Chapter 13 - Subclinical Features as Treatment Barriers

Summary

Due to the rates of comorbidity between OCD and EDs, it is common for clinicians to encounter patients with subclinical features of each disorder. This can present in various ways, such as patients having a primary diagnosis of one disorder but with subclinical features of the other, or patients having a subclinical secondary feature of the other disorder. One of the most common co-occurring traits in EDs and OCD is perfectionism, which may present as high achievement, rigidity, overpreparedness, thoroughness, extreme promptness, and checking behaviors related to many domains, but it can also present as avoidant and somewhat scattered. Perfectionism in EDs would typically include content related to diet, eating behaviors, and exercise, whereas in OCD it may be related to morality-based obsessions. Impression management is another trait that is often seen in both disorders, which can cause anxiety and self-doubt. This can make it difficult for patients to be honest with their provider, thus hindering the treatment process. Orthorexia is a subclinical disorder that has traits of both EDs and OCD, highlighting the complication of subclinical features presenting at the same time.