Can OCD Affect My Eating Disorder?

Have you ever had a thought that you just couldn’t stop thinking, or felt like you absolutely had to do things in a certain order or by some other self-imposed routine? Those thoughts and feelings are similar to what happens for someone who has Obsessive–Compulsive Disorder (OCD). Now, imagine that same level of anxiety being tangled up with an eating disorder -such as anorexia, bulimia, or binge eating - where food, body image, and control become the center of your daily thoughts. For some people, these conditions overlap, creating a confusing web that can feel impossible to untangle.

For therapy to be effective, it’s crucial that both disorders are recognized and properly diagnosed. This is especially true when Binge Eating Disorder (BED) may be present. If one condition is overlooked, treatment may miss the mark, recovery can be slower, and the symptoms of one disorder can reinforce the other. Understanding the full picture ensures that treatment targets each disorder appropriately, giving the person the best chance to heal.

How Common Is This Combination?

OCD and eating disorders are more closely linked than most people realize. Research shows that among those with eating disorders, up to 41% also meet criteria for OCD (Williams, Brown, Sandoval-Araujo, Russell, & Levinson, 2022). That’s nearly half of all cases, which is a striking number when you think about it. It shows that this combination of disorders is not at all uncommon. 

Why does this matter? When OCD and an eating disorder occur together, each can intensify the other. Intrusive thoughts about contamination or symmetry might amplify anxieties about food or exercise. Conversely, strict routines around eating, counting calories, or purging can feed the perfectionism and compulsions that are central to OCD. Studies suggest that having both conditions often leads to more severe symptoms and a more challenging recovery process (Vanzhula, Kinkel-Ram, & Levinson, 2021; Dondu, A., & Sevincok, L., 2025).

Consider the story of Emma, a 23-year-old college student. She struggled with bulimia, frequently bingeing on large amounts of food and then purging. Alongside this, she had persistent, intrusive thoughts about germs and cleanliness, leading her to wash her hands dozens of times a day. Her intrusive thoughts were strongest after having purged in the bathroom. Her bulimia caused behavior that fueled her obsessive thoughts, creating the need for compulsive behaviors until she found herself in a cycle she felt powerless to escape.

How Are They Similar?

OCD and eating disorders share some patterns that make them feel similar at first glance:

Obsessions and Compulsions: Both conditions involve intrusive thoughts and repetitive behaviors. In OCD, this might look like fears of contamination or checking locks multiple times; in an eating disorder, the obsessions often revolve around calories, weight, or body shape, and behaviors include restricting, bingeing, or purging.

For example, Jason, a 29-year-old man with anorexia, meticulously counts every calorie he eats. He struggles to enjoy eating as he continually has thoughts like, "If I eat this slice of pizza, I’ll completely lose control and gain a ton of weight overnight." At the same time, he has intrusive thoughts about leaving doors unlocked at home, which he compulsively checks. The anxiety from both sources feels equally urgent and all-consuming.

Perfectionism and Control: Both disorders often involve a need to feel in control. People with OCD typically feel that to be content, or anxiety-free, everything must be “just right,” while someone with an eating disorder might feel they can’t be happy until they have the “perfect” body. This shared perfectionism can make it hard to tell where one disorder ends and the other begins.

Thought–Action Fusion: In both conditions, someone might feel as if simply thinking about something can cause it to happen or increase the likelihood that it will. For instance, someone might think, “I want to eat that cookie. Oh no, thinking about that cookie could have caused me to gain weight!” while another thinks, “I hope I didn’t leave the stove on, it might burn down the house!” The thought alone might make them feel like the likelihood of the house actually burning down is higher. Both involve an illogical belief that their thoughts are more powerful than they actually are.

How Are They Different? 

Even though OCD and eating disorders overlap, there are key differences:

• Focus of Obsessions: Eating disorders are almost always focused on food, calories, weight, and body shape. OCD obsessions can be more broad:  ranging from fears of causing harm, to contamination, to symmetry.
   
• How Thoughts Feel: People with OCD often find their thoughts alien or unwanted—they know they’re irrational but can’t stop them. In some eating disorders, particularly those tied to body image, the thoughts may feel essential or justified, not intrusive in the same way.
   
• Underlying Drivers: OCD is primarily anxiety-driven, with a need for certainty and control. Eating disorders often also involve self-worth, body image, or societal pressures. While both conditions involve the need for control, the reason behind it can differ.

Take Lena, for instance. She restricts her food intake obsessively. She also has compulsive rituals around cleaning her apartment. For her, the eating restriction feels tied to appearance and self-esteem, while the cleaning stems from anxiety about germs. Even though both are compulsive, the motivations are distinct.

Why a Clear Diagnosis is So Important—Especially with Binge Eating

Binge Eating Disorder (BED) is often misunderstood. People with BED frequently consume large amounts of food in one sitting and feel out of control while doing so (DiLossi & Harrison, 2023). Unlike anorexia or bulimia, binge episodes are usually not followed by purging or extreme restriction, which can make the disorder harder to recognize. When OCD is also present, bingeing may appear as a compulsive response to anxiety, making it difficult to determine whether the behavior is part of OCD rituals or a separate eating disorder. Misdiagnosis can lead to ineffective treatment, slower recovery, and worsening symptoms.

BED is common but often untreated due to shame or embarrassment. Effective treatment requires addressing both disorders: BED typically involves Cognitive Behavioral Therapy (CBT) adapted to binge patterns, focusing on identifying triggers, regulating emotions, and restructuring thoughts around food. OCD treatment often includes Exposure and Response Prevention (ERP) to reduce compulsions and intrusive thoughts. In some cases, medications like SSRIs can help manage anxiety, depression, or compulsive behaviors in either disorder. When both BED and OCD are present, a coordinated approach that targets each disorder individually while addressing overlapping symptoms is essential.

Noah, a 35-year-old man, struggles with both BED and OCD. He binge-eats when anxious and then feels compelled to wash his hands repeatedly. If a clinician focused only on his OCD, his binge episodes might go untreated, prolonging distress and potential health consequences. Conversely, focusing only on his BED would leave compulsive rituals unchecked, reinforcing anxiety. Only by recognizing both disorders can treatment be timely and effective.

Understanding the Intersection

Recognizing how OCD and eating disorders interact can help you spot patterns in yourself or someone you care about. Up to 40% of people with eating disorders also experience OCD (Williams et al., 2022), and anxiety, rituals, and perfectionism often appear in both, feeding into each other in ways that can feel overwhelming.

Even with overlap, it’s important to remember that OCD and eating disorders are distinct. OCD is typically driven by intrusive thoughts and a need for certainty, while eating disorders often involve body image, self-worth, and cultural pressures. Someone with OCD may find their thoughts distressing or alien, while a person with an eating disorder may see thoughts about food or weight as necessary or justified. This distinction is critical because treatment strategies differ.

Getting a clear diagnosis—or recognizing that more than one disorder may be present—is essential. Without clarity, therapy may fail to address key behaviors, recovery can be slower, and frustration rises for both the individual and their support network. Effective treatment for co-occurring disorders often combines approaches, such as CBT for both ED and OCD symptoms, ERP for compulsions, and sometimes medication to help regulate anxiety and compulsive behaviors. Tailoring interventions to address both disorders simultaneously improves the chances of lasting recovery.

Take Emma, Jason, Lena, and Noah. Each person’s experiences show how OCD and eating disorders can weave together in unique ways. Emma struggles with bulimia and obsessive cleaning, Jason counts calories compulsively while checking locks repeatedly, Lena combines food restriction with anxiety-driven rituals, and Noah binge-eats while performing hand-washing routines. Their stories highlight the importance of careful evaluation, individualized treatment, and addressing the specific needs of each disorder.

Treatment Approaches for Co-Occurring OCD and BED

Treating OCD and eating disorders together requires a thoughtful, individualized approach. Because the disorders can feed into each other, addressing only one may leave the other untreated, prolonging distress and slowing recovery. A clear diagnosis of both is the first step toward an effective treatment plan.

Cognitive Behavioral Therapy (CBT) is a foundational approach for both conditions. For BED, CBT focuses on identifying triggers for binge episodes, regulating emotions, and restructuring thoughts about food, weight, and body image (DiLossi & Harrison, 2023). For OCD, CBT often incorporates Exposure and Response Prevention (ERP), a method that helps individuals confront intrusive thoughts or anxiety-provoking situations without performing compulsions. When both disorders coexist, therapists adapt CBT to address food-related compulsions alongside other OCD behaviors, helping the individual break the cycle of anxiety and rituals.

Medication can also play a supportive role. Selective Serotonin Reuptake Inhibitors (SSRIs), commonly prescribed for OCD, can help reduce compulsive behaviors and anxiety. These medications can also be used to treat some eating disorder symptoms (Fornaro et al, 2023). This makes SSRIs a promising option when both OCD and some eating disorders are present. 

Integrated strategies are key. For example, a person who binge-eats in response to anxiety and then engages in checking or cleaning rituals can benefit from a plan that targets both the bingeing and the compulsions. Therapists might teach skills for tolerating anxiety without resorting to bingeing or rituals, while also addressing distorted beliefs about food, body, and control. Group therapy or support networks can provide additional reinforcement, helping individuals feel less isolated and more accountable as they navigate both disorders.

Consider Noah again. By recognizing both his BED and OCD, his treatment plan could include ERP for his hand-washing compulsions and CBT strategies tailored to his binge episodes. This dual approach not only reduces anxiety and compulsions but also helps him develop healthier eating patterns and coping skills, increasing the likelihood of long-term recovery.

Ultimately, effective treatment for co-occurring OCD and BED depends on accurate diagnosis, individualized therapy, and coordinated strategies that address both disorders simultaneously. Ignoring one or assuming both stem from a single issue risks prolonging suffering and reducing the chances of a full recovery.

Final Thoughts 

Living with both OCD and an eating disorder can feel overwhelming, but recovery is possible, especially when each disorder is recognized and addressed. Because OCD and eating disorders often feed into each other, getting a clear diagnosis is essential. Knowing exactly what you are dealing with ensures that therapy focuses on the right behaviors, thoughts, and underlying causes, rather than missing critical pieces of the puzzle.

The experiences of Emma, Jason, Lena, and Noah show just how challenging these intersections can be. Each person faced different combinations of compulsions, anxiety, and food-related behaviors. Their journeys highlight why personalized, integrated treatment—combining CBT, ERP, and, in some cases, medication—is so important. When both disorders are properly diagnosed and treated, individuals gain the tools to manage anxiety, resist compulsions, and develop healthier relationships with food and body image.

You are not alone in this journey. For support and guidance, consider reaching out to StopOCD to connect with specialists who understand the complexity of co-occurring OCD and eating disorders. Taking the first step toward clarity and professional care can open the door to lasting healing.

References 

1. Williams, B. M., Brown, M. L., Sandoval-Araujo, L., Russell, S., & Levinson, C. A. (2022). Psychiatric comorbidity among eating disorders and obsessive–compulsive disorder and underlying shared mechanisms and features: An updated review. Journal of Cognitive Psychotherapy, 36(3), 226–245. https://doi.org/10.1891/JCPSY-D-2021-0011 
2. Vanzhula, I. A., Kinkel-Ram, S. S., & Levinson, C. A. (2021). Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis. Journal of Affective Disorders, 283, 302–309. https://doi.org/10.1016/j.jad.2021.01.083
3. Dondu, A., & Sevincok, L. (2025). Clinical characteristics of obsessive-compulsive disorder comorbid with obsessive-compulsive personality disorder: subtype implications. Frontiers in Psychiatry, 16, 1577042. https://doi.org/10.3389/fpsyt.2025.1577042 
4. DiLossi, J., & Harrison, M. (2023). Understanding Eating Disorders. In Comorbid Eating Disorders and Obsessive-Compulsive Disorder: A Clinician’s Guide to Challenges in Treatment, Cambridge: Cambridge University Press. https://www.cambridge.org/core/books/comorbid-eating-disorders-and-obsessivecompulsive-disorder/understanding-eating-disorders/5E30368CE7BDD3D7669023EB01A70D4A  
5. Fornaro, M., Mondin, A. M., Billeci, M., Fusco, A., De Prisco, M., Caiazza, C., Micanti, F., Calati, R., Carvalho, A. F., & de Bartolomeis, A. (2023). Psychopharmacology of eating disorders: Systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders, 338, 526–545. https://doi.org/10.1016/j.jad.2023.06.068