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Recently, my therapist and I explored the origin of my eating disorder and the co-occurring mental health issues that I may or may not have experienced. I only recently learned that those who have eating disorders such as Anorexia, Bulimia, or Binge Eating Disorder (BED) often experience other mental health issues. These can include (but are not limited to) depression,generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.
Studies show that about two-thirds of people with eating disorders also suffer from an anxiety disorder, most commonly obsessive-compulsive disorder or OCD. In fact, those diagnosed with eating disorders like Anorexia or Bulimia are anywhere from 11 to 69 percent likely to develop OCD. Eating disorders and anxiety disorders share traits that contribute to their development and account for the high rate of co-morbidity.
What is Obsessive-Compulsive Disorder?
People who have obsessive-compulsive disorder struggle with either obsessions or compulsions, or (more commonly) both. Obsessions are frequent and recurrent thoughts or impulses that affect daily life and can sometimes be inappropriate (i.e. sexual in nature or causing self-harm). The thoughts someone with OCD experiences are usually intense and recurring. Someone may attempt to ignore, suppress, or stop the thoughts by doing some other action--a compulsion. Compulsions are repetitive actions that are performed in response to an obsession. Common compulsions are hand washing, body checking, counting, or repeating words. Someone experiencing OCD likely knows that their thoughts or actions are excessive and unreasonable, but continues to engage in them anyway. The line between healthy and unhealthy obsessions is necessarily grey, but if an obsession or compulsion is getting in the way of life, it's probably an issue.
How OCD and Eating Disorders Mix
People with eating disorders and people with OCD experience intrusive thoughts and compulsive actions. But for people who only experience an eating disorder, obsessions and compulsions are typically limited to thoughts and actions about food and/or weight. Chewing and spitting (which I wrote about here) is a common compulsion related to eating disorders, as well as body checking, calorie counting, weighing oneself, or eating specific foods or only during specific times. When a person with an eating disorder also has obsessions and compulsions about other areas of their lives (not only around food), they may also be experiencing symptoms of OCD.
A 2003 research study found that women who experienced OCD in childhood are at a higher risk for developing an eating disorder later in life. Individuals who suffer from Anorexia commonly diet and exercise excessively while those with Bulimia usually develop a vicious cycle of bingeing and purging. Sometimes (as with yours truly), people engage in both. Those with anorexia often have distorted body image, an irrational fear of gaining weight, and other food-related obsessions. Those with bulimia usually consume large quantities of food, causing enormous guilt and shame and a desire to purge. Bingeing is also accompanied by feeling out of control. In both cases, the obsession with controlling ones body causes high levels of anxiety that can only be reduced by ritualistic compulsions characteristic of OCD.
As with OCD, compulsions are commonly strengthened by other personality traits, such as uncertainty, meticulousness rigidity, and perfectionism. If you ask an Anorexic if he or she is a perfectionist, they will likely laugh--of course they are. But Anorexics also often exhibit overvalued ideation (the tendency to cling to their beliefs despite evidence to the contrary), cognitive distortions such as all-or-none thinking, and attempts to gain control of their environment. For Bulimics, the need to feel relieved of the obsessive guilt and shame following binges causes them to compulsively purge the food they consumed, repeating the cycle over and over again. Perfectionism, an excessive desire for social approval or acceptance, and bouts of anxiety or depression are also common.
Molly Seidel, professional Saucony long-distance runner and Olympic marathon qualifier said, "With OCD, you just have this anxiety all the time and feel like you can’t control anything, so you develop patterns and behaviors. I would compulsively knock on things in specific patterns because you feel like you have some control over the universe. Over time with running, it developed into turning my eating or my running into a control mechanism."
Both eating disorders and OCD are rooted in the desire for control, so the fact that they often overlap is hardly surprising.
Diagnosis and Treatment
OCD and eating disorders mirror each other in many ways and it can therefore be difficult to differentiate between the two. Clinicians will likely examine the specific behaviors an individual exhibits and the motivations behind those behaviors. Whereas patients with eating disorders are primarily driven by concerns of physical appearance, OCD patients may be restricting their eating for reasons very different than body image concerns. Furthermore, for cases in which an individual qualifies for both diagnoses, such as an Anorexic or Bulimic who also experiences non-food related OCD symptoms, like checking, knocking, or hand washing, it is still imperative to consider whether or not their symptoms are being motivated by both disorders simultaneously. The treatment for both conditions involves some combination of cognitive behavioral therapy (CBT), medication if necessary, and individual or family counseling.