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Should eating disorders be classified as forms of OCD?

By Robin Benzriham on Unsplash

As someone whose OCD has been in remission for two years, I've got a fair share of knowledge about the disorder. The psychologist treating me made sure that I knew exactly what was happening at every stage of the process. I can draw every diagram and graph she did, and explain it. After a B in Psychology A Level, I know even more. And whilst studying for that A Level, I hit a surprising connection.

Some eating disorders sound like OCD.

And it got me thinking, should eating disorders be classed as a form of OCD?

I want to add in a couple of disclaimers. First: I don't have an eating disorder. I have disordered eating, and I am classed as at risk, but I don't currently have one. For three weeks, three years ago, I starved myself of everything but crackers and orange squash due to OCD, but that's a different matter.

Secondly, although I'm talking about eating disorders generally, I'm referring to weight loss disorders, rather than binge eating disorder and so on.

OCD stands for Obsessive Compulsive Disorder. It's marked by a cycle of intrusive thoughts, or "obsessions," uncontrollable feelings about them, compulsive behaviours and finally short term relief as the amygdala calms down its production of adrenaline for a few minutes. The reason psychologists refer to it as a vicious cycle is because it's just that: a cycle. It's hard to know where the start is.

Eating disorders involve intrusive thoughts, too. In fact, most mental illnesses come with intrusive thoughts. People with eating disorders generally obsess over body image and calorific value of food, but they might also obsess over thoughts similar to those with depression, about their own worth. On the other hand, people with OCD have intrusive thoughts about a wide range of worries, from contamination and "did I actually do that right?" to "I think I've done that but I haven't really." I'm the former, contamination OCD. It's the most common, accounting for about a third of all patients (although if eating disorders were classed as a form of OCD, they would be the most common). Contamination can mean different things for different people. For most it means germs, but for some it can mean dust, glitter or even an imaginary substance. OCD is not logical. But, as any eating disorder survivor will tell you, neither are they.

Eating disorders also include compulsions, just like OCD. Whereas compulsions in OCD patients involve checking or seeking reassuring behaviour, eating disorder compulsions often mean reducing or eliminating food, over-exercising to burn off unwanted calories, or forcing oneself to throw up to make sure the food never hits one's intestines. All of these are compulsive behaviours: behaviours that provide short-term relief from burning intrusive thoughts. Much like compulsions in OCD, these behaviours can be illogical — opening and shutting cupboard doors is no more going to keep one's parents safe than making oneself vomit is going to do much except ruin your teeth (Hint: you've probably already taken in a lot of the nutrients!) — but they can also be logical, but pushed to the extreme. Take my obsessive hand washing. I was worried about getting ill. The hand washing was extreme and unnecessary; normal levels of hygiene would have been adequate. Similarly, someone wanting to lose a bit of weight might cut back on how much they eat, whereas someone with a weight loss disorder might carry out self-starvation in an extreme situation.

On the surface therefore, eating disorders fit the description of OCD. They involve obsessive thinking, compulsive behaviours and distress. The two families of disorders are also sometimes treated similarly, which indicates that it might be a similar neurological problem causing the disorders. The binge-purge cycle of bulimia is sometimes treated with antidepressants. Known in the medical world as SSRIs (Selective Serotonin Reuptake Inhibitors), these medications block the reabsorption of serotonin, the chemical that makes people happy and awake, between synapses. This allows serotonin to be released successfully, and so the person is happier. In bulimia, SSRIs can be used to regulate emotion. They can reduce the depressive feelings that cause the binging, and lower the guilt that creates the purging. Likewise, OCD is often treated with antidepressants, which reduce anxiety and curb intrusive and obsessive thoughts. Although disorders like anorexia and other EDNOS are not commonly treated with SSRIs, I believe that they would have a positive impact on sufferers of eating disorders, which I will explain more about in the next paragraph. There is a major downside to the use of antidepressants in patients with weight loss disorders, and that is that antidepressants can make people gain weight, which would likely exacerbate the problem.

The more I learn about eating disorders, the more similarities I find it has with OCD. In fact, this paragraph was originally intended to be the start of the opposing argument, but I can no longer see how it can be.

Eating disorders and OCD both stem from a deficit of accurate perception. It's well-documented that people, women especially, perceive themselves as "fatter" than people of the same size. Eating disorder sufferers take it to the extreme. In treatment, people often say that they see themselves as overweight, even when they are normal size or underweight. This lack of perception is echoed in OCD sufferers, who are likely to exaggerate risks of things they want to prevent. For example, during my worst time I perceived the risk of contamination and getting ill as much greater than it actually is. I would have called it 99.9 percent from contact with any surface I considered "dirty," whereas the real risk is much much lower.

On the other hand, many mental illnesses involve a lack of accurate perception, so this is not unique to eating disorders and OCD.

For decades, Cognitive Behavioural Therapy has been essential in the treatment of a wide range of mental illnesses. I've undergone it twice, and I'm doing it a third time currently, all for different reasons. Although it is used to treat the problematic thought processes behind many eating disorders, just as it is used to help OCD patients, in OCD treatment the majority of the therapy is to cut out compulsions from the vicious cycle, whereas treatment of eating disorders with CBT focuses on the obsessions. CBT is used to "prove" to OCD patients that their obsessions are nothing to worry about, whereas with eating disorders CBT can help change the person's perception of themselves and food. This is a major difference, and the only major difference.

In conclusion, I strongly believe that the psychological and medical worlds would benefit from seeing eating disorders as OCD. The description fits, the treatment is similar. The only question is — why don't we call it OCD?

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