There was a time when my son Dan would go days at a time without eating. When he did eat, it would have to be specific food at specific times in specific places. There was no negotiating with him, and his health suffered. You might think he was obviously suffering from an eating disorder.
But he wasn’t. He was dealing with severe OCD.
While it can be argued that both OCD and eating disorders involve obsessions and compulsions, as well as the need for control, those who suffer from eating disorders typically obsess over their weight and/or body image. My son was not focused on either. His eating (or not eating) rituals stemmed from magical thinking, a cognitive distortion that is common in those with OCD. Maybe something bad might happen if he ate on Tuesday, for example. Eat that peanut butter sandwich before midnight and someone he loved might die. Others with OCD might restrict their food intake for other reasons, perhaps because they are concerned about germs and contamination.
In this great article on the OCD Center of Los Angeles Blog, Kimberley Quinlan discusses the similarities and differences between OCD and various eating disorders. Interestingly, orthorexia, a condition where sufferers obsess over eating a perfectly healthy diet, is the eating disorder (not yet listed in the DSM-5, but included in the category of “Avoidant/Restrictive Food Intake Disorder”) that is most similar to OCD. Obsessions revolve around health, and not weight and/or body image. Examples of compulsions include an inordinate amount of time reading labels for nutritional content, and avoidance of social situations where food choices might be questioned or challenged. So is orthorexia an eating disorder or a type of OCD? Are all eating disorders a subset of OCD? How do we classify these disorders and what does it all mean?
I’ve written before about my feelings about getting too caught up in the labels of brain disorders. Whether we are talking about OCD, eating disorders, GAD, depression, or other illnesses, we are just using words to describe specific symptoms, which often overlap. I think, in many cases, these labels are more helpful to health care professionals than sufferers, as they allow for diagnoses to be made. And the right diagnosis will hopefully lead to the right treatment.
Not surprisingly, Cognitive Behavioral Therapy (CBT) can be successful in treating eating disorders, just as it is with OCD (ERP therapy is a type of CBT). It follows that when symptoms of disorders overlap, treatment plans might too.
Both OCD and eating disorders can be devastating, even deadly, illnesses. They need to be diagnosed by competent health care professionals and then attacked full force. The good news is they are both treatable, and with the right therapy, sufferers can recover.