This week we continue our theme of eating and food.
Every so often, eating disorders are marked by repetitive and obsessive thoughts as well as ritualistic and compulsive behaviours. According to statistics, those with disturbed eating habits have more tendencies to co-morbid conditions such as OCD (obsessive-compulsive disorder) and anxiety disorders. Treatment providers may find it challenging to differentiate the disorders, considering that OCD and eating disorders have some overlapping traits. Clients, in like manner, may have manifestations of both disorders -unique from each other.
Understanding the differences and the similarities between OCD and eating disorders is helpful to developing a more complete understanding of a client's manifestation/s and, consequently, comprehensive treatment interventions.
Comparing OCD and Eating Disorders
DSM-5 states that OCD is marked by repetitive and intrusive thoughts which lead to compulsive behaviors. These behaviors are such in order to pacify the anxiety that accompanies the obsessions. The object of the person's obsessions and the particular compulsions they show varies across presentations. In addition, many cases of OCD vary in form with each individual.
As previously mentioned, symptoms of eating disorders and symptoms of OCD are characteristically similar. In particular, those with disturbed eating habits may experience repetitive thoughts about body image and food and manifest behaviors that are ritualistic. Common ritualistic behaviors in eating disorders include: frequent weighing of self to check for body changes, monitoring of body for any changes in size and shape, engaging in rituals around eating (e.g. eating foods in a specific order or cutting food into tiny pieces), and avoidance of food that are linked to fear of weight gain.
An individual's relationship with their thoughts and actions is the key difference between OCD and eating disorders. A person with OCD usually has an ego-dystonic relationship with their actions and thoughts. This means they find the compulsions and obsessions aversive to or in conflict with their identity. On the other hand, in eating disorders the relationship between the person and their actions and thoughts are ego-syntonic, meaning they feel aligned with these behaviors and thoughts. Identifying this makes a huge difference in treatment.
People with OCD are usually eager to get rid of their thoughts and feelings, while those with disturbed eating habits may feel attached to the elements of their disorder since it feels to them like a part of their identity.
Co-morbidity and Overlap
When OCD co-occurs with an eating disorder, treatment providers can see various manifestations. A typical one is a person has both disorders, and the disorders are mutually exclusive and unrelated from one another. An example of this is a person with anorexia nervosa who also does ritualistic cleaning. In this case, the ritual cleaning is completely unrelated to feelings and behaviors linked to the fear of gaining weight and the restricted eating observed in those with anorexia nervosa.
Two disorders overlapping would be another common manifestation. In this instance, the symptoms of the eating disorder are related to the compulsions and obsessions observed in OCD. An example of this is an individual with anorexia who does ritualistic exercise. This person may have difficulty disengaging from the ritualistic exercise and may need to engage in repetitions before they can stop because of the compulsive nature of this behavior. In this case, the exercise rituals and the thoughts/feelings linked to the fear of gaining weight are closely related. With this manifestation, it is more challenging to differentiate between the disorders considering their overlapping characteristics. It is important that when possible, eating disorder practitioners who struggle to distinguish the difference consult with an OCD specialist to establish proper diagnoses.
Treatment
Treatment for OCD and eating disorders will look similar since both share overlapping diagnostic characteristics. Exposure therapy is one intervention common across disorders. This entails exposing the client to the feared stimulus to help them build up a tolerance to their fear and cultivate a new association to that stimulus. When treating clients with disturbed eating habits, they are exposed to food. When treating individuals with OCD, they are exposed to the fear their obsessions take –emphasizing the goal of refraining from their compulsive actions. Treatment for a client with both OCD and eating disorder has the same emphasis on blocking the compulsive response. With such, a client for example is not only exposed to food but would be trained by refraining from any eating rituals in which they may engage compulsively.
Exposure hierarchy is one helpful intervention when doing exposure treatment. This is specifically designed to help the client and the practitioner to determine the feared stimuli which the client will be exposed to during treatment. An exposure hierarchy starts from the bottom with the least triggering stimulus to the most triggering one at the top. Exposure therapy traditionally involves working from the base of the hierarchy and building to the top as the individual slowly habituates to the feared stimuli. Clients with OCD, clients with eating disorders, and clients with both benefit from this intervention.
Another intervention is cognitive treatment –which varies across disorders. While most clients with OCD realize that their obsessions are senseless and they have difficulty handling these thoughts, clients with eating disorders have difficulty seeing the distortion in their thinking. Therefore, CBT–cognitive behavior therapy(which helps in identifying and challenging these distorted thoughts) may benefit people with eating disorders more.
In contrast, ACT–acceptance and commitment therapy(which emphasizes the changing of a person's relationship to their feelings and thoughts) would be more effective for a client with OCD who can already identify distortions in their thinking.
Both OCD and eating disorder specialists will likely see the overlap of these disorders in their practice. Establishing the similarities and differences (and identifying appropriate interventions) is an essential aspect of treatment for either, or both, disorders.
Do you think you have a problem with food? Is your OCD exacerbating other issues? Man an appointment at Jarvis Hypnotherapy - we can help!