Understanding OCD and Eating Disorders

OCD and eating disorders can sometimes appear similar. Both disorders involve obsessive thoughts, but the main difference between the two is that eating disorders involve an obsession with weight, body shape, and food intake, specifically ^[1]. In this article, we’ll review the similarities and differences between OCD and eating disorders.

What is OCD?

Before diving into the differences between OCD and eating disorders, it’s helpful to have an understanding of each disorder on its own. Obsessive-compulsive disorder (OCD) is a mental health condition that involves unwanted thoughts called obsessions. These thoughts might involve taboo desires related to sex or aggression. They can also involve fears that a person or their loved ones will be harmed or become ill, for example^[2].

For people with obsessive-compulsive disorder, intrusive, unwanted thoughts are quite distressing. They can make it difficult to function in daily life and be successful with work and relationships. Many people with OCD engage in repeated behaviors called compulsions. These behaviors are intended to stop obsessive thoughts or reduce the anxiety that comes along with them. For instance, a person who is fearful of becoming ill may repeatedly wash their hands. Alternatively, some people with OCD perform rituals they believe will cancel out unwanted thoughts related to sex or aggression^[2].

What Are Eating Disorders?

Understanding the relationship between OCD and eating disorders also requires knowledge of eating disorders. The term “eating disorders” refers to a group of conditions that involve a disturbance in eating-related behaviors alongside negative or distressing emotions. There are various types of eating disorders, but the three most common are described below^[2]:

• Anorexia Nervosa: Individuals with anorexia nervosa experience an extreme fear of weight gain. They are seriously worried about becoming fat, and they restrict food to avoid gaining weight. Those who live with this eating disorder engage in self-starvation and continue to do so, even when at a dangerously low body weight.
• Bulimia Nervosa: Those with bulimia nervosa engage in repeated binge-eating episodes, in which they consume much more food than a person typically would under similar circumstances. During these episodes, they lose control of their eating, and afterward, they compensate for the binge through unhealthy methods like excessive exercise, self-induced vomiting, or laxative misuse. Like those with anorexia, individuals with bulimia place a significant amount of importance on their weight and body shape when evaluating their worth.
• Binge-eating Disorder: Finally, binge-eating disorder involves repeated episodes of binge-eating, as is the case with bulimia. However, those with binge-eating disorder do not compensate for binges by engaging in inappropriate compensatory behaviors like self-induced vomiting. They lose control when eating, and often feel ashamed or disgusted with themselves for binging. People who live with binge-eating disorder are at risk of obesity-related health conditions, such as hypertension and diabetes.

OCD vs. Eating Disorders: Key Similarities

Now that you understand the basics of both OCD and eating disorders, it’s time to look at the similarities between the two. First, eating disorders and OCD come with similar thinking patterns. In OCD, a person develops obsessions that can be related to various topics, such as illness, harm, or religious taboos. Similarly, with eating disorders, people experience intrusive thoughts related to weight, body shape, and food intake^[1][2].

Similarly, both conditions can involve compulsive behaviors. With OCD, people engage in repetitive behaviors, like hand-washing, to help them cope with intrusive thoughts. In those with eating disorders, compulsive behaviors are related to food intake. For instance, a person with anorexia may follow food rituals, such as cutting food into small bites or only permitting themselves to eat certain types of food^[1][2].

Both OCD and eating disorders can involve obsessive thoughts combined with compulsive behaviors, but the similarities between the two do not end there. Research on the two disorders shows that they both tend to involve personality traits like perfectionism and neuroticism. So, both disorders can be influenced by the pursuit of perfection and a tendency to experience anxious and rigid thinking patterns^[3].

Finally, both conditions involve emotional distress. In eating disorders, a person is likely to experience distress related to body image. They may also become distressed about managing their food intake; for instance, those with anorexia worry about how to keep food intake low when eating in public or attending parties. Furthermore, a person with bulimia or binge-eating disorder is likely to become distressed about the amount of food consumed during binge episodes. In cases of OCD, distress arises from intrusive thoughts; while compulsions may serve as a method for reducing distress, they are time-consuming and interfere with daily life^[1][2].

What Is Food-related OCD (Food OCD)?

The similarities between OCD and eating disorders are so strong that some researchers have coined the term food OCD. While not a formal diagnosis, food OCD involves obsessions specifically related to food and eating.

A person with food-related OCD worries about the health-related implications of food. They may spend time engaged in compulsive behaviors, like checking the ingredients list of foods, double-checking expiration dates, or developing rules about what foods are safe to eat. Sometimes, the term “orthorexia” is used to describe cases of food OCD, but even orthorexia is not a formal disorder included in diagnostic manuals^[4].

OCD vs. Eating Disorders: Key Differences

Despite similarities between the two, OCD and eating disorders are two distinct conditions. First, the core motivations between the two differ. OCD behaviors, such as rituals and repeated checking, are driven by fear and anxiety. A person with OCD seeks to reduce their anxiety by engaging in these compulsions ^[2].

On the other hand, in those with eating disorders, anxiety comes from dissatisfaction with one’s body and concerns related to weight and body shape. Similarly, obsessions in eating disorders focus on food, weight, and one’s bodily appearance, whereas in OCD, obsessions can involve a wide range of fears and topics^[1][2].

Finally, there are different behavioral goals associated with OCD vs. eating disorders. In cases of OCD, people engage in compulsive behaviors to reduce their anxiety and reduce the risk of perceived harm^[2]. On the other hand, behaviors in anorexia and bulimia are intended to control weight and body shape^[1].

OCD vs. Eating Disorders: Impact

Both eating disorders and OCD result in distress, and both disorders can interfere with daily functioning. Eating disorders are linked to psychological distress, which can make it difficult for a person to perform their roles^[5]. For instance, a parent who has an eating disorder may become so fixated on their body-related concerns that they have difficulty remaining present in their parenting role. Similarly, a working person may find it challenging to complete their job duties when consumed by eating disorder symptoms.

Eating disorders are also related to difficulties with social functioning^[6]. A person with an eating disorder may isolate themselves from peers because of eating disorder behaviors. They may also struggle to communicate clearly and maintain friendships. Similar impacts are seen in individuals with OCD. Research shows that OCD is associated with difficulties completing household tasks, performing job duties, and maintaining social relationships^[7].

Can You Have OCD and Eating Disorders at the Same Time?

Yes, you can have OCD and eating disorders at the same time. In fact, the comorbidity of OCD and eating disorders is high. This means that it’s common for people with eating disorders to also have OCD, and vice versa.

One review of multiple studies found that, in those with eating disorders, 13.9% had OCD at some point during their lives, and 8.7% currently had OCD. The studies in the review also revealed that people with eating disorders were almost 9 times as likely to have OCD at some point during their lives when compared to those without eating disorders^[8].

Given the high comorbidity between OCD and eating disorders, some people may ask, “Can OCD cause eating disorders?” While the two disorders are linked, this doesn’t necessarily mean that one causes the other. Instead, there seem to be common factors that underlie both OCD and eating disorders. For example, perfectionistic personality types can increase the risk of both OCD and eating disorders ^[3]. There also appear to be shared genetic risk factors that can contribute to both OCD and eating disorders ^[8].

OCD vs. Eating Disorders: Diagnosis

Sometimes, symptoms of OCD and eating disorders can appear similar, which can present challenges during diagnosis. To ensure a proper diagnosis, it’s essential for clinicians to conduct in-depth interviews and psychological evaluations. Ultimately, the clinician must review diagnostic criteria to determine whether an OCD diagnosis or an eating disorder diagnosis is more appropriate. It’s also important to remember that a person may meet the criteria for both disorders^[8].

Perhaps the simplest way to determine whether a person has OCD vs. an eating disorder is to evaluate the focus of symptoms. In OCD, symptoms are primarily anxiety-driven, and a person performs compulsive behaviors to reduce anxiety. Alternatively, in eating disorders, rituals and other compulsive behaviors come from a desire to control body weight and shape. If OCD symptoms involve food-related concerns, it’s helpful to consider whether these concerns are related to body image or to fear. For instance, a person with OCD related to food may be concerned that food is contaminated or unhealthy, rather than being concerned about weight gain^[1][2][9].

OCD vs. Eating Disorders: Treatment

Given their similarities, OCD and eating disorders may also have similar treatment regimens. Below are common treatments used for both conditions:

• Cognitive-Behavioral Therapy (CBT): CBT is a form of talk therapy that helps people to correct negative or distorted thinking patterns. It is a gold standard treatment for both OCD and eating disorders^[9].
• Exposure and Response Prevention (ERP): This treatment can be used for OCD to reduce compulsive behaviors, but it’s also used in the treatment of bulimia nervosa. Exposing someone with bulimia to their favorite foods and then preventing them from binging can teach them that they can learn to control binging behavior^[9].
• Medication: A type of medication called selective serotonin reuptake inhibitors (SSRIs) is prescribed for both OCD and eating disorders^[9].

While eating disorders and OCD may be treated in similar fashions, there can be some differences. For example, individuals with eating disorders often benefit from nutrition counseling to help them learn healthy eating patterns^[10].