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:
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.
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 relapseof 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.
During CBT sessions with a trained therapist, those in recovery from anorexia can expect the following types of topics to be covered:
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.
According to the International OCD Foundation, the two main approaches to OCD treatment are Cognitive Behavioral Therapy (CBT) and medication.
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 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.