The Relationship Between OCD and Eating Disorders

A blog entry from our Intern Makenzie Teramo 

Guess what? There is a fifth Monday of July! What better way to blog than with a guest blogger! Integrated Eating is delighted to present a blog from our nutrition intern, Makenzie Teramo. While interning for us this summer she attended a webinar given by The Renfrew Center and presented by Lewis Jones, PsyD called OCD and ED: The Alphabet Soup No One Will Eat. This blog will discuss the similarities and differences between OCD and eating disorders, their definitions, behaviors, and treatment. 

Obsessive Compulsive Disorder:

OCD is a disorder consisting of negative recurring thoughts known as obsessions and the consistent behaviors that follow or compulsions. Obsessive themes can range from cleanliness, numbers, getting things ‘just right’, or symmetry. Many think this disorder simply a pesky habit or a phobia, but it is not. 

The obsessions are typically not food related, unless an individual is also dealing with eating issues, disordered eating or an eating disorder. For this reason it can be easier to diagnose someone with OCD when symptoms are not food related. Other examples below show food related behaviors which are more difficult to differentiate between OCD and an ED.

Eating Disorder:

When OCD and Eating Disorders intersect can see in its influence in eating behaviors such as:

  • Hoarding

  • Body dysmorphia

  • Restricting 

  • Binging 

  • Binging and purging 

  • Food sensitivities

Statistics demonstrate that people with eating disorders are more vulnerable to co-morbid diagnoses such as anxiety disorders and obsessive-compulsive disorder (OCD). A study done in 2004 demonstrated that 41% of those affected by an eating disorder also deal with OCD. Research demonstrates that between 25% and 69% of women with anorexia nervosa and between 25% and 36% of women with bulimia also have OCD. 

ARFID (Avoidant Restrictive Food Intake Disorder) is one such eating disorder diagnosis we see a lot of crossover with OCD behaviors and symptoms. Those struggling with ARFID have an intense lack of interest or aversion to food as well as extreme sensitivities around eating. They may experience intensity or distortion around textures such as taste, texture, or smell. Many times they will stop eating a certain food due to past negative experiences with the food or surrounding the experience of eating. While obsessive and compulsive thoughts and behaviors are seen in all eating disorders (and sub-clinical disordered eating), ARFID is a disorder with a particular concentration of overlapping symptoms. 

Similarities & Differences

Below we discern the similarities and differences between OCD and Eating Disorders. They are similar in that they: 

  • Individuals with OCD and Eating disorders both experience a  feeling of dread when the need arises to have to sit with “what will happen next” after an event. 

  • Both OCD and Eating disorders relate around a perfectionistic framework. Individuals with both disorders can have unrealistic expectations and standards. 

  • They both exhibit rigidity. Change, transition and flexibility are very challenging. They cannot discern the difference between structured routine and rigid patterns. 

  • Those struggling with OCD and/or Eating disorders are more isolated. They tend to participate less in social activities and have a limited amount of hobbies. 

True clinical instincts are needed to differentiate between OCD and Eating disorders. Some food related issues can be OCD behaviors not necessarily disordered eating symptoms. There is a need to understand the behavior as well as the motive behind the thought, symptom or behavior.  

For Example:

  • Throwing out food- Is it because there is worry it is expired or are they discarding the food to restrict calories?

  • Checking the refrigerator- Is an individual checking to see what they are missing or what they need or what to binge on?

  • Avoiding public eating- Is it because there is worry about contamination or a lack of trust of calorie/fat content, lack of control or judgement about the food?

  • Skipping meals-Is it due to being preoccupied with other types of behaviors or because they are actively restricting?

  • Washing hands-Does the individual feel the compulsion for cleanliness or do they feel the need to wash their hands to rid themselves of oils and fats on their fingers from eating that feels triggering?

Treatment:

Treatment for one of these disorders is challenging enough. When an individual is struggling with OCD and Eating disorders, creating the appropriate treatment modality is crucial. 

  • Support: A therapeutic treatment team is a critical must for individuals seeking treatment and recovery from eating disorders and/or OCD. In addition, family and friends can be a life line. 

  • Assessment: Proper assessment must be done to clearly diagnose both OCD and/or an Eating Disorder. A thorough intake includes discussion on what the triggers and origins of their obsessions and compulsions. Many individuals with eating disorders do not realize they also have OCD. Their treatment efforts may be undermined by OCD symptoms that are not being addressed.  Those with OCD may not understand how obsessions and compulsions influence food, eating or body image. 

  • Exposures: Exposure therapy can be a helpful treatment modality for both OCD and Eating disorders as it builds a tolerance and a new stimulus towards past, present or future fears. Exposures typically done include exercises to diminish rituals with exercise, food, or body image. Examples include learning to tolerate more infrequent weighing, extinguishing body checking or limiting cutting food into tiny bite sizes. 

  • Family counseling: Sometimes family support includes family counseling. This enhances  treatment and recovery efforts of patients by having a family process together. 

  • Medical attention: In some cases medical attention is necessary. This includes higher levels of care that specifically treat both OCD and Eating disorders. 

Additional Resources:  

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.

Anderluh, M.B., Tchanturia, K., Rabe-Hesketh, S., & Treasure, J., (2003). Childhood obsessive-compulsive personality traits in adult women with eating disorders: Defining a broader eating disorder phenotype. American Journal of Psychiatry, 160(2), 242-247.

Kaye, W.H., Bulik, C.M., Thornton, L., Barbarich, N., Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia. American Journal of Psychiatry, 161(12), 2215-2221.