Co-morbid Conditions:

Eating Disorders

About Eating Disorders

Eating disorders are complex mental health conditions characterized by persistent disturbances in eating behaviors, food intake, body image, and the way individuals relate to food.

Common eating disorders include:

  • Anorexia nervosa 
  • Avoidant/restrictive food intake disorder (ARFID)
  • Binge eating disorder
  • Bulimia Nervosa

Individuals with an eating disorder may experience fear related to food, often alongside anxiety, depression, or trauma. Eating disorders can affect individuals of all backgrounds and can have both physical and emotional consequences.

Comorbidity with OCD

Obsessive-compulsive disorder (OCD) and eating disorders share features including rigid thinking patterns, perfectionism, and reduced tolerance of uncertainty. Individuals may experience intrusive thoughts related to food, body image, or contamination, alongside compulsive behaviors such as restriction, checking, or ritualized eating patterns.

In subtypes like contamination OCD, restrictive behaviors may be driven by fear of illness. In harm OCD, eating may become associated with risk and responsibility, leading to avoidance.

Regardless of OCD theme, disordered eating patterns in OCD arise from intrusive fears and compulsions rather than body image or weight-related concerns.

  • Avoidance of foods perceived as contaminated physically (e.g., unpackaged, touched, or prepared by others) or emotionally (e.g., in contact or associated with certain locations, items, or reminders that elicit a feared emotional state)
  • Restriction to pre-packaged, sealed, or “safe” foods only
  • Excessive washing, checking, or preparation rituals before eating
  • Avoidance of eating or drinking due to fear of illness, germs, or bathroom use
  • Avoiding food from packages with certain words or numbers
  • Counting bites, chewing food a certain number of times
  • Rigid rules about timing, placement, or combinations of food
  • Feared outcomes associated with certain numbers or measurements (e.g., x number on the scale will lead to x feared outcome)
  • Avoidance of foods perceived as morally wrong, impure, or unethical
  • Excessive concern about ingredients violating religious or moral rules
  • Repetitive checking of labels or seeking reassurance
  • Needing food arranged in a precise way
  • Distress if food is mixed, uneven, or imperfect
  • Delayed or avoided eating if conditions are not “just right”
  • Excessive time spent preparing or organizing meals

Treating Co-morbid OCD and Eating Disorders

Evidence-based treatment for co-occurring OCD and eating disorders often involves cognitive behavioral therapy (CBT), exposure and response prevention (ERP), nutritional rehabilitation when appropriate, and interdisciplinary care.

For more information on the treatment of OCD and eating disorders, please visit:

IOCDF.org
NationalEatingDisorders.org

Resources

National Association of Anorexia Nervosa and Associated Disorders (ANAD): https://anad.org 

IOCDF OCD and Eating Disorders Special Interest Group: https://iocdf.org/special-interest-groups/eating-disorders/ 

Mid-Atlantic Alliance for Eating Disorders: https://www.allianceforedmidatlantic.com 

National Eating Disorders Association (NEDA): https://www.nationaleatingdisorders.org/

Wilmington, DE Eating Disorder Support Group: https://www.allianceforeatingdisorders.com/groups/wilmington/

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