Both OCD and eating disorders in adolescence revolve around the teenager's need to control her body and what goes into it. Of course, given the fact that healthy eating is essential to your teenager's health, this area can become a source of tremendous conflict between parents and teenagers with OCD. Because eating disorders already affect so many teenagers, the parents of teenage OCD sufferers must stay on high alert for any symptoms that appear to cross the line from OCD to the more extreme behaviors associated with eating disorders. Among the symptoms of an eating disorder is a complete or near complete refusal to eat, binge eating, the repeated throwing up of food, also called purging, or an “inappropriate compensatory behavior.”
According to the Anxiety Disorder Association of America (ADAA), OCD is one of the most common anxiety disorders to co-occur with eating disorders. Here's how ADAA summarizes the overlapping symptoms of these two disorders:
Eating disorders and OCD share many of the same features. Females with anorexia may suffer from obsessions with exercise, dieting, and food. They often develop compulsive rituals such as weighing every bit of food, cutting food into tiny pieces, repeated checking of weight, or mirror checking. There are also similar characteristics between bulimia and OCD. Like the compulsions in OCD, binges are difficult to resist and hard to control. While binges provide some immediate relief to the sufferer, like the compulsions characteristic of OCD, this relief is short-lived and temporary.
This disorder is marked by an intense fear of gaining weight or becoming fat, even if the sufferer is substantially underweight. Infrequent or absent menstrual periods (the absence of at least three consecutive menstrual cycles) in females who have reached puberty is one alarm signal for parents of a teenage girl that anorexia nervosa may be present in addition to OCD.
Teenagers with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Teenagers with anorexia nervosa who regularly engage in binge eating or purging behavior are considered to have the binge-eating/purging type of anorexia nervosa. For the behavior to be clinically defined as a disorder, the binge eating and inappropriate compensatory behaviors must both occur, on average, at least twice a week for three months. Because purging or other compensatory behavior follows the binge-eating episodes, young people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they often fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Fear of Vomiting
Not necessarily associated with an eating disorder, many young people with OCD have an extreme fear of vomiting. The idea of throwing up can prompt the child with this obsessive fear into a panic attack or other OCD ritualizing behaviors. Some may not exhibit other obvious symptoms of OCD, but may show more subtle avoidance behaviors; for example, a fear of going near anyone with any sort of illness (past or present) or disability, refusal to go on buses, on long car rides or amusement park rides, or into public places with dank smells.
Exposures to deal with a fear of vomiting would bring the child into contact first with images of her trigger, and then with the actual places and smells associated with the same trigger in order to habituate her to these things and slowly free her from the underlying obsession.
Body Dysmorphic Disorder (BDD)
A body image disorder with the clinical name body dysmorphic disorder, or BDD, is another condition that co-occurs frequently with OCD in teenagers. This disorder is characterized by a general dissatisfaction with the body, or parts of the body, causing the teenager recurring obsessions that cause severe emotional distress and interfere with his ability to function. BDD develops most frequently during adolescence and affects about one percent of the general population.
Many of the symptoms of BDD overlap with OCD, particularly the teenager's extreme self-consciousness about appearance, which causes teens with both disorders to check themselves repeatedly in mirrors, pick at their skin, groom excessively, and change outfits often. Both also attempt to hide these behaviors from others. Despite their similarities, OCD and BDD are considered two separate disorders. If you notice a concentration of these symptoms in your teenager, bring the question of a comorbid or co-occurring diagnosis to the attention of her mental healthcare provider.