OCD and Eating Disorders

The Westwood Institute for Anxiety Disorders offers a program for OCD and Eating Disorders

• Are you concerned about your appearance?
  
• Preoccupied with the fear of getting fat?
  
• Spending lots of time looking into mirrors?
  
• Afraid of being evaluated and criticized for your appearance?
  
• Obsessing about food?
  
• Counting calories?

OCD and Eating Disorders: Comorbidity

Eating disorders of all types often develop in young people as an unhelpful way of coping with stress, especially in women. While the age at which these problems start is similar to that of most other psychiatric disorders, for the most part there are few similarities between eating disorders and other diagnoses. The differences between specific eating disorders are also vast, each with their own specific list of symptoms necessary to make a diagnosis. However, despite the rather unique characteristics of eating disorders, there are some common features that they share: the presence of anxiety, eagerness to please, and perfectionism. The high rate of anxiety experienced by those suffering from eating disorders is temporarily reduced when they engage in ritualistic behaviors specific to their eating disorder: the binge-eater binges, anorexic works out, and bulimic purges.

When anxiety increases, ritualistic behaviors increase in response. Keeping a strict food diary which is updated obsessively, performing workouts that last hours, and engaging in near-constant weigh-ins are just some examples of ways in which the ritualistic nature of eating disorders can spiral into full-blown Obsessive-Compulsive Disorder (OCD). When these two disorders occur together (comorbidly), they feed off of each other and present in a way that clinicians may find difficult to treat.

Recently, the National Institute of Mental Health has noted similarities between OCD and eating disorders which are more than superficial — abnormal levels of the neurotransmitter serotonin and elevated levels of the hormone vasopressin are common features in both types of disorder. This may indicate that not only do those who suffer from OCD and eating disorders have similar emotional mindsets, but also that they have potentially similar chemical mindsets. It comes as no surprise then, that research shows a lifetime incidence of 31% of OCD among those with anorexia nervosa. It is clear that effective treatment is especially important in cases where these disorders occur together.

Dr. Eda Gorbis, a UCLA professor and practitioner with extensive experience in treating comorbid OCD/disordered eating at the Westwood Institute of Anxiety Disorders, offers specialized treatment for these dual syndromes with a focus on cognitive-behavioral therapy (CBT) and cognitive restructuring. CBT should address healthy coping strategies for stressful situations and correctly identifying triggers. Exposure therapy for comorbid OCD/anorexia might mean going to the fair to look at one's body in a funhouse mirror or wearing tight clothing. Cognitive restructuring should focus on improving self-image, reducing feelings of helplessness, and identifying patterns that result in unhealthy decisions. SSRI's may be necessary, and in some cases group of family therapy proves especially helpful as well.

As is always the case in the treatment of OCD, patients benefit most from treatment that is specifically tailored for their unique needs, whatever they may be. The guidance of an engaged, creative therapist gives patients the strength to face a two-headed beast and, most important of all, relief.