What parents should know about OCD, which frequently co-occurs with eating disorders

If you have a child with an eating disorder like bulimia, binge eating disorder or anorexia, then you may need to untangle multiple mental illnesses to help her heal. Eating disorders often co-occur with other mental illnesses, including depression, panic disorder and obsessive-compulsive disorder (OCD).

Here is some information about OCD to consider as you observe your child and consider treatment paths. Work with your child’s treatment team to accurately diagnose and treat each co-occurring illness separately but within an overall treatment plan.

  • OCD is a type of anxiety disorder.
  • Kids who have OCD have either obsessions or compulsions or both.
  • Compulsions are things that kids do actively, like lining up objects, or mentally, like counting in their head.
  • The person who has OCD treats his or her anxiety with obsessive or compulsive behaviors in an attempt to feel less anxiety. Unfortunately, the rituals created with OCD only provide temporary relief.
  • OCD often first develops between ages 6-9, but it can occur earlier or later. Symptoms often become more challenging as they go more underground during adolescence.
  • A child or adolescent with OCD will be very rigid and rule-bound in many areas of his or her life.
  • The most common treatment for OCD is a type of cognitive behavioral therapy (CBT) called exposure and response prevention, or ERP.
  • ERP is designed to help a child gradually learn that he or she can tolerate feelings of anxiety without resorting to OCD behaviors.

While in the storm of an eating disorder, it may be hard for you to identify what falls outside of the eating disorder itself, but a comprehensive mental health plan that incorporates all co-occurring disorders may be the answer to true recovery. Below are some behaviors that you may observe if your child has an eating disorder and you suspect OCD may be involved:

Body dysmorphic disorder (BDD)

BDD is when someone obsesses over minor or imagined flaws in his or her appearance. BDD is on the spectrum of OCD and is also often observed in people who have eating disorders. An example is your regular-sized daughter looks in the mirror at herself and observes imaginary pockets of fat, sees blemishes that don’t exist, or worries about excessive body hair.

Food obsessions

Food obsessions occur when someone obsesses over food arrangement, food quantity, food quality, food cleanliness and other food-based obsessions. This can often be seen in someone suffering from anorexia who might obsessively cut, arrange and eat just a few small slices of celery. For people who engage in bingeing, it may involve obsessively planning and executing a binge in a particular, ritualistic manner.

Skin picking

Skin picking is also observed in both OCD and eating disorder behaviors. Skin picking is a disorder in which a person picks at their skin constantly. Some may report a sense of calm or well-being while picking, but others do it completely mindlessly, without remembering that it happened. Skin picking can be correlated with BDD, in which the child perceives imperfections and thus is trying to remedy them, and also with anxiety, as a form of self-soothing.

Please speak with your child’s treatment team to determine whether your child should be (or has already been) evaluated for OCD.


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This information was informed by a very helpful “Parents Guide to OCD” provided by The Child Mind Institute.

Access the full guide here.