Eating Clean: Restrictive Diets May be Masking Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by obsessive, disruptive thoughts and accompanying compulsive behaviors usually designed to address the intrusive thoughts. Some OCD thoughts and behaviors are relatively easy to spot and identify as irrational even as you are in the midst of them; for example, a fear of germs that leads to repetitive, excessive hand-washing is simple to identify. Likewise, having to check that the door is closed 7 times before you leave the house is a clearly dysfunctional response to anxiety. Indeed, one of the most frustrating parts of OCD is often that you are entirely aware of the irrational nature of your thoughts and behaviors, but feel powerless to stop them. However, when obsessions and compulsions manifest in ways for which there is a social precedent and support, things can become murky. In the case of restrictive diets, widespread enthusiasm for preoccupation with food type and intake may be making it easier for diet-related OCD symptoms to go unrecognized, both by yourself and others, prolonging your emotional suffering and having potentially devastating effects on your physical health.

Food-related OCD can manifest in multiple ways. Some people may only eat foods of a specific color or have to chew a piece of food a certain number times, actions which are easier to pinpoint as maladaptive. Others, however, become obsessed with nutritional value, food purity, and particular food groups, which dovetail into pre-existing narratives about healthy eating. But OCD goes beyond an overenthusiastic focus on good eating habits—it becomes a disruptive force in your life. You may experience extreme anxiety about the source of food products, obsessive checking of labels, engaging in detailed nutritional calculations, and extensive time spent researching, acquiring, and preparing foods. You may decline to eat foods you do not consider to be clean, refuse to eat food whose origins you are uncertain of, and decline to participate in activities that would require eating food you have not prepared yourself. As Marjorie Nolan Cohn, a dietician and spokeswoman for the Academy of Nutrition and Dietetics describes, “[You] may not be able to go out to a restaurant with [your] friends because [you] don’t know what’s in the food or it’s not cooked in a certain way or what if it’s not organic olive oil?” Sometimes, this compulsive behavior leads to dangerously unbalanced diets and low caloric intake as you struggle to find foods that meet your strict requirements. Even if you remain physically healthy, the impairment to your social and professional functioning can be severe, and the psychological toll of constant worry is deeply painful.

It is estimated that 10-17% of people who have OCD also have a co-occurring eating disorder.[2. https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/] While eating disorders and OCD have a high co-morbidity rate, highly restricted eating, while disordered, is not necessarily a discrete eating disorder. Understanding the relationship between your disordered eating and your OCD requires careful assessment from highly trained clinicians with experience differentiating between anxiety and eating disorders. In general terms, eating disorders and OCD may look similar and manifest in closely related ways, but the driving forces behind them are different in meaningful aspects. Anorexia and bulimia usually center around body image; that is, they arise from a preoccupation with the way the body looks, particularly in terms of weight. OCD, on the other hand, is rooted in overwhelming obsessions that are separate from a desire to look a certain way or weigh a particular amount. Instead, they are extensions of contamination fears, anxiety about harm, and a desire for order and perfection and require specially targeted interventions to address the root of the problem.