Obsessive-Compulsive Disorder and Eating Disorders

When the Thoughts and Urges Are About More Than Just Food

BSIP / Getty Images

When you have an eating disorder such as anorexia, bulimia, or binge-eating disorder, it's not unusual for you to also have another mental health issue. These problems can include (but aren't limited to) depression, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.

In fact, 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. In fact, studies have shown that for those diagnosed with eating disorders like anorexia nervosa or bulimia nervosa, they are anywhere from 11 to 69% more likely to develop OCD. It is believed that eating disorders and anxiety disorders share traits that contribute to their development and account for the high rate of comorbidity.

What Is Obsessive-Compulsive Disorder?

As its name implies, people who have obsessive-compulsive disorder struggle with either obsessions or compulsions, or (more commonly) both.

Obsessions are recurrent and frequent thoughts or impulses. They intrude on your daily life, and they can be inappropriate (for example, some people have sexual obsessions or obsessions about harming others). These obsessions cause distress and anxiety.

The thoughts are not simply worries about real-life problems (although they may involve exaggerated versions of real-life problems). The person involved usually attempts to ignore, suppress, or stop the thoughts by doing some other action or thought—a compulsion.

Compulsions are repetitive behaviors or mental acts that are performed in response to an obsession. Common compulsions are acts such as hand washing, repeated checking (to see if the door is locked or an appliance is turned off, for example), praying, counting, or repeating words. Although the goal of these acts is to reduce anxiety and worry, they are excessive.

The person experiencing these obsessions and compulsions may be aware that the thoughts and actions are excessive and unreasonable. However, the obsessions and compulsions continue to cause distress and take up significant portions of time. This disrupts the person's normal routine and can cause problems in work, school, and/or relationships.

Many people wonder: At what point does something cross the line into obsessive-compulsive behavior? There are no specific guidelines as to how often or how many times a thought or action must occur in order to be considered obsessive-compulsive disorder, but you can ask yourself the question, "Does it get in the way of my life?" as a starting point to determine if it's an issue for you.

For example, hand washing is an activity that we are encouraged to do in order to keep ourselves and others clean and healthy. But when hand washing becomes so time-consuming that hands begin to bleed, or that a person isn't able to participate in activities, then it has become a problem.

How OCD Relates to Eating Disorders

Both people with eating disorders and people with OCD experience 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 a person with an eating disorder also has obsessions and compulsions about other areas of their lives, they may also be experiencing symptoms of OCD.

Interestingly, a 2003 research study found women who experienced OCD in childhood are at a higher risk for developing an eating disorder later in life.

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 engage in ritualistic behaviors such as body checking and frequent weighing.

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 aligns with their disorder.

How This Affects Treatment

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/or psychotherapy.

Cognitive-behavioral therapy (CBT) has been found to be an effective treatment for both OCD and for eating disorders. In CBT, clients are taught how to modify behavior patterns as well as to recognize and challenge dysfunctional thoughts.

Exposure and response prevention (ERP) is another type of psychotherapy that has been shown to be 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 any type of 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 actually very similar to what many people go through in the treatment and recovery from their eating disorders as well. 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 is working with them to prevent these situations from occurring. 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 the treatment of 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.

8 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.
  1. Anxiety and Depression Association of America. Anxiety, depression & obsessive compulsive disorder.

  2. 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

  3. Neziroglu F. International OCD Foundation. The relationship between eating disorders and OCD part of the spectrum.

  4. Anxiety and Depression Association of America. Obsessive-compulsive disorder (OCD).

  5. American Psychiatric Association. What is obsessive-compulsive disorder?.

  6. National Institute on Mental Health. Obsessive-compulsive disorder.

  7. Anderluh MB, Tchanturia K, Rabe-hesketh S, Treasure J. Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. Am J Psychiatry. 2003;160(2):242-7. doi:10.1176/appi.ajp.160.2.242

  8. 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

Additional Reading

By Susan Cowden, MS
Susan Cowden is a licensed marriage and family therapist and a member of the Academy for Eating Disorders.