The Intersection of Eating Disorders and OCD: 3 Tips From a Therapist

By: Jennifer Rollin, LCSW-C, Therapist & Founder of The Eating Disorder Center

​She is exhausted. She is terrified of her body changing and is caught in a tiring cycle of overexercising. She wishes she could take some time off from the gym, but she is terrified to do so. She is so tired of living this way, but also scared to recover. Additionally, she feels tortured by a relentless voice that tells her if she doesn’t engage in certain behaviors, that bad things will happen to her family. She feels lost, alone, and completely trapped by her own mind. She is struggling with an eating disorder and OCD.
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The Intersection Between Eating Disorders and OCD

As an eating disorder therapist in Rockville, Maryland, who also works with clients with co-occurring OCD, I have observed over the years that there is a significant overlap between eating disorders and OCD. There also appears to be a higher prevalence of people who suffer from both eating disorders and OCD.

Eating disorders often involve a fixation on food, body size, and/or exercise (although not every eating disorder involves all three). Typically, individuals with eating disorders have eating disorder thoughts as well as compulsive behaviors. These behaviors could include restricting, binging, purging, or exercising. While eating disorders and OCD are mental illnesses NOT choices, often these behaviors may be (in part) attempts at safety-seeking, reducing anxiety, coping with trauma, longing for companionship etc. 

OCD typically involves intrusive thoughts, images, or urges and then mental and/or physical compulsions that are aimed at an attempt to try to ‘reduce anxiety.’ While eating disorders also can involve intrusive eating disorder thoughts and then compulsive behaviors that are aimed at reducing anxiety. The trouble is that individuals with eating disorders and OCD become caught in exhausting loops of engaging in compulsions to try to ‘feel better,’ which only serves to make them feel more trapped, tired, and miserable in the long-term.

Eating disorders and OCD can also be intertwined and symptoms can play off of each other for some people. 

Some Tips For Those Struggling with an Eating Disorder and OCD:

1. Work on reducing or eliminating reassurance-seeking behaviors.

 Examples of reassurance-seeking behaviors include the following: 

• Someone with an eating disorder repeatedly asks a loved one, “Do I look like I’ve gained weight?”
• Someone with OCD asking a friend over and over, “Do you think I’ve studied for long enough?”

Reassurance-seeking may feel like it helps in the short term. However, all it truly does is keep someone trapped in the exhausting eating disorder and OCD cycle.

Loved ones can avoid fueling the eating disorder and OCD by responding with something like, “It sounds like these disordered thoughts are really loud right now. I’m sorry you’re having a hard time,” instead of providing reassurance.

The opposite of seeking reassurance is trying to work on both accepting uncertainty and non-engagement responses. 


2. Practice non-engagement responses to OCD/eating disorder thoughts:

I know this is not easy when an eating disorder and OCD are yelling in your ear; however, with time and practice, it can become more ingrained and natural.

Examples of non engagement responses are as follows:

• OCD: If you don’t touch the doorknob, your boss is going to fire you.
• Non-engagement response: I understand you’re feeling anxious about this. I’m sorry that these thoughts are so loud.
• OCD: But what if your boss fires you and you lose your income? You’d be in a terrible situation!
• Non-engagement response: Maybe he will. Maybe he won’t. But I'm not going to touch the doorknob.
• OCD: He’s going to fire you if you don’t touch it!
• Non-engagement response: Anything is possible in this world. I don’t have 100 percent control over the outcome, and that’s ok. 

3. Find a therapist who truly specializes in eating disorders and OCD.

Working with clients with eating disorders and OCD is a unique skillset that requires a lot of experience and training.

Unfortunately, clinicians who lack experience may be well-meaning but may be ineffective or even make the situation worse. For instance, someone who lacks knowledge about eating disorder and OCD treatment may spend a session where the client is ruminating the whole time, and the therapist falls into an unhelpful cycle with them.

At The Eating Disorder Center, we have therapists who specialize in eating disorders and OCD in Rockville, Maryland, Arlington, Virginia, and virtually throughout Maryland, Virginia, Washington, D.C., Florida, and Pennsylvania.

We use a blend of the top treatments. Two that can be extremely helpful when it comes to both eating disorders and OCD are Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy.

We are compassionate, action-oriented therapists who would love to help you to find freedom from an eating disorder and to take back your life from OCD.

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Take the first step towards healing. You don’t have to continue to feel so trapped and alone anymore.

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Journal Prompts:

1. Reflecting on Fear and Uncertainty:

• What fears arise for you when you think about reducing or stopping certain behaviors?
• How do you currently respond to uncertainty? What would it feel like to accept some of that uncertainty, even for a moment?

2. Acknowledging Exhaustion:

• How does the cycle of your eating disorder and OCD impact your energy levels, physically and emotionally?
• If you could press pause on these cycles for one day, how would you use your time and energy differently?

3. Non-Engagement Practice:

• Think of a recent intrusive thought that led to a compulsion. What could a non-engagement response look like for that situation?
• Write down a dialogue between yourself and the intrusive thought, practicing non-engagement responses such as “maybe, maybe not.”

4. Reassurance: 

• What types of reassurance-seeking behaviors do you notice in yourself?
• How does seeking reassurance affect your anxiety? Could you experiment with pausing and sitting with discomfort instead?

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 Schedule a FREE 15-minute consultation to explore how eating disorder therapy or recovery coaching can help you to find freedom.
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🌟 Available in MD, VA, DC, PA, NY, FL, and CA for eating disorder therapy
🌍 Offering recovery coaching worldwide 

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The Eating Disorder Center is a premier outpatient eating disorder therapy center founded by Jennifer Rollin. We specialize in helping children, teens, and adults struggling with anorexia, binge eating disorder, bulimia, OSFED, and body image issues. We provide eating disorder therapy in Rockville, MD, easily accessible to individuals in Potomac, North Potomac, Bethesda, Olney, Silver Spring, Germantown, and Washington D.C. We also provide eating disorder therapy in Arlington, Virginia and virtually throughout Virginia. Additionally, we offer eating disorder therapy virtually in New York (NYC), Florida, Pennsylvania, and California. We provide eating disorder and EMDR trauma therapy in Rockville, Maryland and virtually throughout Maryland and Virginia. We provide eating disorder recovery coaching via Zoom to people worldwide. Connect with us through our website at www.theeatingdisordercenter.com