There are certain mental illnesses that often overlap or are found in the same individual as distinct disorders. Anorexia and OCD (Obsessive-Compulsive Disorder) are two mental health disorders that have many similar features and a strong comorbidity, meaning that they often co-occur in the same individual.
Link Between Anorexia and OCD
Why do they often co-occur? Well, first and foremost, there are certain common characteristics that a person who has these disorders share, such as being Type-A individuals, perfectionists, and having high anxiety. In fact, both Anorexia Nervosa and OCD are known to be manifestations of anxiety.
Both Anorexia and OCD occur in people who have some sort of anxiety or fear of their worlds. They may have undergone a trauma or feel ill-equipped to cope with their lives in some way.
They feel the need for more order. Both Anorexia and OCD provide a way for these individuals to order their worlds with rules and restrictions, which gives them something concrete to hold onto and track from day-to-day.
These rules and restrictions manifest differently in each disorder. In OCD, the rituals could be about a plethora of different categories (some common areas are cleanliness, symmetry, and safety.) In Anorexia, the rules are generally around food and frequently exercise.
OCD is comprised of obsessions or unwanted intrusive thoughts that the individual has, and often, these are coupled with compulsions, which are either thoughts or actions that the person needs to perform to try and rid themselves of the irrational thought.
Common Traits Between OCD and Anorexia
OCD is on the anxiety spectrum, and individuals that have OCD are often looking to control their environment and world around them with their rigid rituals. Anorexia Nervosa is also commonly about control and rigidity.
The individual with Anorexia uses certain rules and rituals around food (and sometimes exercise) specifically as a means to feel more secure and safe. Thus, both disorders, as Bethany Kregiel says, “have intrusive thoughts and compulsive actions” .
In fact, “studies show that about two-thirds of people with eating disorders also suffer from an anxiety disorder. Of these, the most common is obsessive-compulsive disorder or OCD. In fact, some studies have shown that in women with Anorexia Nervosa, the rate of OCD is between 25% and 69%” .
The link between the disorders is so strong that, commonly, when an individual recovers or begins to improve from one of these illnesses, they tend to increase behaviors in the other since they feel out of control. Their rigidity begins to take on another form through the other disorder.
Difference Between Anorexia and OCD
While Anorexia and OCD share many common traits, there is a key difference between the two disorders. As Susan Cowden says, “an important distinction between OCD and Eating Disorders lies in the relationship that the individual has with their thoughts and actions, meaning that they find obsessions and compulsions in conflict or aversive to their identity” .
More specifically, Anorexia is ego-syntonic, meaning the individual sees themselves and the illness as one, or that the illness is their identity. This makes recovery incredibly difficult for someone suffering from Anorexia because they are fearful of who they will be without their Eating Disorder.
In contrast, OCD is ego-dystonic, meaning that there is a strong distinction the individual has between themselves and the disorder. They are typically very interested in ridding themselves of their OCD thoughts and behaviors because they are experiencing the disorder as highly unpleasant and separate from themselves.
Given the fact that the OCD sufferer understands their disorder is irrational, it causes them even more distress that they cannot simply talk themselves out of it. Each disorder has its own difficulties, which makes it extremely challenging to recover. Yet, both Anorexia and OCD sufferers can get treatment and recover successfully, and there are specific treatments that can work for both disorders.
Treatments for OCD and Anorexia
Exposure and Response Prevention (ERP) therapy is a treatment that is commonly used with OCD. The individual identifies their fears and, with the help of their therapist, forms a hierarchy of their highest to lowest fears.
They began by exposing themselves to their lower-level fears and work their way up from there.
The individual can track their feelings and thoughts each step of the way with the help of their therapist.
ERP can also be used with those suffering from Anorexia in targeting specific fears having to do with food, weight, and body image. Another form of treatment for both OCD and Anorexia is Radical Acceptance.
Radical Acceptance (RA) talks about the individual intentionally letting go of their fears and accepting the world which they find to be frightening. Radical Acceptance is helpful for both disorders since people who struggle with them are often tied to their rituals in an effort to numb or block out their fears of the outside world.
With RA, they are encouraged to accept that even though the world can be a scary place they still have the ability to live successful, healthy lives without the need for rigidity.
If you are struggling with Anorexia or OCD, you might feel frightened. You may feel like your life is out of your control and that you are beyond help.
But recovery for both illnesses is possible. The first step towards recovery is developing an awareness of why you are struggling with your specific disorder(s) in the first place.
From there, you will learn how and why it is manifesting in you the way that it is, and you will learn healthy coping mechanisms you can utilize to replace the maladaptive ones. With these healthy coping mechanisms, the world can begin to feel a bit less scary.
Resources: Kregiel, Bethany. (2019). Eating Disorders and OCD: A Complicated Mix. Walden Behavioral Care. Waldenbehavioralcare/blog/eating-disorders-and-ocd-a-complicated-mix/  Cowden, Susan. (2019, August 16). Obsessive-Compulsive Disorder and Eating Disorders. Very Well Mind. http://www.verywellmind.com/obsessive-compulsive-disorder-and-eating-disorders-1138191
About the Author:
Emma Demar, LMSW is a therapist at Intrinpsych Woman on the Upper East Side of Manhattan. She holds an LMSW from Fordham University and holds a BA in Creative Writing from Trinity College. Emma recently completed a 2-Year Fellowship at Intrinpsych where she was expertly trained in Eating Disorders and DBT.
She uses a holistic approach in working with her patients, drawing from her background in Psychodynamic, CBT, and DBT, and she likes to begin where the client is and work from a strengths-based perspective. She specializes in Eating Disorders, OCD and related mental health disorders. Emma uses a direct, honest and open approach in working with her patients, who are generally women ages 12 to 32. She freelance writes for various mental health websites, and she blogs on her own website, thattrendytherapist.com.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Reviewed & Approved on November 4, 2019, by Jacquelyn Ekern MS, LPC
Published November 4, 2019, on EatingDisorderHope.com