The Connection Between Eating Disorders and OCD

Part of our OCD articles. For evaluation and medication management, see OCD care at Ridge Way.

The connection between eating disorders and Obsessive-Compulsive Disorder (OCD) matters because both are serious conditions that can take over daily life. They may seem different on the surface, but research shows they often occur together. Understanding the link can help people recognize symptoms and find the right kind of care.

In this post, we explore the relationship between eating disorders and OCD, the symptoms of each, how they overlap, and how they differ. Ridge Way does not treat eating disorders. We refer eating disorder care to specialists, and we list a free eating disorder helpline below.

What Are Eating Disorders?

NIMH describes eating disorders as serious illnesses marked by severe disturbances in a person’s eating behaviors. People may become preoccupied with weight loss, body shape or control of what they eat. Common types include the following.

• Anorexia nervosa. Severe food restriction and a distorted body image. MedlinePlus says it is the least common of the three main eating disorders, but often the most serious.
• Bulimia nervosa. Binge eating followed by purging, such as vomiting, laxatives or excessive exercise.
• Binge eating disorder. Eating large amounts of food without control, followed by guilt and shame. It is the most common eating disorder in the U.S., according to MedlinePlus.
• Disordered eating. Behaviors like skipping meals, dieting and moralizing food. The National Alliance for Eating Disorders notes that these do not always meet the criteria for an eating disorder, but they can develop into one.

Eating disorders are not simply about food. According to MedlinePlus, they are caused by a complex mix of genetic, biological, behavioral, psychological and social factors. People with eating disorders also have a higher risk of depression, anxiety disorders and substance use disorders.

What Is OCD?

According to NIMH, OCD is a disorder marked by uncontrollable, recurring thoughts (obsessions), repetitive behaviors (compulsions), or both. Obsessions are unwanted, intrusive thoughts, images or urges that cause intense distress. Compulsions are behaviors a person uses to try to get rid of the obsessions or reduce the distress.

• A person with OCD may fear germs and wash their hands again and again.
• Someone else may feel a strong need for order and spend a long time arranging objects exactly.

How Are Eating Disorders and OCD Connected?

Research shows a meaningful connection between eating disorders and OCD. An expert article from the International OCD Foundation reports that studies have found OCD in 11% to 69% of people with eating disorders. The same article reports eating disorders in 10% to 17% of people with OCD. The estimates vary widely between studies, but both are higher than expected.

1. Shared Characteristics

The IOCDF article notes that both conditions can involve intrusive thoughts that lead to ritual-like behaviors. For example, consider these patterns.

• Someone with anorexia may spend much of the day preoccupied with restricting food.
• A person with bulimia may follow a binge with purging, such as vomiting or misusing laxatives.

2. Perfectionism

The IOCDF article lists perfectionism as a trait common to both conditions. Standards may center on weight, appearance or daily routines.

3. Anxiety and Rigidity

Anxiety often runs alongside both conditions. People with eating disorders have a higher risk of anxiety disorders. The IOCDF article describes how uncertainty, rigidity and perfectionism can strengthen compulsions in both conditions.

4. Body Image and How the Two Differ

Preoccupation with body shape and weight is a core feature of eating disorders. This overlap between OCD and body image is where the two can be confused. The IOCDF article notes a key difference. People with eating disorders are mainly driven by concerns about appearance, while a person with OCD may restrict food for very different reasons.

Symptoms of OCD Eating Disorder Overlap

Recognizing the symptoms of OCD and eating disorders can help identify when they occur together. Signs to watch for include the following.

• Preoccupation with food. Constant thoughts about food, meals or calories.
• Rigid rules. Strict eating or exercise routines that feel impossible to change.
• Fear of weight gain. Intense worry about weight or body shape.
• Ritual-like behaviors. Repeated behaviors around food or exercise that are hard to stop.
• Emotional distress. Guilt, shame or panic when a rule or ritual cannot be followed.

If you or someone you know has these signs, look for care from professionals who understand the comorbidity of OCD and eating disorders. An eating disorder specialist and an OCD clinician may both be needed.

OCD and Specific Eating Disorders

The connection between OCD and anorexia, bulimia or binge eating disorder varies from person to person.

1. OCD and Anorexia

NIMH says people with anorexia often have constant thoughts about food, weight or body shape. Restrictive eating can take on a repetitive, rule-bound quality that resembles OCD rituals.

2. OCD and Bulimia

Bulimia involves binge eating followed by purging. The IOCDF article reports that exposure and response prevention has been particularly effective for bulimia.

3. OCD and Binge Eating Disorder

According to MedlinePlus, binge eating disorder involves eating large amounts of food without control, then feeling guilt and shame. Those feelings can add to distress and keep the cycle going.

4. OCD and Disordered Eating

Disordered eating, like dieting or skipping meals, sits on the same spectrum as eating disorders. The National Alliance for Eating Disorders notes that these behaviors can grow into a full eating disorder, so early recognition matters.

Why Recognizing the Link Matters

When both conditions are present, everyone involved in care needs to know about both. The IOCDF article explains that the reason behind a behavior matters. Restricting food because of body image concerns is different from restricting food because of an OCD fear, and the treatment plan reflects that.

How Are OCD and Eating Disorders Treated?

According to MedlinePlus, eating disorders are usually treated by a team. Care can include psychotherapy, nutrition counseling, medical monitoring and medication when appropriate. Severe cases may need hospital or residential care. Ridge Way does not provide any of this eating disorder care, and refers it out.

1. Exposure and Response Prevention (ERP)

According to the IOCDF, ERP is the most effective first-line therapy for OCD in adults, children and teens. It works when a knowledgeable therapist guides it. It is a form of cognitive behavioral therapy delivered by a trained therapist.

2. Nutrition Counseling

Nutrition counseling is part of standard eating disorder treatment. The IOCDF article also recommends that physicians and nutritionists be part of the team.

3. Medication

The IOCDF says SSRIs are effective for OCD and are often used together with ERP. Read more about how antidepressant medication is used.

Where to Find Eating Disorder Support

The National Alliance for Eating Disorders runs a free helpline at (866) 662-1235. It is open Monday through Friday, 9 a.m. to 7 p.m. Eastern time. Licensed therapists who specialize in eating disorders answer it, and they offer support and referrals to all levels of eating disorder treatment.

The helpline is not a crisis line. If you or someone you love is thinking about suicide or self-harm, call or text 988 at any hour. If there is immediate danger, call 911.

When to Get Help

Consider an evaluation if obsessive thoughts, rituals or rigid rules about food are causing distress or taking up a lot of your day. If you or a loved one is struggling with both, help is available. The National Alliance for Eating Disorders notes that early care makes a difference.

Ridge Way provides psychiatric evaluation and medication management for adults, teens and children age six and older, through telehealth across Georgia and at our Sugar Hill office. Ridge Way does not treat eating disorders. We refer eating disorder care out, and our medical team can refer you to a therapist for ERP. See what we treat and what we refer out, or learn about OCD care at Ridge Way.

You do not need a referral unless your insurance plan requires one. Request an appointment and we will usually call you back within one business day.