Almost all types of mental health conditions are more common among people who have an eating disorder. These conditions are often referred to as “co-occurring disorders.” One particular co-occurring disorder that has drawn a lot of attention from researchers and the general public is obsessive-compulsive disorder or OCD. The relationship between eating disorders and OCD can be complicated, making it more difficult to treat each of these conditions. However, with the right program, both of these conditions can be addressed effectively.
About Eating Disorders
Eating disorders are mental health conditions that involve an intensive focus on body shape, weight and/or food in general. These disorders usually involve disordered eating behaviors, and they may also include other dangerous behaviors designed to encourage weight loss and/or prevent weight gain. The most common examples of eating disorders are bulimia nervosa, anorexia nervosa, and binge eating disorder. Most people who have eating disorders have an unreasonable concern about their appearance and/or a poor body image.
Without eating disorder treatment, these disorders tend to continue to worsen. Left untreated, they can affect the patient’s physical and mental health in many ways, leading to a lower quality of life and a potential for fatal complications. For this reason, seeking prompt treatment is highly recommended.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder, which may also be called “OCD,” is a common mental health condition that can affect daily life considerably. People who have OCD struggle with obsessions, which are intrusive, uncontrollable thoughts that continue to come back over and over. These thoughts lead the individual to engage in rituals designed to alleviate the associated distress. These behaviors are known as “compulsions.”
Obsessions can be focused on almost any topic, but some of the most common focuses include fear of germs, having things in perfect order and thoughts of harm. In the case of someone with an eating disorder, OCD obsessions may be related to food or body shape. People who suffer from OCD feel that they cannot control their compulsive thoughts or the ritualistic behaviors that accompany them. The behaviors performed to alleviate the discomfort of obsessions do not bring OCD sufferers any pleasure, but only relieves stress or anxiety.
Common Underlying Factors
Eating disorders and OCD have common underlying factors that increase the likelihood of them developing together, whether or not they interact with one another. For example, both disorders are often tied to anxiety. In the case of OCD, anxiety contributes to the development of obsessions and the desire to take action. In eating disorders, anxiety causes the sufferer to spend more time worrying about their weight or body shape. Likewise, both of these disorders are more common among people who have experienced trauma in the past. Identifying and addressing these common underlying factors is typically an important component of any treatment program designed for people with both an eating disorder and OCD.
Interactions between Eating Disorders and OCD
Eating disorders and obsessive-compulsive disorder often go hand-in-hand. In fact, according to the International OCD Foundation, as many as 69 percent of people with eating disorders may also experience symptoms of OCD. Among people who have OCD, the rates of eating disorders may be as high as 17 percent.
Intuitively, it makes sense that eating disorders and OCD would be associated with one another. Eating disorders often involve an obsession with weight or food in general. Also, many people who struggle with eating disorders engage in ritualistic disordered eating behaviors, such as eating only certain categories of foods, not allowing foods to touch and/or purging after every meal.
OCD and Anorexia Nervosa
OCD is a common co-occurring mental disorder among people who have anorexia nervosa. Anorexia nervosa usually involves an intensive concern with maintaining a certain weight and/or losing weight by restricting calories. People who have anorexia nervosa and OCD together are often plagued by obsessive thoughts relating to their weight and/or eating behaviors. To alleviate distress, they may engage in specific disordered eating behaviors, such as counting bites of food or arranging food in specific ways.
OCD and Bulimia Nervosa
OCD is also incredibly common among people with bulimia nervosa. In many cases, it may serve to perpetuate the eating disorder. People with bulimia nervosa have obsessions similar to people with anorexia nervosa. They are often concerned about their appearance and/or weight. To alleviate their concerns, they may engage in some of the same food-related rituals as people with anorexia nervosa. However, someone with bulimia nervosa will also engage in a cycle of binging and purging.
When OCD and Eating Disorders Are Mutually Exclusive
In some cases, a patient may have both OCD and an eating disorder, but without an interaction between the two disorders. For example, the individual’s OCD may be focused on contamination and/or germs without any consideration for body shape, food or weight. In these cases, the two disorders co-occur together because they stem from similar underlying causes, such as a history of trauma and/or a tendency toward perfectionism.
It is important to note that even if a person has OCD and an eating disorder that seem to be mutually exclusive, treating both disorders at the same time is still recommended. The goal of any eating disorder treatment program should be to help the patient heal in all aspects of their life and build the healthiest future possible. Not only that but failing to treat OCD during the eating disorder treatment program may make the patient more vulnerable to stress and triggers after discharge, which may raise the chances of relapse.
Treatment for People with OCD and an Eating Disorder
When someone has both an eating disorder and OCD, they need specialized treatment. Without the proper treatment plan to address both of these issues simultaneously, the chance of a full recovery is not as high. For this reason, it is important to approach this situation with care.
To effectively treat both the eating disorder and co-occurring OCD, a treatment program should:
1. Formally diagnose the individual with both the eating disorder and OCD.
In some cases, a person who has an eating disorder and OCD may be unaware of one or both conditions. The best programs will include a thorough assessment designed to identify the patient’s eating disorder and consider the presence of any other mental health condition, including OCD. These conditions cannot be treated effectively unless they have been properly diagnosed. Making them aware of these issues can also help with the effectiveness of the treatment program.
2. Incorporate the treatment of OCD into the patient’s eating disorder treatment plan.
OCD is a difficult disorder to treat. However, if this disorder is not treated, the obsessions and associated rituals will make it difficult for someone to maintain recovery even after receiving treatment for the eating disorder. Specific treatments aimed at addressing the eating disorder should be included in their treatment plan. Examples of treatments that can be effective for patients with OCD include psychotherapy, behavioral therapy, and medication.
3. Customize treatment based on the needs of the individual.
Every person is unique. While some patients have eating disorders and OCD that are deeply intertwined and related to one another, others may deal with each condition separately. Likewise, some people may respond to certain treatment approaches better than others. For this reason, treatment programs need to be tailored to the individual’s situation. The best eating disorder treatment programs will involve a thorough assessment and careful, customized treatment planning.
4. Maintain a staff of professionals, including those who have recovered from eating disorders or other mental health conditions.
The most effective eating disorder treatment programs are operated by a staff of professionals, including psychiatrists, medical doctors, and nurses. The staff may also include individuals who have recovered from eating disorders, OCD or other related conditions, as these individuals can relate to patients on a deeper level.
Because of the complex nature of dual diagnosis cases, it is important to compare eating disorder treatment programs carefully before enrolling. Asking about each of the issues listed above is recommended for the best results.
The Importance of Aftercare
Everyone who enters residential treatmentfor an eating disorder should have a plan for aftercare before being discharged from the facility. However, aftercare planning is even more important for someone who also suffers from OCD. On its own, OCD is a pervasive condition that can dramatically decrease the quality of life. Whether or not a given person’s OCD is intertwined with their eating disorder, having OCD makes eating disorder treatment more complicated. Ongoing treatment after discharge that focuses on both the OCD and the eating disorder is the best way to reduce the chance of relapse and give the individual the best chance of embracing a healthier life and remaining fully recovered.
Treating Eating Disorders and OCD at Monte Nido
At Monte Nido, we are well aware of the potential for eating disorders to co-occur alongside a variety of other mental health conditions, including OCD. For this reason, our program has been specially designed to identify any other mental health conditions a client may possess so we can incorporate them into treatment. Before beginning treatment at our facility, every client will spend time undergoing a thorough assessment. At this time, a licensed psychiatrist and other professionals will look for signs of any mental health condition that could complicate treatment and recovery. If we discover that a client has OCD, we will use this information to guide treatment, aftercare planning, and discharge. We will also take the time to explore the specific relationship between OCD and the eating disorder, as this relationship can vary from one patient to another.
When developing the client’s treatment plan, we keep the diagnosis of OCD in consideration at all times. We will incorporate treatments specifically designed to address OCD into an individualized program, which may include psychotherapy, behavioral therapy, medications, alternative therapies and more. Throughout the program, the client’s progress will be assessed at regular intervals. Progress assessments will always considertheir progress concerning the eating disorder, as well as OCD and any other mental health disorders that may be present. Before discharging clients from treatment, we will spend substantial time planning for aftercare, which will be designed to provide continuing support for both the eating disorder and OCD.
If you or someone you love is showing the signs of an eating disorder complicated by OCD, getting the right treatment is essential. Monte Nido is staffed by professionals, and we have the resources to facilitate a lasting recovery and a bright future, even for people who have more complex cases. Please contact Monte Nido today to find out more about how our program can help.
Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.