Obsessive Compulsive Disorder and Eating Disorders
“I’m so OCD about organizing things.” “They seem to be a little OCD about handwashing.” Maybe you’ve heard or said phrases like this or one similar. Today, we are talking about OCD (Obsessive Compulsive Disorder), its co-occurrence with eating disorders, and why saying these phrases can cause harm.
What is OCD?
Please note: This post is for basic educational purposes. OCD education, diagnosis, treatment, and subtypes are vast and would take multiple blog posts to touch on every aspect. We are covering a very high-level overview to share basic information.
Obsessive Compulsive Disorder (OCD) is a mental health condition characterized by two types of symptoms: obsessions and compulsions. The obsessions and compulsions work in a cycle like this.
An obsession is an intrusive or repeated thought, image, urge, or feeling. The obsessions cause distress of some kind - anxiety or fear. An obsession is ego-dystonic, meaning that it goes against an individual's values or beliefs, leading to distress. Everyone experiences intrusive thoughts or images, but someone without OCD can move on more easily, while someone with OCD can get stuck in the cycle. So, to tend to the distress from the obsession, a compulsion is done. This is a behavior used to reduce distress, but it only offers temporary relief.
Diagnostic Criteria
Some of the criteria a practitioner would look for in an OCD diagnosis based on the DSM-5 include:
Presence of Obsessions, Compulsions, or Both
Obsessions (intrusive, unwanted thoughts, urges, preoccupations, or images) that:
Cause significant anxiety or distress
Are difficult to ignore or suppress
Compulsions (repetitive behaviors or mental acts, like checking, counting, or washing) that:
A person feels driven to perform in response to an obsession or rigid rule
Are meant to reduce anxiety but are excessive or not connected in a realistic way to the feared outcome
Can be a mental act like rumination or reviewing certain things
The Obsessions/Compulsions:
Take up a lot of time (more than 1 hour per day).
Cause significant distress or interfere with daily life (work, school, relationships, etc.).
There are other obsessive-compulsive-related disorders characterized by body-focused repetitive behaviors (hair pulling, skin picking) and attempts to stop or decrease these behaviors.
Like other mental health conditions, individuals who are part of the Global Majority (Black, Brown, Asian, Indigenous, and dual-heritage people or those that have been racialized as an ‘ethnic minority), LGBTQIA+, and Disabled community are more likely to be underdiagnosed, misdiagnosed, and not receive treatment. Cultural differences in symptom expression, clinician biases, and limited representation in research contribute to these challenges. Addressing these disparities requires culturally competent diagnostic tools, increased awareness among healthcare providers, and inclusive research practices to ensure accurate diagnosis and effective treatment for all individuals.
Subtypes
OCD has different themes or subtypes. Different subtypes can be treated differently. NOCD has a great list of 18 common subtypes, a few of which include:
Contamination OCD
“Just Right” OCD
Postpartum OCD
Relationship OCD
Harm OCD
Checking OCD
Causes of OCD
Like all mental health conditions, there is no one exact cause of OCD, but rather a combination of biological, genetic, environmental, and psychological factors contribute to its development.
Biological Factors:
Brain Structure and Function: Differences in certain areas of the brain, particularly those involved in decision-making and behavior regulation, have been observed in individuals with OCD. These abnormalities may influence the manifestation of obsessive-compulsive behaviors.
Neurotransmitter Imbalances: Disruptions in neurotransmitters, especially serotonin, dopamine, glutamate, and GABA, are believed to play a role in OCD. While medications affecting serotonin levels can alleviate symptoms, the exact relationship between neurotransmitter imbalances and OCD is still being studied.
Genetic Factors:
A familial link has been identified, with studies indicating that individuals with a first-degree relative (such as a parent or sibling) who has OCD are at a higher risk of developing the disorder themselves. This risk is more pronounced if the relative developed OCD during childhood or adolescence.
Environmental Factors:
Stressful Life Events/Trauma: Experiences such as trauma, abuse, or significant life changes may trigger or exacerbate OCD symptoms in predisposed individuals. For example, OCD may be more common in people who have been bullied, abused, or neglected, and it sometimes starts after an important life event, such as childbirth or a bereavement.
Learned Behaviors: Observing and internalizing compulsive behaviors from family members or others can contribute to the development of OCD. This suggests that certain behaviors may be acquired through environmental exposure.
Psychological Factors:
Personality traits such as perfectionism and a heightened sense of responsibility may increase susceptibility to OCD. Individuals with these characteristics might develop compulsive behaviors as coping mechanisms to manage anxiety or perceived threats.
Co-occurrence with EDs
Approximately 18% of individuals with eating disorders have a lifetime comorbidity with OCD, with rates slightly higher in anorexia nervosa (19%) compared to bulimia nervosa (15%). Research indicates a notable overlap between OCD and eating disorders, like the following:
Genetic predisposition and heritability
Personality traits like perfectionism and heightened fear of making mistakes
Trauma exposure
Neurobiological factors like neurotransmitter imbalances
Common Symptoms and Challenges
We work with a variety of clients on the eating disorder spectrum, and many clients have a co-occurring OCD diagnosis. It’s also crucial to note that eating disorder thoughts and behaviors can look similar to those with OCD. Let’s look at an example.
Tyson has intrusive, distressing thoughts about gaining weight, especially if they eat certain foods or miss workout days. These thoughts leave Tyson with intense anxiety and preoccupation with food choices and their body for at least 85% of their day.
To relieve this anxiety, they engage in food rituals, like calorie counting, restricting, weighing their food, only eating at certain times of day, and reviewing what they’ve eaten over the last few days multiple times, even though they know exactly what they ate.
It sounds a lot like Tyson is getting stuck in the OCD cycle. With this cursory information, it’s impossible to determine if Tyson has an eating disorder AND OCD. It’s important to understand if obsessions and compulsions show up in other areas of life rather than just with food.
It’s also important to note that treatment for an eating disorder and OCD simultaneously can be incredibly challenging. The client and clinician must work together to determine how to address each and whether or not treatment should focus on one before the other.
Treatment Modalities
Two of the most well-established treatment modalities are Exposure and Response Prevention (ERP) and SSRIs, as explained below. Internal Family Systems (IFS) could also be used with ERP to understand better and prepare Parts for exposure work.
Exposure and Response Prevention (ERP): A form of CBT that involves gradual exposure to anxiety-provoking stimuli while preventing the associated compulsive response. ERP is particularly effective for OCD and can be adapted to address eating disorder behaviors.
Medications: Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) are commonly prescribed to reduce symptoms of OCD.
Moving Forward
Again, there is a wealth of information to share about OCD. The NOCD website is one of my favorites, and I recommend it to clients who want to learn more about OCD. If you or someone you know is struggling with OCD and/or an eating disorder, reach out to the CCN Team today!
Resources Used:
[1] Arifi, F. (2024, November 27). What is the OCD cycle? The four steps of OCD. NOCD. https://www.treatmyocd.com/what-is-ocd/info/ocd-stats-and-science/the-ocd-cycle-visualized-how-the-condition-works
[2] National Eating Disorders Association. (2025, March 21). Eating Disorders and Obsessive Compulsive Disorder (OCD) - National Eating Disorders Association. https://www.nationaleatingdisorders.org/eating-disorders-and-obsessive-compulsive-disorder/
[3] Mandelli, L., Draghetti, S., Albert, U., De Ronchi, D., & Atti, A. (2020). Rates of comorbid obsessive-compulsive disorder in eating disorders: A meta-analysis of the literature. Journal of Affective Disorders, 277, 927–939. https://doi.org/10.1016/j.jad.2020.09.003
[4] International OCD Foundation. (2017, October 11). International OCD Foundation | The relationship between eating disorders and OCD part of the spectrum. https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
[5] National Eating Disorders Association. (2025b, March 21). Eating Disorders and Obsessive Compulsive Disorder (OCD) - National Eating Disorders Association. https://www.nationaleatingdisorders.org/eating-disorders-and-obsessive-compulsive-disorder/
[6]The Alliance for Eating Disorders Awareness. (2024, November 11). The connection between eating disorders and OCD. National Alliance for Eating Disorders. https://www.allianceforeatingdisorders.com/the-connection-between-eating-disorders-and-ocd/
[7] O’Connor, K. (2020). Benefits, detriments of screen time for children debated at AACAP. Psychiatric News, 55(23). https://doi.org/10.1176/appi.pn.2020.11b1
[8] International OCD Foundation. (2024, December 16). International OCD Foundation | What causes OCD? https://iocdf.org/about-ocd/what-causes-ocd/
[9] Pollack, L. O., & Forbush, K. T. (2013). Why do eating disorders and obsessive–compulsive disorder co-occur? Eating Behaviors, 14(2), 211–215. https://doi.org/10.1016/j.eatbeh.2013.01.004
[10] Simpson, H., & Hezel, D. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian Journal of Psychiatry, 61(7), 85. https://doi.org/10.4103/psychiatry.indianjpsychiatry_516_18
