When we talk about eating disorders, we usually think about young people who have rituals around food and worry a lot about what and how much they eat. Some might also picture them being overly concerned about their appearance, similar to those with body dysmorphic disorder. But what many don't realize is that eating disorders can also be linked to OCD, or obsessive-compulsive disorder. This connection hasn't been studied much. What's even more concerning is that when people seek help for these issues, it's often hard for professionals to tell if it's OCD, an eating disorder, or both causing the problems. This confusion can make it tricky to figure out the best way to help.

By the end of this video, you’ll learn how to tell the difference between eating disorders and OCD, can you have both, and the best mode of treatment we’re going to use for it.

Many studies have found that people with eating disorders are more likely to also have OCD, and vice versa. For example, in 2004, researchers found that 64% of people with eating disorders also had anxiety disorders, and 41% of them specifically had OCD.
Some experts think eating disorders might be a part of the OCD spectrum, but it's still not clear if they're closely related or separate conditions with similar symptoms.
Clinicians struggle to tell if someone's condition is a form of OCD or a separate disorder with OCD-like symptoms. People with anorexia often diet and exercise too much because of obsessive thoughts about their weight and appearance. Bulimia involves cycles of eating large amounts of food followed by purging, driven by guilt and shame.

Both disorders can be life-threatening and stem from intrusive thoughts. Anorexics may see themselves as overweight even when they're dangerously thin, while bulimics feel out of control during binges and then obsessed with sickness and disgust afterward.

Anorexia, bulimia and OCD Connection

In both anorexia and bulimia, strong worries lead to anxiety that only goes away with certain actions. Wait doesn’t that sound like OCD?

People with anorexia might carefully choose, buy, cook, and decorate food before eating it. Like with OCD, these actions are often made worse by being unsure, very careful, rigid, and wanting things to be perfect. Anorexics might also have strong beliefs and think in extremes, and try to control everything around them.
For bulimics, the guilt and shame after eating a lot make them get rid of the food by purging, and then they do it again and again. Perfectionism, wanting to be liked by others, and feeling anxious or sad are also important here.

In both anorexia and bulimia, people get really stuck on thoughts about their body, weight, and food. This leads them to follow strict routines for eating, dieting, and exercising. The link between these disorders and OCD is that they both involve overwhelming thoughts and actions that can make it hard to live a normal life.
For example, someone with OCD might feel like a door isn't locked even when it is, so they check it over and over. Similarly, a person with anorexia might feel fat even if they're thin, so they keep checking their stomach and trying to lose weight no matter what.
And like how someone with OCD never feels like things are "just right," someone who is bulimic can be stuck in a cycle of binge eating and purging, never feeling satisfied. Sometimes, behaviors that seem like an eating disorder are actually because of OCD, and vice versa. For instance, someone might lose weight a lot because of OCD fears, or they might obsessively measure their food to try to lose weight. There are lots of ways these disorders can look similar, but they come from different reasons.

One person counts how many bites or pieces of food they eat, thinking there's a "right" number. They might do this to control how much they eat and lose weight. Another person washes their hands a lot because they're scared of germs or dirt making them sick. They might even wash to get rid of any fats and oils that could make them gain weight. Someone else throws away food if the packaging is damaged, fearing it might make them sick. Or they might throw out food if they find out it has too many calories.
Some people keep asking questions at a restaurant because they're not sure what's in the food and want to make the perfect choice. Others avoid going into the kitchen because they're worried about accidentally mixing cleaning products with their food.
Another person checks the fridge and other places in the house all the time to make sure everything is in the right spot. But someone else might keep checking those places to find more food during a big binge.
Are you seeing a pattern here?
The main areas I look for for both OCD and eating disorders are:
They both tend to have intrusive thinking, urges, impulses, and ideas. Their brain puts meaning upon these whether they are true or not. Anxiety and distress are felt because of the meaning. They both feel the urge to relief this tension or anxiety so they do a compulsion to give it to go away.

In the case of OCD, it may be reassurance asking, checking, washing hands. With eating disorders, it may be binging, purging, reassurance asking, and checking.

They feel temporary relief, but at the end of the day may still believe the ultimate threat or meaning the brain put on it. Yes, you can have both an eating disorder and OCD and one without the other appear very similar.

So what do you think this means? We can do essentially the same treatment for either OCD and/or eating disorders. Exposure therapy. To learn to sit with the discomfort of the threats, change behaviors, and retrain the brain.
For example: For people with conditions like ARFID, where they're really anxious about certain foods, exposure therapy can be a big help.
In this therapy, patients might be asked to try foods they're scared of, but ones that are similar to the ones they feel safe eating. For kids and younger patients, it might mean drawing pictures or playing with toys that look like the foods they're afraid of. Then eventually introducing those foods. Finding different responses to the threats, and sitting with discomfort.

People with eating disorders often worry a lot about how their body looks, and exposure therapy can help with these fears. They might check their body size a lot or avoid looking in mirrors. In exposure therapy, they might gradually spend more time looking at themselves in the mirror without saying negative things. Often without putting judgement. It’s called perceptual retraining. Feeling discomfort and not doing any safety behaviors or compulsions. They might start with parts of their body that bother them the most, like their stomach or thighs. By doing this, they can learn to handle the worry and fear about their body and stop avoiding it.
Eating disorders can make it hard for people to be around others and eat in public. Exposure therapy can help with the anxiety about being social and eating with others. For example, they might do exercises to gradually get more comfortable in social situations with food, like going to a small party with friends or eating at a restaurant. By doing these things, they can feel more confident, face their fears, and learn better ways to deal with social situations involving food.
Unlike with OCD, we can challenge various unhelpful thinking patterns with eating disorders. Things like all-or-nothing thinking, catastrophising, and so forth. Each person’s treatment is going to be slightly different.

What is the same with eating disorders and OCD is the perception of the threat. Let’s retrain the brain and teach it that maybe the ideas and threats may not be as accurate as it tells you and get back to the life you actually want to live. Anything that is interfering with your life is something you don’t need to do. Even if you have to do some uncomfortable things.

While I have a very short description of what treatment looks like, their may be more that is involved with your treatment. The important thing to remember is that treatment for eating disorders is not talk therapy. It’s doing therapy. What am I going to do today that challenges the way I think or believe.

So what do you think? Have you seen a link between OCD and eating disorders?

To learn more about exposure therapy and how it works, go watch this video here.