The Link Between OCD and Eating Disorders in Adolescence

Although it is widely recognized that eating disorders primarily begin during the adolescent period, the centrality of obsessive-compulsive symptomatology and dynamism, and their relationship to adolescent conflict and development, has not been generally accepted or understood. Social pressures toward conformity with the ideal of (especially feminine) thinness, which are especially influential during the adolescent period, combine with obsessive-compulsive predispositions to produce eating disorder symptoms and patterns of behavior.

Obsessive preoccupation with images of food as well as ruminative calorie counting, and ritualistic behavior regarding food, use of laxatives, and vomiting, together with a focus on control, doing and undoing rituals and other obsessive-compulsive defenses, and a sado-masochistic orientation to the body all point to an essential obsessive-compulsive disorder. Control is a significant factor in all aspects of the illness: control of calories, weight, bowel evacuation, food intake and digestion, cleanliness, achievement, perfectionism, the results of ordinary behavior, and interpersonal relationships.

The presence of dysphoric affect or emotion (unease and dissatisfaction) and the sometimes moderate effect of antidepressant medication with eating disorder patients has led to an unwarranted belief in an underlying depressive disorder. However, careful assessment of 11 studies presenting differential diagnostic data regarding anorexia nervosa reveals that both eating- and noneating-related obsessive-compulsive patterns and symptoms are universal together with an overall incidence of depressive patterns and symptoms.

With critical re-evaluation of data presented, the obsessive-compulsive condition equals or supersedes the depressive one in many samples. Moreover, given the intense achievement orientation of virtually all persons with obsessive-compulsive illness, along with other psychodynamic factors, depressive symptoms could well be considered a secondary breakdown effect.

If the all-pervasive obsessive-compulsive nature of eating-related symptomatology is taken into consideration, depressive symptoms must be considered either incidental or insignificant. As patients with eating disorders are notoriously secretive and oftentimes misleading about their symptoms and themselves, an important diagnostic assessment of such patients in intensive treatment at a long-term hospital facility (Austen Riggs Center, Stockbridge, Massachusetts) was carried out for the research. Compared with a varied comparison group randomly selected from the remainder of the hospital patient population, obsessive-compulsive manifestations of rumination, ritualistic behavior, excessive cleanliness, excessive orderliness, perfectionism, miserliness, rigidity, scrupulousness, and self-righteousness were all significantly associated with the eating disorder patient group.

The current eating disorder picture, therefore, clearly appears to be a modern form of obsessive-compulsive illness beginning during the adolescent period. Treatment, therefore, should focus on the components of this syndrome together with psychological difficulties in adolescent development and factors of pre-occupation and rejection of food. Cognitive-behavioral therapy has been notably successful and several forms of interactive and dynamic psychotherapy are also quite effective.

Adolescence is a difficult period of life adjustment, especially in modern society in which pressures on development into adulthood are deceptively strong, competitive, and often unguided Adolescents have to develop both autonomy and connection with others, to cope with tendencies to overshoot the mark of independence with rebellion, to carry out the complex task of identity development and crystallization of stable personality and mental competence. Among the variety of emotional problems that first develop during adolescence is obsessive-compulsive symptomatology developed from a fearful need and pre-occupation with control and the subsequent eating disorder of anorexia nervosa.