OCD, food rituals and rules
People with obsessive-compulsive disorder (OCD) typically have unwanted thoughts or feelings (obsessions). They develop rituals (compulsions) that offer temporary relief from these uncomfortable thoughts and feelings.
People with eating disorders often have food rituals and strict food rules. These rituals impact their food choices, leading to disordered eating thoughts and behaviors.
When you have both OCD and an eating disorder, food rules and rituals can become unmanageable, severely impacting daily life.
The connection between OCD and eating disorders
What does it look like when obsessive-compulsive disorder (OCD) and an eating disorder overlap? Kathryn Johnson, MA, RD/LD, CEDRD-C, nutrition director at Eating Recovery Center (ERC) shares,
“With both OCD and eating disorders, we see the obsessive nature of thoughts and constant rumination that create rules and compensatory behaviors. These behaviors may seem illogical to others. But to the person experiencing them, they are very real.”
Individuals with OCD may insist on eating foods in a certain order, or they may eat only foods with certain ingredients or textures. These types of behaviors can trigger or intensify an eating disorder. Johnson elaborates on the suffering that this can cause,
“Many individuals with OCD and eating disorders also carry a tremendous amount of guilt and shame."
Eating disorders & OCD: Who is impacted?
- Research shows that up to 94% of people with eating disorders also have co-occurring mental health conditions, including mood and anxiety disorders, body dysmorphia or OCD.
- One study[1] revealed that up to 41% of individuals with the eating disorders anorexia and bulimia also had OCD.
- A retrospective review of several studies[2] indicated that 18% of all people with an eating disorder will develop OCD in their lifetime versus 2.3% of the general population.
Read more facts and statistics about OCD here.
OCD and the eating disorder ARFID
Avoidant/restrictive food intake disorder (ARFID) occurs when an individual avoids eating specific foods, restricts their food intake or avoids eating altogether.
Many symptoms related to OCD may manifest in individuals with ARFID, including:
- Avoiding certain foods due to negative perceptions of what might happen if they are eaten
- Eating only sealed, prepackaged items
- Eating only foods that the individual has prepared themselves
- Avoiding social events because “safe” foods aren’t readily available
OCD and orthorexia
Orthorexia is a pattern of disordered eating that involves an obsession with eating only foods perceived to be "clean" or "healthy."
Compulsions associated with orthorexia include:
- Eating only certain types of ingredients in a perceived health-oriented way
- Spending hours at multiple grocery stores seeking the “right” brands and ingredients
- Spending hours planning out and preparing food for consumption
How is OCD similar to an eating disorder?
Individuals with OCD and disordered eating share several commonalities, regardless of the specific type of eating disorder. Johnson comments,
“Individuals with OCD and eating disorders will often have strict rules about what they can and cannot do with food. Addressing these behaviors with logic alone won’t be enough because these fears and behaviors aren’t necessarily logical. This can be very challenging for a person’s support system, because they know that the individual won’t gain X amount of weight overnight if they eat a slice of cake, just like they know a person’s mother won’t be harmed if they don’t check the locks three times.”
What does it look like to have both OCD and an eating disorder?
Along with the symptoms listed above, signs of co-occurring OCD and eating disorders include:
- Difficulty performing daily tasks, like school and work
- Having an increasingly smaller social circle or isolating
- Real life consequences like having difficulty enjoying a toppings-heavy hot dog with their friends at a baseball game
- Having thoughts related to food ("food noise") and ruminating or fixating on these thoughts
All of these scenarios impact an individual’s overall mental and emotional wellness, because they need to devote a great deal of time, effort and resources to eating in a specific way so they can satisfy the obsessional thought patterns and ease the accompanying anxiety.
Is it OCD, an eating disorder or both?
Due to the overlap in symptoms, it can be difficult to know where an individual’s OCD compulsions and eating disorder behaviors begin and end. Johnson weighs in,
“To meet the criteria for OCD, an individual would need to have additional obsessions and compulsions not related to body weight, shape or size. These may include only walking on certain blocks or touching every doorknob they walk past.”
Other symptoms, Johnson explains, can be part of both diagnoses. These can include obsessively counting calories or washing hands for fear of potentially “contaminating” the food you eat. In these instances, finding the underlying reasons for the behaviors may unlock some clues.
“Take the instance of an individual who has a hard time eating food outside the home,” Johnson says. “That person may be fearful of eating certain foods, but their primary concern isn’t that they’ll gain weight—which could be a sign of an eating disorder—but that they will become very sick—which could be the sign of OCD.”
How to know for sure? Request a screening for OCD. OCD can be underdiagnosed and misdiagnosed and may complicate eating disorder recovery.
“Eating disorder and OCD behaviors are often indistinguishable without some processing and exploration,” adds Adee Levinstein, MS, RD, LD, CEDS-C, clinical dietitian training specialist with ERC Pathlight.
Levinstein recommends waiting to assess for OCD if a person is malnourished. A malnourished brain can present with OCD symptoms. These symptoms can resolve with proper nutrition.
Treating both the eating disorder and OCD
During OCD and eating disorder treatment at ERC Pathlight, individuals will undergo exposure therapy, which reduces the anxieties associated with specific obsessions and compulsions. And a multidisciplinary approach is key. Says Johnson,
“Our team – psychiatrist, therapist and registered dietitian – meet constantly to support individuals in learning and practicing coping skills safely. From a nutritional standpoint, we work to interrupt disordered eating patterns and normalize an individual’s eating patterns,”
Levinstein adds. “This approach supports the effectiveness of any therapeutic and medicinal interventions.”
View a sample session of exposure therapy for OCD.
Where to find help for OCD and eating disorders
“First and foremost, it’s important to know that co-occurring OCD and eating disorders can be treated, and symptoms can improve,” Levinstein says.
The key, she says, is to find a multidisciplinary team that can help people with co-occurring conditions find their individual path to lasting recovery. At ERC Pathlight, treatment begins with a conversation.
“We’ll learn more about the drivers of a person’s obsessions and thought patterns so we can tailor treatment in a structured, comprehensive way,” Brandenburg says.
If a person’s eating disorder behaviors are impacting their overall physical health, they will likely receive treatment at Eating Recovery Center.
If their disordered behaviors are more secondary or strongly driven by their OCD diagnosis, then Pathlight Mood & Anxiety Center programming may be a better fit. Treatment options include transcranial magnetic stimulation (TMS).
Families play a vital role in recovery
Conditions like OCD and eating disorders impact the entire family, which is why we give families the education, tools and support they need when they need it.
“For treatment to succeed, everyone will need to push back and set limits,” Johnson says. “It can be challenging at times, but your support will help your loved one feel comfortable as they navigate new triggers and exposures after treatment.”
Recovery is within reach
Every day, our experienced clinical team helps many people improve their relationship with food. Make peace with your plate and reach out for help today. Please give us a call at 866-622-9614 or fill out a quick form here and we'll reach out to you soon.