Obsessive-Compulsive Disorder (OCD) is an anxiety disorder and often co-occurs with addiction and eating disorders, creating a complex clinical picture that requires careful and specialized treatment. Research indicates that approximately 25–40% of individuals with an eating disorder also meet the criteria for OCD, and 15–20% of individuals with substance use disorders may also have OCD symptoms (Torres et al., 2006; Grant et al.,2020). One striking fact is that the average time it takes for an individual to receive an OCD diagnosis is 17 years from the onset of symptoms (International OCD Foundation, n.d.). This delay is often due to stigma, lack of provider education, and underrecognition of symptoms in primary care and mental health settings.
How Do I Know If I Have OCD?
While every case is unique, OCD is characterized by two main components with symptoms and behaviors lasting more than one hour per day:
- Obsessions – intrusive, unwanted thoughts, images, or urges that cause distress.
- Compulsions – physical or mental actions taken to reduce the distress caused by obsessions.
For example, someone might have an unwanted thought like “What if I’m a murderer?” and respond with compulsions such as:
- Mentally analyzing whether they are capable of murder
- Seeking reassurance from loved ones
- Reading articles about the likelihood of random violence
- Avoiding or removing sharp objects from the home
Understanding Generalized Anxiety Disorder (GAD)
While GAD and OCD can sometimes look similar, there are key distinctions.
GAD is characterized by excessive and persistent worry about multiple life areas—such as health, finances, relationships, and work—that is difficult to control and lasts for at least six months (American Psychiatric Association, 2022).
Key features of GAD include:
- Chronic worry about real-life concerns (as opposed to the intrusive, irrational fears seen in OCD)
- Rumination, or the repetitive dwelling on distressing topics without moving toward problem-solving
- Physical symptoms such as muscle tension, restlessness, fatigue, and difficulty
sleeping - Safety behaviors or avoidance strategies to reduce perceived risks, such as not
attending social events for fear of illness
Rumination plays a central role in maintaining GAD symptoms. Unlike problem-solving, rumination tends to be circular and unproductive, often leading to greater distress.
In GAD, safety behaviors and avoidance reinforce the anxiety cycle in a way similar to compulsions in OCD—but without the presence of intrusive, obsessional thoughts. ERP can still be effective in GAD treatment when avoidance is targeted.
Why Stabilization Comes First in OCD Treatment
For individuals with co-occurring eating disorders or substance use disorders, it’s crucial to stabilize these conditions before starting Exposure and Response Prevention (ERP)—the gold standard treatment for OCD. ERP is a structured short-term therapy that involves intentionally confronting feared situations (exposures) while resisting the urge to engage in compulsions (response prevention). The goal is habituation—reducing anxiety through repeated exposure without engaging in avoidance behaviors. However, ERP can be emotionally and physiologically taxing. For those in early recovery from addiction or eating disorders, the stress of ERP may trigger relapse. This is why treatment sequencing matters: stabilization first, ERP second.
What ERP Looks Like in Practice
ERP is never about forcing someone to do something unsafe. Exposures are gradual and collaborative for both OCD and GAD.
For example, if job interviews trigger generalized anxiety or OCD obsessions we would start
by
- Talking about interviews in session
- Watch videos of interviews
- Role-play interviews
- Write a worry script imagining worst-case scenarios
- Progress to attending an actual interview
ERP can be equally effective for OCD and certain anxiety disorders, including GAD, when avoidance is a central feature.
Barriers to Getting ERP
While ERP is highly effective—with up to 60–80% of people with OCD showing significant improvement (Foa et al., 2005)—access remains limited because:
- ERP requires specialized training and certification
- Few therapists are experienced in treating both OCD and co-occurring conditions like addiction and eating disorders
- Some clients require higher-intensity ERP (2–5 sessions per week) before stepping down to maintenance therapy
Assessment tools such as the Dimensional Obsessive-Compulsive Scale (DOCS) and GAD-7 help clinicians measure symptom severity and track progress.
My Perspective as a Clinician
My approach to ERP blends clinical expertise with compassion. As someone who developed OCD and an eating disorder as a child—with themes of scrupulosity (religious OCD)—I understand firsthand how challenging ERP can be, but also how life-changing the results are. In private practice, I assess severity to determine whether clients can begin ERP once a week or need a higher level of care. After intensive treatment, many clients attend maintenance sessions, usually bi-monthly at first and then every two months, to maintain progress.
If you’re struggling with OCD or Generalized Anxiety and also navigating recovery from addiction or an eating disorder, specialized and sequential treatment can help you reclaim your life.
Reach out for a comprehensive assessment to determine the best treatment pathway for you.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Foa, E. B., Yadin, E., & Lichner, T. K. (2005). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide. Oxford University Press.
Grant, J. E., Williams, K. A., & Potenza, M. N. (2020). Impulse-control disorders in individuals with obsessive compulsive disorder. The Psychiatric Clinics of North America, 43(4), 629–641. https://doi.org/10.1016/j.psc.2020.08.004
International OCD Foundation. (n.d.). About OCD. https://iocdf.org/about-ocd/ Torres, A. R., Prince, M. J., Bebbington, P. E., Bhugra, D., Brugha, T. S., Farrell, M., Jenkins, R., Lewis, G., Meltzer, H., & Singleton, N. (2006). Obsessive-compulsive disorder: Prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. American Journal of Psychiatry, 163(11), 1978–1985. https://doi.org/10.1176/ajp.2006.163.11.1978
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