I Was a Guest on Full Plate and We Went Deep!
I recently had the privilege of joining Abbie Attwood on her podcast Full Plate for a conversation I've genuinely been wanting to have for a long time. We talked about OCD, generalized anxiety, disordered eating, intrusive thoughts, and perhaps most importantly, why misdiagnosis can silently shape someone's entire recovery journey for the worse. If any of this touches something in your own experience, I hope this post (and the episode) gives you language you've been looking for.
Abbie opened the episode by sharing something deeply personal: she spent most of her life being told she had generalized anxiety disorder, when what she actually had was OCD. The years of wrong treatment, of trying to think her way out of something that doesn't respond to thinking, contributed, she believes, to eventually developing an eating disorder. The OCD needed somewhere to go, and it found one.
That story is not unusual. And it is exactly why conversations like this one matter so much.
Listen to the Full Episode
"Is It OCD, Anxiety, or Disordered Eating?" — Full Plate Podcast with Abbie Attwood, MS
Why OCD Gets Missed So Often
One of the first things Abbie and I dug into was the enormous gap between how OCD is publicly understood and what it actually looks and feels like for the people living with it. The cultural image of OCD, someone who washes their hands repeatedly or needs objects arranged just so, captures one narrow presentation of the condition while leaving out the vast majority of people who have it.
OCD is, at its core, a disorder of intrusive thoughts and compulsive relief-seeking. The brain generates an unwanted, frightening, or distressing thought, the obsession ,and the person performs some behavior (or mental act) to reduce the resulting anxiety. That behavior is the compulsion. The relief it brings is real, but it is also temporary, and the cycle restarts, often intensified.
Compulsions don't have to be visible. They can be entirely internal: mentally reviewing a memory, seeking reassurance from others, researching online, arguing with a thought, praying, or replaying a situation to try to "figure it out." This presentation is sometimes called Pure-O OCD, and it is one of the most underdiagnosed forms because there is nothing obviously compulsive to observe from the outside. From the outside and often from the inside, too, it just looks like worry.
"The key difference is that with OCD, the intrusive thoughts feel ego-dystonic, foreign, horrifying, completely at odds with who you are. The distress is actually a signal that the thought runs counter to your values."
— Dana Colthart, LCSW, on Full Plate
This is one of the most important distinctions between OCD and generalized anxiety disorder (GAD). GAD tends to involve broad, shifting worry that feels connected, even proportionate , to real circumstances. OCD tends to involve obsessions that feel intrusive and alien. Someone with harm OCD is not secretly violent; the thought is terrifying precisely because harming someone is the last thing they would ever want to do. The intensity of the distress is often the clearest signal that OCD is present.
What We Covered in the Episode
Topics from the conversation
What OCD actually looks and feels like — because it isn't hand-washing and organization
The key difference between OCD and generalized anxiety disorder, and why misdiagnosis is so common
How the OCD cycle works: the obsession, the compulsion, the temporary relief, and why that relief is the trap
Reassurance-seeking as a compulsion, and how it shows up in food and body-image relationships
Pure-O OCD: when the compulsions are entirely mental, and why this goes undiagnosed so often
Taboo and shameful intrusive thoughts, why the most disturbed person is almost never the one who'd act on it
Ego-dystonic vs. ego-syntonic: what this distinction means for disentangling OCD from eating disorders
How diet culture functions like a mass OCD delivery system — rules, rituals, fear, and relief that never quite arrives
How OCD and eating disorders mimic each other, overlap, and take turns in recovery
What ERP (Exposure and Response Prevention) actually is and why the discomfort is the point
Why your brain watches your actions, not your words and what that means for healing
The systemic piece: how disordered behaviors get praised in some bodies and diagnosed in others
The Eating Disorder Connection
Perhaps the part of this conversation I felt most eager to have was around how OCD and eating disorders intertwine — because this is something I see in my practice constantly, and it is still not widely understood even within clinical communities.
Food is a uniquely powerful arena for the OCD mind. Our culture has constructed an elaborate architecture of rules, fears, and rituals around eating — and that architecture maps almost perfectly onto the OCD cycle. There is an obsession (this food is dangerous; eating this means something bad about you or your body), a compulsion (restrict, avoid, check the label, follow the rule), and temporary relief (the brief sense of control, virtue, or safety that follows). Then the anxiety returns, often stronger, and the cycle begins again.
Abbie put it powerfully in our conversation: diet culture functions like a mass OCD delivery system. And she's right. It hands people the obsessions and the compulsions pre-packaged, and then calls the suffering "discipline."
"Clinicians treating eating disorders are often the only voice in a client's life saying 'you don't have to do this.' The rest of the world is still cheering the restriction on."
— Dana Colthart, LCSW, on Full Plate
The relationship between these conditions isn't always straightforward. For some people, an eating disorder develops first and OCD features emerge within it. For others, OCD was present long before the eating disorder, and disordered eating became the arena where the OCD found its expression — in part because food restriction and rigid eating rules are so culturally normalized that no one questions them, and sometimes actively rewards them.
In recovery, the two conditions can seesaw. A person makes meaningful progress with their eating disorder and then finds OCD surfacing in a new domain — contamination fears, relationship obsessions, health anxiety — because the underlying pattern of intrusive thought and compulsive relief-seeking hasn't been directly addressed. This is one of the clearest arguments for treating the full clinical picture, not just the most visible symptom.
Why Misdiagnosis Changes Everything
Getting the right diagnosis isn't just about labeling. It shapes the entire course of treatment — which therapies you receive, how you understand your own experience, and whether the work you're doing is likely to actually help.
The gold-standard treatment for OCD is Exposure and Response Prevention (ERP): deliberately confronting feared thoughts, feelings, and situations without performing the usual compulsive response, so the brain can learn that the anxiety decreases on its own — that the compulsion was never necessary. This is not comfortable work. The discomfort is not incidental; it is the mechanism through which change happens.
Someone with OCD who is treated only with standard cognitive therapy — challenged to examine and dispute their intrusive thoughts — may find that the analysis becomes its own compulsion. Thinking about the thought more carefully, looking for proof it isn't true, rehearsing reassuring counterarguments: these are all compulsions in disguise. The more effort you pour into arguing with OCD, the more credence you're giving it.
I also want to name the systemic dimension of this. Disordered eating and OCD-related behaviors are not treated equally across all bodies. In some bodies, restriction is recognized and treated as a symptom of illness. In others, those same behaviors are praised, encouraged, or rendered invisible. Effective, ethical treatment has to reckon with this reality — has to recognize that the cultural environment we're all living in is actively making recovery harder, and harder for some people than others.
A Note for Anyone Recognizing Themselves
If you've listened to the episode, or if you've read this far, and something is resonating, I want to gently say: that recognition matters. You don't need a tidy diagnosis to deserve support. You don't need to be certain before you reach out.
What I'd suggest looking for, when you're ready, is a therapist who holds genuine expertise in both OCD and eating disorders. Ask whether they use ERP. Ask whether they approach eating and body image from a weight-inclusive lens. Notice whether you feel genuinely seen in the conversation, not just assessed.
The loops you may be caught in have a name. They are not a character flaw. They are not evidence that you are too broken or too far gone. They are patterns that developed for real reasons, often very understandable ones and with the right support, they can change.
Come Find Me in Bergen County (or Anywhere in New Jersey)
I'm Dana Colthart, a Licensed Clinical Social Worker and Certified Eating Disorder Specialist based in Bergen County, New Jersey. At Clear Light Therapy, I specialize in OCD, anxiety, and eating disorders, including the complex and often invisible ways these conditions overlap. My approach is grounded in ERP and ACT for OCD, and in weight-inclusive, trauma-informed care for eating disorders.
I offer in-person sessions in Bergen County, NJ and telehealth therapy for clients across New Jersey. If our conversation on Full Plate stirred something in you, or if you've been carrying something that doesn't quite have a name yet, I would be honored to sit with you in that.
Listen to the Episode on Full Plate
The first part is free for all listeners. Find it on Substack, Apple Podcasts, or Spotify.
DC
Dana Colthart, LCSW, CEDS
Licensed Clinical Social Worker & Certified Eating Disorder Specialist. Founder of Clear Light Therapy, Bergen County, NJ. Specializing in OCD, anxiety, and eating disorders using ERP, ACT, and weight-inclusive care.
Listen to the Episode
Dana's guest appearance on Full Plate with Abbie Attwood, MS — available now on Substack, Apple Podcasts, and Spotify.
