If you struggle with Obsessive Compulsive Disorder alongside your eating disorder, you are not alone. I did too! There is a markedly elevated risk for OCD among those with eating disorders, according to the National Eating Disorder Association. If you are someone who struggles with multiple disorders, you are not alone and professional treatment options will help you manage the symptoms. In this article, we will explore the connection between eating disorders and OCD.

According to the National Eating Disorder Association, 69% of patients with anorexia and 33% of patients with bulimia suffer from OCD. This is compared to 1.2% of the overall US population and 2% worldwide according to the National Institute of Health.

According to the American Psychiatric Association, “Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person’s daily activities and social interactions.”

OCD is a serious disorder that negatively impacts the day-to-day life of those who suffer from it. The unreasonable obsessive thoughts and resulting compulsive behaviors are not easily dismissed for fear of the result. The persistent intrusiveness creates mental and physical distress. OCD obsessions and compulsions can generally be categorized into subtypes, but you may not fit into one specific subtype. You could also fit into many different subtypes. It’s also important to recognize that anything can become a compulsion. The thoughts and behaviors are uniquely exemplified in individuals with eating disorders compared to those without. Now, we will explore just a few of the common OCD subtypes.

Contamination:

One becomes obsessed with germs and toxins which can result in excessive food and hand washing, changing clothes often, and creating “clean zones” in their environment. The fear of illness from germs overrides all thoughts of normal exposure and cleanliness. OCD creates a deep overriding fear that without the compulsive behaviors, the individual will risk severe consequences. Individuals with eating disorders can develop a fear of contaminated foods. The current rise and misinterpretation of “clean” eating and organic foods is causing an increased number of fear foods.

Just Right:

The obsession with symmetry and exactness resulting in extreme organization, arranging, or counting may force the person to stop eating in public. Individuals unrealistically fear the consequences of not executing a counting ritual or things being out of order. They will move their silverware or drinking glass to a certain location, and count or lift them a certain number of times. They may only eat at specific times or locations. These behaviors result in social isolation and negatively impact personal relationships.

Checking and Rechecking:

Individuals will compulsively check and recheck light switches, door locks, electronics, candles, etc. They experience extreme difficulty in leaving their home and staying away for fear of what they may have forgotten. The rechecks may require a specific pattern or counting ritual (three rounds of checking the stove followed by four rounds of locking and unlocking the entry door). Their daily lives are dictated by constantly reviewing what they have previously done to safeguard them from the responsibility of causing harm. For more information on unconventional subtypes of OCD, check out this article from Jenna Overbaugh: Exploring Uncharted Territories: Unconventional Subtypes of OCD.

Dysorexia is the pattern of disordered eating closely related to OCD. Individuals develop extreme selectivity in their eating, slowly removing foods with certain textures or colors. They may begin food hoarding as a comfort mechanism to ensure that “safe” foods are available.

Orthorexia is a disordered eating pattern that can also fall into the realm of OCD. Individuals are obsessively compelled to eat only “clean”, pure, non-toxic foods and ingredients. Their behaviors become more restrictive as the illness progresses and oftentimes is combined with excessive exercise.

What does Treatment Look Like?

Successful treatment for eating disorders with co-occurring OCD is individualized and may include medication or specific brain treatments. Exposure Response Therapy is one of the most successful forms of Cognitive Behavioral Therapy (CBT) for individuals with eating disorders and OCD, however, everyone responds to treatment differently. Clients can also work with eating disorder coaches through facing fear foods until the individual has successfully rewired negative thought patterns and gained confidence in understanding that the perceived consequences are no longer a threat. The International OCD Foundation has a resource directory where you can find therapists, clinics, support groups, and other organizations specializing in OCD in your area. Their website also has a wealth of resources, and ways you can get involved. NOCD is another fantastic resource that offers affordable and convenient therapy, and they are covered by many different insurance plans. Their therapists are trained in ERP (Exposure and Response Prevention) and understand all of the different subtypes.

In conclusion, managing eating disorders along with OCD and general anxiety disorders is frustrating and can lead to a serious cycle of unhealthy negativity. Early intervention is best along with continued mindfulness and recovery care. Thankfully, there are a multitude of resources to help you recover from both your eating disorder and OCD. I also highly recommend Jenna Overbaugh’s podcast, All The Hard Things. Jenna is a licensed therapist who has been working with people with OCD and anxiety since 2008. She has a fantastic blog, newsletter, free masterclass, and a newly launched online course. Her resources are incredibly helpful to anyone struggling with OCD. I highly recommend checking out her website here!

Recovery is possible.

If you need more support on your eating disorder recovery journey, I would be honored to work with you as your eating disorder recovery coach. I offer a free 25-minute consultation call, you can ask me all the questions you may have and see if I seem like a good fit for your journey. Please contact me here for 1:1 private eating disorder recovery coaching. Full recovery is possible for everyone!

Merrit Elizabeth

Merrit Elizabeth Stahle is an Eating Disorder Recovery Coach certified by The Carolyn Costin Institute. She holds a master’s degree in Health Promotion Management and a certification in Applied Neuroscience. She is fully recovered from an eating disorder and she has years of experience working with women with eating disorders.