There was a time when my son Dan would go days at a time without eating. When he did eat, it would have to be a specific food at a specific time in a specific place. There was no negotiating with him, and, not surprisingly, his health suffered. You might think he was obviously battling an eating disorder.
That wasn’t the case, however. He was dealing with severe obsessive-compulsive disorder.
While it can be argued that both OCD and eating disorders involve obsessions and compulsions, as well as the need for control, those who suffer from eating disorders typically obsess over their weight or body image. My son was not focused on either. His eating (or not eating) rituals stemmed from magical thinking, a cognitive distortion that is common in those with OCD. Maybe something bad might happen if he ate on Tuesday, for example. Eat that peanut butter sandwich before midnight and someone he loved might die. Others with OCD might restrict their food intake for other reasons, perhaps because they are concerned about germs and contamination.
Recently, a lot of attention has been paid to the “newest” eating disorder: orthorexia. Those who suffer from orthorexia typically obsess over eating a perfectly healthy diet. Interestingly, this eating disorder (not yet listed in the DSM-5, but included in the category of “Avoidant/Restrictive Food Intake Disorder”) is the one that is most similar to OCD. Obsessions revolve around health, and not weight or body image. Examples of compulsions include an inordinate amount of time reading labels for nutritional content, and avoidance of social situations where food choices might be questioned or challenged.
So is orthorexia an eating disorder or a type of OCD? Are all eating disorders a subset of OCD? How do we classify these disorders and what does it all mean?
I’ve written before about my feelings about getting too caught up in the labels of brain disorders. Whether we are talking about OCD, eating disorders, generalized anxiety disorder, depression, or other illnesses, we are just using words to describe specific symptoms, which often overlap. I think, in many cases, these labels are more helpful to health care professionals than sufferers, as they allow for diagnoses to be made. And the right diagnosis will hopefully lead to the right treatment.
Thankfully, cognitive-behavioral therapy (CBT) is often successful in treating orthorexia and other eating disorders. Exposure and response prevention (ERP) therapy, the front-line treatment for OCD, is also a type of CBT. It follows that when symptoms of disorders overlap, treatment plans might too.
Anorexia nervosa, bulimia, binge eating disorder, orthorexia and other eating disorders can be devastating, even deadly illnesses. The same holds true for OCD. But there is hope. These disorders need to be diagnosed as soon as possible by competent health care professionals, and then attacked full force. With the right therapist and the right therapy, they are beatable, and sufferers can go on to live happy, rewarding and meaningful lives, without their illness controlling them.