OCD and binge eating disorder: What’s the connection?

Binge eating disorder (BED), one of the most common eating disorders, is characterized by episodes of urges to eat large amounts of food in a short period of time. People who binge eat feel a loss of control—as if they can’t stop eating once they start, or can’t avoid starting. Some people feel compelled to eat until all the food on their plate (or in their kitchen) is gone. This might lead to restricting food intake the next day to compensate for what they ate. The cycle repeats, often leaving people trapped in a pattern of binging and self-criticism.

Interestingly, researchers have observed that there are parallels between eating disorders like BED and obsessive-compulsive disorder (OCD). After all, many people with OCD also feel a loss of control—that’s the nature of compulsions. When people with OCD experience obsessions, or intrusive thoughts, they then seek to “neutralize” the thoughts with certain repetitive behaviors to find relief. 

But what’s the connection between BED and OCD, really? Keep reading to find out.

Binge eating disorder & OCD: a comparison 

If you eat a lot of food or regularly avoid food, it must be an eating disorder, right? Not necessarily. Someone with OCD might be eating in a way that resembles disordered eating because of an intrusive thought that says, “If you don’t eat this exact combination of foods in this exact order you’ll get cancer, or you’ll choke to death, or something bad is going to happen to your loved one”—basically to prevent any outcome that is core to the obsession.

“Simply put, the biggest difference between OCD and BED is the presence of compulsions,” explains licensed therapist Mia Nunez, PhD, LP. “In OCD, you’re going to see someone doing compulsions—behaviors that either reduce anxiety and distress in the moment or prevent a feared outcome related to the obsessions.”

When overeating happens in OCD, there’s usually an obsession at play. “Somebody with OCD could get hung up on chewing food just the right amount of times, or eating the right number of bites, and then they end up eating more than they intended to,” says Nunez. 

As one person posting to Reddit explained, “This one time I thought there were 15 biscuits in one package so I planned to eat 3 [at a time] but there were actually only 14—so I had to eat the last two by themselves which left me feeling very unsatisfied so I had to open another pack.” In other words, the feeling of not having it be “just right” in OCD can lead to behaviors that resemble a binge.

The important thing to look at when this plays out is how frequently the binges happen. When people with OCD who engage in binge eating do so infrequently, they don’t meet the criteria for BED, says Nunez. For a BED diagnosis, binge eating occurs at least once a week for 3 months, on average.

Lastly, Nunez points out that avoidance in BED is a behavior that can look a lot like an OCD compulsion. “People can be fearful that they will engage in a binge eating episode, and then do things to try to prevent themselves from binging, like avoiding an aisle in the grocery store or restaurants that sell foods that they’ve binged on in the past,” Nunez says. 

BED vs. OCD: at a glance

While consulting with a clinician who can diagnose you is critical, here are some distinctions that can provide some clues about what’s really at play.

• If you’re eating past the point of satisfaction, even when you’re not hungry, you might have BED. 
• If you’re eating past the point of satisfaction because you have to take an even number of bites, you might have OCD. 

• If you eat until you feel uncomfortably full to escape an emotion like depression, you might have BED.
• If you eat until you feel uncomfortably full to “neutralize” an obsessive thought, you might have OCD.

• If you’re not leaving the house because you’re ashamed or feeling guilty about eating, you might have BED.
• If you’re not leaving the house because the food you ate doesn’t feel “just right,” you might have OCD. 

Can OCD and BED occur at the same time?

Yes. Research shows that up to 30% with BED also experience OCD. Other studies found that among people with OCD, 7.2% were diagnosed with BED. 

Research has identified shared personality traits, such as perfectionism and neuroticism, that can be present in both conditions. Likewise, genetics may contribute to the overlap: A 2021 study found that eating disorders and OCD may be related to some of the same genes. Biological influences have also been observed in OCD and BED—where dysregulation of certain neurotransmitters may affect mood, impulse control, and reward processing.

However, researchers point out that these factors do not fully account for the correlation between the two conditions and more studies are needed.

What is known is the fact that when the disorders co-occur, it’s important to see clinicians who are trained to spot OCD and BED—as recovery depends on an accurate diagnosis of both conditions.

How to treat BED, OCD, or both at the same time

Here’s the bright spot: OCD and eating disorders are highly treatable.

With eating disorders, there’s a physical component to recovery. This might include getting to a healthy weight, normalizing hormone levels, or addressing other health issues that may have been caused by BED.

Then there’s the need to address the mental component, which is commonly done through cognitive behavioral therapy (CBT). While there are many forms of CBT, Dialectical Behavior Therapy (DBT) is a specific type that may be particularly helpful. DBT is aimed at helping people build better coping skills such as learning how to tolerate distressing feelings without engaging in disordered eating behaviors.

OCD, however, needs a different treatment approach. Exposure and response prevention (ERP) is a form of therapy that was developed specifically to treat OCD, and it’s backed by decades of clinical research. ERP works by disrupting the cycle of obsessions and compulsions.

During ERP, people are encouraged to gradually and carefully confront their obsessions, sit with the discomfort they feel, and resist the urge to perform compulsions. Luckily, an ERP therapist who specializes in ERP is there for guidance every step of the way, as this is a very collaborative form of therapy.

Over time, ERP teaches your brain that discomfort from obsessions will go away—or they’ll be drastically reduced—when you don’t give in to compulsions. 

If you’re diagnosed with both OCD and BED, it’s best to pursue both treatments. “If you have a therapist who is trained in eating disorder treatment as well as ERP, you could probably blend the treatment, but otherwise you would want to do both CBT and ERP,” Nunez says. 

The bottom line: BED and OCD can cause a lot of distress, but help is available. Working with a specialist can help you get to the root causes of your behaviors with food—and put you on a path toward recovery.