Thoughts, Food, and Freedom: OCD and Eating Disorders

The brain can be an exhausting place, especially when it’s being commandeered by intrusive thoughts. Sometimes it feels like the tape will never stop playing, “Did you really turn off the oven when you left this morning?” “Maybe you hit that person with your car and didn’t realize, better check!” Having obsessive-compulsive disorder (OCD) is difficult enough, but when an eating disorder is co-occurring, that can get even more exhausting.

The DSM-V characterizes Feeding and Eating Disorders as “persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” This is often accompanied by intrusive thoughts centered around food. In both OCD and eating disorders, intrusive thoughts become so disruptive it makes it hard to really be present anywhere, and since OCD and eating disorders have a 40% overlap rate, it’s important we talk about it.

OCD has a particular way of latching onto the things we care about most, with the aim to cast doubt and uncertainty in places where we wish we could be the most certain. When it comes to eating disorders, it’s common to have thoughts like:

• I already ate way too much today; I shouldn’t be hungry.
• If I start eating, I might not be able to stop so I just shouldn’t start.
• I have to make sure I’ve exercised enough before I can eat.
• I need to lose weight; my stomach looks so fat.
• My legs are so much bigger than all my friends’ legs.
• I have no self-control; I shouldn’t have eaten dessert with dinner.
• I need to stick to my diet, I feel so guilty for cheating.
• I’m going to start restricting again tomorrow so I better eat as much as I can today.

Often with eating disorders, food consumption, body image, and exercise become the most central focus. It’s consuming and can lead to isolation and diminished ability to function in daily life. It’s like every time you try and think of something else, your brain pulls you right back to food and body image. Because it becomes important, OCD wants a piece of it. OCD shows up in various forms, wearing many different masks. Here are some examples of how this can show up with a co-occurring eating disorder:

• Sugar is bad, and if I eat sugar, I will gain weight.
• One cookie will completely contaminate my body; I’ve been keeping it clean with only healthy foods.
• Did I really measure my portions correctly? What if I was wrong?
• What if I forgot to track something I ate earlier?
• What if my body is changing but I’m not noticing?
• I shouldn’t eat this food because some people don’t have enough food.
• I must make sure I’m doing my specific exercise routine perfectly, so my body doesn’t change.
• I’ll just weigh myself one more time to make sure it’s the same as it was an hour ago.

Eating disorders and OCD are often characterized by rigidity and compulsive behaviors, both seeking some kind of control and certainty when there isn’t much to be had. This can quickly lead to more and more intense attempts at perfection. It just never feels like enough.

Perfectionism

“Perfectionism refers to the drive to meet a high standard, being highly critical of oneself, and experiencing significant distress in response to perceived failure. This trait may make a person more vulnerable to developing both an eating disorder and OCD.”

We know perfect isn’t real. Nobody’s perfect; even Hannah Montana says so. But we certainly will give it a try. The thing with both OCD and eating disorders is that nothing ever feels good enough, especially when striving for perfection. The perfect diet, the perfect body, the perfect life decisions, the perfect conversation—they are ideas, but not reality. This can leave people with OCD and eating disorders striving for something that can never be obtained, leading to a continuous loop of compulsive behavior and restriction, accompanied by an internal voice screaming to “do better.” It’s compelling and hard to not listen, but what if that voice doesn’t actually have your best interest in mind? Maybe you find yourself in this loop and feel ready to make some change.

Treatment

Seeking any kind of mental health treatment can be intimidating, so it’s important to get an idea of where to start looking. The gold standard for OCD treatment is ERP (exposure and response prevention), which incorporates behavioral changes through exposure and response prevention, as well as cognitive restructuring. Similarly, CBT-E (enhanced cognitive behavioral therapy) is a highly recommended treatment for eating disorders.

“CBT-E encourages patients to become curious about their eating habits. Through the use of strategic behavior changes, such as regular eating routines and new coping skills, patients are able to see changes in their thought patterns and symptoms.” Both of these treatments encourage gradual behavioral change, challenging maladaptive cognitions, and repetition of behaviors that align with the goals and values of the client. If possible, finding co-occurring treatment that treats both conditions simultaneously is the most beneficial. It’s time to take back life from OCD and eating disorders, you deserve it.