Obsessions and Restrictions: The Complex Interrelation Between Eating Disorders and Obsessive-Compulsive Disorder
*Disclaimer*
This article discusses Obsessive Compulsive Disorder, Anorexia and other mental health disorders. Whilst advocacy regarding my experience with anorexia nervosa is familiar to me now, I have not previously spoken quite so openly about my experience with OCD. Please be respectful. My experiences both with anorexia nervosa and Obsessive Compulsive Disorder have at times followed a very stereotypical representation. I want to preface that my experiences do not speak for everyone, and that the way in which my symptoms have presented is in fact a rarity. Most people who experience eating disorders are not underweight, nor are they ever hospitalised. Anorexia is also not the only eating disorder and is in fact less prevalent than both Binge Eating Disorder and Bulimia Nervosa.
Unfortunately, I think it remains true that all mental illnesses are still widely misunderstood by society, but perhaps none more so than OCD.
No, OCD is not ‘obsessive coffee disorder’ or ‘obsessive Christmas disorder’, nor is it ‘the obsessive cleaning disorder’.
I’m fed up with seeing the jokes that people believe to be so witty… “I have CDO, it’s like OCD but the letters are in alphabetical order” is a classic. I’m fed up hearing OCD be used so flippantly. There is no such thing as ‘a bit OCD’ nor is a serious, debilitating mental disorder something that should ever be laughed about.
Obsessive Compulsive Disorder has been a part of my life since as long as I can remember. Even early in my childhood before I could even identify it, it was present.
Throughout primary school, I had a phobia of vomit which morphed into a phobia of germs and contamination. If a classmate were to even mention sickness, I would enter threat mode and take drastic measures to avoid them – holding my breath as I walked past them and making sure to put as much distance between us as possible. I would fret over whether I had inhaled their air or if I had touched the same item that they had.
Though my experience started out as contamination OCD, it expanded far beyond this. It is vital to recognise that there are numerous types of OCD, many of which are far less commonly discussed. Hoarding, moral scrupulosity, magical thinking, relationship, sexual orientation, harm, religious, checking, and symmetry OCD are just some examples of these. I urge you to look into these if you are not familiar, as I’m sure that doing so will only strengthen my message that OCD is so much more than just counting and cleaning.
By the age of 12, various intrusive thoughts had become well embedded and a standard, yet restrictive, part of my day that I, for the most part, had learned to live with. But as I transitioned to high school, OCD morphed again. My symptoms became interwoven with moral scrupulosity and directed towards education (as that was something that was not only accepted, but also encouraged).
I entered an academic ‘Gifted and Talented Education’ program and was thrust into a world centering grades and studiousness. I became obsessive and compulsive in the way I studied, which helped me quieten some of the thoughts around contamination. I would receive constant praise for my dedication and many would compliment my moral conviction – I felt like a ‘good’ person, and the more I studied the more this was true.
However, this in itself became a prison and it took control of my entire life. My habits became unprecedentedly extreme.
OCD often compelled me to unrelentingly chase respect or admiration beyond just academic validation. Unsurprisingly in a world so filled with diet culture, it wasn’t long before what I perceived to make a person admirable and respectable extended to food.
It was here that I truly learned that OCD rarely exists in isolation. It shares similar neural pathways to a number of other conditions, to the point where it can become an impossible job to discern what is OCD and what is another disorder. It is in this complex intersection that the lines of a singular diagnosis start to cross and blur and bleed.
In the initial stages I did not intentionally diet nor did I endeavour to lose weight, I simply felt compelled to act in a way that was deemed to be acceptable in accordance with the highly disordered messages I was receiving. Without my cognisance, OCD morphed into something even more treacherous. It was no longer just debilitating but also life-threatening as it morphed into anorexia nervosa.
The view that eating disorders are a result of vanity is untrue on so many accounts.
Whilst body image certainly plays a role in eating disorders and for many may be a catalyst, it is certainly not the only factor that contributes and drives them. For some – like myself – body image and body dissatisfaction may not precipitate an eating disorder, but rather may emerge as a secondary concern. I don’t dispute that weight and shape have been deeply embedded with my own anorexia, though perhaps it is not always the central factor especially when co-morbidities are at play.
When I became physically unwell, my symptoms could no longer be brushed off and I eventually (after a long struggle for intervention) received treatment. It became immediately apparent that there was and is a concerning lack of recognition of the intersectionality and fluidity between co-occurring diagnoses.
I was treated purely for anorexia. I was re-fed and medically stabilised to a point where my body could (just) function, but aside from that I was very much left alone. I did receive some therapy whilst I was inpatient though what I do remember all had a very specific focus on weight, shape, exercise, and image.
If anything, I felt like a fraud given that fixation on how I looked and my body itself were more a secondary component of my eating disorder. I learned that it should have played a greater role and that I should have loathed my body more, which was not at all hard to do as it rapidly changed from nutritional rehabilitation. I picked up new disordered behaviours and learned about calories in great depth. I was conditioned to become more afraid of food than I ever was before and began to develop more of a hyperfixation around my weight and shape.
OCD and anorexia complement one another – they fit together like pieces of a jigsaw.
Unfortunately, I think that even if I had been offered holistic support, I don’t necessarily think it would have really been helpful. I’d hidden OCD for so long that it was a secret which I didn’t believe I would ever share with anyone. I remember my hand sanitiser being confiscated from my hospital room as my hands became red raw and bleeding. Though it brought me great shame, it was a part of me and my only remaining coping mechanism.
After discharge I fell back into obsessive, compulsive study. My grades were even better than before and I was topping all of my classes, but my body was struggling majorly and I had quite literally nothing else in my life. I would wake up to alarms and study habitually for hours and hours, I’d time my toilet breaks and I’d bring flashcards wherever I went. I was controlled by the fear that if I were to allow myself rest time I wouldn’t achieve what was expected of me (mainly by myself, teachers and students).
After around six months I ended up as a revolving door patient and my ill health also meant I lost my ATAR (not from my lack of ability to achieve, more so the fact that my body could not survive what I was doing to it).
Losing my study also meant that my focus became primarily anorexia, and my OCD yet again adapted to harness this. Numbers of all sorts were again a point of hyperfixations – step counts, calories, times of day. Though it was easy to attribute these to anorexia, in truth they were just as much driven by obsession and compulsion.
By this time, anorexia and OCD were impossible to separate.
It was also messily mixed in with C-PTSD from the forceful treatment I’d received alongside other co-occurring diagnoses. I was labelled as ‘unresponsive to treatment’ and ‘complex’ as interventions that purely re-fed me failed time and time again.
I believe that neurodivergence is likely a key factor at play for me, and that this is yet another reason that the very streamlined model of treatment and family based therapy was not effective for me, especially given that intervention was majorly delayed.
I’ve come to accept this is not a fault of my own, rather a disjointed system.
It’s really only been this year that I’ve started to understand more about myself and to let go of the judgement I hold towards my inability to conform to standard treatment models. Treatment models that fail to consider intersectionality and the complexities of the human brain. Criteria which class disorders so rigidly and strictly (which is exactly what we are trying to overcome in the case of both eating disorders and OCD) and which treat mental illnesses in isolation. Frameworks developed for an over-simplified hypothetical patient and which fail to recognise the multi-dimensionality of human nature.
I’ve learned that the way into recovery for myself is not through formalities and superficial conversations about emotions that I’m already hyper-aware of, but through leaning into and embracing discomfort and imperfection. I move forward not only embracing, but also seeking things that challenge me and that go against the grain. That lay outside of traditional approaches and most certainly that stray from my own comfort zone.
I move forward, challenging the mould and breaking the walls that have held me for so long. Doing so with a small number of clinicians that I trust as opposed to ever-changing faces that are far too overworked to understand my own complex needs and who are taught in accordance with a very medical model of care. Professionals who are neurodiversity-informed, HAES-informed and trauma-informed, and who don’t try and sculpt me to fit a traditional model of treatment that was designed as a quick remedy.
Making this approach the norm will only come with a commitment to platform the voices of lived experience and incorporate them into interventions. Whilst learned experience is essential, it is only one component and fails to take into account the infinite number of factors and influences that come into play in the messy reality that is life.
So, if you take away anything this OCD Awareness Week, let it be this:
- We need greater recognition of the linkages between numerous mental health disorders – specifically of that between eating disorders and obsessive-compulsive related disorders.
- Obsessive Compulsive Disorder is far more complex and diverse than it is made out to be – it is not merely cleanliness and organisation.
- We must amplify the voices of those of us with lived experience in the mental health field just as we would in other sectors, arguably more so.
Written by Rachael Burns
Rachael is a young person living on Whadjuk Noongar boodja (WA) and a passionate mental health and disability advocate with lived and living experience in both respective fields. She sits on numerous advisory groups, is the Treasurer for Youth Disability Advocacy Network, has volunteered in numerous capacities, and much more. Rachael aspires towards a career within the Lived Experience sector where she can influence real, meaningful changes and dismantle stifling stigma.
Get support & learn more
For support with eating disorders or body dissatisfaction, connect with the Butterfly National Helpline by calling 1800 ED HOPE (1800 33 4673) or chat online or email, 7 days a week, 8am-midnight (AEST).
For support with and information about Obsessive Compulsive Disorder (OCD), visit SANE, Health Direct or call Kids Helpline (for those aged 5-25) on 1800 55 1800. Researchers from UNSW have also developed a directory of clinicians in Australia that offer specific treatment for OCD.
Find an eating disorder professional
To find an eating disorder professional that understands the intersection between neurodivergence and eating disorders, search Butterfly’s Referral Database and select ‘neurodivergent’ from the ‘populations’ search criteria.
Learn more about eating disorders, OCD and neurodivergence
- Eating disorders and Neurodivergence: A Stepped Care Approach by the National Eating Disorder Collaboration & Eating Disorders Neurodiversity Australia
- Eating Disorders Neurodiversity Australia
- Different Not Less, by Chloe Hayden – Chloe is a 24-year-old actor, disability advocate, and author with autism, ADHD, and lived experience of an eating disorder. Her book discusses the complex interaction between neurodivergence, disability and mental health, and celebrates the beauty that is human diversity.