Eating Disorders and Obsessive-Compulsive Disorder (OCD) share many similarities. They are both disorders of control. They involve obsessive thinking and compulsive behavior. They are  disruptive and debilitating. It is not surprising that there is often overlap in diagnoses. Research has found that up to 69 percent of people with eating disorders have been diagnosed with OCD. Additionally, 10-17 percent of people with OCD have been diagnosed with an eating disorder.

Is it an Eating Disorder or OCD?

Because they look alike, it can be difficult to differentiate whether someone is suffering from OCD, an eating disorder, or if they occur together (i.e., comorbid).

Signs It Is OCD

In OCD, you are usually going to have a mix of obsessive thoughts and compulsive behaviors, although you can have one without the other. Obsessions are recurrent thoughts that are intrusive and not easily eliminated. Compulsions are repetitive behaviors that are used to reduce obsessive thoughts. For example, someone may obsess about catching germs and getting sick. As a result, they wash their hands excessively. The need to wash hands takes up a considerable amount of time and disrupts their other responsibilities. Age of onset for OCD usually occurs at two periods: one during the tween years and for others during early adulthood.

Signs It Is An Eating Disorder

Eating disorders are characterized by obsessive thoughts about weight and body image. Rituals are instituted to help people control their food intake goals, usually by restricting and binging. People with eating disorders are highly critical of themselves and often have a poor self-image. The age of onset for eating disorders is similar to OCD with an average age of 18.

How Do I Tell The Difference?

Sometimes a compulsion will look like it is related to weight and body image but it is actually about something else. For instance, maybe you have a germ obsession and you don’t eat certain foods because you doubt their cleanliness. You restrict what you eat but your behavior is due to avoidance of germs, not weight gain. You may also see someone with OCD switch around their compulsions. At one point they may restrict their food intake due to germs but a week later they won’t touch door handles for the same reason. The obsessive thoughts are similar but they may manifest themselves in different ways. In these cases, you can see that OCD is not about weight and body image. In summary, when thoughts of body image and weight are the precipitators of compulsive behavior then it is an eating disorder. When they are not it is OCD. When they are both it is comorbid.

Perfectionism in OCD and Eating Disorders

The personality characteristic of perfectionism appears to be highly related to both OCD and eating disorders. Perfectionism, of course, has a positive and negative side. Used positively, perfectionism leads to high expectations and good organizational skills, On the negative side, perfectionism is related to unreasonable and often unattainable expectations. OCD and eating disorders exhibit a clinically unhealthy level of perfectionism. It has been hypothesized that being perfectionistic is at least partly responsible for the high comorbidity between OCD and eating disorders. Indeed, research has found that perfectionism (along with neuroticism) mediates the relationship between many eating disorders and OCD symptoms.

How Do I Treat Comorbid Eating Disorders And OCD?

Cognitive-Behavioral Therapy (CBT)

In CBT, people are taught how to employ positive behaviors and challenge distorted thoughts. This has practical value for the treatment of both OCD and eating disorders. People with eating disorders tend to have unrealistic thoughts about their weight and their body. In OCD, distorted thoughts fuel obsessive thinking. In both disorders, healthy actions need to be implemented to help reduce maladaptive behavior. CBT is effective in reducing the symptoms of both OCD and eating disorders, although it has been less studied in the adolescent population.

Exposure and Response Prevention (ERP)

The gold standard therapy for OCD is exposure and response prevention. This treatment involves exposing the person to stimuli that induce obsessive thoughts but preventing them from acting on their compulsions. Preventing the response shows the person that they will be okay even if they do not exercise their compulsion. ERP also works in the treatment of eating disorders. Clinicians help people cope with their urges to binge, restrict, and exercise despite an overwhelming feeling that they need to control their behavior.

Medication

Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly used medications in the treatment of eating disorders and OCD. They have shown promising results in the treatment of bulimia but not as much success with anorexia or the adolescent population. Medication has exhibited more efficacy in treating OCD. SSRIs have been found to reduce symptoms in approximately half of all patients suffering from the disorder.

Although it can be confusing to differentiate between eating disorders and OCD, they are both disruptive problems with potentially serious consequences. When they occur together, it presents a more complicated clinical picture that is difficult to treat. If you have a concern about whether you may have one or both of these disorders it is important to seek professional help.