The Link Between Anorexia and Obsessive Compulsive Disorder

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In the world of mental health, several conditions frequently overlap or are found in the same individual. These are called co-occurring or co-morbid conditions

Among eating disorders, anorexia nervosa (AN) frequently co-occurs with obsessive-compulsive disorder (OCD).3 The two share a number of similar features, and it’s sometimes hard to tell whether someone has one disorder, both, or which one is the primary problem or contributing to the other. 

Still, there are treatment options that have been developed to help the people caught in the crosshairs of these two difficult conditions. These programs can help people change their unhelpful thoughts, face their fears, and learn healthier ways to cope with stress.

Table of Contents

    How Often Do OCD and Anorexia Nervosa Co-Occur?

    Anorexia nervosa and obsessive-compulsive disorder both develop in people as maladaptive coping mechanisms. The heavy reliance on rituals in both conditions serves almost as a false balm, offering a sense of control and assurance when someone is experiencing stress or anxiety.

    This common link is a powerful one and likely at the heart of why so many people who experience one of these disorders go on to develop the other.

    Research has shown that people with eating disorders are nine times more likely to develop traits of OCD at some time in their lives.1 When it comes to anorexia nervosa specifically, the numbers are even higher.
    One study revealed that 19% of patients with AN would go on to develop OCD in their lifetime, while 14% of participants had already experienced a co-morbid diagnosis.2 Another found that anywhere from 35-44% of patients with anorexia nervosa experienced obsessive-compulsive behaviors.3

    Shared Traits of OCD and Anorexia Nervosa

    Primarily, anorexia nervosa and obsessive-compulsive disorder both function as ways to cope with trauma, stress, and anxiety. As such, the conditions share a number of traits, thought patterns, and concerns. 

    Ritualistic Behavior

    When people struggle with OCD, they experience intrusive thoughts, which are only quieted (in their mind) after they perform a certain behavioral or mental task, sometimes called a ritual.

    For example, someone with the condition may be plagued by the thought, “My whole family will die.” The solution they come up with to alleviate that thought may be to check that the stove is turned off so the house won’t burn down.

    Since the thought is intrusive and pervasive, the person will continue to have it, which in turn drives their continued use of ritualistic behavior.

    Anorexia nervosa can develop as a result of a similar pattern. Still, whereas with OCD, someone may be concerned about anything from safety to symmetry to the cleanliness of their home, people with anorexia nervosa focus on food and body image.

    As such, many ritualistic behaviors of people with AN happen during mealtime. They may:

    • Cut food into tiny pieces
    • Eat their food in a particular order
    • Chew each bite a specific number of times 
    • Keep different types of food from touching

    These actions help people to manage their anxiety regarding food. By controlling what and how they eat, they can control their food intake to avoid gaining weight, which is their real fear. 

    Anxiety

    Indeed, fear and anxiety are big drivers of both conditions.

    Obsessive-compulsive disorder was previously considered a form of anxiety disorder, with individuals looking to alleviate that stress by controlling their environment through rigid rituals. 

    People with anorexia nervosa use rules and rituals around food and sometimes exercise to feel more secure and safe. Both disorders have intrusive thoughts and compulsive actions at their center.

    The link between the disorders is so strong that when an individual begins to improve from one of these conditions, they may start exhibiting more behaviors of the other in an unconscious attempt to regain the control they feel they’re losing. Their rigidity can take on another form through the other disorder.

    Perfectionism

    Researchers say people with both anorexia nervosa and OCD struggle with performance-related concerns.3 They are driven by a need to be “perfect” and feel intense shame and anxiety when they make a mistake. 

    Performance-related stress only reinforces the need for rituals, as the actions can soothe the shame or fear that arises from perceived missteps.

    Cognitive Inflexibility 

    Both OCD and anorexia nervosa are upheld by something called cognitive inflexibility.

    People who struggle with this trait exhibit a very rigid way of thinking and problem-solving, and they often have trouble adapting to change in their environment.4 

    This kind of mindset is another factor that reinforces the use of ritualistic behavior in both OCD and anorexia nervosa. These actions not only help alleviate stress in the short term but become so ingrained that the idea of changing them then produces even more anxiety.

    Differences Between Anorexia and OCD

    While AN and OCD share many common traits, there are a few key differences between the two conditions. 

    Ego-Syntonic Conditions

    Anorexia nervosa is ego-syntonic. This means the individual sees the symptoms of the condition as being a good, helpful, or positive thing, and the condition is part of their identity. 

    This is one of the aspects that make recovery from anorexia nervosa so difficult. People may become so deeply involved in their disordered thoughts and behaviors that they aren’t able to separate themselves from the condition or tell who they are without it.5

    Ego-Dystonic Conditions

    On the other hand, obsessive-compulsive disorder represents an ego-dystonic condition. In these cases, individuals have a negative reaction to the disorder because it is frustrating or creates other problems.

    People with OCD tend to understand that the invasive and pervasive thoughts they experience are products of their own minds and imaginations. This realization is thought to contribute to their compulsive behaviors.6

    The stress of experiencing continuous thoughts that one is unable to successfully suppress can cause even more stress, leading someone to lean more heavily on their ritualistic behavior.

    Therapy Sessions

    Treatment Options for Anorexia and OCD 

    Anorexia nervosa and obsessive-compulsive disorder share so many of the same drivers and traits it’s often difficult for mental health professionals to determine which disorder their patients are dealing with, if not both.

    Still, some treatments have been developed that can help people struggling with a tricky co-morbid diagnosis.

    Exposure & Response Prevention Therapy

    Many people with OCD and AN benefit from exposure and response prevention (ERP). 

    In this program, individuals identify their fears and, with the help of their therapist, are slowly exposed to situations that arouse these anxieties. 

    The idea is not to remove distressing thoughts but to normalize the situations that may provoke them. A therapist helps people track and understand their thoughts and feelings.

    Dialectical Behavior Therapy

    Another form of treatment for both OCD and anorexia nervosa is dialectical behavior therapy (DBT). 

    This form of psychotherapy focuses on helping people make positive changes in their lives. It partially does this by building the skills needed to develop mindfulness, communication, and emotional regulation.

    DBT teaches skills that help people expand their rigid thinking to accept the world as it is rather than relying on ritualistic behavior to cope with things they don’t like about it. It’s helpful for both AN and OCD, as fear, anxiety, and cognitive inflexibility are primary drivers of both.

    Group Therapy

    Sometimes, people with OCD and anorexia nervosa may benefit from sharing their experiences with others going through these difficult conditions. 

    In group sessions, they might discuss their fears and rituals. They might also be encouraged to eat their meals together without engaging in comforting rituals. 

    Finding Help for Anorexia and OCD

    Dealing with anorexia nervosa, OCD, or both can be frightening. You may feel like your life is beyond your control or that you are beyond help. But it’s important to remember that recovery is always possible. 

    Therapy or other treatments can help you understand why you are struggling and learn healthy coping mechanisms to replace the maladaptive ones. 

    With these coping mechanisms in place, the world can start to feel less scary, and you can continue on the path to a happier and healthier future.

    1. Gramigna J. (2021, July 20). People With Eating Disorders Have Nine Times Greater Risk of Lifetime OCD. Healio. Accessed August 2022. 
    2. Mandelli L, Draghetti S, Albert ., De Ronchi D, & Atti AR. (2020). Rates of comorbid obsessive-compulsive disorder in eating disorders: A meta-analysis of the literature. Journal of Affective Disorders; 277:927–939.
    3. Levinson CA, Zerwas SC, Brosof LC, Thornton LM, et al. (2019). Associations between dimensions of anorexia nervosa and obsessive-compulsive disorder: An examination of personality and psychological factors in patients with anorexia nervosa. European Eating Disorders Review; 27(2):161–172.
    4. D-Arrigo T. (2020, December). Eating Disorders OCD Common Comorbidities. Psychiatric News. Accessed August 2022. 
    5. Gregertsen EC, Mandy W, & Serpell L. (2017). The Ego Syntonic Nature of Anorexia: An Impediment to Recovery in Anorexia Nervosa Treatment. Frontiers in Psychology, 8:2273.
    6. Obsessive-Compulsive and Related Disorders: Symptoms. (2022). Stanford University. Accessed December 16, 2022.

    Published January 24, 2025

    Reviewed by: Eric Patterson, LPC