Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fears about eating disorders

By Shawna Ecklind, LMFT

Sep 29, 20226 minute read

Reviewed byTaylor Newendorp

Concerns, worries, and behaviors that center on food and cause disordered eating could also potentially be obsessions and compulsions that fall under subtypes of OCD known as Health OCD or Contamination OCD. The symptoms that present with OCD and an eating disorder can be difficult to distinguish, as there is a possibility for overlap in symptoms. There is also a possibility of having both an eating disorder and OCD about health concerns/contamination. 

Both OCD and eating disorders can involve compulsions and obsessive thinking patterns. For instance, with an eating disorder, one might experience an obsessive focus on their body and fears about their body image. Compulsive acts in both OCD and Eating Disorders can also look similar, such as washing food excessively, avoiding food or certain types of foods, or restricting food intake. In order to tell the difference between the two conditions, it can be useful to examine the specific behaviors and the motivation behind those behaviors. Most people with eating disorders are engaging in compulsions due to concerns about body image, including an excessive focus on losing weight, staying within a rigid weight range, and trying to attain or maintain a specific body shape. Someone with OCD themes focused on health concerns or contamination may be engaging in the same compulsions for reasons unrelated to weight or body image, such as a fear of being contaminated or a fear that food will affect their health negatively. Since there is a possibility for so much overlap between the two diagnoses, it is beneficial to understand the motivations behind certain behaviors.  

OCD can involve fears around food and eating in several different categories:

  • Counting: Individuals may count the number of bites, the number of calories in each bite, make sure the food is even or odd, or chew the correct number of times. 
  • Germs/Contamination: The food may have not been washed properly, the food may have touched other things and thus gotten germs on it, the fear that someone else put germs on the food. 
  • Illness: The food could cause illness or injury to oneself or others by not being safely stored, not being properly cooked, or any other reason. 
  • Magical thinking: There is a right way to chew, cook, or wash to ensure health, weight loss, or any other unrealistic outcome. 
  • Harm: Fears about serving food to others due to fears about sickness or negligence. 
  • Perfectionist: Fears about the food not being cooked correctly, or not knowing how to make it perfectly. 
  • What if I have an eating disorder?
  • What if this food negatively affects my health?
  • What if I don’t cook the food and I (or someone else) get sick?
  • What if this abnormality in the packaging means the food is bad?
  • What if something touched my food?
  • What if I left something on my hands after touching this food and I end up ingesting it?
  • What if I don’t chew my food enough?
  • What if I eat too many calories/or too little calories and it has a negative impact on me?

Common triggers

People with Health/Contamination OCD that centers on food or eating disorders may be triggered by any situations involving food, eating, preparation of food, handling of food in any stages, and the effects of the food on their body. It may present differently in each person: while one individual may be able to eat food that others prepare, they may not be able to prepare their own food for fear of contamination. 

  • Food
  • Preparing Food
  • Eating
  • Looking at calorie counts of food
  • Getting any type of food on hands
  • Reading labels on food containers
  • Seeing others eat or prepare food
  • Storing food
  • Body sensations–feeling overly full, feeling hungry, any amount of stomach upset, heartburn, etc.
  • Looking in the mirror
  • Receiving comments on their body from other
  • Receiving comments about their food or eating habits

How can I tell if it’s OCD, and not anxiety or an eating disorder?

There is not always a clear way to know for sure if symptoms like these that you are experiencing come from an eating disorder or are a product of Health/Contamination OCD. Understanding the motivation behind the obsessions and compulsions can assist with this. All symptoms should be discussed with a licensed professional before determining if you are struggling with OCD, an eating disorder, or both. Since there can be so much overlap in symptoms between OCD and an eating disorder, you should consult with a professional before taking any further steps. 

If you have an understanding of the motivation behind your behaviors, that may help you discern between the two diagnoses and provide an opportunity for you to further explore symptoms with a licensed professional. It would be helpful to identify if you are restricting food intake to make changes to your body image, or if the concerns and compulsions that you experience are motivated by other fears.

Common compulsions

When people with fears around food and eating in Health/Contamination OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in behaviors to help alleviate that fear or distress. These behaviors can be either physical or mental. 

Compulsions performed by people with OCD eating disorder fears include:

  • Checking and rechecking food and labels
  • Seeking reassurance from others and reassuring oneself that food is/was safe/okay
  • Avoidance of certain foods, cooking foods, or touching foods
  • Scanning or checking their body to see how the food affected them
  • Washing self and food items
  • Throwing out food or avoiding purchasing food

How to treat fear of eating disorder

Health/Contamination OCD can be debilitating for people who struggle with it, but it is highly treatable by doing exposure and response prevention (ERP) therapy with a trained professional. Working with a trained professional will entail identifying compulsions, obsessions, and core fears at the heart of those obsessions. Through a functional assessment, the clinician will assist you in building a hierarchy of your fears and obsessions that will structure your exposures, or exercises you will do with the guidance of your therapist. During exposures, you purposefully expose yourself to feared situations in order to resist engaging in compulsions, and allow for your brain to learn that it does not need to engage in compulsions in order to reduce distress. 

Since OCD and Eating Disorders could both be present, it may be effective to treat both of these diagnoses together. The treatment for an eating disorder may incorporate ERP, but could also involve Cognitive Behavioral Therapy, antidepressants, and family therapy, as well working with a medical professional. Since there are many medical complications that are associated with Eating Disorders, working with a medical professional is often highly encouraged.

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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