From the Guidelines
Yes, Obsessive-Compulsive Disorder (OCD) is commonly comorbid with eating disorders, with research indicating that approximately 25-69% of individuals with eating disorders also experience OCD symptoms, a rate significantly higher than in the general population. This comorbidity is supported by the American Psychiatric Association's practice guideline for the treatment of patients with eating disorders, which notes that individuals with eating disorders often have co-occurring psychiatric conditions, including OCD 1. The comorbidity of OCD and eating disorders manifests in several ways, including intrusive thoughts, ritualistic behaviors, and rigid thinking patterns. In anorexia nervosa, obsessions about food, weight, and body image often resemble OCD-like preoccupations, while bulimia nervosa may involve compulsive binge-purge cycles.
The shared neurobiological mechanisms of OCD and eating disorders include dysregulation of serotonin systems and abnormalities in frontostriatal circuits. Treatment approaches typically address both conditions simultaneously, often combining cognitive-behavioral therapy (CBT) with medication such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (20-80mg daily) or sertraline (50-200mg daily) 1. Exposure and response prevention techniques are particularly effective for addressing both the OCD symptoms and eating disorder behaviors.
Key considerations for treatment include:
- Comprehensive assessment to identify co-occurring OCD and eating disorders
- Integrated treatment approaches that address both conditions simultaneously
- Use of evidence-based therapies, such as CBT and SSRIs
- Monitoring of treatment response and adjustment of treatment plans as needed
- Consideration of the impact of comorbid OCD on eating disorder recovery and vice versa. The presence of comorbid OCD can complicate eating disorder recovery, making comprehensive assessment and integrated treatment essential for optimal outcomes, as noted in the Nature Reviews Disease Primers article on obsessive-compulsive disorder 1.
From the Research
Comorbidity of Obsessive-Compulsive Disorder (OCD) and Eating Disorders
- OCD and eating disorders commonly co-occur, with comorbidity rates as high as 41% 2
- Studies have shown that individuals with eating disorders are more likely to have comorbid OCD, with rates ranging from 15% to 38% 3
- The comorbidity of OCD and eating disorders can lead to worse treatment outcomes and a need for adapted treatment approaches 3
Shared Features and Mechanisms
- Potential shared features of OCD and eating disorders include age of onset, course of illness, obsessions, compulsions, and ritualistic behaviors 2
- Shared mechanisms that may explain the comorbidity of OCD and eating disorders include genetic and neurobiological mechanisms, anxiety and fear, repetitive negative thinking, perfectionism, intolerance of uncertainty, distress tolerance, and impulsivity 2, 4
- Thought Action Fusion (TAF) is a cognitive pattern that may underlie the comorbidity of OCD and eating disorders, and has been shown to predict treatment outcomes 5
Treatment Approaches
- A multimodal treatment approach that addresses both OCD and eating disorders simultaneously can be effective in reducing symptoms of both disorders 6
- Treatment approaches that target specific OCD symptom dimensions and TAF in addition to eating disorder-focused treatment may be beneficial for enhancing overall treatment outcomes 5
- Dimensional symptom models, such as network models, may advance the conceptualization, treatment, and prevention of comorbid OCD and eating disorders 4