The Relationship Between OCD and Eating Disorders

OCD basics

What is OCD?

OCD is a mental illness categorized by obsessions, anxiety, and compulsions. Obsessions are intrusive thoughts which an individual with OCD finds important and distressing. We all have intrusive thoughts. They’re often a bit ‘strange’ or of a taboo nature. They pop into our head without warning and typically don’t reflect our true feelings or thoughts. Someone without OCD will let intrusive thoughts pass without reflecting much on them.

However, someone with OCD will attach great significance to these thoughts. They will think that they have a lot of meaning, and therefore often find their taboo or disturbing nature very upsetting. This is what makes the difference between intrusive thoughts and obsessions. Obsessions can centre around a variety of topics or ‘themes’. One person might have obsessions around multiple topics, or might find that their obsessions are focused around one particular topic.

Once obsessions are present, they begin to cause a lot of anxiety and fear. Someone with OCD is likely to find that their anxiety levels are very high a lot of the time. They are likely to fear what will happen as a result of their obsessions and feel very uncomfortable about these thoughts. They feel the need to do something to cope with these feelings and this is when compulsions come into the picture.

Compulsions are ritualistic, repetitive actions which the person carries out to try to ‘deal’ with their obsessions. This might be to try and prevent something bad happening as a result of their obsessions or to try to lessen their emotional distress. There are a wide variety of compulsions which can be carried out depending on the person and the topic of their obsessions, such as checking behaviours, avoidance, seeking reassurance, and so on. As with obsessions, an individual can display more than one type of compulsion.

Compulsions might ease the anxiety caused by obsessions at first but that anxiety quickly comes back, often with increased strength. The individual will then desperately carry out more compulsions to try to regain that relief. Compulsions can carry on for hours of the day making it very hard to function. Even if the individual knows logically that their obsessions and compulsions are not grounded in reality, they will still feel driven to act on them. This is the vicious cycle of OCD.

Symptoms of OCD

There are a wide range of potential symptoms of OCD. Of course, we’re all individuals so each person may experience OCD differently and display varying symptoms. Symptoms will also vary depending on the specific obsessions and compulsions experienced. If you have OCD, general symptoms may include:

• Having repetitive, distressing intrusive thoughts
• Ruminating on thoughts (meaning going over and over things in your mind)
• High levels of anxiety
• Feeling driven to carry out repetitive or ritualistic actions
• Finding a lot of your day is taken up by these actions
• Feeling unable to stop your actions
• Experiencing fear or dread of ‘something bad’ happening
• Self doubt
• Feelings of guilt or being a ‘bad person’
• Feeling very responsible for the safety of others
• Magical thinking (meaning you think your words, thoughts, or actions can cause, influence, or prevent events)
• Finding it difficult to function or focus
• Finding it hard to maintain relationships

Eating disorder basics

What is an eating disorder?

An eating disorder is a mental illness which distorts the relationship an individual has with food, creating an unhealthy dynamic towards eating. An eating disorder will often make the person physically unwell as well as mentally unwell. The American Psychiatric Association (APA) explains, “Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions.”

Eating behaviours can vary depending on the type of eating disorder. Some people may eat too much and might gain weight. Others may eat too little and lose weight. It’s important to note here that anyone, at any weight, can experience an eating disorder. Not all eating disorders will result in changes in weight. All eating disorders are valid.

If you have an eating disorder, it’s likely you will spend a great deal of time focused on food, eating habits, and often body image. You may experience high levels of anxiety and fear around food and weight changes. It’s also common to perceive your body differently than how it actually looks. For example, if you are losing weight, you might see yourself as fat, even if you are dangerously underweight. It’s common to be very self-critical and unhappy with your appearance, striving for a sense of perfection your disorder has set out for you.

Individuals with eating disorders are likely to find it very difficult to control their symptoms. Eating disorders are very difficult to live with. Someone with an eating disorder is likely to struggle to function and to concentrate as their mind is overtaken with their disorder. They may find it difficult to maintain relationships with friends and loved ones, and might begin to feel very alone. It’s common to feel depressed and hopeless. Some people may find that their performance at work or school is affected, and they may end up losing their job or leaving education.

As we mentioned earlier, eating disorders have physical consequences as well as mental symptoms. Food is the fuel our body needs to function and it’s vital that we get the right nutrients. When we don’t, our body struggles to function properly and our health declines. Those with eating disorders may find that they develop short term or even long term health issues as a result. Overall, living with an eating disorder can be incredibly difficult, but it’s important to remember that you can get help. We’ll discuss treatment options later in this article.

Types of eating disorders

There are a number of eating disorders, all with individual symptoms and challenges. Common eating disorder diagnoses include:

• Anorexia nervosa

  An individual with anorexia will have a negative self image, low self-esteem, and may feel that they are overweight (even if they are not). The disorder centres around trying to lose weight or keep your weight as low as possible.

  If you have anorexia, you might do this through reducing food intake, avoiding high calorie foods, or stopping eating, often to the point that it becomes very dangerous for your physical health. Some individuals with anorexia exercise to excess, which may be done instead of, or alongside, food restriction. The mental health charity Mind explains: “If you get an anorexia diagnosis, this is because you are not eating enough food to get the energy you need to stay healthy.”

• Bulimia nervosa

  Someone with bulimia typically has a very negative body image and may feel a desire to lose weight or keep their weight low. If you have bulimia you will engage in binges, which means that you lose control and eat a lot of food in one sitting. Binges typically happen when you are feeling very stressed or anxious. After a binge you will usually feel very guilty and ashamed of yourself.

  Binges are then followed by purging, which means trying to get rid of the food you’ve consumed. This is often done by making yourself vomit or using laxatives to make yourself go to the toilet a lot. Some people might excessively exercise, restrict calories, or stop eating after a binge to try to stop themselves gaining weight from the food they’ve eaten.

• Binge eating disorder (BED)

  Binge eating disorder is also referred to as compulsive eating. Individuals with BED will lose control and eat large quantities of food in one sitting. They will typically feel very ashamed and be hard on themselves afterwards. Binges are typically done to ‘deal’ with anxiety, stress, or distress.

  Those with BED tend to turn to food to cope with their emotions generally, using it as a way to make themselves feel better. Unfortunately, in the long run it actually makes them feel worse, yet they will feel powerless to stop their behaviour. The charity Mind explains: “If you have binge eating disorder you might feel that you can’t stop yourself from eating, even if you want to.”

• Other specified feeding and eating disorder (OSFED)

  This sounds complicated but an OSFED is simply an eating disorder which doesn’t fit all of the symptoms of anorexia, bulimia, or binge eating disorder. It doesn’t mean that your disorder is any less valid and you can still get treatment for your symptoms. It’s also important to remember that you are not alone. In fact, the NHS states that a diagnosis of OSFED is more common than that of any of the other types of eating disorders.

Symptoms of an eating disorder

Symptoms of eating disorders will vary depending on the type of eating disorder an individual is experiencing. General symptoms someone with an eating disorder may experience include:

• An ongoing, unhealthy relationship with food
• Low self esteem
• Preoccupation with food and eating
• Excessively worrying about your weight and body image
• Drastically changing your eating habits
• Significant changes in your weight
• Your weight being too high or too low for your age and height
• Excessive exercising
• Having strict routines or rules around food
• Avoiding eating with others
• Mood changes, including depression, anxiety, and more
• Feeling physically unwell (dizziness, temperature regulation issues, fatigue, digestive issues, etc)

Parallels between OCD and eating disorders

Anxiety and fear

Both types of disorder include symptoms of high anxiety. This anxiety plays a significant part in the cycle of both disorders, causing emotional distress which the individual feels the need to try to resolve. Likewise, fear is a catalyst in both types of disorder, with the individual being focused on trying to avoid a feared outcome.

Both types of disorder also tend to involve fear of the unknown, because an individual will worry about potential triggers in situations they are unable to control or predict. Triggers refer to anything which could evoke the negative emotions associated with an aspect of the individual’s disorder.This fear and anxiety feels extremely uncomfortable and infiltrates most, if not all, areas of the individual’s life.

Intrusive and obsessive thoughts

Although the themes of the thoughts vary, both disorders involve an individual having repetitive, intrusive thoughts which the individual attaches a great deal of significance to. Due to the way the individual attaches such importance to these thoughts, the thoughts become obsessive. The obsessive thoughts can take over a person’s mind, influencing how they view the world and themselves. Obsessive thoughts evoke high levels of anxiety and distress in both types of disorder.

Compulsive behaviours

Just as both types of disorder involve obsessive thoughts, they also both involve compulsive behaviours. We’ve mentioned compulsions as part of the OCD cycle. Those with eating disorders also carry out repetitive, ritualistic behaviours. This article from an eating disorder treatment facility shares some examples of these behaviours: “body checking for any changes in shape and size, weighing self frequently to check for body changes, avoiding foods associated with fear of weight gain, and engaging in rituals around food intake, such as cutting food into tiny pieces or eating foods in a certain order.”

In both types of disorder, these compulsive behaviours are driven by the need to deal with obsessive thoughts and the emotional distress which accompanies them. These behaviours all take up a lot of time during the day and are disruptive to daily functioning. The compulsive behaviours can all vary in severity depending on the type behaviour and the individual.

Self doubt

Each disorder features symptoms of self doubt and lack of confidence in one’s own mind and memory. In OCD, the individual commonly doubts their own memory about whether they have carried out specific actions. For example, if someone has checking compulsions and sees themselves lock the door as they leave the house, they might walk away from the house and still doubt whether they really locked the door. Therefore they will return and check it again, perhaps by physically checking the door won’t open this time. This can go on and on.

Similarly, someone with an eating disorder may not trust their own perception, particularly if they have a distorted body image as we mentioned earlier.. For example, they might not trust what they see in the mirror as they may perceive they are overweight when they are not. It’s also very common for people with eating disorders to lack confidence in general and to doubt their own abilities.

Rumination

Rumination refers to repeatedly going over thoughts in your mind, in particular negative thoughts. Ruminating on negative thoughts tends to amplify them and make them seem even more important. Ruminating on intrusive thoughts is common in both OCD and eating disorders. OCD UK states: “In the context of OCD a rumination is actually a train of prolonged thinking about a question or theme that is undirected and unproductive.” The same can be said of eating disorders. Individuals may ruminate on negative feelings, on obsessive thoughts, or anything that is related to their disorder.

Issues around control

Trying desperately to have control paired with a lack of control over symptoms are present in both types of disorder. In OCD, individuals will often struggle in situations they can’t fully control for fear of triggers or of something bad happening. Compulsions tend to revolve around trying to have some control, such as trying to prevent something bad happening or attempting to get their anxiety under control. Unfortunately, the OCD cycle is usually out of their control without treatment, so obsessions and compulsions run rampant.

In eating disorders, individuals often try to control their anxiety and their issues around body image with their compulsive actions, such as restricting food and excessive exercising. Some (but not all) eating disorders develop from a sense of needing to have something to control in a world where other things feel out of control.

In some cases, people with eating disorders feel successful in controlling their eating habits where they might have felt they are failing in other areas of life. This article from the Eating Disorder Hope explains: “for those individuals, exerting control over their eating behaviors was perceived as a success in a world where they viewed themselves as a failure in many other areas of functioning.”

Just as with OCD, people with eating disorders fear what will happen if they lose control. They may fear what will happen if they begin to put on weight or if they need to change their eating habits, which can understandably make recovery particularly challenging. In a similar way to OCD, before treatment the symptoms of eating disorders are actually out of their control and are perpetuating the cycle of the disorder.

Perfectionism

Perfectionism can, in theory, be a positive personality trait. It can drive us to strive for improvement, to do our best, and to reach our goals. However, it can also become negative when we put too much pressure on ourselves. When mental illness comes into play, perfectionism can be particularly troublesome. This article states: “Perfectionism is related to unreasonable and often unattainable expectations. OCD and eating disorders exhibit a clinically unhealthy level of perfectionism.”

Within both types of disorder there tends to be a determination for perfection. If something doesn’t meet the standards the disorder has set out for the individual, it can cause a great deal of distress. In OCD, individuals fear what will happen if things are not ‘done right’. This article from Beyond OCD mentions that those with OCD often face, “an overwhelming fear of making mistakes; an intense need for things to be “perfect” or “done right” – may or may not be accompanied by a fear that harm will come to oneself or others if things are not done perfectly.”

Those with eating disorders tend to be striving for what they may view as the perfect body image. They might be trying to achieve their perception of the ‘perfect weight’. However, it’s important to note that these goal posts can be constantly changing and tend to leave the individual constantly feeling ‘not good enough’. It’s also common to fear what will happen if they don’t stick to their strict rules around food perfectly. In fact, research has shown that those with eating disorders tend to exhibit high levels of perfectionism as a personality trait in general, even after recovery.

Compulsive eating related behaviours

Someone with OCD may display what is known as compulsive eating related behaviours. This doesn’t mean that they have an eating disorder, but from an outside perspective the behaviours may look very similar. For example, someone with OCD might count the exact mouthfuls of food they are eating or the number of calories on their plate to make sure they stick to a ‘lucky number’ or because it ‘feels right’. This can look the same as calorie counting or food restriction in someone with an eating disorder.

Alternatively, someone with OCD who has contamination obsessions might throw out a specific food because they fear it’s contaminated. This can look the same as someone with an eating disorder throwing away foods which may be high in calories. Someone with OCD may ensure that items on their plate are aligned perfectly because they have symmetry compulsions. They might avoid the kitchen to avoid triggering cleaning compulsions. They may only eat food of a certain colour, shape, or texture because it ‘feels right’ or is ‘lucky’. The examples are copious and all look very similar to eating disorder behaviours.

The International OCD Foundation explains clearly: “There are many instances in which patients demonstrate behaviors that at first glance appear to be indicative of an eating disorder, but actually turn out to be a result of OCD. As an illustration, consider the OCD sufferer who may lose weight excessively and appear anorexic yet is doing so merely as the result of contamination concerns or time-consuming rituals that prevent him or her from eating on a regular basis.”

Neurophysiological similarities

Although more research is needed, some work suggests that both OCD and eating disorders share similar differences in the brain. In particular, the prefrontal cortex and caudate nucleus seem to be affected in both types of disorder. These areas of the brain have many vital roles including learning, memory, motivation, emotional control, and impulse control. It’s easy to see how abnormalities within these areas of the brain could contribute to the symptoms of these disorders.

The International OCD Foundation discussed a study on the topic which asked participants with both disorders to carry out tasks using these areas of the brain specifically. The article explains: “The study found that both groups had difficulty with the task and had higher cerebral glucose metabolism, suggesting a connection between the two disorders and offering evidence that, “ritualized obsessive and compulsive behavior (with reference to eating disorders, as well as washing and checking OCD) could have its origin within common neurobiological abnormalities,”

Isolation and avoidance

Isolation and social withdrawal is common within both types of disorder. This is typically to avoid situations which may trigger symptoms. For example, someone with contamination OCD might avoid social situations because they fear a friend may want to shake their hand, which could trigger their fears around germs. Someone with an eating disorder may avoid a social situation because they fear it will involve food and will trigger their symptoms. Individuals may also avoid any other situation which they may find triggering.

Over time, social withdrawal can lead to a breakdown in relationships. It may also be that avoidance causes difficulties in attending work, school, or keeping up with other commitments. This can lead to problems with functioning. It’s common for isolation to lead to feelings of loneliness and depression. This can actually exacerbate symptoms.

Depression

As we mentioned, social isolation can play a significant part in causing a low mood: it’s human nature to need social interaction. The difficulties of living with such debilitating disorders can also understandably lead to depression. Both OCD and eating disorders are extremely challenging and can leave sufferers feeling very negative about themselves and about the future. It can feel as though there is no hope for recovery. The risk of depression leading to self harm, along with suicidal ideation and suicidal actions is high in both types of disorder. .

Problems with relationships

As well as the social withdrawal we mentioned earlier causing issues within relationships, the toll of symptoms in both types of disorder can cause issues. Individual’s might feel that their loved ones don’t understand what they’re going through. Even if loved ones mean well and are trying to help, they might be saying or doing things which are actually unhelpful.

For example, if you have a loved one with OCD you may try to force them to stop their compulsions. Unfortunately, this only worsens their anxiety and isn’t productive. Likewise if you have a loved one with an eating disorder, you may be forceful in trying to get them to eat, but this can actually worsen their symptoms. This can cause the individual with the disorder to become frustrated and short tempered. Loved ones of someone with one of the disorders may feel very stressed and worried, which can also contribute to tense connections.

Differentiating between OCD and eating disorders

A focus on weight and body image

This first difference may seem like quite an obvious one, but it’s important to mention it. Eating disorders are centered wholly around body image, weight, and food. While these factors may play into some small parts of an individual’s OCD, they are far from the whole basis for the disorder.

Motivations behind compulsive eating related behaviours

Although compulsive eating related behaviours can look the same as eating disorder behaviours, the key difference is the motivation behind these behaviours. An individual with an eating disorder is motivated to carry out these behaviours in order to change or maintain their weight or body image. Conversely, someone with OCD is motivated by the cycle of obsessions and compulsions. They are carrying out these behaviours to keep up with the rituals and repetitive behaviours their OCD has set out for them, rather than to lose weight or change their body image.

The motivations behind these behaviours are how we can distinctly tell the difference between the two types of disorder. Therefore during the diagnostic process it’s important for any mental health professional to get to the root of behaviours, rather than just looking at them on the surface. This article explains: “Whereas patients with eating disorders are primarily driven by concerns of physical appearance, and consequently alter their eating patterns in order to lose weight accordingly, OCD patients may be restricting their eating for reasons very different than body image concerns.”

Ego-dystonic versus ego-syntonic relationships with symptoms

While both disorders centre around intrusive thoughts, how these thoughts are interpreted can be very different. For someone with OCD their intrusive thoughts are always highly upsetting because they don’t align with who they are as a person. Their intrusive thoughts can be very taboo and upsetting and don’t reflect the individual’s true thoughts or feelings in any way. The same applies to their actions, which we know as compulsions: they don’t want to be carrying out compulsions, their compulsions don’t reflect their feelings, and the individual finds them distressing.

This is known as an ego-dystonic relationship the individual has with their intrusive thoughts and actions. This article explains that an ego-dystonic relationship with symptoms means, “that they find the obsessions and compulsions in conflict with or aversive to their identity.” This conflict with their symptoms means that people with OCD are very keen to put a stop to their symptoms, even if they find it nerve wracking to reach out for treatment.

On the other hand, someone with an eating disorder may not always find their intrusive thoughts bothersome. This is because their intrusive thoughts align with how they’re feeling (even though these feelings are caused by their disorder). They also don’t always find their compulsive behaviours upsetting, because they line up with their feelings and their ‘goals’. It’s important to note that this doesn’t mean that an eating disorder isn’t upsetting or emotionally difficult.

This relationship with their symptoms is known as ego-syntonic. This article states that an ego-syntonic relationship with symptoms means, “that the person feels aligned with these thoughts and behaviors.” Since individuals with eating disorders feel that their symptoms align with who they are as a person, they may not want to part with them, even if they know this is logically best for them: this can make treatment particularly difficult.

Comorbid OCD and eating disorders

Why the two disorders are so commonly comorbid is not yet known. Experts think it could be due to some of the overlapping factors we mentioned, such as high anxiety; personality traits like perfectionism; similar abnormalities within the brain; and so on. It may be down to genetics or factors in an individual’s personal history. Whatever the cause, there is an undeniable connection between the two.

Either type of disorder on it’s own can be very challenging to live with, but when you pair both together it can make coping with life very difficult. Since both disorders can be worsened by stress, anxiety, and other heightened emotions, it can be a delicate balancing to keep things under control. When one disorder is triggered, it can markedly worsen the other.

Treatment for comorbid disorders can also be more challenging. It can be tough for the individual and professionals to separate which symptoms are caused by OCD and which are caused by the eating disorder. Thankfully, both disorders can be treated together to provide relief for patients with comorbid disorders. We’ll go into more detail about treatment later in this article.

What to do if you have symptoms of OCD or an eating disorder

Talk to someone you trust

One of the first steps you should take is talking to someone you trust. This can feel really frightening and might not be something you want to do, but it’s important you do reach out. Starting with someone you trust, like a friend or family member, can be a good first step on the way to getting help. Once you’ve spoken to that first person, it will get gradually easier to start talking about how you’re feeling and what you’re going through.

Some good tips for making that first conversation easier include letting the person know you have something really important you want to talk about; choosing an environment in which you feel safe to have the conversation; taking your time; and being as honest and open as possible. Once you’ve told someone, they may be able to help you to start your recovery journey.

Find professional help

A next, absolutely vital step is to seek professional help. This can feel overwhelming and you might not want to get help. Particularly if you have symptoms of an eating disorder, thinking about what recovery might entail can feel terrifying. However, it’s vital to think about the future and what’s truly best for you. Remember that getting help is how you can get your life back, find happiness, and be your healthiest self. We’ll discuss how to access treatment later on in this article.

Be proactive with treatment

Once you are actively in treatment, it’s really important that you are proactive. Attend every session and really get as involved as you feel able. Be proactive between sessions in doing ‘homework’ and practicing strategies you’ve been taught. Remember that the professionals are there to help you: you must engage with them and put in the work to get better. It’s hard work, but it will be worth it in the end.

Practice self-care

It’s so important that you practice self-care before, during, and after treatment. Self-care refers to any action you take to look after your physical or mental health. Sometimes when we have a mental illness, self-care can be difficult, especially when we feel really badly about ourselves. However, the more we routinely make self-care a priority, the easier it will become and the more we will see the benefits.

Self care can include doing your best to keep a regular sleep schedule; keeping up with personal hygiene; reaching out when you need help; doing things that bring you joy; attending therapy; and so on. Fundamentally, it’s important to be kind to yourself: treat yourself with kindness and respect.

Find ongoing emotional support

While you’re going through recovery and moving forward after treatment, it’s important you have emotional support. This can be through opening up to your loved ones and allowing them to be there for you. You could also seek support by finding other people who are going through similar struggles to you. You may be able to find local support groups or you could find other people online through social media. There are also lots of charities who specialize in OCD and eating disorders who may be able to pinpoint you to resources, support groups, and who even have helplines you can call to talk to someone.

How to help a loved one with OCD or an eating disorder

Be there to listen

This step always sounds very simple, but it’s sometimes the most effective thing you can do. Simply let them know you’re there for them and be there to listen when they want to talk. You don’t need to know what to say or offer advice, you just need to listen to them. This can help them to feel less alone and encourage them to reach out to you for help when they need it.

Don’t assume

It’s so important not to assume what your loved one is thinking or feeling. Don’t assume reasons for their behaviours or why they have developed their disorder. Even if you have done some research, it’s really important to remember that everyone is individual and will have their own experiences, reasons, and feelings. The charity Mind discusses this in relation to eating disorders saying: “if you interpret someone’s eating problems in a particular way – without really listening to the person themselves – it could add to their feelings of helplessness. It could also make them less able to share their difficult emotions and seek support.”

Don’t try to force them to change their behaviour

As much as you might want your loved one to stop their compulsions or to eat in a healthy way, it’s not as simple as that. Trying to force someone to change their behaviour not only minimizes what they are going through, it can actually make their symptoms worse.

Help them seek treatment

Gently encouraging your loved one through the process of seeking treatment can be incredibly helpful. As we mentioned above, don’t try to force them to go to treatment, but instead try to help them find ways to make it work for them. When they’re ready to seek treatment, you could offer practical support such as taking them to appointments, being there for moral support, and even engaging in therapy sessions with them if they feel comfortable with the idea.

Help them find positive, reliable information

If your loved one wants to do research about their symptoms and find out more, this is really positive. The more they learn, the more self aware they will be and the better they will be able to help themselves. However, some information online may be unreliable or triggering. You can help them by finding trustworthy resources for them to read, such as mental health charities and educational resources.

Be patient

Remember that recovery will take time. Progress may look like very small steps forward and there will be setbacks along the way. Be patient and gentle with your loved one and understand that they are likely doing their very best.

Don’t comment on their appearance

If your loved one has symptoms of an eating disorder, it’s really important you don’t comment on their appearance, even if you think it’s in a positive way. This can be really triggering for them. Instead you can ask more neutral questions such as ‘how are you?’ or give more neutral compliments like ‘you’re an amazing person’. You can find lots of resources online about how to talk to someone with an eating disorder.

Look after yourself

Lastly, it’s extremely important that you take good care of yourself. If you are burnt out emotionally or physically, you can’t be there for your loved one properly. Make sure you’re practicing self-care, taking breaks, and talking to someone about how you’re feeling.

Treatment options for eating disorders

Medication

There are no medications specifically designed for eating disorders, but you may be offered some medication to treat underlying problems such as depression and anxiety. The medication most commonly offered is antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It’s also possible you may be offered an antipsychotic.

These medications help to lessen anxiety and stabilize your mood. They’re typically used to ease symptoms while you engage in therapy to address the eating disorder more specifically. Psychiatric medications do have potential side effects, so it’s important to talk things through thoroughly with your doctor before starting any medication.

Nutritional education

Nutritional education helps to teach you about your disorder so you can better understand what is going on in your mind and body. You’ll also learn about how and why changing your eating habits will work and enable you to recover. The goal is to give you the information and skills you need to recover and to cope going forward after treatment is complete. This article explains: “Educational lessons include information on the basics of nutrition, the negative impact of starvation on the body, and how to develop healthy meal plans and a pattern of eating regularly.”

Refeeding

If you are underweight, particularly if your physical health is in jeopardy, it’s likely that refeeding will be introduced. This article from Mind explains that refeeding: “means being given food with the aim of bringing your weight up to a healthy level – it involves helping you to gain weight so that your energy levels and your physical health improve.” You might be given specific or specialized foods to help you gain weight. This can understandably be a difficult process but it will be done gradually and with plenty of support.

Cognitive behavioural therapy for eating disorders (CBT-ED)

CBT-ED is a specialized form of CBT which helps you to look at the thoughts and behaviours which are fuelling your eating disorder. Over time you’ll learn to change unhelpful thoughts patterns and behaviours, and instead will be equipped with the skills to replace them with more positive, helpful thoughts and actions which will enable you to recover.

Mindfulness

Mindfulness is a process that involves being present in the moment, acknowledging thoughts and feelings without judgement. This can be done through meditation, visualization, breathing exercises, and mindful movement. Guided mindfulness techniques are sometimes used as part of eating disorder treatment to promote relaxation and help you to better control your emotions.

Family therapy

Attending therapy as a family can help to deal with any family issues which are contributing to your eating disorder. It can also allow family members to better understand what you are going through and learn how to properly support you.

Treatment options for OCD

Medication

Just as with eating disorders, there is no medication specifically to treat OCD, but medication is sometimes used to ease anxiety and help to stabilize your mood. Selective serotonin reuptake inhibitors (SSRIs) are typically prescribed for those with OCD.

Cognitive behavioural therapy (CBT)

CBT is the first line of treatment for OCD. Through CBT you will be guided through replacing negative thoughts and actions which are contributing to your OCD. You’ll learn to break the OCD cycle and implement positive coping strategies to help you overcome your disorder.

Exposure and Response Prevention (ERP)

ERP is the primary form of CBT used to treat OCD. Through ERP you will gradually be exposed to your obsessions and learn to face them without reacting with a compulsion. Over time as you see that nothing bad happened when you didn’t carry out a compulsion, anxiety will ease and you will feel more in control. This actively breaks the OCD cycle. This sounds scary and can be difficult, but the treatment is proven to work and is done gradually with guidance.

Acceptance and commitment therapy (ACT)

ACT is another option for OCD treatment. While it isn’t the first treatment recommended, it can be useful for some patients and has promising results. Rather than trying to change thought patterns as with CBT, ACT focuses on helping you to accept your thoughts. You’ll learn how your thoughts are influencing your behaviours and learn to change your behaviours to break the OCD cycle.

Mindfulness

Guided mindfulness techniques are often used as part of OCD therapy. Mindfulness can be helpful in helping patients relax; reducing anxiety and stress; encouraging greater emotional control; improving sleep; and helping to make other treatments more effective. Once you learn the skills of mindfulness, you can carry them forward to help you cope even after treatment has ended.

Treatment for comorbid OCD and eating disorders

When the disorders present comorbidly, they should be treated at the same time. This is primarily because one disorder can influence the other. If one disorder was treated before the other, the untreated disorder could easily trigger the other, causing continual relapses during treatment. Although treatment for comorbid OCD and an eating disorder can be more challenging, it is possible to successfully treat the two disorders together.

As you can see from the treatments we have discussed for the disorders individually, there are many overlaps in treatment. The International OCD Foundation explains that treatment typically involves: “some combination of cognitive-behavioral therapy, antidepressant medication, and family counseling.”

Antidepressants can help to control anxiety and lessen symptoms of depression caused by both disorders during treatment. Mindfulness can also be useful to promote relaxation during comorbid treatment. CBT will commonly be used to address both disorders, as it’s format works well in addressing symptoms of both eating disorders and OCD.

ERP is often used to treat the two disorders at once, since eating disorders also cause compulsive behaviours. ERP can help patients face their fears stemming from both disorders and teach them gradually that they don’t need to be afraid. This article explains that ERP for eating disorders will often be centred upon, “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.”

During comorbid treatment it’s really important that patients are monitored closely to aid them in their progress and ensure they are coping with the demands of treatment. If you’re going through treatment, it’s also vital that you have personal support during this time. Make sure you talk to your loved ones and let them be there for you. Family treatment is often used for comorbid disorders to help family members learn how to better support their loved one.

Accessing treatment

Seeing your doctor

Your first option is always to go and see your doctor, particularly if you are not already under the care of a mental health team. Talk to your doctor about what you have been going through. They should be able to refer you to a mental health team or for psychological therapy. Depending on where you live, you might also be able to self refer. It’s important to bear in mind that this typically involves being on a waiting list as demands are high. How long the wait will take depends on where you live.

Through your mental health team

Once you’re under the care of a mental health team, they will be able to guide you through getting the psychological treatment you need. If they don’t bring up a specific therapy that you feel would work for you, speak up and ask about your options.

Private treatment

Private therapy allows you to access treatment quickly, when you want it. However, it can be a very costly option. If you feel this option is for you, make sure you do your research and find a therapist who is appropriately qualified.

Online treatment

Online treatment programmes allow you to access treatment quickly, in the comfort of your own home. They let you work through the treatment programme at your pace, and are a more cost effective option than private treatment.

Inpatient treatment

If you are very unwell, particularly if you have an eating disorder and are very underweight, you may be referred to inpatient treatment. This means that you go to stay in a hospital or clinic for a little while. This can sound scary but you will be surrounded by a team of specialists who can help to get you healthy again and equip you with the tools you need to cope when you leave to go home.

Whichever treatment method you choose, ensure you take your time to do what is best for you. Remember that even though it is hard and at times, might feel like climbing a mountain, your journey to recovery is worth the hard work! You can recover and reclaim your life!

References

The American Psychiatric Association, (2017), “What Are Eating Disorders?”

Mind, (2017), “Eating problems”.

NHS, (2018), “Eating disorders”.

Bethany Kregiel, (2020), “Eating Disorders and OCD: A Complicated Mix”. Walden Behavioral Care.

OCD UK, (2020), “Types of OCD”.

McCallum Place, (2019), “The Illusion of Control in the Development of Eating Disorders”. Eating Disorder Hope.

Calm Blue Waters Counselling, (2020), “Is it an eating disorder or OCD?”

Beyond OCD, (2019), “Need for Perfection”.

Lauren Muhlheim, PsyD, CEDS, (2020), “Perfectionism in Eating Disorders”. Very Well Mind.

Fugen Neziroglu, PhD, Jonathan Sandler, BA, (2009), “The Relationship Between Eating Disorders and OCD Part of the Spectrum”. International OCD Foundation.

American Addiction Centers, (2018), “Treating Anorexia with OCD”.

Makenzie Teramo, (2019), “The Relationship Between OCD and Eating Disorders”. Integrated Eating.