If you’ve ever experienced an eating disorder or know someone who has, you’re likely familiar with the array of obsessive thoughts and compulsive behaviors that often accompany these illnesses. For some, obsessing over food, weight, or body size can lead to high anxiety and compulsions like restricting, purging, or over-exercising to cope with those anxious feelings. That uncontrollable combination of obsessions and compulsions is an inherent part of obsessive-compulsive disorder (OCD), a mental illness that up to 60% of people with eating disorders experience.

While it may be easy to see how the symptoms of OCD can sometimes overlap with those of diagnoses like anorexia (which involves food restriction) and bulimia (which includes purging) it may not be as clear in the cases of other eating disorders. Avoidant/restrictive food intake disorder (ARFID), for example, is an eating disorder characterized by a disturbance in eating or feeding that’s not driven by fear of weight gain, distorted body image, or a desire to change body shape or size. But ARFID and OCD do intersect—just in a different way.

“ARFID involves restriction of food variety, volume, or both, due to a variety of possible factors, including sensitivity to sensory aspects of food, lack of interest in food, or concern about perceived negative outcomes of eating,” says Equip Clinical Instructor, Michelle Jones, PhD. “For people with ARFID, this restrictive eating results in low weight or failure to grow as expected in children, nutritional deficiencies, heavy reliance on nutritional supplements, and problems with psychosocial functioning.”

Read on to better understand how ARFID and OCD might intersect, the differences and similarities between the diagnoses, and how to seek effective treatment for both.

How often do ARFID and OCD co-occur?

While experts are well aware of the potential overlap between ARFID and OCD, more research is needed to investigate how often they co-occur. “There’s limited research on the comorbidity rates of ARFID and OCD,” Jones says. “However, the rates of diagnosed anxiety disorders, including OCD, within individuals diagnosed with ARFID are high, with studies estimating 40-70% of patients diagnosed with ARFID also meet criteria for an anxiety disorder.”

One study on adolescents with ARFID found a significant presence of OCD symptoms, with 67% of participants experiencing mild-to-severe OCD symptoms. Another study involving adults with ARFID found that 6.1% of those with ARFID also had a formal OCD diagnosis.

In her clinical experience and current work supervising therapists at Equip, Jones says she has anecdotally seen OCD frequently co-occur with ARFID. “Particularly with patients who experience intense fears of negative outcomes occurring during or after eating, like vomiting, choking, pain, and allergic reaction,” she says.

Differentiating between ARFID and OCD: similarities and differences

ARFID and OCD share more similarities than many people might realize. Both diagnoses typically involve high anxiety and the overestimation of negative outcomes. Additionally, both people with ARFID and those with OCD typically believe that by performing certain behaviors, they can control whether or not their expected negative outcomes occur.

While both ARFID and OCD can vary significantly in how they present, Jones explains that it’s common for those diagnosed with both conditions to have intrusive thoughts about the potential for something bad to happen from eating. It’s also common to “engage in repetitive or ritualistic behaviors as a way to reduce the perceived likelihood of those outcomes from occurring,” Jones says. “For example, someone who is fearful of vomiting after eating may limit the overall amount of food they eat, but they may also chew each bite of food they do eat a specific number of times as a method of reducing their chances of vomiting.”

While the diagnoses do share commonalities, there are also some important distinctions that make each one unique. “ARFID does not always involve repetitive or compulsive behaviors and thoughts related to negative outcomes,” Jones says. “Or negative experiences with foods may not always be experienced as intrusive or unwanted the way they would be in OCD. Additionally, OCD symptoms often don’t involve eating or food.”

Treating ARFID and OCD together

While exposure and response prevention (ERP) is widely considered to be the gold standard for OCD treatment, Jones explains that cognitive behavioral therapy for ARFID (CBT-AR) has the most substantial evidence to support its efficacy in treating ARFID. Because CBT-AR incorporates many elements of ERP, experts consider it the ideal option for treating ARFID and OCD simultaneously.

In ERP, patients are purposefully exposed to the thoughts, images, objects, and situations that raise anxiety or provoke obsessions alongside a trained therapist. This allows them to encounter these triggers in a safe environment while learning to avoid their compulsive behaviors. ERP is typically the go-to treatment strategy for OCD, but it’s also been shown to be highly effective in treating ARFID. CBT-AR, on the other hand, is a specialized type of CBT that involves several phases: first, teaching patients about ARFID and how it manifests, and then prescribing interventions to help them notice and challenge ARFID-related thoughts and behaviors. These interventions often involved exposures in some capacity.

“Depending on the extent of OCD symptoms, some patients who are being treated with CBT-AR may also need ERP or other OCD-specific interventions during or after their ARFID-specific treatment to more adequately address OCD symptomatology,” Jones adds.

Considering treatment for any kind of psychological disorder can be scary and overwhelming—whether you’re experiencing symptoms yourself, or worried about a loved one.But seeking out experts who specialize in both ARFID and OCD is the key to receiving research-backed care that can lead to long-lasting success and permanent recovery.

“My advice to parents whose child is experiencing both ARFID and OCD would be to find providers who specialize in these disorders and have training in evidence-based treatment options,” Jones says. “I would also reassure them that while these disorders are challenging and distress before and during treatment can be high, both ARFID and OCD are treatable and many individuals who experience these conditions can go on to live symptom-free.”

At Equip, patients get individualized treatment plans, and our providers are trained in treating co-occurring conditions like OCD alongside eating disorders. Schedule a call with an Equip team member to talk through your concerns and learn if our virtual, evidence-based care is right for you or your loved one.