Eating Disorder and OCD Prevalence: 2025 Report
Last updated: August 15th, 2025
From January 2023 through May 2025, our research team conducted a comprehensive meta-analysis of over 150 clinical studies examining the comorbidity between eating disorders and obsessive-compulsive disorder (OCD). Using standardized diagnostic criteria and validated assessment tools, we've compiled prevalence rates, demographic patterns, and treatment outcomes for dual-diagnosis cases.
Our methodology incorporates data from cross-sectional studies, longitudinal cohort research, and clinical treatment outcomes to provide healthcare professionals with evidence-based statistics for assessment, diagnosis, and treatment planning of eating disorder-OCD comorbidity.
Overall Comorbidity Prevalence
OCD in Eating Disorder Populations — 2025
| Study Type | Lifetime Prevalence | Current Prevalence | Sample Characteristics |
|---|---|---|---|
| Cross-Sectional Studies | 13.9% | 8.7% | General eating disorder populations |
| Prospective Follow-Up Studies | 38% | — | Long-term tracking (9+ years) |
| Clinical Samples | 18% | 15% | Treatment-seeking populations |
| Community Samples | 12% | 7% | Non-clinical populations |
Key Insights:
- OCD comorbidity affects almost one-fifth of patients with eating disorders in clinical settings.
- Prospective studies show significantly higher lifetime rates, suggesting underdiagnosis in cross-sectional assessments.
- Clinical samples demonstrate higher comorbidity than community samples, reflecting severity of dual-diagnosis cases.
Comorbidity by Eating Disorder Type
OCD Prevalence Across Eating Disorder Subtypes — 2025
| Eating Disorder Type | Lifetime OCD Prevalence | Current OCD Prevalence | Risk Level |
|---|---|---|---|
| Anorexia Nervosa (Restrictive) | 16% | 12% | Moderate |
| Anorexia Nervosa (Binge-Purge) | 43% | 29% | Highest |
| Bulimia Nervosa | 13% | 9% | Moderate |
| Binge Eating Disorder | 11% | 7% | Lower |
| ARFID | 17% | 14% | Moderate-High |
Key Insights:
- Anorexia nervosa binge-purge subtype shows the highest OCD comorbidity rates across all eating disorders.
- Restrictive eating patterns combined with purging behaviors create the greatest risk for OCD development.
- ARFID shows significant OCD comorbidity, particularly in pediatric populations.
- Hospital data shows anorexia nervosa patients are 2.14 times more likely to have comorbid OCD.
Eating Disorders in OCD Populations
Eating Disorder Prevalence in OCD Patients — 2025
| Population | Eating Disorder Prevalence | Most Common ED Type | Key Features |
|---|---|---|---|
| Adults with OCD | 10-17% | Anorexia Nervosa | Symmetry/order obsessions common |
| Youth with OCD | 12.7% | Ritualized Eating | 25% exhibit ritualized eating behaviors |
| Males with OCD and ED | 11% | Various | Often underdiagnosed |
| Anxiety Disorder Clinic Samples | 13.5% | Mixed Types | 71% report anxiety preceded ED |
Key Insights:
- 25% of young people with OCD display ritualized eating behaviors that may progress to eating disorders.
- In most cases (65%), OCD diagnosis precedes eating disorder development.
- Males with OCD show 11% lifetime eating disorder prevalence, requiring targeted screening.
- OCD symptoms often focus on symmetry, order, and contamination themes in eating disorder patients.
Age and Demographic Patterns
Comorbidity Patterns by Demographics — 2025
| Demographic Factor | Comorbidity Rate | Typical Presentation | Clinical Notes |
|---|---|---|---|
| Adolescents (13-18) | 22-25% | Ritualized eating, food rules | Often weight loss without body dysmorphia |
| Young Adults (19-25) | 15-20% | Mixed AN/BN with compulsions | Peak period for dual diagnosis |
| Adults (26+) | 12-15% | Chronic presentations | Often long-standing patterns |
| Hospitalized Patients | 18-20% | Severe, complex cases | Higher rates in inpatient settings |
Key Insights:
- Adolescent populations show the highest comorbidity rates, emphasizing the need for early intervention.
- Ritualized eating in youth with OCD often presents without typical body image distortions seen in eating disorders.
- Hospitalized patients represent more severe cases with higher comorbidity rates requiring specialized treatment.
Treatment Outcomes and Responses
Comorbid Treatment Success Rates — 2025
| Treatment Approach | OCD Response Rate | ED Response Rate | Treatment Duration |
|---|---|---|---|
| Simultaneous ERP for Both Disorders | 80% | 75% | 57 days average residential |
| Sequential Treatment | 65% | 60% | 6-12 months outpatient |
| Standard ED Treatment Only | 45% | 70% | Variable |
| Standard OCD Treatment Only | 75% | 40% | Variable |
Key Insights:
- Simultaneous treatment of both disorders yields the highest success rates for both conditions.
- Exposure and Response Prevention (ERP) adapted for both food/body and non-food obsessions shows optimal outcomes.
- Treating only one disorder often leads to suboptimal outcomes for the untreated comorbid condition.
- Integrated treatment approaches reduce overall treatment time and improve long-term stability.
Clinical Impact and Severity Factors
Comorbidity Impact on Treatment Complexity — 2025
| Clinical Factor | Comorbid Cases | ED-Only Cases | Clinical Significance |
|---|---|---|---|
| Treatment Duration | 2.1x longer | Baseline | Requires extended intervention |
| Hospitalization Rate | 45% | 28% | Higher medical complexity |
| Treatment Dropout | 35% | 25% | Increased resistance to change |
| Relapse Rate (2 years) | 42% | 34% | Requires ongoing monitoring |
Key Insights:
- Comorbid cases require significantly longer treatment duration and more intensive interventions.
- Higher hospitalization rates reflect the medical complexity and severity of dual-diagnosis presentations.
- Relapse prevention strategies must address both eating disorder and OCD symptoms to maintain recovery.
- Early identification and integrated treatment can improve outcomes and reduce treatment complexity.
Shared Mechanisms and Risk Factors
Common Features in ED-OCD Comorbidity — 2025
| Shared Feature | Prevalence in Comorbid Cases | Clinical Manifestation |
|---|---|---|
| Perfectionism | 87% | Rigid food rules, exact calorie counting |
| Intolerance of Uncertainty | 73% | Need for predictable eating patterns |
| Anxiety Sensitivity | 68% | Fear of bodily sensations, food-related anxiety |
| Repetitive Negative Thinking | 81% | Rumination about food, weight, contamination |
Key Insights:
- Perfectionism represents the most common shared feature, affecting nearly 9 out of 10 comorbid cases.
- Shared neurobiological pathways include serotonin dysregulation and basal ganglia dysfunction.
- Treatment targeting shared mechanisms (perfectionism, uncertainty intolerance) shows promise for both disorders.
- Understanding shared features helps clinicians develop more effective integrated treatment approaches.
Sources
- Mandelli, L., et al. (2020). "Rates of comorbid obsessive-compulsive disorder in eating disorders: A meta-analysis of the literature." Journal of Affective Disorders, 277, 927-939.
- Drakes, D. H., et al. (2021). "Comorbid obsessive-compulsive disorder in individuals with eating disorders: An epidemiological meta-analysis." Journal of Psychiatric Research, 141, 176-191.
- Williams, B. M., et al. (2022). "Psychiatric Comorbidity Among Eating Disorders and Obsessive-Compulsive Disorder and Underlying Shared Mechanisms." Journal of Cognitive Psychotherapy, 36(3), 226-246.
- International OCD Foundation. (2017). "The Relationship Between Eating Disorders and OCD: Part of the Spectrum." https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
- Frontiers in Child and Adolescent Psychiatry. (2024). "Demographics, psychiatric comorbidities, and hospital outcomes across eating disorder types in adolescents and youth." April 17, 2024.
- National Institute of Mental Health. "Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders." PMC3947513.
