Treating Anorexia with OCD
How to Treat Someone with Anorexia and OCD?
People who have both anorexia and OCD need treatment for both conditions, but they should get that treatment at the same time, preferably by the same team of providers. This co-occurring treatment approach helps provide a comprehensive toolkit people can use to gain control of both conditions and avoid future relapse episodes.
Anorexia is a complex disorder. While anorexia often operates in silence, there are some visible signs that can alert friends and family members that the disorder is present.
The Diagnostic and Statistical Manual of Mental Health Disorders – 5 (DSM-5) is the main diagnostic tool for mental health professionals. As DSM-5 sets forth, the following are the diagnostic criteria for anorexia:
- A body weight that is significantly lower than what is considered normal or healthy for that person
- A phobia or intense fear of weight gain or becoming “fat”
- Any one or more of the following: thoughts that interfere with the perception of one’s weight or shape, self-evaluation that is unduly influenced by one’s weight or shape, or an ongoing inability to recognize that one’s current low weight presents serious health risks
To receive a diagnosis of OCD, a person must undergo a thorough evaluation with a trained mental health professional. Certain symptoms must be present to render a diagnosis, and a clinician will determine the current severity of the person’s OCD. The following provides insight into some of the OCD criteria that a mental health professional may consider during an OCD assessment:
- A person must experience compulsions, obsessions, or both.
- The compulsion or obsession must occupy a significant amount of time and interfere with day-to-day functioning.
- If obsessions are present, their persistence and strength are assessed.
- Compulsive behaviors are employed to suppress the obsessions.
- If compulsions are present, the accompanying actions are excessive and do not realistically relate to the person’s problems or obsessions.
Studies show a link between anorexia and OCD (i.e., one disorder may be a risk factor for the other, or they may co-occur with such frequency there is thought to be a connection). One research study found that 64 percent of participants with an eating disorder also had an anxiety disorder, and of this group, 41 percent had OCD. Some researchers have even considered that anorexia is on the OCD spectrum because of the obsessive and compulsive behaviors involved in the disorder. The specific relationship between these two disorders is unknown, but the linkage suggests that a clinician may want to screen a person with anorexia for OCD as well.
Treatment for Dual Diagnoses
Individuals who have co-occurring anorexia and OCD require treatment for each condition. It is well-established in the field of mental health treatment that either condition can exacerbate the other. Further, if one disorder is treated and not the other, the untreated condition could trigger a relapse of the other condition.
Treatment for anorexia and OCD requires that the traditional tracks for each treatment be followed alongside one another. Ideally, treatment should be integrated in one treatment program. However, if treatment occurs in two separate facilities, the best practice is for the treatment team in each program to communicate with one another to provide a coordinated care plan.
A traditional, research-based approach to anorexia treatment relies on therapy, nutritional educational, medical monitoring, and medications (as available and advisable). While there are various schools of therapies applied to the treatment of anorexia, the most commonly used approaches are Cognitive Behavioral Therapy (CBT) in group sessions as well as individual counseling sessions and family therapy.
Cognitive Behavioral Therapy
CBT for anorexia can last as long as necessary, whether in group or individual sessions, and it has been shown to be effective in the treatment of anorexia and other eating disorders. CBT is considered to be a long-lasting therapy; research shows that clients continue to apply the skills and strategies developed in CBT sessions to their lives even after therapy ends.
During CBT sessions with a trained therapist, those in recovery from anorexia can expect the following types of topics to be covered:
- Education about anorexia, especially how to recognize symptoms and a relapse
- How to keep a diary that can be supportive of recovery
- How to eat regularly and healthfully
- Ways to manage destructive thoughts that are supportive of anorexia
- How to change destructive behavioral patterns supportive of anorexia
- How to manage feelings, such as low self-esteem
- Strategies to cope with daily or episodic stress in a healthy way
- How to overcome negative self-image and body image perceptions
Nutritional education is a critical feature of anorexia treatment. Educational lessons include information on the basics of nutrition, the negative impact of starvation on the body, and how to develop healthy meal plans and a pattern of eating regularly. The goal of nutritional education is to provide lasting knowledge and skills to help a recovering person to maintain a healthy weight and balanced diet after formal treatment ends.
The medications used in the treatment of anorexia either target underlying feelings, such as antidepressants to treat depression, or the symptoms associated with conditions related to the disorder, such as medications for heart or digestive problems. While medications may be prescribed to address specific symptoms, medications will not “cure” anorexia. Instead, ongoing and comprehensive therapy is needed to address the thoughts and behaviors associated with the disorder.
Treatment for OCD
CBT is considered the gold standard of treatment for OCD, though other approaches can be taken, depending on the treatment center’s recovery philosophy.
CBT for OCD
CBT sessions for OCD have a highly pragmatic approach and are proactive. In a typical CBT session, the therapist and client work cooperatively to actively assess the OCD behaviors as well as the thoughts underlying them. The therapist and client then work in conjunction to devise concrete strategies to reduce occurrence of OCD behaviors. The recovering person gradually learns to no longer believe or accept obsessive thoughts and develops new behaviors in response to the anxiety underlying the disorder.
Most recovering persons in CBT will significantly improve in 4-6 months of meeting weekly with a therapist. After weekly sessions end, a recovering person may still receive 2-3 additional sessions, to check in and address any aspects of recovery that need additional attention. Some people may require a more intensive treatment plan, such as 2-3 sessions per week, or weekly CBT sessions for longer than three months.
Treating professionals will determine the best course of treatment for each individual, in cooperation with that person.
Research shows that the most effective medications for OCD are antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Brand name SSRIs that are used for OCD include paroxetine (Paxil), fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa). Research shows that OCD relates, at least in part, to serotonin levels in the brain.
Serotonin is a brain chemical that plays an important role in a person feeling happiness. Research shows that individuals with OCD can benefit from having more serotonin in the synapses between neurochemicals and receptor sites in their brains. SSRIs work to stop the serotonin pump in the brain from taking serotonin out of the synapse (i.e., they stop the serotonin pump from recycling serotonin). Almost 66 percent of people with OCD show significant relief of their OCD symptoms after taking SSRIs; however, SSRIs and other medications to treat OCD work best in conjunction with therapy.
Disclaimer: AAC facilities do not treat anorexia. If you, or someone you love, need treatment for anorexia, high-quality care is available at specialized treatment centers across the country.