Is There an Association Between Eating Disorders and Obsessive-Compulsive Disorder?

One-dimensional beliefs about people with eating disorders assume the problem revolves exclusively around food obsessions – how much they eat, when they eat, what they eat, and whether the food will cause weight gain. Another common but false assumption about people with anorexia nervosa, bulimia nervosa, or bingeeating disorder is that they are self-obsessed. This assumption is misleading and completely false. In fact, eating disorders are not always about food or losing weight – although those are concerns people with an eating disorder often have, disordered eating behaviors are more often a coping mechanism for stress, past trauma, and/or negative emotions. Body image and body dysmorphia certainly play a role in eating disorders, of course. However, unlike the idea that many have that those factors are the sole or primary causes of eating disorders, they are only a part of the picture.

Instead, it’s more realistic to compare most eating disorders to a mental illness called obsessive-compulsive disorder (OCD) which involves a person acting on obsessive thoughts to alleviate extreme anxiety. Both forms of disorder tend to share a variety of facets; the age of onset is usually about 16 to 21 years old, the disorder features repetitive, compulsive behaviors, and anxiety is a common trigger. A person with OCD might fear that if they don’t take a certain path to work each day, bad things will happen to their family – so they compulsively take that route. In a similar vein, a person with anorexia nervosa, in order to avoid a perceived negative outcome – in this case, weight gain – will follow compulsive urges to count calories and avoid eating.

The two types of disorder share more than compulsive behaviors, though. There is also a shared genetic component for people at risk for both disorders.

Per the International OCD Foundation, “Numerous studies have now shown that those with eating disorders have statistically higher rates of OCD (11% – 69%), and vice versa (10% – 17%).”

This leads to the thinking that OCD and eating disorders that feature compulsive behaviors concerned with body weight – like anorexia nervosa, bulimia nervosa, binge eating disorder – as well as those which do not involve body image or weight concerns – like ARFID (Avoidant/Restrictive Food Intake Disorder) –share similar brain patterns.

Any worthwhile eating disorder treatment center addresses a co-diagnosis of an ED and OCD with effective, evidence-based psychotherapies that guide clients through the process of self-discovery, mindfulness, and coping with anxiety in healthy ways. The treatment of both OCD and eating disorders both feature cognitive training therapies that focus on helping the individual receiving treatment to identify, analyze, understand, and ultimately replace the disordered thoughts that lead to destructive or compulsive behaviors.

Symptoms of Obsessive-Compulsive Disorder

OCD is a severe anxiety disorder compelling people to perform the same actions over and over again. Unless they can engage in repetitive actions and complete them to their satisfaction, people with OCD will continue feeling extreme anxiety, guilt, and panic. The anxiety level of people with OCD is so high that their compulsion to repeat actions often interferes with their ability to complete routine daily activities and maintain relationships. A few common OCD “rituals” include counting objects, stepping in and out of doorways, rearranging items, compulsively checking light switches and kitchen equipment, and the like.

The Symptoms of Eating Disorders

There are several different types of eating disorders – most but not all of them share certain symptoms and causes, with differing disordered behaviors presenting. Common symptoms include low self-esteem and distorted body image, especially when it comes to their weight and body size, although these feelings are almost never the only cause of disordered eating.

People with eating disorders often feel a strong sense of guilt and shame about their eating behaviors – both when they eat (feeling guilt about “getting fat”) and about the disordered behaviors (such as purging or restricting). These negative feelings spur a sense of losing control, which triggers further disordered behaviors, and on in a compulsive cycle. Some of the major eating disorders that require treatment include:

• Anorexia Nervosa – Defined by food intake restriction, weight loss and/or inability to maintain a medically viable body weight, and a distorted body image, anorexia nervosa is perhaps the first disorder most people think of when it comes to eating disorders. In many ways, anorexia nervosa hares similarities with OCD, specifically a compulsive urge to count calories and other factors when it comes to food intake.
• Bulimia nervosa – This disorder also generally features a negative or distorted body image, but the individual’s weight is not a diagnostic concern as strongly as with anorexia nervosa. People with bulimia nervosa repeatedly binge-eat foods and then purge the food due to feelings of guilt or disgust about the foods they’ve eaten. Purging can take many forms, such as abusing diet pills or excessive exercise, but vomiting is the most common method.
• Binge Eating Disorder – The most common form of eating disorder, binge eating disorder also involves frequent and repeated binge eating episodes, without “compensatory” purges. People with binge eating disorder often feel out of control with their eating habits, bringing a sense of shame – and in a vicious cycle, engage in binge eating to alleviate the negative emotions. AS with the other disorders we’ve mentioned, and with OCD, cognitive retraining techniques such as Cognitive Behavioral Therapy (CBT) are often used in treatment.

How Is an Eating Disorder Like OCD?

Research shows that people entering an eating disorder recovery center are often co-diagnosed with obsessive-compulsive disorder. One study found 41 percent of subjects with an eating disorder suffered from OCD. Why do so many teens and adults with anorexia nervosa, bulimia nervosa, or binge-eating disorder entering an eating disorder treatment program have obsessive-compulsive disorder?

Eating disorders are characterized by extreme behaviors involving how the individual eats and relates to food. Whether someone eats too little or too much food or eats and then forces themselves to throw up, these behaviors often arise from anxiety-provoking, “automatic” thoughts. When the disorder has fully set in, unless these thoughts can be acted on, the person’s anxiety level continues rising and becomes unendurable. Only ritualistic compulsions like withholding food from the body, eating enormous amounts of food, taking diuretics/laxatives to expedite the elimination of the food from the body, or preparing large meals for others without eating anything provides temporary relief of severe anxiety and dread.

Modern eating disorder treatment addresses the origin of the obsessive thoughts people have concerning food intake, weight gain, and body image. Just as people with OCD feel compelled to check, count, or wash something repeatedly, a person with an eating disorder and OCD is obsessed with thoughts about being too fat, unattractive, and not “perfect.” Perfectionism to a debilitating degree is a common psychological symptom of many eating disorders.

Consequently, they feel compelled to follow a strict diet, to constantly inspect their appearance in mirrors, and prevent weight gain by any means possible. Before starting n treatment at an eating disorder recovery center, serious medical problems resulting from malnutrition, purging, or binging on unhealthy food must be addressed and resolved.

Another characteristic associating OCD with eating disorders is the inability of people with an eating disorder to be satisfied with what they see in a mirror. For example, someone with anorexia nervosa will continue seeing a “fat” person in the mirror even if they are malnourished. As long as they keep having obsessive, distorted thoughts about their appearance, they will be compelled to restrict food intake.

The best eating disorder treatment program includes mental health therapy and counseling that addresses the obsessive-compulsive aspects of an eating disorder. the best eating order recovery centers provide psychiatric evaluations for all patients entering day treatment or residential treatment programs to ensure all patients receive optimized individual recovery plans.

Co-occurring Eating Disorders and OCD Can Be Treated

Eating disorder treatment centers often specialize in treating more than one disorder simultaneously – out of great need. Since disorders like OCD, or depression, or PTSD can trigger disordered eating behaviors (and vice versa), the staff at the center must be able to address both disorders as the foundation for a full recovery. The good news is that much of the psychiatric treatments available at these facilities are valid for both eating disorders and OCD. If you or a loved one is struggling with an eating disorder as well as a psychiatric disorder like obsessive-compulsive disorder, call out for help today – there is hope for the future.