When OCD Isn’t Your Only Diagnosis

If you deal with OCD on a day-to-day basis, you probably already know that obsessive thinking can really get in the way. At nOCD, many of us have experienced firsthand how OCD can turn any ordinary activity– from grocery shopping to checking email– into a stressful and exhausting ordeal.

OCD is definitely a pain. But for many, the distress caused by OCD might only be part of the picture. A number of people who suffer from OCD deal with a second (and even a third) mental health condition, like depression, anxiety, social phobia, and/or an eating disorder. According to one study, a shocking 74% of patients diagnosed with OCD also met the criteria for at least one other disorder.

Treating OCD in the context of an additional diagnosis can be challenging. Which is the primary concern? Do the disorders exacerbate each other? Is an individual using effective coping mechanisms to tolerate anxiety, or is he or she using one symptom to manage another? And can the treatment methods for one condition make the other one worse?

For the 64% of individuals with eating disorders who also have OCD, the overlap between the two conditions can be hard to manage. Both rely on patterns of obsession, avoidance, and ritualistic behavior, making exposure and response prevention (ERP) exercises particularly difficult. For example, if someone is practicing exposures with the fear foods they normally avoid, they might be tempted to use OCD rituals to mitigate the onslaught of anxious thoughts that result. During an exposure, someone with an eating disorder must sit not only with the anxiety of eating a fear food, but also the anxiety of not partaking in an OCD ritual to calm the anxiety caused by the fear food in the first place.

An individual in treatment for both disorders might also struggle with their different perceptions of their diagnoses. OCD is generally experienced as an ego-dystonic disorder, meaning the disorder and its symptoms are in opposition to an individual’s nature, desires, values, and self-image. Eating disorders, on the other hand – especially anorexia nervosa – are more often experienced as ego-syntonic, meaning they’re congruent with an individual’s personality and values.

Dealing with the symptoms of multiple disorders can be quite challenging. But here’s the good news: because the disorders are so intertwined, participating in effective treatment for one disorder has been shown to diminish the other, too. This doesn’t mean OCD treatment with magically cure an eating disorder, or vice versa – but it does mean that practicing ERP for OCD might make food exposures a little easier, and that food exposures might make ERP for OCD a little bit easier, too. Sure, you deal with more symptoms and distress – but you also get more “bang for your buck” with treatment!

Dealing with comorbid diagnoses? Have any tips or best practices? Let us know on Facebook, Twitter, and Instagram @treatmyocd. We want to hear from you!

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Phoebe Kranefuss

Author Phoebe Kranefuss

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