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

Affiliations

¹ Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA. Electronic address: avantika.kapadia@louisville.edu.
² Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: laura_thornton@med.unc.edu.
³ Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, TX, USA. Electronic address: melissa.chernoff@ttu.edu.
⁴ Department of Psychology, Texas State University, San Marcos, TX, USA. Electronic address: abramovitch@txstate.edu.
⁵ Department of Psychology, Fordham University, Bronx, NY, USA. Electronic address: mckay@fordham.edu.
⁶ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: jabramowitz@unc.edu.
⁷ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: zyilmaz.ncrr@au.dk.
⁸ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: crowley@unc.edu.
⁹ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: cynthia_bulik@med.unc.edu.
¹⁰ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Population Health, Curtin University, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia. Electronic address: hunna_watson@med.unc.edu.

PMID: 39864784
PMCID: PMC11952142 (available on 2026-04-15)
DOI: 10.1016/j.jad.2025.01.068

Observational Study

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

Avantika Kapadia et al. J Affect Disord. 2025.

. 2025 Apr 15:375:496-507.

doi: 10.1016/j.jad.2025.01.068. Epub 2025 Jan 24.

Authors

Affiliations

¹ Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA. Electronic address: avantika.kapadia@louisville.edu.
² Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: laura_thornton@med.unc.edu.
³ Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, TX, USA. Electronic address: melissa.chernoff@ttu.edu.
⁴ Department of Psychology, Texas State University, San Marcos, TX, USA. Electronic address: abramovitch@txstate.edu.
⁵ Department of Psychology, Fordham University, Bronx, NY, USA. Electronic address: mckay@fordham.edu.
⁶ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: jabramowitz@unc.edu.
⁷ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: zyilmaz.ncrr@au.dk.
⁸ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: crowley@unc.edu.
⁹ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: cynthia_bulik@med.unc.edu.
¹⁰ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Population Health, Curtin University, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia. Electronic address: hunna_watson@med.unc.edu.

PMID: 39864784
PMCID: PMC11952142 (available on 2026-04-15)
DOI: 10.1016/j.jad.2025.01.068

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.

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Conflict of interest statement

Declaration of competing interest AK, LMT, MAM-C, AA, DM, JSA, ZY, JJC, and HJW report no interests to declare. CMB reports Pearson Education, Inc. (author, royalty recipient).

References

1. Abramovitch A, Abramowitz JS, & McKay D (2021). The OCI-12: A syndromally valid modification of the obsessive-compulsive inventory-revised. Psychiatry Research, 298, 113808. 10.1016/j.psychres.2021.113808 - DOI - PubMed
1. Ahn J, Lee JH, & Jung YC (2019). Predictors of suicide attempts in individuals with eating disorders. Suicide and Life-Threatening Behavior, 49(3), 789–797. 10.1111/sltb.12477 - DOI - PubMed
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1. Altman SE, & Shankman SA (2009). What is the association between obsessive-compulsive disorder and eating disorders? Clinical Psychology Review, 29(7), 638–646. 10.1016/j.cpr.2009.08.001 - DOI - PubMed
1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., txt rev). American Psychiatric Association.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous