In a recent article in the OCD Newsletter, entitled “OCD and Anorexia,” psychologists Eda Gorbis, Ph.D. and Jenny Yip, Psy.D. highlight the striking similarities between these disorders. Obsessive-compulsive disorder (OCD), an anxiety disorder characterized by obsessive thought patterns and/or behavioral (or mental) compulsions, seems to be linked to the restriction and compulsions around food, typical of eating disorders. In fact, it’s estimated that almost half of those diagnosed with anorexia also meet criteria for OCD. Looking at an eating disorder, it’s hard not to see the components of OCD: ruminations about calories consumed or weight gained, compulsive weighing/mirror-checking/exercise, purging as compulsive compensation for a binge.
Both OCD and EDs have been linked with imbalances in the neurotransmitter, serotonin. As such, selective serotonin reuptake inhibitors (SSRIs) are the psychotropic line of defense for both. And finally, similar therapeutic interventions are effective for both. Cognitive-behavioral therapy, which addresses dysfunctional thought and behavioral patterns works quite well in both group and individual settings with each patient population. Exposure and response prevention, a specific behavioral intervention that involves exposure to anxiety-provoking stimuli with the simultaneous prevention of a target behavioral response (e.g., OCD patients might be instructed to “sit with” feelings of contamination while avoiding hand-washing, ED patients might be instructed to “sit with” feelings of fullness after a meal without purging or running to the scale or mirror for self-evaluation) has demonstrated significant efficacy rates as well.
According to Gorbis and Yip, some researchers are considering the idea of subsuming eating disorders under the OCD diagnosis. Taking a look at the criteria for OCD from the current Diagnostic and Statistical Manual (DSM-IV; APA, 1994) below, it seems clear that if we substitute calorie counting, fears of gaining weight, mirror-checking/weighing, and/or bingeing/purging with some of the behaviors provided, we might just have a good fit. One notable difference is that described under criterion B, which suggests that in OCD, the obsessions or compulsions are recognized to be unreasonable. In some eating disorder constellations, particularly those that are more restrictive in nature, it seems that this criterion may not be met.
A. The Person Exhibits Either Obsessions or Compulsions
Obsessions are indicated by the following:
1) The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
2) The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3) The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action.
4) The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).
Compulsions are indicated by the following:
1) The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2) The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children.)
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).
E. The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.