OCD and Eating Disorders

By tiverylucky,freedigitalphoto.net

By tiverylucky,freedigitalphoto.net

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.

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20 Responses to OCD and Eating Disorders

  1. This whole is it OCD or is it an eating disorder issue is really complicated isn’t it? It really points out how important it is to understand the purpose of a behavior, doesn’t it? A workout partner of mine grew up with debilitating OCD and knows all about what we deal with in our family. At one point when she was still a teen, her therapists thought she had an eating disorder since she was severely restricting her food intake. It turned out it was OCD thinking. She has this belief that she had to adhere to PERFECT intake of nutrients each day to be healthy, or something bad would happen. She had such a difficult time getting the nutrients to balance the right way that she barely got any food into her before she burned out and got exhausted. Luckily, her treatment team figured it out.

  2. 71º & Sunny says:

    I had a very knowledgeable psychologist once tell me that essentially, Anorexia was an OCD spectrum disorder. I believe it. The focus may be different, but the thought processes are very similar (including many cognitive distortions, desire for perfection, etc.) and there certainly are compulsions that go along with those obsessions. Rogers in Wisconsin is a well known OCD residential treatment center and they also have an eating disorders center too. I heard at the OCD conference last summer, from one of their top doctors, that they have added CBT to the eating disorders treatment plans. I asked him what was the success rate of treatment of their eating disordered patients versus patients in other eating disorder treatment centers. I wasn’t surprised at the answer. He said, “as good or better.”

    • That’s so interesting Sunny, and I’m glad to hear about Rogers’ success with CBT and eating disorders. I find eating disorders frightening as the stakes are so high; the compulsions can lead to death. We certainly need successful treatments. Thanks for sharing.

  3. Rose says:

    Very informative, Janet. I appreciate your knowledge and really think you are helping people out here on the interwebs.

  4. Patty says:

    Hi Janet,
    It amazes me how relavent your posts are to my OCD! I started therapy in my mid-20’s for an “eating disorder” which cropped up the same time my OCD symptoms really ramped up (trauma trigger:my Dad passed away). Long story-short, the therapy did not help. I have not mentioned in any earlier comments, but my main OCD symptoms involve hoarding food, rearranging the pantry/fridge until they are “right”, donating expired items, tossing perishable items on their expiration date and restocking. Until starting ERP, I would spend so much times reading labels for nutritional values and searching for containers with the longest expiration date. I would buy healthy foods I would eat, foods I would eat occaisionally (meaning once the box was open I wouldn’t eat anymore), and foods that I knew I would never eat, but thanks to magical thinking…I would buy them anyway. At one point I had to have a certain brand of crackers in my pantry or I feared something would happen to one of my brothers! The grocery store was one of my favorite places to be. I am now going through daily exposures with my pantry, as well as with my food shopping. It is one of the hardest things I have ever had to do, but I know that it will all pay off! Thanks again for your post! Best wishes, Patty

    • Thank you for sharing your story, Patty, and I am so sorry things have been so tough for you. One thing I’ve learned about OCD is that when I hear of people having “unusual” compulsions, invariably there are many OCD sufferers out there who say, “Wow, I do that too!” My guess is you’ve helped a lot of people not feel alone by posting your comment. I am so glad to hear you are moving forward with ERP. As you say, it’s not easy, but the pay off is huge. Good Luck and please keep me posted!

  5. This is very interesting, Janet. I had something go haywire with my eating when I was 19 years old, and to this day, I don’t know if I had the beginnings of an eating disorder or if it was a new way for OCD to present. I guess, as you say, labels don’t matter. But I was obsessed with the number of calories I ate. I wanted to get thinner, though.

    But I have also struggled with not wanting my lips to touch utensils, especially those in a restaurant. I think that was related to contamination issues. It has become such a habit that I still notice that i sometimes “pull” my food off the fork with my teeth. I don’t think it adversely affects my life–I still eat out–but I do think it’s a holdover from my OCD contamination days.

    • I think your comment shows how entwined eating disorders and OCD can be, Tina. And also how the degree of your thoughts can turn them into obsessions. I mean, who among us hasn’t counted calories before? But when you become obsessed with these thoughts, well that’s a different story. Thanks for sharing and I’m glad you still eat out, because it’s fun 🙂

  6. Tea and OCD says:

    This I can understand. I just had a month and a half food compulsion that came about during a really bad OCD episode and the trigger was surprising. I ate the EXACT something for lunch and supper everyday in the same bowl with same fork. I don’t eat breakfast but it was the same food and I used to do that when I was younger and sit in same spot eat something and had to have supper at certain time. Latest episode came about and knocked me for a good while. It makes no logical sense but did at the time.

    • You said it! “It makes no logical sense.” It sounds as if this OCD episode did not revolve around weigh/body issues at all, but was “classic OCD,” as opposed to an eating disorder. I hope you are doing well now and wish you all the best. Thank you for sharing!

  7. Abigail says:

    Sometimes when my OCD and depression are on the rise, I have “safe” foods and not-so-safe foods. Safe foods include pizza (particularly deep dish frozen pizzas, and a certain brand is the safest – no, wait, I switched to the french bread pizzas, same brand, though. And cereal, especially raisin bran, is safe. Milk isn’t so safe, though. And it sometimes centers around me not wanting to feel sick (conveniently, or not so conveniently, I can feel sick for either too much or too little food). Especially around when I’ve had the stomach flu.

    But my eating issues aren’t an eating disorder (I don’t think). There was a time when I was afraid I wasn’t eating enough, so I was afraid of being underweight, but that sounds more like being afraid of having an eating disorder (i.e., OCD) than actually having one.

    I read a book, “Brave Girl Eating,” which was really good, about a girl with an eating disorder, and I really felt for the girl because the thought processes were so similar to OCD. And I really loved how the mom recognized how brave her daughter was in making herself eat.

    • Hi Abigail, Thanks so much for sharing and I agree that what you describe sounds like OCD. I also read “Brave Girl Eating” and nodded my head through the whole thing because I had all the exact same feelings and thoughts as the author (the mom) of the book. No question to me there is a relation between OCD and eating disorders.

  8. va says:

    I love this post. While I did wander dangerously close to an eating disorder my senior year, and my behavior now from the outside might look like severe anorexia at times, the eating issues now are completely OCD-driven, not at all linked to anorexia. I am lucky enough to have a counselor who understands the difference and has been amazing through my most recent struggle…two and a half weeks ago I completely stopped eating and drinking b/c my OCD got triggered really bad…although I am sure it is probably scary for a counselor to hear that someone is not drinking anything and not eating anything, my counselor didn’t show that fear and didn’t try to scare me into it (which probably would have just made the anxiety go so much higher it would have become even less feasible). Instead she was really gentle and caring and let me know if her door was open I could feel free to stop by if I was available, and although she was about to go on vacation, over the few days she was still around I got to a point where I was at least eating something three times a day and drinking a cup of water everyday. Eating and drinking were so stressful that I was crying each of those three times a day I had to get food to my mouth, but though refusing food and water is characteristic of anorexia, I would have been super offended if anyone had suggested I had an eating disorder…

    • I am so sorry things have been so difficult for you va,and have seen firsthand how tormenting eating and drinking can sometimes be for those with OCD. I’m glad you have a counselor you feel comfortable with and wish you all the best as you move forward toward recovery.

  9. Karen jones says:

    Va, so sorry to hear of your trouble although it sounds like you have a good therapist. Our son has just stopped eating and drinking due to his Ocd which had been under control. Now my son sees images in his head that stop him from eating etc. He can’t get a therapist for a week. Can you explain what /how your therapist helped please. We’ve all been telling him if he doesn’t eat/drink he’ll be in hospital and make matters worse. So scarring him into eating. The opposite of what your therapist seems to have done. Any help at all- even your therapist details would be welcome as he’s loosing weight fast but dehydrating too. Doctors know has he’s now taking mitazapine to help his mood and appetite fast.thank you.

    • Hi Karen, I’m not sure if Va will reply but if your son is severely dehydrated I strongly suggest taking him to a hospital emergency room where they can at least give him intravenous fluids. Dehydration can be dangerous. I hope the therapist he will be seeing is trained in ERP therapy and has successfully treated OCD. I wish you and your son all the best as he works to get his OCD under control.

    • Wiggle Worm says:

      Hey! It’s va (I have a new online moniker now)…I told my therapist when I was triggered really badly that I wasn’t able to eat or drink but it was so bad that I wasn’t going to be able to be convinced to do it. She challenged that a little but mostly respected that I wasn’t ready to try it. The next day I let her know that if she had any openings in her schedule again that I couldn’t eat on my own but I was ready to be pushed and try. She had me come in with my food and left me alone for a few minutes while she heated her own food after asking if it would be helpful or triggering for her to eat as well. I played with the spoon and ate nothing. She pretty much just said this is how much time we have, do you think you can take a bite, and asked me how I was doing. She attempted to make conversation to distract me but that was making me cry because it was taking all the concentration I had to force the food into my mouth. She attempted to give me a water bottle and take a drink, but when I refused she just let me know that she’d be there if I wanted it later. (I definitely didn’t). It was really good to finally get some food in my body.

      I don’t feel comfortable giving my therapist’s details, because while this story shows the very small good side of her, on the other more dominant side she was abusive and I am dealing now with the repercussions of the abuse. I thought so little of myself then that I didn’t understand that what she was doing to me wasn’t okay, and I thought I could make it better if I could figure out how to live up to her expectations of me, but now I know that I should have gotten out of the relationship and found someone who could help me without creating a different problem in the process. I don’t want anyone else to be hurt by her. Trust me, the bad far outweighs the good. I am certain with another therapist I could have seen a similar or better results without the abuse that was occurring at the same time. Even in that encounter with helping me eat, while I wouldn’t she was abusive in that encounter, she still needed to try to make me happy for her for one of her accomplishments…not the time and place for that, and a bit of a boundary violation.

      I agree with Janet though, that if he is severely dehydrated it might be time to give him an ultimatum to either drink or go to the emergency room. It will most likely be terrifying for him, but you don’t want to lose him because it is more comfortable in the short term…and sometimes an ultimatum really might be what he needs…and like is known in the eating disorder world, it is important to re-nourish the body before the mind will work well enough to be able to process and learn to do anything differently. If he hasn’t been eating and drinking for a while his brain function may be compromised enough that you won’t really make any progress until his body has the nutrients to function properly. I might be careful in how you present it to him so that he doesn’t see you as the enemy, but I know that at least for me when I got over the wall and got a little food and water in me, it made getting the rest of the way a lot easier–I could lean back a little on that I had had a little and was still okay, but more importantly, I was still deeply ensnared in OCD, but I really could tell a difference in my thinking and functioning after I had eaten. Every bite was a terrifying struggle, but once I had the food in I really did notice a difference in a good way. It took a few weeks before I was eating anywhere close to normally again, but even just celebrating the accomplishments of 5 cheerios and a sip of water in the morning before school was vital in my success (positive reinforcement).

      Sorry this is really long. I hope it helped at least a little to answer your question.

      • Thank you so much for taking the time to respond, va. So much of what you say was true for my son as well, especially the effects on the mind of dehydration. I did end up taking him to the emergency room where he was also diagnosed with hypokalemia (low potassium) from not eating or drinking. What a difference in his thinking and demeanor once he was rehydrated! Thanks again for sharing and I hope things are going well for you.

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