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Simultaneous Treatment of OCD, Eating Disorders Offers Better Chance for Recovery

Research at Rogers Memorial Hospital indicates that simultaneous treatment of obsessive-compulsive disorder (OCD) and eating disorders can be more effective with a multi-modal approach.

The results of a recent outcome study held at Rogers Memorial Hospital have been published by Routledge, Taylor & Francis Group in its journal – Cognitive Behaviour Therapy. Pulled from data for patients admitted to Rogers’ Eating Disorder Center (EDC) from 2006-2011, the research indicates that simultaneous treatment of obsessive-compulsive disorder (OCD) and eating disorders can be more effective with a multi-modal approach.

The article, “Treatment of Obsessive Compulsive Disorder Complicated by Comorbid Eating Disorders,” is published in the current issue of Cognitive Behaviour Therapy, and three of Rogers’ specialists were among the co-authors: Bradley C. Riemann, Ph.D., Clinical Director of the OCD Center and Cognitive Behavioral Therapy (CBT) Services, Theodore E. Weltzin, M.D., FAED, FAPA, Medical Director of Eating Disorders Services; and Rachel C. Leonard, Ph.D., Behavioral Activation Specialist and Clinical Supervisor.

“It’s not unusual for eating disorders and OCD to occur together,” Dr. Weltzin explained. “To date, however, there has been little data regarding the best methods to treat these complex cases. At Rogers, we specialize in the treatment of both disorders and typically evaluate for comorbidity at admission. Our residential treatment program has been developed with a cognitive-behavioral approach for patients with both OCD and an eating disorder. This outcome study confirms that simultaneous treatment is an effective strategy for treating complex cases."

Research Highlights

To address the gap in data for treatment of complex cases where patients have co-occurring eating disorders and OCD, the study was developed to see how these patients would benefit from a multi-modal program. The hospital’s residential treatment program used a cognitive-behavioral approach for patients, integrating standard exposure and response prevention (ERP) for OCD in treatment that was specifically adapted for eating disorder pathology. Patients also received a supervised eating plan, medication management and social support. Of the patients admitted to the program between 2006 and 2011, 56 completed all the study measures at admission and discharge, and all showed improvement in the severity of OCD, eating disorders and depression. Included in the study were patients who had not adequately responded to outpatient treatment.

“The results of this study are exciting,” Dr. Riemann said. “What differs in this program is the development of a menu plan based on the hierarchy of feared situations and the manner in which the therapist helps patients face these situations in graduated steps of increasing difficulty. Although this may sound

a bit like the standard introduction of challenge foods to the patient, it is unique in the detail of rated food fears and how the fear hierarchy shaped the menu plan. This way of introducing foods more closely resembles ERP rather than the standard CBT used for eating disorders. The results further substantiate the belief that many disorders overlap with others and that it’s imperative to treat all of them simultaneously to achieve a truly effective recovery.”

An internationally recognized expert in the assessment and treatment of OCD and other anxiety disorders, Dr. Riemann leads a staff of behavioral specialists who are trained to utilize both CBT and ERP as part of individual treatment plans. He added that one of the keys to this program was the use of ERP techniques to treat both OCD and pathological eating fears and behaviors. As part of the study’s treatment, therapists helped patients generate a hierarchy of situations that triggered anxiety or distress. Then, they helped patients face the situations through exposures so that they would grow accustomed to the various scenarios and diminish anxiety. Patients were also asked to stop the behaviors and rituals (response prevention) to break the connection with those situations. By using these methods, patients began to recognize their irrational beliefs and work through them. ERP procedures also addressed eating pathology, incorporating a menu plan that was consistent with the ERP hierarchy, thereby further conditioning the patient to the various foods/behaviors that created the stress.

Five other distinguished colleagues co-authored the research: H. Blair Simpson, M.D., Ph.D. (New York State Psychiatric Institute); Chad T. Wetterneck, Ph.D. (University of Houston); Shawn P. Cahill, Ph.D. (University of Wisconsin); Joanna E. Steinglass, M.D. (Columbia University); and Martin E. Franklin, Ph.D. (University of Pennsylvania). The Rogers Center for Research and Training, along with the Institutional Review Board of the University of Wisconsin-Milwaukee, approved the study.

Rogers’ Role in the Industry

Recognized for leading the way through published outcomes research, Rogers Memorial Hospital is the world’s largest provider for intensive residential treatment of children, adolescents and adults with OCD and anxiety disorders. Rogers is also a nationally respected leader in evidence-based treatment of eating disorders for children, teens and adults. In addition, Rogers’ Eating Disorder Center has a separate unit for the treatment of males with eating disorders, as well as co-occurring anxiety disorders. As part of admission to studies, patients provide written informed consent for their data to be included in the research. Rogers Center for Research and Training oversees all such studies.

For more information on comorbidity and multi-modal treatment, as well as Rogers’ outcome studies, check www.rogershospital.org or call 800-767-4411.

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Andy Schwartz August 08, 2013 at 11:59 PM
Dr. Weltzin...I am a graduate of Rogers Men's Eating Disorder on April 4, 2000. I believe that was a year before your arrival. The OCD center had just pretty much started up in 2000 and in a unit of 10 men in the ED Residential program, I would easily estimate that 25% needed a combined program. Mainstreaming back into the community is where we usually fall on our faces. I know all too well, spending my life savings at that point in time during the years 1998, 1999, and finally 2000. I do not have OCD. However, the number of returning men who I knew from all of the previous years I was trying to overcome bulimia was very apparent. I certainly hope that you now have in place a "simultaneous treatment program." Bottom line Doctor Weltzin, I was fortunate to have a very progressive Health Care Provider...permitting me to keep returning to Rogers. I was their first male ever approved by Anthem Blue Cross/Blue Shield of Connecticut. But, I'm one of the lucky few...my point here is that simultaneous treatment of both disorders need to be diagnosed upon entrance to Rogers and these men are given the appropriate treatment immediately. I certainly hope you reply to several of the issues I have raised. Thank you to all of those people and my compatriots that has made it possible for me to be living in recovery for 13.5 years, having been an actively bulimic male for 31 years! I think I might even qualify or the Guinness Book of Records!! -- Andy Schwartz

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