Obsessive-compulsive symptoms in individuals with a history of eating disorders

Abstract

Background: OCD symptoms are well documented in anorexia nervosa (AN) and to a lesser extent in bulimia nervosa (BN), yet remain virtually unstudied in binge-eating disorder (BED).

Methods: In this cross-sectional observational study, 5927 participants with lifetime eating disorders (EDs) (i.e., past or current) were categorized into five groups based on their diagnostic histories: AN only (n = 2330), BN only (n = 740), BED only (n = 665), AN and another ED diagnosis (AN Mixed) (n = 1293), and BN and BED (BN-BED) (n = 899). Obsessive-Compulsive Inventory-12 scores were compared across these groups and with OCD (n = 1040), anxiety-related disorders (ANX) (n = 423), and non-clinical community (NCC) (n = 1194) cohorts.

Results: OCD symptoms were common among individuals with lifetime AN, BN, BED, and multiple EDs, with obsessing being the most prevalent dimension, followed by ordering, checking, and washing. The obsessing scale, which captures general intrusive thoughts rather than traditional OCD obsessions, was notably high. ED groups generally scored higher on the OCI-12 subscales than the ANX and NCC cohorts but lower than the OCD cohort, although ordering severity was higher in some ED groups. Positive correlations were found between ED symptoms and OCI-12 subscales, and gender-diverse individuals and men had greater OCD symptoms than women.

Conclusions: Clinicians should be vigilant for OCD symptoms in individuals with AN, BN, and BED. These findings call for research on the mechanisms linking EDs and OCD symptoms and support integrated treatment approaches for both conditions.

Keywords: Anorexia nervosa; Binge-eating disorder; Bulimia nervosa; Comorbidity; Eating disorders; Gender; Obsessive-compulsive disorder symptoms.