Eating Disorders Understanding Obsessive Compulsive Disorder and Eating Disorders By Susan Cowden, MS Susan Cowden, MS Facebook LinkedIn Susan Cowden is a licensed marriage and family therapist and a member of the Academy for Eating Disorders. Learn about our editorial process Updated on January 30, 2023 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Goldman, PhD, FTOS Medically reviewed by Rachel Goldman, PhD, FTOS Facebook LinkedIn Twitter Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change. Learn about our Medical Review Board Print BSIP / Getty Images Table of Contents View All Table of Contents Understanding the Connection Potential Complications Diagnosis Treatment Coping Eating disorders, which include anorexia, bulimia, or binge-eating disorder, are complex physical and mental illnesses characterized by damaging relationships with eating, food, exercise, and body image. It is not unusual for you to also have another mental health issue, including obsessive-compulsive disorder (OCD). OCD is a condition that causes obsessions (recurrent thoughts) and compulsions (repetitive behaviors). Studies show that about two-thirds of people with eating disorders also have a co-occurring anxiety disorder. Of these, one of the most common is obsessive-compulsive disorder or OCD. Research indicates that people diagnosed with eating disorders like anorexia nervosa or bulimia nervosa are 11% to 69% more likely to develop OCD. This article discusses the connection between obsessive-compulsive disorder and eating disorders. It also explores how having one condition can affect the diagnosis and treatment of the other. The Connection Between OCD and Eating Disorders It is believed that eating disorders and anxiety disorders share traits that contribute to their development and account for the high rate of comorbidity. Eating disorders and OCD are both characterized by intrusive thoughts and compulsive actions. But for those people who only have an eating disorder, these obsessions and compulsions are typically limited to thoughts and actions related to food and/or weight. For example, they may engage in excessive exercise or repetitive calorie counting. When people with an eating disorder also have obsessions and compulsions about other areas of their lives, they may also be experiencing symptoms of OCD. One 2020 study found that some women with OCD have an elevated risk of either having an eating disorder or developing one in the future. People with eating disorders can have symptoms that are very similar to symptoms of OCD. For example, people with eating disorders can experience repetitive thoughts about food, body weight, and body image. They may also perform ritualistic behaviors such as body checking and frequent weighing. Key Differences The difference is that people who have an eating disorder do not view these thoughts and behaviors as problematic, where people who have OCD typically find these thoughts and behaviors bothersome or distressing. With an eating disorder, the thoughts and behaviors help to maintain the condition and align with the disorder. Complications of OCD and Eating Disorders Having both conditions may contribute to more significant symptom severity, more severe outcomes, and greater challenges in treatment. Research has found that obsessions were strongly related to eating disorder symptoms in people with co-occurring OCD and anorexia nervosa. Eating disorders carry a high risk for impairment and an increased risk of dying. Because OCD and eating disorders frequently co-occur, it is possible that having both conditions might contribute to more severe symptoms and worse outcomes. Because of overlapping symptoms, it is possible that a person with an eating disorder might also have undiagnosed obsessive-compulsive disorder. If the condition goes untreated, it can complicate and undermine interventions since the untreated obsessions and compulsions uphold the eating disorder. Eating disorders have serious medical complications, including cardiovascular, gastrointestinal, endocrine, and neurological problems. Proper treatment for eating disorders and co-occurring conditions is important to minimize these potential health risks. Diagnosis of OCD and Eating Disorders When diagnosing co-occurring OCD and eating disorders, doctors and mental health professionals need to examine the symptoms and motivations behind them. Because eating disorders may lead to significant and visible changes in body weight and medical complications, symptoms are sometimes attributed to the eating disorder without recognizing the impact of OCD. To make a diagnosis, a healthcare provider will conduct a physical exam and psychological evaluation. They may also order additional medical tests to evaluate health and check for complications. Treatment of OCD and Eating Disorders Anytime that a person is experiencing symptoms of more than one condition, it can complicate treatment. Fortunately, there are effective treatments for both eating disorders and OCD. Obsessive-compulsive disorder is typically treated by medication and psychotherapy. Eating disorder treatments are complex and focus on medical stabilization, nutritional therapy, cognitive-behavioral interventions, and other psychotherapies. Medications Antidepressants and antipsychotics can be helpful in the treatment of OCD. Four selective serotonin reuptake inhibitors are approved by the Food and Drug Administration (FDA) to treat OCD: Luvox (fluvoxamine) Paxil (paroxetine) Prozac (fluoxetine) Zoloft (sertraline) If such medications don't lead to an adequate response, SSRIs may also be augmented with antipsychotics such as Abilify (aripiprazole), Risperdal (risperidone), and Seroquel (quetiapine). Medications are sometimes prescribed to treat symptoms of co-occurring anxiety or depression in eating disorders. SSRI antidepressants can help treat symptoms of bulimia and binge eating disorder. Vyvanse (lisdexamfetamine) is FDA-approved to treat binge-eating disorder. Psychotherapy Psychotherapy is an important part of treatment for both OCD and eating disorders. Two that are commonly utilized are cognitive-behavior therapy and exposure and response prevention. Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) is an effective treatment for OCD and eating disorders. In CBT, clients are taught how to modify behavior patterns and recognize and challenge dysfunctional thoughts. Exposure and Response Prevention Exposure and response prevention (ERP) is another type of psychotherapy effective at treating OCD. As its name implies, a therapist using ERP will expose the client to anxiety or obsession-inducing situations and then work with the client to prevent them from engaging in compulsive behavior. For instance, if the person is struggling with frequent hand washing, an ERP therapist may work with the client to wash their hands less frequently or to wash their hands for a shorter duration. This is similar to what many people go through in treating and recovering from their eating disorders. For example, someone with anorexia or bulimia experiences a great deal of anxiety when they eat a meal. Although they may have urges to exercise, purge or restrict after a meal, the treatment team works with them to prevent these situations. In a higher level of care, such as inpatient hospitalization or residential treatment, they may be physically prevented from acting upon those urges. A combined protocol for a comorbid eating disorder and OCD should include exposure and response prevention. Fortunately, many therapists who work with eating disorders are familiar with treating other conditions that commonly co-occur with them. But if your therapist isn't able to treat your OCD, sometimes people will see two different therapists, with each one focusing on the specific symptoms they specialize in. Coping With OCD and Eating Disorders In addition to seeking appropriate treatment, some strategies can help you cope with co-occurring OCD and an eating disorder. Steps you can take include: Practice self-care: Caring for your physical and mental health is critical. Make sure you get plenty of sleep and engage in activities that bring you joy. Use relaxation strategies: Living with a mental health condition is more difficult when you are anxious and stressed. Strategies such as deep breathing, visualization, and progressive muscle relaxation can help relax your mind and body. Try mindfulness: Mindfulness is a practice that can improve self-awareness, ground you in the present, and help you better deal with stress. It involves focusing on the present moment rather than worrying about the past or future. Keep a journal: Journaling can help you make sense of your experiences, notice patterns, and identify triggers. Support Groups Support groups can also be an essential source of support when recovering from an eating disorder and coping with a co-occurring condition such as OCD. Research has shown that support groups can help improve social support, coping skills, and psychiatric symptoms. Best Eating Disorder Support Groups Summary Eating disorders and OCD share similar symptoms, including obsessions and compulsions. These conditions can also co-occur, complicating the diagnosis and treatment process. Effective treatments are available, but it is essential to get an accurate diagnosis to treat each condition appropriately. A Word From Verywell Eating disorders are serious mental health conditions that can have serious health consequences. When these conditions occur alongside obsessive-compulsive disorder, they can be more challenging to diagnose and treat. If you are experiencing symptoms of either condition, it is vital to speak to your doctor. They can evaluate your symptoms and recommend treatments to help you recover from your eating disorder and manage OCD symptoms effectively. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. 12 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Anxiety and Depression Association of America. Anxiety, depression & obsessive compulsive disorder. Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004;161(12):2215-21. doi:10.1176/appi.ajp.161.12.2215 International OCD Foundation. The relationship between eating disorders and OCD part of the spectrum. Cederlöf M, Thornton LM, Baker J, et al. Etiological overlap between obsessive-compulsive disorder and anorexia nervosa: a longitudinal cohort, multigenerational family and twin study. World Psychiatry. 2015;14(3):333-338. doi:10.1002/wps.20251 Bang L, Kristensen UB, Wisting L, et al. Presence of eating disorder symptoms in patients with obsessive-compulsive disorder. BMC Psychiatry. 2020;20(1):36. doi:10.1186/s12888-020-2457-0 Levinson CA, Brosof LC, Ram SS, Pruitt A, Russell S, Lenze EJ. Obsessions are strongly related to eating disorder symptoms in anorexia nervosa and atypical anorexia nervosa. Eat Behav. 2019;34:101298. doi:10.1016/j.eatbeh.2019.05.001 NEDA. Health consequences. Fineberg NA, Reghunandanan S, Simpson HB, et al. Obsessive-compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults. Psychiatry Res. 2015;227(1):114-125. doi:10.1016/j.psychres.2014.12.003 Mcelroy SL, Hudson J, Ferreira-cornwell MC, Radewonuk J, Whitaker T, Gasior M. Lisdexamfetamine dimesylate for adults with moderate to severe binge eating disorder: Results of two pivotal phase 3 randomized controlled trials. Neuropsychopharmacology. 2016;41(5):1251-60. doi:10.1038/npp.2015.275 Simpson HB, Wetterneck CT, Cahill SP, et al. Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cogn Behav Ther. 2013;42(1):64-76. doi:10.1080/16506073.2012.751124 Cordeiro F, Epstein DA, Thomaz E, et al. Barriers and negative nudges: Exploring challenges in food journaling. Proc SIGCHI Conf Hum Factor Comput Syst. 2015;2015:1159–1162. doi:10.1145/2702123.2702155 Worrall H, Schweizer R, Marks E, Yuan L, Lloyd C, Ramjan R. The effectiveness of support groups: a literature review. Mental Health and Social Inclusion. 2018;22(2):85-93. Additional Reading Association AP. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013. Fairburn CG. Cognitive Behavior Therapy and Eating Disorders. New York, NY: Guilford Press. 2008. Swinbourne J, Hunt C, Abbott M, Russell J, St clare T, Touyz S. The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust N Z J Psychiatry. 2012;46(2):118-31. doi:10.1177/0004867411432071 Tagay S, Schlottbohm E, Reyes-rodriguez ML, Repic N, Senf W. Eating disorders, trauma, PTSD, and psychosocial resources. Eat Disord. 2014;22(1):33-49. doi:10.1080/10640266.2014.857517 Tyagi H, Patel R, Rughooputh F, Abrahams H, Watson AJ, Drummond L. Comparative prevalence of eating eisorders in obsessive-compulsive disorder and other anxiety disorders. Psychiatry J. 2015;2015:186927. doi:10.1155/2015/186927 By Susan Cowden, MS Susan Cowden is a licensed marriage and family therapist and a member of the Academy for Eating Disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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