How does OCD and eating disorders interact

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Obsessive-compulsive disorder (OCD) and eating disorders are two distinctive conditions, but the two have more in common than many people think—and can be especially tricky to navigate when they occur together.

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OCD and eating disorders

In fact, eating disorders and obsessive-compulsive disorder have a long shared history that’s well-documented. Since 1939, study after study has uncovered and confirmed a relationship between the two frequently comorbid—or, simultaneously occurring—conditions. (2)

In a more-recent examination on the matter, as many as 64 percent of study participants were found to have both an eating disorder and some form of anxiety disorder, with 41 percent of that group specifically struggling with OCD. (1) A correlated finding noted that up to 17 percent of people primarily diagnosed with OCD also have an eating disorder. (2)

Somewhat less time has been spent analyzing why these conditions develop in tandem so often. One hypothesis is that both conditions can stem from dysregulated levels of serotonin, a hormone that plays a role in the feelings of happiness and satiety. (3) But the disorders share a number of traits that in many ways make them a natural pairing.

Both conditions revolve around experiencing obsessions—or, recurring thoughts or impulses—and compulsions—the reoccurring, often repetitive behaviors made in reaction to those thoughts. 

The relationship between obsessions and compulsions is a delicate one, and very individual, but it leads to the telltale behaviors of obsessive-compulsive disorder, such as someone washing their hands until they’re raw to avoid contracting germs. 

When it comes to eating disorders, the persistent, disruptive thoughts have primarily to do with food and body image, with the disordered eating behavior made in response to those anxieties.

Essentially, if eating disorders create patterns of disordered eating behavior, obsessive compulsive disorder can act as both engine and enforcer of those actions. Examples of this may include compulsive exercising, food rituals, and an obsession with weighing oneself. 

Once the brain starts thinking in this way, it may be possible for one disorder to lead to another, as evidenced by one study that saw women who struggled with OCD in childhood at higher risk of developing an eating disorder later on. (4)

Still, there are different facets of OCD that can show up differently in the various types of eating disorders.

OCD and anorexia

Perhaps the strongest link between anorexia nervosa (AN) and OCD is perfectionism. Often a major component of both disorders, the trait describes the consecutive setting of exceptionally high goals and the direct tethering of one’s self-worth to achieving those goals.

Of course, nobody is perfect, and the discomfort of this realization can lead to OCD sufferers with anorexia not eating as a compulsive response.

The intense fear of gaining weight is another potential obsession that can push someone with OCD and AN into not eating. (4)

OCD and bulimia

Obsessive-compulsive disorder also commonly presents as ritualized behaviors, i.e. knocking on a door a certain number of times before coming inside.

This aspect of OCD can lend itself to sustaining the types of ritualized eating behaviors frequently connected to bulimia, many of which inform the rhythms of someone’s binging and purging cycles. (3) 

People who struggle with bulimia may also be driven by feelings of guilt and shame. (4) When presenting as an “obsession” for someone who also has OCD, these unpleasant feelings can act as a catalyst for either binging or purging episodes.

OCD and binge eating

People with binge eating disorder may feel a heavier impact from the compulsion aspect of OCD than the obsession.

In fact, the binge eating episodes people struggling with this disorder partake in are often described as “compulsive,” with the person being unable to control or stop themselves. A loss of control over how much food is consumed is actually one of the behaviors that defines binge eating disorder.

Treating co-occurring OCD and eating disorders

When a person has any two co-occurring conditions, it can impact the way they’re treated or the type of treatment they receive. People struggling with both OCD and an eating disorder may fare better with certain types of therapies than with others.

One of the most popular treatments, for both disorders, is cognitive behavioral therapy (CBT). Through a mixture of talk therapy and a prescribed set of mental exercises, CBT can help a person unlearn harmful behavior and thought patterns, even those that have become deeply entrenched.

Exposure therapy is another popular treatment for both OCD and eating disorders. In both cases, the exposure to feared thoughts or scenarios is meant to desensitize the person to the anxiety caused by those fears. For someone with both OCD and an eating disorder, this can help sever the tie between the obsession and the compulsion.

Of course, each case is as unique as the person going through it, so there are any number of techniques or methods that may be tried to help someone struggling with both obsessive-compulsive disorder and an eating disorder. But, in any situation, it’s important to remember that it’s possible for those people to find help—and make a full recovery.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Kaye, W. H., Search for more papers by this author, Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., Group, the P. F. C., Duncan, L., Marsh, R., Wagner, A., Yohanan, M., Godart, N., & Micali, N. (2004, December 1). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry. Retrieved June 9, 2022, from https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.161.12.2215 
  2. The relationship between eating disorders and OCD part of the spectrum. International OCD Foundation. (n.d.). Retrieved June 9, 2022, from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/ 
  3. Tyagi, H., Patel, R., Rughooputh, F., Abrahams, H., Watson, A. J., & Drummond, L. (2015). Comparative prevalence of eating disorders in obsessive-compulsive disorder and other anxiety disorders. Psychiatry Journal, 2015, 1–6. https://doi.org/10.1155/2015/186927 
  4. Anderluh, M. B., Tchanturia, K., Rabe-Hesketh, S., & Treasure, J. (2003). Childhood obsessive-compulsive personality traits in adult women with eating disorders: Defining a broader eating disorder phenotype. American Journal of Psychiatry, 160(2), 242–247. https://doi.org/10.1176/appi.ajp.160.2.242

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