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Identification and treatment of eating disorders in people with obsessive–compulsive disorder

Joanna E Steinglass

Patients with obsessive–compulsive disorder (OCD) commonly struggle with an eating disorder as well, which raises several issues for treatment providers. First and foremost, the patient who is seeking treatment for OCD may not have identified or disclosed the presence of an eating disorder, leaving it to the clinician to accurately assess these diagnoses. Diagnosis of an eating disorder in a patient with OCD follows the same guidelines as diagnosis in a patient without OCD. The assessment may be complicated by the patient’s lack of insight or ambivalence regarding treatment for the eating disorder (as distinguished from the treatment for OCD). Treatment of OCD can be complicated by the presence of an eating disorder. Patients with anorexia nervosa may not respond to pharmacologic interventions. Malnourishment in patients with anorexia nervosa or bulimia nervosa may impair the patient’s participation in psychotherapy for OCD. Clinicians treating patients with OCD need to be adept at diagnosing eating disorders in this population, and will need to consider the role of the eating disorder when planning treatment.