Understanding Obsessive Compulsive Disorder and Eating Disorders

Eating disorders, which include anorexia, bulimia, or binge-eating disorder, are complex physical and mental illnesses characterized by damaging relationships with eating, food, exercise, and body image. It is not unusual for you to also have another mental health issue, including obsessive-compulsive disorder (OCD).

OCD is a condition that causes obsessions (recurrent thoughts) and compulsions (repetitive behaviors). Studies show that about two-thirds of people with eating disorders also have a co-occurring anxiety disorder. Of these, one of the most common is obsessive-compulsive disorder or OCD.

This article discusses the connection between obsessive-compulsive disorder and eating disorders. It also explores how having one condition can affect the diagnosis and treatment of the other.

The Connection Between OCD and Eating Disorders

It is believed that eating disorders and anxiety disorders share traits that contribute to their development and account for the high rate of comorbidity.

Eating disorders and OCD are both characterized by intrusive thoughts and compulsive actions. But for those people who only have an eating disorder, these obsessions and compulsions are typically limited to thoughts and actions related to food and/or weight.

For example, they may engage in excessive exercise or repetitive calorie counting. When people with an eating disorder also have obsessions and compulsions about other areas of their lives, they may also be experiencing symptoms of OCD.

People with eating disorders can have symptoms that are very similar to symptoms of OCD. For example, people with eating disorders can experience repetitive thoughts about food, body weight, and body image. They may also perform ritualistic behaviors such as body checking and frequent weighing.

Complications of OCD and Eating Disorders

Having both conditions may contribute to more significant symptom severity, more severe outcomes, and greater challenges in treatment. Research has found that obsessions were strongly related to eating disorder symptoms in people with co-occurring OCD and anorexia nervosa. 

Because of overlapping symptoms, it is possible that a person with an eating disorder might also have undiagnosed obsessive-compulsive disorder. If the condition goes untreated, it can complicate and undermine interventions since the untreated obsessions and compulsions uphold the eating disorder.

Eating disorders have serious medical complications, including cardiovascular, gastrointestinal, endocrine, and neurological problems. Proper treatment for eating disorders and co-occurring conditions is important to minimize these potential health risks.

Diagnosis of OCD and Eating Disorders

When diagnosing co-occurring OCD and eating disorders, doctors and mental health professionals need to examine the symptoms and motivations behind them. Because eating disorders may lead to significant and visible changes in body weight and medical complications, symptoms are sometimes attributed to the eating disorder without recognizing the impact of OCD. 

To make a diagnosis, a healthcare provider will conduct a physical exam and psychological evaluation. They may also order additional medical tests to evaluate health and check for complications.

Treatment of OCD and Eating Disorders

Anytime that a person is experiencing symptoms of more than one condition, it can complicate treatment. Fortunately, there are effective treatments for both eating disorders and OCD. Obsessive-compulsive disorder is typically treated by medication and psychotherapy.

Eating disorder treatments are complex and focus on medical stabilization, nutritional therapy, cognitive-behavioral interventions, and other psychotherapies. 

Medications

Antidepressants and antipsychotics can be helpful in the treatment of OCD. Four selective serotonin reuptake inhibitors are approved by the Food and Drug Administration (FDA) to treat OCD:

• Luvox (fluvoxamine)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

If such medications don't lead to an adequate response, SSRIs may also be augmented with antipsychotics such as Abilify (aripiprazole), Risperdal (risperidone), and Seroquel (quetiapine).

Medications are sometimes prescribed to treat symptoms of co-occurring anxiety or depression in eating disorders. SSRI antidepressants can help treat symptoms of bulimia and binge eating disorder. Vyvanse (lisdexamfetamine) is FDA-approved to treat binge-eating disorder.

Psychotherapy

Psychotherapy is an important part of treatment for both OCD and eating disorders. Two that are commonly utilized are cognitive-behavior therapy and exposure and response prevention.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is an effective treatment for OCD and eating disorders. In CBT, clients are taught how to modify behavior patterns and recognize and challenge dysfunctional thoughts.

Exposure and Response Prevention

Exposure and response prevention (ERP) is another type of psychotherapy effective at treating OCD. As its name implies, a therapist using ERP will expose the client to anxiety or obsession-inducing situations and then work with the client to prevent them from engaging in compulsive behavior.

For instance, if the person is struggling with frequent hand washing, an ERP therapist may work with the client to wash their hands less frequently or to wash their hands for a shorter duration.

This is similar to what many people go through in treating and recovering from their eating disorders. For example, someone with anorexia or bulimia experiences a great deal of anxiety when they eat a meal.

Although they may have urges to exercise, purge or restrict after a meal, the treatment team works with them to prevent these situations. In a higher level of care, such as inpatient hospitalization or residential treatment, they may be physically prevented from acting upon those urges.

Fortunately, many therapists who work with eating disorders are familiar with treating other conditions that commonly co-occur with them. But if your therapist isn't able to treat your OCD, sometimes people will see two different therapists, with each one focusing on the specific symptoms they specialize in.

Coping With OCD and Eating Disorders

In addition to seeking appropriate treatment, some strategies can help you cope with co-occurring OCD and an eating disorder. Steps you can take include:

• Practice self-care: Caring for your physical and mental health is critical. Make sure you get plenty of sleep and engage in activities that bring you joy.
• Use relaxation strategies: Living with a mental health condition is more difficult when you are anxious and stressed. Strategies such as deep breathing, visualization, and progressive muscle relaxation can help relax your mind and body.
• Try mindfulness: Mindfulness is a practice that can improve self-awareness, ground you in the present, and help you better deal with stress. It involves focusing on the present moment rather than worrying about the past or future.
• Keep a journal: Journaling can help you make sense of your experiences, notice patterns, and identify triggers.
  

Support Groups

Support groups can also be an essential source of support when recovering from an eating disorder and coping with a co-occurring condition such as OCD. Research has shown that support groups can help improve social support, coping skills, and psychiatric symptoms.

Summary 

Eating disorders and OCD share similar symptoms, including obsessions and compulsions. These conditions can also co-occur, complicating the diagnosis and treatment process. Effective treatments are available, but it is essential to get an accurate diagnosis to treat each condition appropriately.

A Word From Verywell

Eating disorders are serious mental health conditions that can have serious health consequences. When these conditions occur alongside obsessive-compulsive disorder, they can be more challenging to diagnose and treat. If you are experiencing symptoms of either condition, it is vital to speak to your doctor. They can evaluate your symptoms and recommend treatments to help you recover from your eating disorder and manage OCD symptoms effectively.