The Intersection of Autoimmune Diseases, OCD, and Anorexia
By Tyler Brink, Clinical Psychology Graduate Student
Individuals who have been diagnosed with an autoimmune disorder in their early childhood can face significant brain impairments during their early development stage. In particular, the prefrontal cortex, which is responsible for decision-making, logical reasoning, and impulse regulation, may be adversely affected. Research has demonstrated a substantial connection between autoimmune disorders and obsessive-compulsive disorder (OCD). Furthermore, OCD and anorexia nervosa (AN), an eating disorder that is characterized by persistent energy intake restriction, intense fear of gaining weight or of becoming fat, and a disturbance in self-perceived weight or shape, share common compulsions and obsessions.
What are Autoimmune Disorders?
Simply put, our immune system protects us against disease. It’s the body’s first line of defense to ward off viruses or bacteria before they enter the body and make us sick. It does this by sending white blood cells, aka soldiers, to fight off viruses and bacteria that may cause disease.
Autoimmune disorders are health conditions in which your immune system attacks your own tissues instead of defending them. A few common autoimmune diseases include, but are not limited to, lupus, rheumatoid arthritis, Sjogren’s syndrome, Crohn’s disease, and type 1 diabetes. Viral infections, exposure to environmental contaminants, smoking during pregnancy, and genetic predispositions are among the most significant triggers of autoimmune diseases.
What is OCD?
Obsessions and compulsions are characterized as Obsessive-Compulsive Disorder (OCD). This act drives one to repeat thoughts, images, urges, or compulsions, over and over again. Constantly checking whether the door is locked or repeatedly washing one’s hands are typical examples. These can be debilitating as they take over your thoughts, beliefs, and behaviors, which negatively affect your overall day-to-day functioning.
OCD is typically linked to a lower quality of life as well as significant social and occupational impairment, as the obsessions and compulsions preoccupy the mind and can cause distress. Rumination, the act of repetitive thinking about a negative experience, is another symptom some individuals with OCD experience.
Implications of Autoimmune Disorders on the Development of OCD
The American Psychiatric Association has recognized pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) as a cause of the sudden onset of obsessions, compulsions, and/or tics (repetitive spasmodic contractions of the muscles). This occurs when the immune system produces antibodies that attack the brain tissue in the basal ganglia, leading to OCD-like symptoms and brain inflammation. Sudden tics, which include rapid motor movements or vocalizations, can also develop as symptoms of autoimmune infections and OCD and are often mistaken for compulsions. This autoimmune attack on the brain is a key factor in the development of OCD, providing a clearer understanding of the condition.
Do Autoimmune Deficiencies Change Over Time?
If you or a loved one were born with an autoimmune deficiency that led to OCD-like symptoms during childhood, some symptoms may change as you reach puberty. For some, symptoms like repetitive movements and obsessive behaviors may lessen, but they may also appear in different forms, such as anorexia nervosa. While repetitive movements may decrease for some, taking control of food for others can feel like the only way to manage one’s mind.
Implications for the Treatment of OCD and Anorexia Nervosa
As someone who has experienced an autoimmune deficiency, OCD with tics, and anorexia nervosa, I can testify and empathize with those reading this who have gone through similar struggles. It can feel like the world is ending and there’s no way out, but I can attest that with the right treatments, adjustments, and support, recovery is definitely possible and sustainable.
The core issues in OCD and anorexia nervosa are the desire for control as a way to manage overwhelm and anxiety. At its core, there is a fear of chaos, unpredictability, and a loss of safety. Control becomes the tool to create stability and order.
For those who are struggling, I have personally found disordered eating patterns as a form of control. This irregular relationship with food might be an out-of-the-box tool, but often, when we have unresolved trauma, be it due to past relationships with caregivers, people who should love us, or situational, we typically turn to what we believe we can control. Also, we tend to focus on the outside of our bodies with anorexia nervosa; the sharp lines become a symbol of the brokenness inside us. This creates the necessary boundaries we feel are needed in those moments. What is to remember in those moments is that you are not alone.
While it may feel extremely draining and exhausting to go through both OCD and anorexia nervosa, treatment options are available, such as dialectical behavior therapy (DBT), inpatient programs, outpatient programs, and group therapy. Due to the comorbidity of these disorders, the therapeutic approach is often similar. Exposure-based therapies and DBT are promising for OCD and anorexia nervosa. DBT consists of motivational strategies, group therapy, distress tolerance, emotional regulation, and interpersonal effectiveness while providing structure and continuous support. Behavioral interventions such as exposure therapy may also be used in DBT.
Many effective OCD treatments, such as behavioral therapy and Exposure and Response Prevention (ERP) therapy, can be beneficial. Additionally, medications like selective serotonin reuptake inhibitors (SSRIs) can help reduce OCD symptoms. A combination of treatment and medication is often recommended for the best results.
If you are someone reading this who is trying to support someone going through an autoimmune disease, OCD, anorexia nervosa, or both, providing unconditional acceptance and support is essential. Battling through compulsions daily is defeating, and negative talk can be discouraging. For those trying to keep a steady recovery, here are a few phrases to avoid when supporting a loved one going through an autoimmune disease, OCD, or anorexia nervosa.
- “Can’t you just EAT?”
- “Why is everything so hard for you?”
- “Just pray about it.”
- “It’s just life; get over it.”
- “Why can’t you just stop?”
Phrases like these are extremely painful to hear and can make someone feel very misunderstood and isolated. Feelings of isolation can also worsen symptoms and make one feel completely unsupported.
Final Thought
When reflecting on anorexia nervosa, we often overlook factors beyond societal pressures and genetics. It’s essential to consider comorbid conditions. Coming to terms with the root of your problems is not only reassuring but also opens many doors. If you are experiencing an eating disorder, obsessive compulsive disorder, or both, whether stemming from an autoimmune disease or genetics, you may be familiar with the term ‘recovery’. Remember, recovery is a non-linear process with ups and downs. Many people fail to mention that you cannot simply ‘get over’ an eating disorder; it doesn’t disappear. Memories and fears can persist.
Finding appropriate support and being gentle and kind to yourself are critical steps to recovery. Recovery is a lifelong journey that never truly concludes. If you have faced such challenges or are currently going through them, remember that your resilience is a testament to your strength.
Knowing you’re not alone can be reassuring. For those experiencing a loved one going through an autoimmune disease, OCD, or anorexia nervosa, providing unconditional acceptance and support is essential, albeit not understanding it. Battling through compulsions daily can feel defeating. Your patience and acceptance can make a world of difference in their recovery journey.
About Tyler
Tyler Brink is a Clinical Psychology graduate student at Pepperdine University and a research assistant whose work examines the complex impact of trauma on mental health. She is particularly interested in how trauma relates to the development and treatment of eating disorders and personality disorders. Tyler is committed to advancing understanding and care for individuals whose experiences of trauma influence their sense of self and relationship with the body. After completing her master’s degree, she plans to pursue her doctorate in clinical psychology, continuing her research and clinical work in these areas.
