Eating Disorders and Obsessive Compulsive Disorder (OCD)

Reviewed by Amy Baker Dennis, PhD, FAED

Approximately 15% to 18% of individuals with eating disorders have OCD.1 This means that about 1 in 6 people with an eating disorder also have OCD. The prevalence rate of OCD in the general population is about 2%, so people with eating disorders are about 8 times more likely to have OCD than the general population.1 OCD is more common in individuals with anorexia nervosa than in people with bulimia nervosa or binge eating disorder.

There are a number of similarities between OCD and eating disorders that may contribute to this high rate of co-occurrence. For example, both conditions involve intrusive thoughts which are unwanted and distressing thoughts, images, or impulses. These thoughts can be about food, weight, body image, contamination, self-harm, or making mistakes. People with OCD and people with eating disorders also engage in repetitive compulsive behaviors that are performed in response to intrusive thoughts and designed to reduce anxiety. Another similarity is the fear of losing control. Individuals with eating disorders fear gaining weight and losing control around food, and people with OCD may fear losing control of their thoughts, actions, or emotions. People with OCD and eating disorders often have a strong need for perfection. This can lead them to engage in rigid and inflexible thinking and behaviors. In addition, both OCD and eating disorders can be triggered by stress or anxiety. Engaging in ritual behaviors are perceived as a coping strategy. However, these behaviors can make the anxiety worse in the long run. Finally, people with OCD and individuals with eating disorders often have low self-esteem. This can be due to their negative thoughts about themselves, their weight, or their body image.2

Obsessive Compulsive Disorder Warning Signs and Symptoms2


  • Feeling distress over repetitive, unwanted, intrusive thoughts, images, or urges
  • Being compelled to engage in “undoing” behaviors to reduce the intrusive thoughts
  • Avoiding certain situations that may trigger obsessional thoughts or compulsive behaviors
  • Preoccupation with symmetry, order and arranging things
  • Checking things over and over again to make sure they are safe (i.e., doors are locked, the stove is off, mirrors in the car checked repeatedly before backing out)
  • Hoarding things even if no longer needed
  • Compulsively counting the things they do (i.e., steps they take, number of times they chew their food, minutes they brush their teeth, eye blinks, exercises repetitions)
  • Preoccupation with cleanliness and/or fear of contamination leading to compulsive handwashing, avoiding anything dirty or things with potential germs
  • Experience their obsessions and compulsions as ego dystonic (refers to thoughts, feelings, or behaviors that are in conflict with a person’s self-concept or values)
  • Recognize these thoughts and behaviors are abnormal and interfere with daily life functioning

Treatment Considerations


Eating disorders and OCD may be treated at the same time and in some cases can be treated in the same manner. However, recovery from one disorder does not ensure recovery from another. Therefore, it is important to seek help for both issues and find a professional or treatment facility that specializes in both eating disorders and OCD. Educate yourself, be proactive, and know that both these disorders are treatable.

Learn more about treatment here.
Learn more about finding treatment providers in your area here.

Sources


[1] Mandelli, L., Draghetti, S., Albert, U., De Ronchi, D., & Atti, A. R. (2020). Rates of comorbid obsessive-compulsive disorder in eating disorders: A meta-analysis of the literature. Journal of affective disorders, 277, 927–939. https://doi.org/10.1016/j.jad.2020.09.003 

[2]American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787