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  • Writer's pictureDr. Jonathan Hoffman

OCD and Eating

Updated: Jul 19, 2022

The drive to eat is necessary for all living creatures- without it they would perish. For most people, eating is as natural as breathing. Unfortunately, this is not the case for many people with OCD or related problems. If you or someone you are concerned about is experiencing difficulties in this area, here are some basics:

Obsessions, compulsions, doubting, perfectionism, and other challenging features of OCD can drastically affect the process of eating. For example, there may be fears involving magically being harmed or harming another person if a certain food is selected or not eaten in a specified manner. Some typical OCD ways to neutralize discomfort are having to chew food according to a special number, having rituals about picking up and putting down utensils and drinking glasses, washing hands or foods excessively, and only being able to eat according to designated times or places.

Sometimes OCD co-occurs with an eating disorder– or triggers one- like anorexia nervosa or bulimia. (Eating disorders are not just a problem among females; although they are far more prevalent in girls and women, there seems to be an increasing percentage of males with these conditions). In such cases, the affected individual might obsess that they could gain weight by just being near fattening food or watching an overweight person have a meal. They might have to constantly check the size of their wrist or another body part, endlessly seeking out reassurance that they have not grown bigger.

Compulsive exercising or purging is often present. In the most dangerous cases, eating can become so anxiety-provoking that it becomes an activity to be restricted as much as possible. Young athletes competing in sports in which achieving perfection and maintaining a lowered weight is magnified may be at higher risk for having obsessions and compulsions affecting their eating habits (e.g. gymnastics).

There are also a number of patterns of disordered eating- also known as dysorexias- that have commonalities with OCD. These include extreme selectivity (pickiness), avoiding foods with discomforting textures or colors, food hoarding, or having a very heightened and distorted connection between what they eat and their self-worth (orthorexia).

Clearly, OCD or OCD-type eating problems can have very serious negative health consequences in addition to the psychological and behavioral ones, ranging from fatigue and poor concentration due to inadequate nutrition to severe physical and mental deterioration. When OCD is present in advanced eating disorders, it can exacerbate life-threatening symptoms.

As OCD-related eating problems often can be chronic and progressive, getting help sooner rather than later is key. Putting together a knowledgeable and experienced treatment team that can comprehensively address the person’s psychological as well as medical problems is also very important.

In addition to medication and nutritional guidance, there are many specific psychological therapies for OCD and eating problems that are available. These treatments can be office-based or, if necessary, provided with closer supervision in a hospital or residential setting. A cornerstone of evidence-based methods that may be applied to OCD and eating is Cognitive Behavioral Therapy (CBT). CBT involves re-structuring erroneous ideas and facing irrational fears about food and weight and is often used in conjunction with techniques that emphasize increasing readiness for change and motivation, mindful eating, and learning more effective stress management skills.

Addressing OCD inter-mingled with eating issues isn’t easy- for the sufferer or their significant others. In fact, many who have this problem can be initially very resistant. Therefore, having patience and a realistic understanding of the difficult path toward making a sustained level of improvement is essential for all concerned. Although as with all problems related to OCD, anyone looking for quick fixes is likely to be disappointed, there is every reason to be hopeful that getting the appropriate treatment in a timely way will lead to improvements in the long run.

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