Article contributed by Jacquelyn Ekern, MS, LPC, President @ Eating Disorder Hope and Crystal Karges, MS, RDN, IBCLC, Special Projects Coordinator @ Eating Disorder Hope
Many individuals who suffer from an eating disorder may also experience a struggle with Obsessive Compulsive Disorder (OCD). In fact, statistics have shown that nearly two-thirds of eating disorder sufferers have been previously diagnosed with another form of anxiety disorder and that 41% of eating disorder sufferers have obsessive compulsive disorder .
Obsessive Compulsive disorder is defined in the Diagnostic and Statistical Manual 5th Edition (DSM-5), as “recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted”, and those individuals with OCD attempt “to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action (i.e. by performing a compulsion).” 
Behaviors that are obsessive-compulsive can be frequently seen in eating disorders, such as anorexia, bulimia, and binge eating disorder. Many of the behaviors or rituals that are characteristic of eating disorders can be considered compulsive, especially as they are often performed in an attempt to remove the anxiety or discomfort experienced. Obsessions that could lead to compulsive behaviors include thoughts related to weight, eating, food, or body image, such as “I need to lose weight”, or “I must restrict my calorie intake”, or “I must exercise to make up for calories consumed.” Compulsive behaviors often observed with eating disorder behaviors include:
- Excessive exercise
- Constantly body checking or examining appearance in mirrors
- Counting calories or caloric intake
- Frequently weighing oneself
- Use of diuretics or laxatives to reduce weight
- Following particular “rules” or “rituals” when eating a meal
- Rigidly tracking intake of carbohydrates, sugars, fats, etc
A commonality between Eating Disorders and OCD is how levels of anxiety are reduced, which is through the mechanism of ritualistic behaviors. For example, an individual with OCD might perform a ritual by chewing their food for a pre-meditated number of times that is “just right” before ingesting. Similarly, a person with anorexia may count bites or pieces of food eaten in a sitting as a means of restricting or limiting portions. In both these cases, rituals are developed to reduce the anxiety caused by a triggering obsession, such as fear of eating or weight gain. The cycles involved with obsessive-compulsive disorder and eating disorders are vicious, repetitive, and can easily begin to overlap with one another. Eating Disorders can evolve as an inherent progression of OCD, as it allows individuals to feel as though they are in control over particular triggers while experiencing the “relief” that is sought after.
If you suspect that you or a loved one is dealing with symptoms of both an eating disorder and OCD or if you are unsure how to distinguish between these two disorders, reach out to your doctor or therapist with your concerns. Many forms of therapy have been proven effective in treating both eating disorders and OCD, such as Mindfulness, Cognitive Behavioral Therapy (CBT), and Exposure and Response Prevention (ERP). Having professional treatment that can adequately address both disorders can ultimately spur greater healing for long time recovery.
References:: Kaye, et. Al. Relationship between Anorexia Nervosa and Obsessive and Compulsive Behaviors. Psychiatric Annals, 1993. (23):365-373. : American Psychiatric Association, DSM-5 Development, http://www.dsm5.org/
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on
March 31, 2014
Published on EatingDisorderHope.com, Eating Disorder Information and Online Rsources