Many people with eating disorders are also diagnosed with Obsessive Compulsive Disorder (OCD). Sometimes these are considered two distinct disorders that need to be managed separately. Research has shown us, however, that the pathology of OCD is markedly similar to some symptoms of eating disorders. That similarity means that many treatment strategies for OCD can also work for eating disorders.
OCD is defined as a recurring fear or negative thought (an obsession) that produces great anxiety and discomfort along with a behavior (compulsion) that develops to reduce this anxiety and discomfort temporarily. One typical OCD obsession is a fear of germs, which is often counteracted by a hand-washing compulsion. Most people diagnosed with OCD know that their obsession is irrational, but cannot shake the anxiety or the need to attempt to lessen it with a compulsion.
Anorexia has, among its symptoms, an irrational fear of fat or gaining weight. The compulsions that often accompany this obsession are weight checking, body checking, calorie counting, etc.
The treatment for reducing compulsions in OCD is something we call ERP – Exposure Response Prevention. For instance, the patient with the germ obsession will wait at first 5 minutes to wash their hands (exposure), and gradually increase this wait period in order to gradually manage the anxiety that is creating by not washing their hands (preventing the habitual response.)
This approach can also work for anorexia. By gradually increasing the wait period before weight or body checking, we can help the patient learn to manage the anxiety that comes with not knowing. During this time period, we remind the patient that compulsions often increase anxiety over time, even though it brings short term relief.
OCD is also known as “the doubting disease.” There is never enough reassurance in OCD or eating disorders that the fear will not come true. The point of treatment is not to give the patient 100% assurance that the fear is false, as perpetual doubt is the hallmark of the disorder. The point is to become okay with uncertainty. Only when a patient can accept that they will never know for sure, can they let an obsession go. This can be incredibly difficult work – but it is highly effective and can lead to finally getting off the merry-go-round of anxiety and checking that so many patients experience.
About the author:
Kate Greenen, LMFT is a clinician at Walden’s Northampton Clinic. She is a licensed Marriage and Family Therapist and has been working with families across western Massachusetts for seven years. Her specialties are helping adolescents and families recover from eating disorders and working with patients with OCD and other anxiety disorders.