Obsessive-compulsive disorder (OCD): Obsessions and compulsions that cause severe distress, and are often present or increased during course of anorexia nervosa illness. Obsessions are persistent and repetitive irrational thoughts or ideas of contamination, violence, doubt or fear that something bad will happen to a loved one. In anorexia nervosa, a person may believe they will ingest calories simply by inhaling air or walking past a discarded chocolate wrapper. Compulsive, refers to the intentional behaviors or mental acts performed in response to the obsession and may include washing, touching objects, counting or carrying out rituals. People with OCD experience their disorder as irresistible compulsions that must be performed even though they generally recognize them as irrational. If prevented from carrying out their rituals they experience intense anxiety or even panic. There is a high co-morbidity between eating disorders and OCD. Once the eating disorder develops obsessive thoughts and rituals often primarily focus on food, eating, calories, weight and/or shape. If OCD symptoms outside of those surrounding weight, shape and appearance are present post nutritional/weight restoration it is important to assess and treat the co-occurring OCD.
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