How OCD Feeds into Eating Disorders 

Emily Koehn

Abstract

OCD is classified as an anxiety disorder, it is the presence of recurrent, intrusive thoughts or repetitive behaviors that a person feels driven to perform. An eating disorder is a psychiatric condition that includes binge eating, strict weight control, such as calorie counting, over-evaluation of one’s body, and injurious actions to maintain weight. An eating disorder can greatly affect an individual life and can create social anxiety. Which can worsen the obsessive-compulsive disorder. OCD potentially forms in the amygdala with the influence of other parts of the brain. Through this, the brain will affect the way OCD affects a person. OCD is likely to develop in childhood, greatly affecting normal behavior. OCD can be treated in a variety of different ways varying in levels of success. Outside stressors and trauma play into OCD and eating disorders through the development of coping mechanisms. Lastly, OCD feeds into Eating Disorders through the similarity of the symptoms. 

What is an Eating Disorder?

An eating disorder is a psychiatric condition that includes binge eating, strict weight control (such as calorie counting) over-evaluation of one’s body, and injurious actions to maintain weight [1]. Eating disorders affect everyone differently, and there are three current formal diagnoses, such as anorexia nervosa, bulimia nervosa, and binge eating disorder. However, there have been several cases of abnormal eating and extreme dieting that have been reported [2]. Abnormal eating can include overeating or not eating enough. Anorexia nervosa is classified as a restricting type. Individuals diagnosed with this disorder  achieve abnormally low weights through severe dieting, fasting, and a need to compulsively exercise strenuously. It has also been seen in individuals with binge eating or purging disorders, with those affected vomiting to lose weight, or misusing laxatives, enemas, or diuretics. This negative self-evaluation is caused by an individual's perception of weight and/or body shape, which impacts their sense of proper food intake. Bulimia nervosa or overeating is characterized by the recurrence of binge eating episodes. During an episode, individuals intake large amounts of food and experience a lack of control. Following the episode, weight- compensatory methods such as self-induced vomiting, the abuse of laxatives, diet pills, fasting, and vigorous exercise are commonly used. Individuals with binge eating disorders typically have chaotic eating patterns and frequently overeat and binge[1]. Eating disorders can make a person feel terrible, and commonly, people feel shame. This shame can in turn  make social situations tense, as many eating disorders concern body image issues. These issues can create social anxiety, and eating disorders are also classified as anxiety disorders.

 Eating disorders have been described as constant and repetitive actions that affect an individual’s eating pattern. In some cases, medication is used to aid those fighting their eating disorderPsychotherapy is also used, which utilizes several different medical professionals, psychiatrists, and psychologists. Different types of psychotherapy include experimental therapies, cognitive-behavioral therapies, eclectic and integrative therapies, marital and family therapies, and multicultural therapies. Experimental therapies are experimental forms of therapy that include music therapy, art therapy, environment therapy, and soon. Cognitive- Behavioral Therapy has become effective and brief.It emphasizes changing dysfunctional behaviors through the application of cognitive and behavioral processes. These include cognitive restructuring, positive reinforcement, development of skills, and self-efficacy. They primarily focus on changing maladaptive cognitions that produce overeating problems. Eclectic and integrative therapy require evidence-based treatments because unique combinations of therapies are likely to lack evidence demonstrating their efficacy, and are based on creating treatment best suited for the patient. This makes it difficult to measure its effectiveness from patient to patient. In integrative therapy, a more systematic approach is used, it is a construct consisting of stages of change in which individuals can be in different stages of readiness for taking effective action. It measures a person’s relationship with themself. Marital and family therapy is individual-based. These problems and conflicts are more interpersonal in nature, and  could be more effective as families or couples work together to resolve these conflicts. They focus mainly on marital or family structures or rules which might be dysfunctional and in need of change. Multicultural therapy focuses primarily on populations that have been stereotyped and marginalized because of race, ethnicity, gender, or sexual orientation. Individuals need help reducing these repressive mechanisms which keep them from being able to experience the important parts of their life. Others may need help reducing the impact of these oppressive forces while also valuing important parts of their personal and social identity. Through this form of therapy, many come to understand the feelings, moods, and reasoning for their behavior. These methods have seen varying levels of success and hospitalization is required for those with severe cases [1].

The Formation of OCD

Obsessive-Compulsive Disorder, or OCD is classified as an anxiety disorder, and  is the presence of recurrent, intrusive thoughts or repetitive behaviors that a person feels driven to perform. These intrusive thoughts are known as obsessions and the repetitive behaviors are compulsions[2]. OCD is commonly misdiagnosed or self-diagnosed. For example, a person who is a “neat freak” isn't necessarily suffering from  OCD. The average age of someone with OCD is around 19 years old [3] and large amounts of evidence has been found demonstrating that OCD is developed during childhood. The effects of OCD have shown people suffer from  symptoms for approximately 9 years. These symptoms often follow cycles of  chronic waxing and waning[3]. Waxing and waning are defined as symptoms that follow a pattern of becoming worse and then slowly finding its way to normalcy, before repeating the cycle again.

In the medial temporal lobe and the amygdala, a collection of discrete cell bodies will form (See figure 1) . The amygdala helps to understand the diverse characteristics of different anxiety disorders[4]. Study of the amygdala has resulted in research showing dramatic changes in emotional function, which is related to the expression of fear. Research has shown that noticeable stimuli in certain regions when not exposed to a threat, are associated with the formation of new associations of rewarding stimuli. The amygdala's role in alerting the individual about threatening aspects of the environment engages other regions of the brain, and this behavior promotes safety, reward, and survival.  [3]. Research has been done by investigating amygdala dysfunction in humans with clinical anxiety disorders. The first wave of functional imaging studies in anxiety disorders utilized symptom provocation paradigms. Provocation paradigms measure functional activity in the brain during a “resting state” [121]It focuses on  disorder-specific stimuli, and has anxious patients undergo brain scanning. It was found that there was greater amygdala activity in patients compared to healthy individuals [4]. This research concluded that disorder-relevant stimuli robustly engage the amygdala, causing anxiety. While not recognizing elevated amygdala responses were specific disorder-relevant stimuli or whether they reflected a more comprehensive pattern of amygdala activity [4].

The amygdala is not the only structure involved in the formation of anxiety and OCD. It is suggested that other brain regions could alter the activity of the amygdala.  The anterior cingulate cortex and the prefrontal cortex, have shown involvement in emotion regulation and conflict monitoring[4]. However, the formation of OCD as an anxiety disorder primarily takes place within the amygdala. 

Early Development of OCD

Normal adolescent behavior can be greatly affected by the interference of OCD, and OCD has been shown with three key predictions. First, self-reported experiences of childhood behavior negative or adverse social events can be associated with mental health problems, in particular, depression, OCD, and suicidal thoughts and behaviors in adults [5]. Secondly, the perception of negative social experiences in childhood from peers could be a stronger predictor of  mental health problems in adulthood. Thirdly, the symptoms of both depression and OCD can mediate associations between perceptions of adverse childhood social experiences and suicidal thoughts and behavior in adulthood [5]. As previously discussed, the shame commonly associated with OCD can greatly affect the way children perceive social behaviors and social situations alike. OCD has also been studied in much younger children as young as 4 and 5 [5]. Younger children were shown to have worsening symptoms, such as high levels of impairment and significant comorbidity in a study  [6]. All subjects in the study had at least one comorbid disorder. Children already diagnosed with another disorder likely affects the prevalence of OCD, and potentially makes it worse. For example, if an individual had OCD and an eating disorder, the two would play into one another due to the shared symptoms of reputation.

Treatment for OCD 

OCD treatment can be difficult for many those diagnosed, due to the various levels of severity. SSRIs, or selective serotonin reuptake inhibitors, are the first line of pharmacological treatment [6]. OCD can be difficult to diagnose as it tends to have varying, nonspecific conditions, and often OCD can be mistaken for ADHD due to the overlapping behaviors. While SSRIs are the first line of treatment, these treatments have shown 40-70% effectiveness in past years. However, in recent studies, it has been found that the influence of genetics and environmental factors in treatment can affect OCD. . Some but not all genes such as BDNF, SLC1A1, COMT, SLC6A4 have been associated with the increased risk of OCD development [6].

Another form of treatment is cognitive-behavioral therapy, CBT, which is a process in which a therapist or psychologist changes the way in which a patient thinks and behaves to curve a disorder or habit. A patient using  CBT faces their fears directly, with the aim to prevent compulsions. [3]. It's been suggested that CBTs and SSRIs heighten the effectiveness when used together, though CBT alone can produce outcomes similar to the combination of CBT and SSRIs when used consistently [3]. Internet-based cognitive-behavioral therapy or ICBT has been used on adults to which the result cannot be assumed, important developmental, cognitive, and motivational aspects that distinguish children from adults [7]. Therapist-guided ICBT is a promising low-intensity intervention for OCD in adolescents which has the potential to increase access to CBT. It could be useful in a stepped care approach in which a large proportion of individuals with moderately severe OCD could first be offered ICBT.

 Effects of stress and trauma and how it leads to Coping Mechanisms

Outside stressors and trauma can also play a large part in the development of coping mechanisms, which can eventually develop into eating disorders. PTSD, Posttraumatic Stress Disorder, is an anxiety disorder in individuals who've faced stressful and traumatic events. As with any other anxiety disorder, this stress disorder induces  fear and avoidant behavior [8].  Those who suffer from this condition experience severe anxiety and flashbacks, some experience trouble sleeping, nightmares, outbursts of anger, loneliness, and depression [8]. These symptoms can induce coping mechanisms in an effort to cope with traumatic flashbacks or stress. Coping mechanisms with stress focus on reducing the frequency or the severity of stressors. However,  it's not often possible to reduce stress and minimize the stress that has developed, for example, from a traumatic event or PTSD. As previously stated, OCD has been seen to develop in childhood, due to environmental factors. Therefore childhood psychopathology uses both objective, subjective disaster-related, an post-disaster factors, through results from screening questionnaires. Those being administered 5 months post-disaster, coping mechanisms adopted subsequently. Thus the need for social support [9].

OCD and Eating Disorders

Eating disorders seem to parallel the symptoms of OCD, and symptoms that they share including obsessions and compulsions. This creates a functional relationship between them. A study conducted by Belloch [10}, examined the function links between UMI, Unique Molecular Identifier, with OCD, BDD (Body Dysmorphic Disorder), IAD (Illness Anxiety Disorder), and EDs concerning the individual. These results showed the similarities and differences within the maladaptive consequences linked to the four UMIs contents. The four UMIs were equally ego-dystonic and similar to both males and females. With the exception of OCD-related intrusion, which is found to be more dysfunctionally appraised by females. [10]. PICA and an eating disorder in which an individual consumes materials such as paper, string, fabric, and erasers, this is commonly a result of stress. This is similar to classified eating disorders as a result of the aforementioned development of coping mechanisms. While PICA is commonly seen within individuals with this unclassified eating disorder, it can become a coping mechanism for stress as an eating disorder is similar to addiction (given its repetitive action). Hence we can see that the repetitiveness of an eating disorder and OCD will feed into one another in some cases, through coping mechanisms. 

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References

[1] Grilo, Carlos. (04/2019).Eating disorders. AccessScience. Pg 1. Retrieved: November 29, 2021. 
[6] Alemany-Navarro, Maria. (04/20/2019). Do polygenic risk and stressful life events predict pharmacological treatment response in obsessive compulsive disorder? A gene-environment interaction approach.Translational Psychiatry. nature.com/articles/s41398-019-0410-0 Retrieved: 12/4/2021
[2] Stein, Dan. (02/2020). Anxiety Disorder. AccessScience. Pg.1. Retrieved: November 29, 2021.

[7] Lenhard, Fabian. (01/2017). Therapist-Guided, Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Trial. ).Journal of the American Academy of Child & Adolescent Psychiatry. Volume 56, Issue 1 Retrieved: 12/5/21.
[3] Kearns, Megan (06/2019). Obsessive-compulsive disorder. AccessScience. doi.org/10.1036/1097-8542.463500 . Retrieved: November 29, 2021.
[8] Butler, Robert. (05/2021). Posttraumatic stress disorder. AccessScience.accessscience.com/content/posttraumatic-stress-disorder/757353. Retrieved: 12/05/2021.

[9], Jeremy. (09/02/2018)) .Optimizing stress responses with reappraisal and mindset interventions: an integrated model. Taylor & Francis Online.Pages 245-261. Retrieved: 12/5/2021
[4]Grupe, Daniel. (2011). Anxiety Disorders and the amygdala. AccessScience. doi.org/10.1036/1097-8542.YB110087. Retrieved: November 30,2021l.
[10] Pascual-Vera, Belen. (17/06/2021).Maladaptive Consequences of Mental Intrusions with Obsessive, Dysmorphic, Hypochondriac, and Eating-disorders Related Contents: Cross-cultural Differences.International Journal of Clinical and Health Psychology, Volume 22, Issue 1. Retrieved: 12/6/2021

[5] Angelakis, Ioannis. (10/10/2020) .Adverse Social Relationships in Childhood: Are there Links with Depression, Obsessive-Compulsive Disorder and Suicidality in Adulthood?

 . SpingerLink. book.doi.org/10.1007/s10578-020-01077-3. Retrieved: November 30, 2021
[12] Rotge, Jean-Yves. (09/2008). Provocation of obsessive–compulsive symptoms: a quantitative voxel-based meta-analysis of functional neuroimaging studies. NCBI.ncbi.nlm.nih.gov/pmc/articles/PMC2527721/. Retrieved: 12/11/2021.