Many people think of OCD as visible rituals—handwashing, checking locks, or repeating phrases. But for many, OCD shows up in more subtle ways, especially when it overlaps with eating disorders.

It may look like:

• constant mental loops you can’t shut off

• a need to feel certain before you can relax

• fear-based rules around food, body, or health

• ongoing monitoring of thoughts, sensations, or behaviors

• reassurance that helps briefly, then fades

When OCD and eating disorder patterns coexist, it can feel like your mind is always on high alert—watching, questioning, second-guessing, and trying to prevent something bad from happening.

It might sound like:

• “If I eat that food, I’ll have to exercise for an hour to compensate”

• “I can’t imagine being able to trust my body for hunger/fullness because I would eat everything in sight”

• “I can’t eat certain foods because I think they will make me feel sick or ill”

• “I keep a mental list of safe foods and stick to those foods only”

Often, people don’t realize OCD is part of the picture at all.

How We Treat This: Inference-Based CBT (I-CBT)

Traditional therapy often focuses on changing behaviors or “tolerating uncertainty.” But when OCD is involved, the issue isn’t only anxiety—it’s how the doubt starts.

Inference-Based CBT (I-CBT) helps you understand how your mind moves from a thought into a full-blown story—often without any real evidence. It focuses on the moment your brain shifts from reality into a “what if” narrative, and how to step out of that story without needing certainty. This is a structured approach to therapy rooted in compassion and getting to know you and your story.

What this work looks like:

• We identify the first leap into doubt (the point where imagination becomes reality)

• We explore how your brain uses checking, scanning, reassurance, and rules to try to feel safe

• We practice stepping back into reality-based reasoning, rather than arguing with intrusive thoughts

• We reduce the need to control food, body, or health through rules and monitoring

This approach is especially helpful if you:

• tried exposure and response prevention (ERP) had found it to be overwhelming

• have tried other therapies and still feel trapped by your thoughts

• feel like your mind is “wired” to overthink or obsess

• want relief without forcing yourself to tolerate endless uncertainty

Our OCD treatment is sprinkled with a dash of weight-inclusive care!