The Connection Between Eating Disorders and Obsessive-Compulsive Disorder

Understanding the Overlap Between Eating Disorders and OCD

Eating disorders frequently overlap with obsessive-compulsive disorder (OCD). OCD is a condition that causes obsessions (recurrent thoughts) and compulsions (repetitive behaviors). Studies show that about two-thirds of people with eating disorder also have a co-occurring anxiety disorder; of these, one of the most common is OCD. Globally, respectively 18% and 15% of people with an eating disorder have a lifetime and current comorbidity of OCD [1]. The prevalence of OCD in the population is 2%, which means that people with eating disorders are eight times more likely to have OCD. For people who have an eating disorder, their obsessions and compulsions are typically related to food and/or weight.

Ego Syntonic vs. Ego Dystonic: A Key Distinction

The main difference between people who have an eating disorder and people who have OCD is that with an eating disorder, these thoughts and behaviors are not viewed as problematic and help maintain the condition. For people with eating disorders, their intrusive thoughts and behaviors are viewed as ego syntonic, which refers to behaviors, values, and ideas that are aligned with the ideal self and current self-image. In other words, people with eating disorders do not view any of their thoughts or behaviors as harmful towards themselves.

For people with OCD, their intrusive thoughts and behaviors are viewed as ego dystonic, which refers to behaviors, values, and ideas that are not aligned with the ideal self. Ego dystonic behaviors, thoughts, and values can be very distressing to a person as they see these as not a part of themselves.

Why This Distinction Matters

The distinctions between ego syntonic and ego dystonic behaviors, thoughts, and values are important in treating these disorders. For people with eating disorders, they may not see their behaviors or thoughts as “harmful” to themselves, and treatment needs to focus on the origins of this disorder and the person’s emotional state. Once the person believes that their behaviors are not in line with their ideal self, they may have an easier time changing their thoughts and behaviors.

The Impact on Daily Functioning

Intrusive thoughts and compulsive behaviors can significantly impair daily functioning. They may lead to excessive preoccupation with food and body image, resulting in behaviors such as restriction or bingeing. Eating disorders and OCD have many overlapping symptoms and it is possible that one disorder can mask the other. If OCD goes undiagnosed or untreated, it can complicate the treatment for eating disorders since the untreated obsessions and compulsions maintain the eating disorder.

Treating OCD & Eating Disorders

OCD can be treated with psychotropic medications and psychotherapy, specifically cognitive behavioral therapy (CBT) or exposure response prevention (ERP) therapy. A combined protocol for eating disorder and OCD should include exposure response prevention therapy. Many therapists are familiar with treating both eating disorders and OCD, but if your therapist is not, it is common to have two separate therapists for each disorder to treat your symptoms.

If you or someone you know is navigating this overlap, know that specialized help exists, and that recovery is possible. The National Alliance for Eating Disorders offers free, therapist-led virtual support groups and a therapist-staffed helpline to connect individuals and families with resources.

Center for Discovery eating disorder programs employ an evidence-based, trauma-informed, weight inclusive treatment approach to address the complex psychological, neurobiological, and medical complications of eating disorders. Center for Discovery offers in person and virtual programming at the residential, partial hospital, and intensive outpatient programming levels of care in 11 states across the country. We are in network with all major insurances. For more information about Center for Discovery, please visit: centerfordiscovery.com.

Sources:

[1] Mandelli, L., Draghetti, S., Albert, U., De Ronchi, D., & Atti, A. R. (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