How Are Obsessive-Compulsive Symptoms Related to Anorexia Nervosa?

What you need to know

• Obsessive-compulsive symptoms are common in people with anorexia nervosa and are associated with more severe illness and worse outcomes.
• This study found that obsessive-compulsive symptoms in anorexia were most strongly related to insecure attachment styles, particularly a high need for approval from others.
• Difficulty describing feelings (a component of alexithymia) was also linked to more severe obsessive-compulsive symptoms.
• Addressing attachment issues and emotional awareness may be important for treating obsessive-compulsive symptoms in anorexia nervosa.

The connection between anorexia nervosa and obsessive-compulsive symptoms

Anorexia nervosa is an eating disorder characterized by restricted food intake, intense fear of gaining weight, and distorted body image. Many people with anorexia also experience obsessive thoughts and compulsive behaviors that go beyond just food and weight. These obsessive-compulsive symptoms can involve things like excessive cleaning, checking, or rigid routines.

Previous research has found that obsessive-compulsive symptoms are more common in people with anorexia compared to the general population. When present, these symptoms tend to be associated with more severe eating disorder symptoms and worse overall outcomes. However, the exact nature of this relationship was unclear.

This study aimed to examine obsessive-compulsive symptoms in young women with anorexia and explore how they relate to other psychological factors like personality traits, general mental health symptoms, and attachment styles. The researchers wanted to understand what might be underlying or contributing to obsessive-compulsive tendencies in anorexia.

How the study was conducted

The study included 41 young women diagnosed with anorexia nervosa and 82 healthy women for comparison. The women with anorexia completed an interview to assess obsessive-compulsive symptoms. Both groups filled out questionnaires measuring:

• Personality traits
• Eating disorder symptoms
• General mental health symptoms
• Difficulty identifying and describing emotions (alexithymia)
• Attachment styles in relationships

The researchers then looked at how obsessive-compulsive symptom scores related to these other psychological factors in the women with anorexia.

Key findings on obsessive-compulsive symptoms in anorexia

When assessed with a standardized interview, over one-third of the women with anorexia had obsessive-compulsive symptoms in the severe to extreme range. This was much higher than would be expected in the general population.

Interestingly, the severity of obsessive-compulsive symptoms was not strongly related to eating disorder symptoms or overall personality traits. There were some connections with anxiety symptoms, but the strongest relationships were with measures of attachment style and emotional awareness:

Insecure attachment: Higher scores on “need for approval” - a measure of anxious attachment - were most consistently associated with more severe obsessive-compulsive symptoms across multiple domains. This suggests that an intense need to feel accepted and validated by others may play an important role.

Alexithymia: Greater difficulty describing feelings was linked to more compulsive behaviors in particular. This indicates that trouble putting emotions into words may contribute to engaging in repetitive actions.

Anxiety: Symptoms of anxiety, especially phobic anxiety, were related to more obsessive thoughts. This fits with the idea that obsessions often involve fear and worry.

What this means for understanding anorexia and obsessive-compulsive symptoms

These findings shed new light on the nature of obsessive-compulsive symptoms in anorexia nervosa. Rather than being closely tied to eating disorder severity or overall personality, they appear to be more strongly connected to attachment issues and emotional processing difficulties.

The strong link with insecure attachment suggests that obsessive-compulsive tendencies may develop as a way to cope with fears of rejection or abandonment. Rigidly controlling one’s thoughts and behaviors could be an attempt to feel more secure when one has an intense need for approval from others.

Similarly, difficulty identifying and expressing emotions may lead to relying on compulsive behaviors as a method of emotional regulation. If someone struggles to understand and communicate their feelings, repetitive actions could provide a sense of control or relief.

Implications for treatment

These results have important implications for treating obsessive-compulsive symptoms in people with anorexia nervosa:

Focus on attachment: Addressing attachment insecurity and fears about relationships may be crucial. Therapy approaches that help build more secure attachments and reduce the need for constant external validation could help reduce obsessive-compulsive tendencies.

Improve emotional awareness: Developing skills for identifying and describing emotions may help reduce compulsive behaviors. Techniques like mindfulness and emotion-focused therapies could be beneficial.

Target anxiety: While not as strongly linked as attachment, anxiety symptoms were still related to obsessive thoughts. Incorporating anxiety management strategies may be helpful.

Look beyond eating symptoms: The findings suggest that obsessive-compulsive symptoms are not just an extension of eating disorder severity. Clinicians should assess for and target these symptoms directly, not assume they will resolve by focusing solely on eating behaviors.

Strengths and limitations of the study

This study had several strengths, including using both interviews and questionnaires to assess symptoms, having a control group for comparison, and looking at a wide range of psychological factors. However, there were also some limitations to keep in mind:

• The sample size was relatively small, especially for women with both anorexia and diagnosed OCD.
• Only women were included, so the results may not apply to men with anorexia.
• The study only looked at one point in time, so it can’t show cause-and-effect relationships.
• Some measures relied on self-report, which can be biased.

Conclusions

• Obsessive-compulsive symptoms are common in anorexia nervosa and may be underdiagnosed.
• These symptoms appear to be strongly related to insecure attachment styles and difficulty processing emotions.
• Treatments for anorexia that incorporate a focus on building secure attachments and improving emotional awareness may help reduce obsessive-compulsive tendencies.
• More research is needed to further clarify these relationships and develop targeted interventions.

This study provides valuable insights into the nature of obsessive-compulsive symptoms in anorexia nervosa. By highlighting the importance of attachment and emotional processing, it opens up new avenues for understanding and treating these challenging symptoms. While more research is still needed, these findings suggest that addressing relationship fears and building emotional skills should be key components of care for people struggling with both anorexia and obsessive-compulsive symptoms.