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Jonathan Lukas: OCD and Severe Anxiety Feed Loss of Appetite

Ritualistic behavior only strengthens the disorder's hold

By Jonathan Lukas, MFT, Noozhawk Columnist |

Throughout my life I have struggled with something that many others with severe anxiety experience: appetite loss.

It’s really a challenge when your mind is locked into a terrifying obsession, or even when there are just so many stressors in life that it just seems like it’s impossible to stomach a meal or even a small bite.

I used to find that my anxiety spikes were so intense that I would gag just from the smell of food. That only fed my obsessions that something was physically wrong with me.

When I was in college, just going out for a meal with friends was a stressor because I feared losing my appetite before we even got to the restaurant. “What if people notice that I’m not eating and ask me what’s wrong?” I would engage in these thoughts and find that when I sat down to eat, I was so concerned about what others thought that my anxiety actually did consistently get in the way of my ability to enjoy myself.

I watched others eating and talking, joking and laughing, and all the while I was in my head telling myself how totally dysfunctional I am not to even be able to just have fun. This affected my self-esteem and led to isolating from friends and just having food delivered to my dorm room where no one could see my problems. This only reinforced the thought that I was incapable of being around people, eating with them and even being good company.

My obsessive-compulsive disorder at that time in my life was so centered on health issues (cancer and HIV) that any loss of appetite would instantly trigger the OCD. I would obsess that the HIV was turning into full blown AIDS, and therefore my appetite would continue to decrease, weight loss would follow, and then I was going to waste away and death would come next. With thoughts like that, it’s no surprise that I had no appetite.

At that time in my journey with OCD, I was unable to see that the loss of appetite was just a normal response to anxiety-provoking thoughts rather than HIV being the actual cause of appetite loss. I didn’t have HIV, but my OCD would not let me believe it could be anything else. The struggle to fight my OCD was too great. With little to no appetite, I wasn’t nourishing my brain, which made it even harder to cognitively process these thoughts in a rational way. I was quick to go right to the physiological disease rather than be willing to accept that it might just be my OCD.

Part of the reason for this is that I engaged in very rigid magical thinking. In other words, if I allowed myself to think that the OCD was causing the appetite loss, my OCD would tell me, “You better not take a chance and think you don’t have AIDS because if you do, I will make the symptoms of your AIDS worse and you will die faster.” I would then get extremely anxious and tell myself, “Jon, don’t even think you don’t have AIDS.” Therefore I was giving OCD exactly what it wanted: me to be scared, full of uncertainty and unwilling to stop feeding the obsessions.

The compulsions from these thoughts often focused on sitting in the library and reading about the latest research on HIV and treatment for full-blown AIDS and reading about the dying process. I was fully locked into OCD. I made sure not to ever allow myself to think I might actually be healthy. I would spend hours a day inspecting my body for lesions, taking my temperature, taking vitamins and holistic remedies to try to slow down the progression of the disease, and worst of all, isolating myself from social contact.

Feeding OCD with ritualistic behavior does nothing but strengthen OCD’s hold over you. If you keep giving it what it wants, it will leave you psychologically and emotionally drained. For me, that meant I had absolutely no appetite to nourish myself and get out of the downward spiral. I couldn’t separate myself from my OCD. It’s pretty easy to see how our appetite can be affected by our thoughts, is it not?

Jonathan Lukas MFT is a psychotherapist specializing in cognitive behavioral therapy. He is in private practice and runs The OCD Treatment Center of Santa Barbara, working with adolescents and adults with anxiety disorders. Click here for more information or call 805.453.2347.




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