Eating Disorders and OCD – Why They Co-Occur
People with eating disorders (ED) have a nine times greater risk of developing lifetime obsessive-compulsive disorder (OCD). In a recent Journal of Psychiatric Research article, a study by Drakes, Fawsett, Rose, et al. also found that those with EDs were at eight times greater risk for current OCD.
Eating Disorders and OCD
Both eating disorders and OCD can result from what I call “dysregulated anxiety.” Anxiety in and of itself is a normal emotion. For example, the discomfort before a test or a presentation can drive one to study and prepare well. And anxiety, when regulated/controlled, is not necessarily negative. For example, taking deep breaths, meditating, or using positive self-talk can control feelings of anxiety. However, anxiety can spiral into more maladaptive and even automatic coping mechanisms when it becomes dysregulated.
Furthermore, the more frequently a specific behavior is used to regulate emotion, the more ingrained (more robust) the neuropathway associated with that emotion becomes. This is true for both eating disorders and OCD.
Examples of Maladaptive Coping Mechanisms:
The more often an individual uses hand washing, for example, to regulate irrational/dysregulated fears about germs, the more frequently they will need to use that mechanism in the future.
The more often an individual uses food restriction to regulate their anxiety, perhaps because of a lack of control in some area of their life, the more frequently they will feel “compelled” to restrict food in the future, particularly when they feel a sense of chaos or lack of control.
Examples of Treatment:
The treatment for both eating ED and OCD is similar.
It is working to identify and resolve the source of the dysregulation through psychotherapy, medication, neuro-behavioral therapies, etc. The source may be biochemical or trauma-related. It may also be a combination of biochemical factors and trauma. The source of dysregulation may determine the treatment plan.
Exposure and Response Prevention (ERP): Exposure refers to the trigger that makes a person anxious. In ERP, you are exposed to distressful thoughts, images, situations, and objects. This goes hand in hand with the support and practice of new and different coping skills in a gradual way. The exposure work takes place within that individual’s “window of tolerance” and works to decrease the strength of the maladaptive neuropathway while creating a new and more adaptive neuropathway.
Response Prevention refers to choosing not to do a compulsive behavior once the anxiety or obsessions have been “triggered.” All of this is done under the guidance of a therapist. However, one learns to do ERP exercises to manage symptoms.
With ERP, the difference is that when you make the choice to confront your anxiety and obsessions you must also make a commitment to not give in and engage in the compulsive behavior. When you don’t do the compulsive behaviors, over time you will actually feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.
International OCD Foundation – “Exposure and Response Prevention (ERP)”
The good news? Despite the complexities of these disorders, the significant advances in neuroscience bring hope of relief for those with OCD and eating disorders. In addition, advancements have been made in diagnosing and treating OCD and eating disorders separately. According to the International OCD Foundation, “Some of the most promising psychiatric investigations into the overlapping symptoms of spectrum disorders have focused on these neurophysiological similarities.” But more is needed to advance our understanding of the overlap between OCD and eating disorders. Identifying the similarities, differences and interventions will guide treatment for one or both of these disorders.