The complex relationship between OCD and eating disorders

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by distressing, intrusive thoughts or images known as obsessions. These thoughts can cause significant anxiety and discomfort. To alleviate the distress, people with OCD engage in repetitive behaviors or mental acts called compulsions. They perform these compulsions in response to the obsessions, aiming to reduce anxiety or prevent a feared event.

Eating disorders (EDs), on the other hand, are a different type of mental health condition. They create unhealthy relationships with food and interrupt a person’s ability to nourish their body properly, often leading to serious health consequences and significant physical and psychological challenges. 

OCD and EDs are two distinct mental health conditions that often occur in the same person at the same time. This is called having a co-occurring condition. If you’re concerned that you might have an ED, OCD, or both, effective treatment is available. The first step toward recovery is learning more about these conditions, including what they have in common and what sets them apart.

How OCD and eating disorders are related

Research shows that people with EDs have higher rates of OCD, and vice versa. We don’t know if one of these conditions can be considered a standalone cause for the other. But the evidence is clear: OCD and EDs often go hand in hand.

Sometimes, OCD and EDs can be mistaken for one another. This is because a person can have an obsession related to food or eating that can look similar to disordered eating. In addition, both OCD and EDs involve intense anxiety, unwanted thoughts and feelings, and ritualistic behaviors. Let’s review some examples to explore how these similarities can take shape.

How OCD can affect your relationship with food

A form of OCD known as contamination OCD causes intense fears of germs and getting sick. So a person with this condition may repeatedly sanitize every surface in their home and follow a specific protocol for cleaning their groceries before eating them. They also may not eat at restaurants or other peoples’ houses, since they can’t clean the food there. 

So other people may never see them eating during social outings, family celebrations, or work events. To the untrained eye, their refusal to eat could appear to be due to anorexia, an ED that involves severely restricting one’s food intake, while it’s actually OCD.

How eating disorders can affect your relationship with food

Bulimia is an eating disorder that causes a cycle of binging large amounts of food and later purging the food from one’s body, often either by vomiting or using laxatives. After binging, a person with bulimia feels compelled to remove the food from their body, and they feel intensely anxious and distressed if they can’t. 

They may feel trapped within this cycle that impacts their mental and physical health each day. But just like a compulsion temporarily reduces anxiety for a person with OCD, binging has a similar effect for a person with an ED. So on the surface, purging could be mistaken for a ritualistic behavior brought on by OCD.

Do you have OCD, an eating disorder, or both?

The difference between OCD and EDs is incredibly nuanced. Symptoms can vary from person to person and can change over time. But it might be helpful to think about the core difference between OCD and EDs in terms of how they relate to a person’s identity. 

Typically, OCD symptoms are egodystonic. This means they are at odds with a person’s values and how they see themselves. But with EDs, symptoms tend to be egosyntonic. This means that symptoms complement or reinforce a person’s idea of their idealized self. 

In other words, most people with OCD are deeply troubled by their obsessions and compulsions. They desperately want to be rid of them. By contrast, people with an ED may value their illness. They may see it as a way of achieving their goals, despite its life-threatening effects.

It’s also important to keep in mind that you can have OCD and an ED at the same time. In that case, for treatment to be effective, your providers must address both conditions at the same time. A mental health provider can conduct a professional assessment to ensure that you receive an accurate diagnosis and appropriate support.

Treatment for OCD and eating disorders

Treatment for OCD and EDs requires a multidisciplinary approach. This means monitoring a person’s physical and mental health at the same time. Some of the most common support options for co-occurring OCD and EDs include:

• Individual therapy: Exposure and response prevention (ERP) is a form of cognitive-behavioral therapy designed to reduce the stress response brought on by triggers. It can be tailored to focus on food and eating. 
• Family therapy: Since OCD and EDs can impact the family unit, it can be helpful to work with a therapist together to improve communication and heal relationships.
• Medication: Sometimes, certain medications are used in the treatment of OCD and/or EDs. You can talk to your provider about whether medication is right for you. 
• Medical supervision: Since EDs can lead to serious medical complications, doctors and nutritionists will likely be a part of your treatment team. 

Find care with Rula

Since both OCD and EDs can involve upsetting and unwanted thoughts and behaviors related to food, it can be hard to tell the difference between them. But if you’re struggling with your relationship with food or eating in any way, know that help is available. 

At Rula, our extensive network includes therapists who specialize in treating co-occurring conditions like OCD and EDs. In just a few clicks, you can explore our digital platform and find an in-network therapist you can meet with at a time and place that works for you. When you need accessible, affordable, convenient care to strengthen your mental health, we invite you to use Rula.

Get started with Rula today