The Link Between OCD and Eating Disorders
Obsessive compulsive disorder (OCD) and eating disorders are two conditions that can co-occur in the same person.
Studies have shown that people with eating disorders such as anorexia, bulimia, avoidant/restrictive food intake disorder (ARFID), or binge eating disorders are more vulnerable to OCD.
What is OCD and how is it different from eating disorders?
OCD is characterized by obsessions wherein you have unavoidable thoughts that keep on repeating in your head. These thoughts are followed by consistent behaviors known as compulsions that make you do certain things in a particular manner.
People with OCD tend to control their environment with strict rituals.
OCD varies from person to person and is disruptive. It can range from numbers, the arrangement of things, symmetry, perfectionism, or cleanliness. These obsessions cause anxiety in the person that can be relieved by compulsive behaviors.
But, eating disorders in people cause them to experience repetitive thoughts and compulsive actions on food intake and perform ritualistic behaviors. Some of these include:
- Constantly checking body weight and shape
- Rigorous exercises
- Avoid food due to fear of weight gain or unpleasant consequences
- Sensitivity to food texture, taste, and color
- Ritualistic behaviors - binging and/or purging.
However, a major difference between OCD and eating disorders lies in the fact that people with OCD find their obsessions and compulsions "in conflict with their identity". They understand their OCD to be irrational and this leads to distress. Hence they would like to get rid of their thoughts and feelings but are unable to do so.
Whereas, in the case of eating disorders, people are in agreement with their thoughts and behaviors. People with eating disorders seem to be bound to their behavior since it feels like "a part of their identity".
Related: Why do we turn to food in times of stress?
What are the similarities between OCD and eating disorders?
In both OCD and eating disorders, people tend to have unreasonable expectations.
Studies show that people with these conditions seek perfection because of which they are extremely rigid in their behaviors. Any kind of change in this behavior seems to be a challenge and will lead to distress.
In eating disorders, a person’s behavior is limited to food intake and/or body weight and image.
However, when a person with eating disorders seems to show obsessions and compulsions about other aspects of their lives, then these symptoms may align with OCD.
For example, a person with anorexia nervosa may engage in repetitive ritualistic exercises as well as cleaning behaviors. Interrupting such behavior is difficult as it is going against their compulsions. Here, cleaning is completely unrelated to the thoughts associated with anorexia such as excessive exercise due to a fear of weight gain.
This shows a complex overlap of symptoms presented with both OCD and eating disorders.
Eating disorders and OCD comorbidity
People with eating disorders and OCD tend to be dysfunctional perfectionists. The overlap lies in the OCD and eating disorders symptoms.
- Intrusive thoughts
- Compulsions to perform rituals to reduce anxiety
- Obsessions to maintain this ritualistic behavior
In eating disorders, these behaviors are associated with food, whereas in OCD it is more general and differential.
Treatment for OCD and eating disorders
Understanding the shared traits and features between eating disorders and OCD will provide therapists with a comprehensive knowledge to differentiate between the common links.
Exposure and response prevention (ERP) therapy is commonly used to treat both disorders. In eating disorders, the person is exposed to the fear of food intake, body image, sensitivity to food type, weight gain, and intense feelings and behaviors associated with it.
It allows the person to recognize their fears and list them in a hierarchy. They are then exposed to face their fears. This helps to gradually build a tolerance to the fears and track their feelings and thoughts. The person is then trained by psychologists to refrain from performing any ritualistic behaviors around food. The same is applicable for OCD.
Cognitive-behavioral therapy (CBT) allows people to identify, challenge, and modify the distortions associated with eating disorders.
A person with OCD can already identify with their garbling thoughts. So, acceptance and commitment therapy (ACT) for eating disorders will help focus on changing the relationship with these feelings and thoughts.
Identification of similarities and differences is important for treating either - or both - disorders.