What Is the 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 pervasive assumption about people with anorexia nervosa, bulimia nervosa or binge-eating disorder is that they are self-absorbed and even narcissistic. This assumption is misleading and completely false. In fact, eating disorders are not really about food or losing weight. 

Instead, an eating disorder is comparable to a mental illness called obsessive-compulsive disorder (OCD) which involves a person acting on obsessive thoughts to alleviate extreme anxiety. 

Eating disorder recovery centers often address 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.

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 and hoarding.

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 ED 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 food intake. 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, intrusive thoughts. 

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.

Obsessive eating disorder treatment addresses the origin of the obsessive thoughts ED patients 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”. 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 some patients can enter 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 ED to ever 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.