability to control these thoughts and behaviours. OCD can affect people of any age, but symptoms are more likely to manifest in early adolescence or adulthood.

Common signs and symptoms of OCD include:

  • excessive hand-washing, “checking”, cleaning, hoarding, counting, repetitive thoughts, or ordering
  • intrusive thoughts that cause anxiety
  • avoidance of certain situations
  • rigidity
  • perfectionism/meticulousness
  • sensitivity to changes in daily life or routine

People with OCD often experience significant levels of distress and anxiety related to their thoughts and behaviours. They may feel overwhelmed and unable to cope with the constant pressure of their obsessions and compulsions. OCD can also make it difficult for people to function in their daily lives and maintain relationships.

Compulsive behaviours associated with OCD include:

  • avoiding activities and situations that may trigger obsessive thoughts
  • engaging in obsessive-compulsive behaviours to relieve anxiety
  • ruminating or obsessing over one’s thoughts
  • difficulty sleeping due to intrusive thoughts
  • frequent “checking” of things related to obsessive thoughts

People with OCD may also experience physical symptoms such as headaches, stomachaches, nausea, and dizziness. These symptoms can be caused by stress and anxiety related to OCD.

Signs of Eating Disorders

Eating disorders are severe mental health conditions that can profoundly impact a person’s physical and mental health. Signs of an eating disorder can include drastic changes in eating habits, extreme concern with body image, and an obsession with food or calories. The most common eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, purging disorder) are distinct conditions but may overlap in their symptoms and causes. Different eating disorder symptoms often include:

  • skipping meals
  • eating very small amounts of food,
  • and avoiding certain food groups.
  • strict, restrictive calorie intake
  • obsession with body image, weight, and shape.

Often, disordered eating is accompanied by obsessive thoughts about body image, weight, and shape. Eating disorders often co-occur and may be driven by body dysmorphic disorder (BDD), a condition where individuals fixate on their perceived flaws in physical appearance. A person with an eating disorder is likely to take measures to hide their body, such as wearing baggy clothes, and may compare the bodies of others verbally. They may also engage with “body checking” – jumping on a scale many times a day or checking the mirror for signs of weight gain.

Obsessions can also be with food. People may hoard food, eat in secret, or become upset when they cannot eat certain foods. They may also become overly preoccupied with counting calories or avoiding certain food groups.

With time, eating disorders tend to have physical effects, which include:

  • extreme fatigue
  • hair loss
  • dry skin
  • rapid weight gain or weight loss
  • changes to the menstrual cycle

If you notice these signs in a young person close to you, don’t delay the choice to seek help. Unfortunately, an eating disorder can bring about lasting mental, physical, and social health consequences, but the earlier you enter treatment, the better your chances of avoiding them. A mental health professional can help to identify the underlying cause of the disorder and provide the necessary support and treatment.

Comorbidity

Eating disorders can develop because of OCD, leading to episodes of more significant OCD symptoms that simultaneously co-occur with OCD. According to a 2020 meta-analysis:

  • 18% of all people with an eating disorder develop OCD in their lifetime (compared to 2.3% of the general population)
  • 44% of people with anorexia have or will have OCD
  • 19% of people who live with bulimia have or will have OCD

Both disorders share a lot of overlapping traits and one disorder may be caused by similar underlying anxieties as the other.

Dysfunctional Perfectionism

Perfectionism can be understood as a characteristic that motivates people to set and uphold unrealistic expectations of themselves and their abilities. A perfectionist is likely to keep going even after they meet their expectations and will often take considerable measures to set themselves up to succeed in their perfectionist goal. Any mistakes or flaws themselves that fall beneath the unrealistically high bar set can cause extreme distress to a perfectionist individual.

In a person with typical obsessive-compulsive behaviour patterns, this could present in many ways. For example, washing hands a certain number of times, and organising their environment in a specific way, while integrating certain ritualistic signals that indicate that a required task is completed. For someone with anorexia nervosa, clinical perfectionism is likely to be body weight directed with unbelievable care put into checking oneself for weight gain or calculating calories in food to the decimal. 

Perfectionism can be understood as a consequence and driver of anxiety for people with OCD and eating disorders. These expectations and the perceived consequences of not meeting them cause both groups of people to structure their lives in rigid ways. This rigidity and fear disrupt many realms – from education and career to family and personal relationships, health, and aspirations.

Control

Extreme control is another theme that connects the way we think about OCD and eating disorders – for similar reasons to perfectionism. It has been posited in psychology that both eating and obsessive-compulsive disorders have a lot to do with the individual’s need for control over a stressfully chaotic world. When expectations are set too high, perfectionists bars that “must” be met, and we as individuals start to manage ourselves and the environment around us to a disordered degree.

The cognitive patterns associated with both disorders lead to repetitive thoughts, ritualistic behaviours, and magical thinking. There are often constant “checks” to make double, triple, and quadruple sure that whatever arenas of chaos or failure are the OCD or ED-affected individual’s feared stimuli do not come to pass. All of this could help the person with controlling personality traits turn the anxious part of themselves on autopilot, appearing to others to engage with the world easily. However, in the long term, all of this feeds into an extreme cycle of stress that can escalate with time as it goes untreated.

Treatment for OCD and Eating Disorders

OCD is often treated with cognitive-behavioural therapy, medications, or a combination. Eating disorders are usually treated with psychotherapy, nutrition counselling, and medications.

Cognitive Behavioural Therapy and Response Prevention

CBT is an evidence-based psychotherapy based on the idea that our thoughts, feelings, and behaviours are interconnected and can influence one another. With CBT scoping kills, clients learn to identify and challenge irrational thoughts and beliefs – cognitive distortions that affect behaviour patterns and inform food-related obsessions. Psychiatry research keeps confirming the power of CBT as a modality for coping with mood disorders, and for decades it has stood as the gold standard of treatment.

One CBT technique, “Exposure and Response Prevention”, works by helping clients recognise their compulsive behaviours and preventing them from giving in to the urge to perform the behaviour. It involves teaching the client not to act on compulsions and instead challenge their irrational thoughts. This type of therapy aims to help the patient become more aware of their OCD and eventually become free of its control.

Selective Serotonin Reuptake Inhibitors – Medication for Obsessive Compulsive Disorder

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed anti-depressant and anti-anxiety medications that have also been proven effective in treating these two disorders. Serotonin is a key regulator of emotions and mood, and deficiency in this crucial chemical seems to be a crucial pillar of many cases of OCD.

Medication can make a big difference in rebalancing the basic chemistry of the brain and returning it to a state of health. However, psychotherapy can still be beneficial in challenging the thought patterns that become ingrained over time, especially in cases where unhealthy compulsions and eating behaviours become ingrained in adolescence.

Successful Treatment for Young People

The Wave offers life-changing residential treatment programmes to teens, adolescents, and young people with eating disorders and OCD. Our dual diagnosis and recovery programme is personalised by our dedicated healthcare professionals and youth specialists to the experience of each client we host, their personal history, triggers, and specific behaviours. Our treatment offers a whole-client approach incorporating evidence-backed psychotherapy, medical intervention, holistic well-being approaches, and gastroeducation.

We are committed to unravelling the net of individual themes that drive eating disorders and OCD in each unique client’s life, helping them reclaim their present and future fully and fearlessly.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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