Obsessive-Compulsive Disorder (OCD) and eating disorders have a complex and intertwined relationship with overlapping symptoms and shared underlying psychological mechanisms.
Obsessive-Compulsive Disorder (OCD) and eating disorders, likeAnorexia Nervosaor Bulimia Nervosa, can exhibit overlapping symptoms because they share similar features, particularly around ritualistic behaviors. Both conditions can involve intense distress and anxiety, particularly if the person is prevented from performing their rituals. Therefore, it can sometimes be challenging to distinguish between these disorders based on symptoms alone, which is why professional evaluation is crucial.
Eating disorders encompass a range of psychological disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, which all involve disturbances in eating patterns and body image.
These are both disorders of control that involve a vicious cycle of obsessive thinking and compulsive behavior. They are disruptive, debilitating, and can significantly interfere with daily activities, relationships, and overall quality of life.
Additionally, both OCD and eating disorders are often associated withperfectionistic tendencies. This perfectionism can contribute to a constant feeling of dissatisfaction and the need to engage in obsessive rituals or behaviors to meet these unattainable standards.
Diagnoses often overlap as OCD and eating disorders frequently coexist, influencing and exacerbating each other’s symptoms.
Research has found that up to 69 percent of people with eating disorders have been diagnosed with OCD. Additionally, 10-17 percent of people with OCD have been diagnosed with an eating disorder (Neziroglu & Sandler, n.d.).
Living with both obsessive-compulsive disorder and an eating disorder can be extremely challenging and can significantly impact a person’s daily life. These two conditions can interact and exacerbate each other, leading to additional distress and difficulties.
This intricate relationship presents unique challenges for individuals experiencing these conditions and requires a comprehensive understanding to guide effective treatment.
Comparison
Focus of Obsessions and Compulsive Behaviors
Both OCD and eating disorders involve the presence of obsessions,intrusive, persistent thoughts, and preoccupationsthat are difficult to control.
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. Compulsions often reduce discomfort, unease, or dissatisfaction when something feels incomplete.
However, the focus of these obsessions and compulsions differ.
Individuals with OCD, and individuals with eating disorders, both perform compulsive behaviors to manage their anxiety and reduce negative affect.
OCD typically involves a range of compulsions, often unrelated to body image or food (e.g.,contamination,symmetry,numbers), while eating disorders primarily revolve around obsessive concerns about food, dieting, and body image.
For instance, someone with an eating disorder might develop strict rules around eating (e.g., only eating specific foods, or at specific times), and become very distressed if these rituals are disrupted.
Yet, OCD compulsions are diverse and not exclusively related to eating or weight, whereas in individuals with eating disorders, compulsive behaviors are centered around food, eating habits, and weight control.
Both conditions can significantly interfere with an individual’s ability to carry out their daily activities and responsibilities.
Causes
The exact cause of neither OCD nor eating disorders is fully understood. The causes of these disorders are complex and multifactorial, involving a combination of genetic, neurobiological, and environmental factors.
Evidence suggests that OCD and eating disorders can run in families (Trace et al., 2013; Pauls, 2022). People with a family history of OCD or a family history of an eating disorder are at a higher risk of developing the disorder, indicating a genetic predisposition.
Additionally, abnormalities in brain chemistry and imbalances in certain neurotransmitter systems (specifically the neurotransmitters serotonin and dopamine), are believed to play a role in both the development and regulation of OCD and of eating disorders.
Environmental factors, such as stressful life events, childhood trauma, significant life changes, or histories of abuse, can contribute to the development of OCD and eating disorder symptoms in some individuals (Rosso et al., 2012; Degortes et al., 2014)
Psychological factors can also play a significant role in developing these disorders. Perfectionism and feelings of inadequacy or a need for control are often present in individuals with OCD and eating disorders (Williams & Levinson, 2021).
Additionally, individuals with certain personality traits, such as high levels of anxiety or impulsivity, may be more prone to developing these disorders (Lilenfeld et al., 2006)
Aim of Behaviors
Both individuals with OCD and individuals with eating disorders often experience high levels of anxiety and emotional distress related to their obsessions.
The difference is that people with an eating disorder typically do not view their obsessive thoughts and compulsive behaviors as problematic, as these thoughts and behaviors help maintain the condition and align with the disorder.
The individual might even misperceive them as a means to cope with, or express feelings about, issues of control, self-perception, and self-worth.
People with OCD, on the other hand, typically find their thoughts and behaviors burdensome and distressing. Thus, they will engage in compulsive behaviors to get rid of the unwanted and anxiety provoking intrusive thoughts and reduce their distress related to the obsessions.
Ritualized eating patterns seen in patients with eating disorders, such as arranging food in a specific way and cutting food into small pieces, are phenotypically similar to rituals, such as washing and avoidance, seen in OCD (Kinkel-Ram et al., 2022).
Treatment Options for OCD and Eating Disorders
Treating both OCD and an eating disorder simultaneously can be complex and requires a comprehensive approach.
It often involves a combination of therapy, such as cognitive-behavioral therapy (CBT), medication management, and support from a multidisciplinary team of healthcare professionals, tailored to each individual’s specific needs.
Cognitive-Behavioral Therapy (CBT)
CBT For OCD
CBT For Eating Disorders
Medications
Medications for OCD
Medications for Eating Disorders
Other Treatment Options for OCD
Other Treatment Options for Eating Disorders
Sources
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Kinkel-Ram, S. S., Grunewald, W., Ortiz, S. N., Magee, J. M., & Smith, A. R. (2022). Examining weekly relationships between obsessive-compulsive and eating disorder symptoms. Journal of Affective Disorders, 298, 9-16.
Neziroglu, F., & Sandler, J. (n.d.).The Relationship Between Eating Disorders and OCD Part of the Spectrum. International OCD Foundation. https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
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Pauls, D. L. (2022). The genetics of obsessive-compulsive disorder: a review.Dialogues in clinical neuroscience.
Williams, B. M., & Levinson, C. A. (2021). Intolerance of uncertainty and maladaptive perfectionism as maintenance factors for eating disorders and obsessive‐compulsive disorder symptoms.European Eating Disorders Review,29(1), 101-111.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Julia Simkus
BA (Hons) Psychology, Princeton University
Julia Simkus is a graduate of Princeton University with a Bachelor of Arts in Psychology. She is currently studying for a Master’s Degree in Counseling for Mental Health and Wellness in September 2023. Julia’s research has been published in peer reviewed journals.
