Are Eating Disorder Symptoms Common in People with OCD?

What you need to know

• About 23% of female patients with OCD reported eating disorder symptoms in the clinical range, compared to 11% of female controls
• 9% of female OCD patients likely had a diagnosable eating disorder, compared to 1% of female controls
• There was no evidence of elevated eating disorder symptoms in male OCD patients
• Clinicians should be alert to eating disorder symptoms in female OCD patients, who may be at higher risk

Background on OCD and eating disorders

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform to relieve anxiety. Common obsessions include fears of contamination or making mistakes, while common compulsions include excessive hand washing or checking behaviors.

Eating disorders are a group of conditions involving disturbed eating behaviors and preoccupation with food, weight and body shape. The main types are anorexia nervosa (restrictive eating leading to low body weight), bulimia nervosa (cycles of binge eating and compensatory behaviors like vomiting), and binge eating disorder (recurrent episodes of eating large amounts of food).

Previous research has found high rates of OCD in people with eating disorders. However, less is known about how common eating disorder symptoms are in people seeking treatment for OCD. Understanding this is important, as the presence of eating disorder symptoms could impact OCD treatment and overall health outcomes.

What did the researchers do?

The researchers recruited 132 patients (94 females, 38 males) who were starting treatment for OCD at a specialized clinic. As a comparison group, they also recruited 260 people from the general population (233 females, 27 males).

All participants completed questionnaires assessing:

1. OCD symptoms (Obsessive-Compulsive Inventory-Revised)
2. Eating disorder symptoms (Eating Disorder Examination-Questionnaire)

The researchers compared scores between the OCD patients and controls to see if eating disorder symptoms were more common in those with OCD. They looked at average scores as well as the percentage exceeding clinical thresholds.

A small subset of 22 female patients also completed the eating disorder questionnaire again 3 months after finishing OCD treatment, to see if symptoms changed.

Key findings

Eating disorder symptoms in female OCD patients

The average eating disorder questionnaire scores were not significantly different between female OCD patients and female controls. However, when looking at clinical thresholds:

• 23% of female OCD patients scored above the cutoff for clinically significant eating disorder symptoms, compared to 11% of female controls
• 9% of female OCD patients likely met criteria for a diagnosable eating disorder, compared to 1% of female controls

This suggests that while eating disorder symptoms are not elevated across all female OCD patients, a considerable subset may have clinical-level symptoms or a diagnosable eating disorder.

Eating disorder symptoms in male OCD patients

There was no evidence of elevated eating disorder symptoms in male OCD patients compared to male controls. However, the number of male participants was small, so these results are less certain.

Correlation between OCD and eating disorder symptoms

In both female OCD patients and female controls, there was a moderate positive correlation between OCD symptom scores and eating disorder symptom scores. This suggests that more severe OCD symptoms tend to occur alongside more eating disorder symptoms.

Changes after OCD treatment

In the small group of female patients assessed 3 months after OCD treatment:

• OCD symptoms decreased significantly
• Some eating disorder symptoms (concerns about weight and shape) decreased modestly
• Other eating disorder symptoms (restrictive eating, eating concerns) did not change significantly

However, this follow-up sample was very small, so these results should be considered preliminary.

What do these findings mean?

The results suggest that while eating disorder symptoms are not generally elevated in female OCD patients as a group, a significant subset may have clinical eating disorder symptoms or a diagnosable eating disorder. Specifically:

• About 1 in 4 female OCD patients reported eating disorder symptoms in the clinical range
• About 1 in 11 female OCD patients likely had a diagnosable eating disorder

These rates were significantly higher than in the general female population. This indicates that some female OCD patients may be at higher risk for eating disorders.

The findings highlight the importance of clinicians being alert to potential eating disorder symptoms when treating female OCD patients. Some patients may need additional screening or treatment for eating disorders alongside their OCD treatment.

For male OCD patients, there was no evidence of increased eating disorder risk, though more research with larger samples is needed to confirm this.

The correlation between OCD and eating disorder symptoms suggests they may be linked in some way. One possibility is that more severe OCD is associated with a higher risk of developing disordered eating. However, this study cannot determine if there is a causal relationship.

Limitations and future research

Some key limitations of this study include:

• Reliance on self-report questionnaires rather than clinical interviews
• Small number of male participants
• Very small sample for the post-treatment follow-up

Future studies should use larger samples, especially of males, and clinical interviews to more definitively assess eating disorder diagnoses. Longer-term follow-up of more patients after OCD treatment would also be valuable to better understand how eating disorder symptoms change over time.

Conclusions

• A significant minority of female OCD patients report clinical-level eating disorder symptoms
• Clinicians should be alert to potential eating disorder symptoms when treating female OCD patients
• Some female OCD patients may benefit from additional screening or treatment for eating disorders
• More research is needed on eating disorder risk in male OCD patients and long-term symptom trajectories