Eating disorders (EDs) and obsessive-compulsive disorder (OCD) are both complex and distressing mental health conditions, each with unique characteristics, yet they often share similar features. Both can cause intense emotional and psychological distress, leading individuals to engage in repetitive behaviors as a way to cope. In many cases, these two disorders co-occur, making diagnosis and treatment more challenging but also providing insights into their shared mechanisms.
In this blog, we’ll explore the relationship between eating disorders and OCD, discuss their similarities and differences, and provide an overview of the treatments that address these conditions together.
Understanding Eating Disorders and OCD
Before we get into the connection between eating disorders and OCD, let’s overview the basics of each. Eating disorders are a general category of mental illnesses that contain distinct diagnoses; OCD is also a specific diagnosis.
What Is an Eating Disorder?
An eating disorder is a mental illness that affects an individual’s relationship with food, eating behaviors, and body image. The five eating disorders listed in the DSM-5 include Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), Avoidant/Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding or Eating Disorder (OSFED). The eating disorder symptoms vary depending on the diagnosis. These disorders are often characterized by preoccupation with food, weight, and body shape, which can lead to harmful behaviors such as restrictive eating, bingeing, purging, or over-exercising.
Eating disorders can have devastating physical, emotional, and social consequences. They can lead to severe undernourishment and malnourishment that impact nearly every organ system and can ultimately lead to death. However, they are not only about food; they involve underlying psychological issues, as patients seek out a semblance of control over their lives by controlling their relationship to eating and their bodies. Eating disorders don’t have a clear cause but are influenced by low self-esteem, trauma, genetics, social pressures, and other environmental factors.
What Is Obsessive-Compulsive Disorder (OCD)?
OCD is a mental health condition that involves persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed in an attempt to alleviate the distress caused by these thoughts. Common obsessions include fears about contamination, harm, or violating moral standards, while compulsions may involve actions like hand washing, checking, counting, or arranging items. There are no official subtypes, but the symptoms of OCD tend to focus on categories like cleanliness, symmetry, taboo thoughts, and hoarding.
The repetitive cycle of obsession and compulsion creates a significant amount of anxiety and can interfere with a person’s ability to lead a normal life.
Similarities Between Eating Disorders and OCD
While eating disorders and OCD are distinct diagnoses, they share several important characteristics, including repetitive thoughts and behaviors. For instance, someone with Anorexia Nervosa may become obsessed with food intake and weight to the point where these thoughts dominate their day-to-day life, much like someone with OCD may experience uncontrollable intrusive thoughts. These intrusive thoughts often lead to compulsive behaviors—whether that’s weighing oneself repeatedly, restricting food intake, or engaging in ritualistic eating patterns.
The hallmark of both conditions is the intense emotional distress that arises from unwanted thoughts and the sense of temporary relief provided by engaging in the associated behaviors. However, this relief is short-lived, and the distress quickly returns, continuing the cycle of obsession and compulsion.
Differences Between Eating Disorders and OCD
Despite their similarities, there are notable differences between EDs and OCD, particularly in the way individuals perceive their thoughts and behaviors.
Awareness of Behavior
One key difference lies in whether the condition is ego-dystonic or ego-syntonic.
Most cases of OCD are ego-dystonic, meaning that individuals with OCD often recognize their obsessions and compulsions as irrational or misaligned with their core values. They know that their thoughts don’t make sense but still feel compelled to act on them to alleviate anxiety. However, some OCD diagnoses have the specifier “with absent insight or delusion,” meaning that there isn’t an awareness of the irrationality.
Eating disorders, on the other hand, are often ego-syntonic, meaning that individuals with EDs may view their thoughts and behaviors as congruent with their goals and self-identity. For example, a person with Anorexia Nervosa may see extreme weight loss as a positive achievement, aligning with their desire for control or societal beauty standards, rather than recognizing it as a problem.
Focus on Body Image
Another key distinction is the focus on body image. While OCD can involve some concerns around physical appearance, body image distortion is much more central to eating disorders. With an Anorexia Nervosa diagnosis, individuals may have a highly distorted view of their own bodies, which drives their disordered behaviors. In contrast, OCD is more likely to involve fears that are unrelated to appearance, such as contamination or causing harm.
Consistency of Compulsions
Finally, rigidity in behaviors is a hallmark of OCD. People with OCD tend to perform their compulsions in highly specific, unchanging ways. While individuals with EDs may display repetitive behaviors—such as consistently eating the same foods or exercising in a particular pattern—this rigidity is not as essential to the diagnosis of an eating disorder as it is to OCD.
Co-occurrence of Eating Disorders and OCD
While eating disorders are their own mental health diagnosis, they commonly co occur with other mental illnesses, including anxiety disorders, depression, and OCD. The similarities between OCD and eating disorders have been observed and studied for nearly a century, starting with the 1939 observations of the “compulsion neurosis” seen as a common personality trait of both disorders.
Statistically, the two conditions tend to be diagnosed together in a greater proportion compared to each disorder’s prevalence. A 2021 meta-analysis found that the lifetime prevalence of someone experiencing OCD along with an eating disorder was about 14% with Anorexia Nervosa having the greatest risk of comorbid OCD. According to the same study, people experiencing eating disorders are eight times more likely to develop OCD than those without an ED.
There are several potential reasons for this connection:
Genetic factors: Both eating disorders and OCD have been linked to hereditary traits, meaning that someone with a family history of either disorder may be more likely to develop one or both.
Innate personality traits: Certain characteristics, such as neuroticism and perfectionism—a tendency toward anxiety, emotional instability, and self-consciousness—are commonly found in individuals with both EDs and OCD.
Trauma: The experience of trauma, particularly in childhood, has been linked to the development of both eating disorders and OCD. Trauma can trigger the need for control, perfectionism, or ritualistic behaviors that help an individual cope with overwhelming emotions or fear.
Understanding how these disorders can occur in concert can help inform treatment strategy.
Treatment Approaches for Eating Disorders and OCD
Treating any mental illness often requires some level of personalization as the underlying causes will likely vary from person to person. However, there are styles of psychotherapy that present the most effective treatment options for both eating disorders and OCD. However, when the two disorders co-occur, this can potentially complicate treatment as both disorders need to be addressed. Overlapping therapeutic techniques can be beneficial for individuals with both conditions to address the distressing thoughts and prevent the compulsive behaviors that follow. Here are some of the common therapy modalities used to treat both eating disorders and OCD.
Cognitive Behavioral Therapy (CBT)
CBT is commonly used to treat both OCD and eating disorders. It focuses on identifying and challenging unhelpful thought patterns and developing healthier behaviors. For individuals with OCD, this may involve challenging the irrationality of obsessive thoughts and learning to tolerate anxiety without engaging in compulsions.
In eating disorder treatment, CBT helps individuals recognize the distorted thoughts they have about food, weight, and body image, and encourages healthier eating behaviors and a more positive self-image.
Exposure and Response Prevention (ERP)
ERP, a specific form of CBT, is often used in the treatment of OCD and eating disorders. It involves exposing individuals to their anxiety triggers in a controlled environment while helping them resist the urge to perform their compulsions. Over time, this reduces the anxiety associated with the trigger and decreases the compulsion.
Dialectical Behavioral Therapy (DBT)
DBT is also an offshoot of CBT that has been specifically used to treat eating disorders. It involves helping people deal with opposite ideas – like a belief that they are overweight with the reality that they are undernourishing themselves. It’s similar to CBT in that it helps people understand their emotional experiences, but it also brings in an extra layer of mindfulness to help tolerate distress without engaging their compulsion. The same technique can be applied to treatments for OCD.
Find Mental Health Treatment with the Alliance
Eating disorders and OCD are both serious mental health conditions that can significantly impact an individual’s quality of life. While they have distinct differences, they have overlapping characteristics—particularly the cycle of obsessive thoughts and compulsive behaviors. Additionally, people with eating disorders are more likely to also be diagnosed with OCD. Understanding the connections between these conditions can guide more effective treatment.
With the right combination of therapies and other interventions, individuals with co-occurring eating disorders and OCD can work toward recovery and regain control over their thoughts and behaviors. Awareness of these conditions and their comorbidity is an important step toward offering the appropriate care and support to those affected. At the Alliance, we offer tools to help you and your loved ones get the help they need on their path to recovery. Our licensed mental health professionals on our helpline can connect you with the best-fit providers and our virtual support groups offer space to process your experiences.
