When OCD and Eating Disorders Overlap: Understand the Connection and the Hope
Blog Post by Our Partners at Eating Recovery Center
When thoughts spiral and disordered eating becomes routine, it may feel impossible to imagine a life where your mind, eating, and self-perception are under your control. Getting the right diagnosis takes courage - and mental health is never “one size fits all.” For those navigating both obsessive-compulsive disorder (OCD) and eating disorders (EDs), these truths are especially important.
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition involving unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). For people with OCD, these obsessions and compulsions are intended to ease distress or prevent a feared outcome. There are different types of OCD and symptoms can show up differently for everyone.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), symptoms must:
Be time-consuming
Cause significant distress or impairment
Not be attributable to another condition
OCD often co-occurs with anxiety, depression, trauma and eating disorders, which can make symptoms harder to recognize without the right support.
How common is OCD?
Many people experience intrusive thoughts or repetitive behaviors, but most do not have OCD. Here are some key OCD statistics at a glance:
About 2.3% of people meet diagnostic criteria for OCD at some time; roughly 1.2% will meet the criteria within a given year [1].
OCD symptoms often begin around age 19; about 1 in 4 cases start by age 14 [2].
In childhood/adolescence, boys are diagnosed more often; in adulthood, women are about 1.6 times more likely to experience OCD [3, 4].
In a pediatric sample (average age 12.7), older teens had higher depression rates, and depression was linked with more severe OCD symptoms [3].
Does OCD run in families?
Research suggests that OCD is more likely to run in families.
First-degree relatives of children with OCD have around a 26% risk for OCD themselves [5].
First-degree relatives of adults with adult-onset OCD have around a 12% risk for OCD themselves [5].
Other large studies have found that genetics strongly increase one’s risk [6].
Where OCD and eating disorders overlap (and why it matters)
OCD and EDs can reinforce each other. The two conditions share multiple traits, such as perfectionism, rigidity, contamination fears, and a drive for control. Here is how the two disorders may show up in day-to-day life.
Eating rituals: Counting bites, cutting food into precise shapes, eating in a set order or feeling upset if meals aren’t “just right”
Reassurance cycles: Repeatedly checking calories/macros/weight or body measurements; seeking reassurance about “good” versus “bad” foods
Avoidance and restriction: Intrusive fears about ingredients, contamination or texture leading to extreme restriction or avoidance
How is ARFID linked to OCD?
Avoidant/restrictive food intake disorder (ARFID) is a serious eating disorder in which people may:
Avoid specific foods
Restrict food intake
Avoid eating altogether
With ARFID, the eating disorder does not stem from concerns about one’s shape or weight. Instead, a person with ARFID develops disordered eating because of:
Sensory sensitivities
Fear of aversive consequences (e.g., choking, vomiting)
Lack of interest in food
When OCD co-occurs with ARFID, patterns may include:
Eating only pre-sealed foods
Insisting on self-prepared meals
Avoiding social events without “safe” foods
A strong need to feel “just right” around food preparation
How is orthorexia tied to OCD?
With orthorexia, a person develops an intense pursuit of dietary “purity” or “clean” eating. What may have started with good intentions begins to harm the individual’s health, relationships and quality of life. While orthorexia is not an official eating disorder diagnosis in the DSM-5, orthorexia behaviors can lead to malnutrition and a number of health complications.
OCD-style rigidity can feed these patterns. Rules multiply, rituals expand and moral value becomes tied to perfectionistic eating (“I’m only ‘good’ if I eat ‘good’ foods.”).
A personal perspective on OCD
Sunnie lived with OCD long before she had a name for it.
“I started to have this fear that somehow something was going to poison me,” she recalls. “If there was any speck in my food, I wouldn’t want to eat it because I was terrified someone had poisoned it.”
Her symptoms quieted for a while, but they returned when she was in college and intensified after the birth of her second child.
“I began to have intrusive thoughts that I would harm someone—mostly my own children. If I had a bad thought … I pinched my leg, pinched behind my leg or scratched my neck … not really intense self-harm, but just enough to put my thoughts somewhere else to just distract myself for that moment.”
After years of confusion, a psychiatrist finally diagnosed her OCD, and she felt like she could breathe again. Now there was a reason behind it—and a path forward to managing it.
How therapy brings healing
People with OCD often feel their compulsions are helping but actually reinforce the idea that the thoughts are the problem.
Through therapy, including exposure and response prevention (ERP), Sunnie learned to face her fears rather than avoid them.
“You sit with that fear again and again until you realize you can beat it. The anxiety lessens with time—it actually works.”
As a parent, Sunnie also learned how to stay calm through her daughter’s anxiety, becoming “an anchor in her storm.” Watching her daughter face fears head-on gave Sunnie perspective and pride.
“Our daughter had to become stronger than the thoughts that wore her down for years. Seeing her rebuild herself showed me that all the effort has been worth it.”
Evidence-based care for OCD and EDs—together
When OCD and eating disorders co-occur, integrated care is essential. This includes:
ERP for OCD: Gradual, supported exposure to feared thoughts/situations while resisting rituals
Science-backed eating disorder treatment: Medical and nutritional stabilization, skills for emotion regulation, and support to rebuild a flexible relationship with food
Multidisciplinary teams: Psychiatrists, therapists, dietitians, medical providers and family members working in sync
Continuum of care, including a virtual option—so treatment can meet you where you are
Recovery looks different for everyone, but with the right plan it’s absolutely possible.
Recovery is always within reach
If you or a loved one is struggling with OCD, an eating disorder, or both, help is available.
Take a free mental health screening or call 866-739-6697 to connect with a compassionate clinician. No referral is necessary.
Sources
1. Ruscio, A.M., Stein, D.J., Chiu, W.T., & Kessler, R.C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry,15(1), 53-63. doi: 10.1038/mp.2008.94.
2. Anxiety and Depression Association of America. Anxiety disorders – Facts & statistics. Accessed June 9, 2025.
3. Peris, T.S., Bergman, R.L., Asarnow, J.R., Langley, A., McCracken, J.T., & Piacentini, J. (2010). Clinical and cognitive correlates of depressive symptoms among youth with obsessive compulsive disorder. Journal of Clinical Child and Adolescent Psychology, 39(5), 616-626. doi: 10.1080/15374416.2010.501285.
4. Fawcett, E.J., Power, H., & Fawcett, J.M. (2020). Women are at greater risk of OCD than men: A meta-analytic review of OCD prevalence worldwide. Journal of Clinical Psychiatry, 81(4), 19r13085. doi: 10.4088/JCP.19r13085.
5. Geller, D.A., Homayoun, S., & Johnson, G. (2021). Developmental considerations in obsessive compulsive disorder: Comparing pediatric and adult-onset cases. Frontiers in Psychiatry, 12, 678538. doi: 10.3389/fpsyt.2021.678538.
6. Kendler, K.S., Abrahamsson, L., Ohlsson, H., Sundquist, J., & Sundquist, K. (2023). Obsessive-compulsive disorder and its cross-generational familial association with anxiety disorders in a national Swedish extended adoption study. JAMA Psychiatry, 80(4), 314-322. doi:10.1001/jamapsychiatry.2022.4777.
About Eating Recovery Center: Eating Recovery Center (ERC) and Pathlight Mood & Anxiety Center is an international center for eating disorders and mood, anxiety and trauma-related disorders recovery providing comprehensive treatment for anorexia, bulimia, binge eating disorder, depressive disorders, anxiety disorders and PTSD. They offer the full spectrum of treatment services adults, adolescents and children of all genders, including Inpatient, Residential, Partial Hospitalization and Outpatient programs. Utilizing a full continuum of care, they provide expert behavioral health and medical treatment for eating disorders and mood, anxiety and trauma-related disorders in an environment of compassion, collaboration, integrity, inclusivity, accountability and flexibility.