Why You Might Be Missing Co-Occurring OCD and Eating Disorder Symptoms in Teens

July 30, 2025

How to Recognize Overlapping Behaviors + A Case Study and Screening Tools to Help

Eating disorders (ED’s) and Obsessive-Compulsive Disorder (OCD) are both serious mental health conditions that commonly emerge during adolescence that can often co-occur in complex ways. Yet in clinical practice, the overlap between these two disorders is frequently missed, especially when food-related rituals and rigid behaviors are assumed to be purely eating disorder-driven.

At Thrive Wellness, we regularly work with teens whose symptoms straddle both diagnoses. These co-occurring cases require nuanced assessment and treatment, because without identifying both conditions, you can’t treat the whole person. Without a co-occurring diagnosis, critical aspects of treatment can be overlooked.

A Case Study: When OCD Masquerades as an Eating Disorder

Consider Sophie, a 15-year-old referred for restrictive eating and significant weight loss. She described fear around eating certain foods, but when asked why, she didn’t reference calories or concern about her body image. Instead, she spoke about being terrified of “getting sick” and her food and utensils being “contaminated.”

Further exploration revealed that Sophie has developed elaborate handwashing routines before meals and avoided any utensils that weren’t thoroughly cleaned several times. Her avoidance of food was not due to a desire to lose weight but was driven by extreme fears of illness, obsessive thoughts about contamination, and compulsive checking, hallmark symptoms of OCD.

Had these behaviors been interpreted only through the lens of eating disorders, Sophie’s OCD could have gone untreated, potentially stalling her recovery and increasing her long-term distress.

Why Co-Occurring Symptoms Are Easy to Miss

The challenge with these types of cases is that ED and OCD symptoms can look strikingly similar: rituals, rigidity, avoidance, and overwhelming distress. But the motivation behind the behaviors is often different.

OCD-driven rituals can center on a vast variety of fears about nearly anything, not just weight or food.
Eating disorder-driven behaviors are often aimed at weight loss, control, or managing body image distress.

When these disorders overlap, symptoms can reinforce each other, making treatment more difficult unless both are recognized and addressed.

What to Watch For in Your Teen Clients

To better identify when OCD may be co-occurring with an eating disorder, look for:

Avoidance of food due to non-weight-related fears (e.g., contamination, getting sick, choking)
Excessive rituals that go beyond typical eating disorder symptoms (e.g., cleaning utensils multiple times, checking expiration dates repeatedly)
Distress when routines aren’t followed, even when weight or body image aren’t involved
Perfectionism or control that extends into non-food-related areas (e.g., schoolwork, personal hygiene, social interactions)

Tools to Help You Screen and Support

To help providers like you better assess for co-occurring OCD and ED symptoms gain clarity on your clients’ conditions, we’ve created a webpage where you can access free screening tools to use at any time. This quick checklist can help flag behaviors and beliefs that warrant a deeper look.

Access our Screening Tools
Register for Our Summer CE Series — Learn more about treating eating disorders in adolescents and how symptoms can present
Refer a Patient or Schedule a Provider Consult — Our team is available for case consults and referrals

Thrive Wellness: Integrated Treatment for OCD and Eating Disorders

We offer evidence-based, integrated care for teens facing OCD and eating disorders. Our team includes licensed therapists, dietitians, medical providers, and specialists trained in ERP (Exposure and Response Prevention), DBT (Dialectical Behavior Therapy), and nutritional rehabilitation.

We understand that healing isn’t linear, especially when two complex conditions are at play. We embrace personalized, collaborative care with other community providers to ensure no aspect of a teen’s mental health is overlooked.

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Is It OCD or an Eating Disorder? What Parents Need to Know

July 17, 2025

As a parent, noticing alarming behaviors around food or routines in your child can raise some important questions. You might be asking yourself, “Is this an eating disorder, obsessive-compulsive disorder (OCD), or something else entirely?” Understanding the signs and differences between these disorders is key to getting your child effective, timely treatment. In this blog, we’ll break down the overlap between OCD and eating disorders, what signs to watch for, and how to get professional help. If you're a parent wondering “Is my child’s eating disorder actually OCD?” or “OCD vs eating disorder in teens,” know that you’re not alone and you’re in the right place to find specialized care for your child. What Is OCD? Obsessive-Compulsive Disorder (OCD) is a mental health condition where unwanted thoughts (obsessions) cause anxiety, leading to repetitive behaviors (compulsions) intended to ease that anxiety. OCD can be focused on any subject. Common obsessions include contamination, perfectionism, scrupulosity, and harm, but sometimes, the content of obsessions can be focused on food, body image, or weight. What Is an Eating Disorder? Eating disorders , like anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID) involve disturbed eating behaviors and intense concerns about body weight or shape. These conditions go beyond dieting or “picky eating” and can become life-threatening without professional intervention. The Overlap: Why It Can Be Confusing OCD and eating disorders often share similar symptoms : Ritualistic eating (e.g., needing to eat foods in a certain order or at a certain time) Rigid rules about food (like only eating certain food groups or certain amounts of food) Excessive checking (like weighing food or body or repeated checking of expiration dates or thorough cooking) Avoidance behaviors ( like avoiding carbs, fats, or other food groups or avoiding places or objects that can trigger obsessions) Distress when routines are disrupted (either around mealtimes or exercise routines) So, How Can You Tell the Difference? Use the following chart to compare and contrast symptoms of OCD and eating disorders.

3 Adolescent Mental Health Red Flags Providers Should Watch for During Summer

June 27, 2025

How school breaks can mask or amplify eating disorders, anxiety, and OCD symptoms and how to intervene

Navigating Coming Out: Emotional Wellness Tips for Every Stage

June 4, 2025

Coming out is a deeply personal, courageous, and in many cases, life-changing act. Whether you're sharing your sexual orientation or gender identity, coming out is about embracing authenticity and sharing an essential part of who you are. During the process of coming out, prioritizing your mental health at every stage is crucial. In this blog, we'll discuss insights and strategies to support your mental health before, during, and after coming out. Wherever you are in your journey, know that your experience is valid and you are not alone. Understanding the Mental Impact of Coming Out Coming out can bring about a lot of big feelings, including fear, relief, joy, anxiety, grief, and hope, sometimes all at once. Know that heightened emotions during this time are completely normal. Sharing such an integral part of yourself with the world can feel intense, but even with the ups and downs, being authentically you is worth it. Because LGBTQIA+ individuals face added mental health burdens due to stigma and discrimination, taking care of yourself during this time is more important than ever. You might experience increased anxiety, mental exhaustion, or avoidance ahead of coming out, so don’t be afraid to reach out for support. At its core, coming out is about authentic self-expression and showing your truest self, which can feel both exciting and scary at the same time . The self-acceptance and community gained from coming out is a vital part of finding long-term strength and joy. Still, it’s okay if you feel uncertain or conflicted, and these feelings are just part of the process. Before Coming Out: Emotional Preparation Coming out starts with reflection. Remember that there’s no rush when it comes to figuring out who you are. It’s okay to take time to understand your identity and what coming out might mean for you. Here are a few questions to consider: What do I hope to gain by coming out? Who feels emotionally safe to talk to? What are my fears, and how can I manage them? Mental wellness tips before coming out: Journaling can help you better understand your feelings and fears and explore different ways to share your truth. Talking through your feelings and different scenarios with a therapist , especially one who is LGBTQIA+ affirming, can help you to feel more supported and ready to come out. Practice grounding techniques like deep breathing, meditation, or visualization to ease anxiety ahead of sharing your identity. Helpful resources for coming out include: Trevor Project Lifeline (1-866-488-7386) TrevorSpace (an online community for LGBTQIA+ youth) OurCenter (a local community center for the LGBTQIA+ community in Reno) During the Coming Out Process: Staying Grounded The act of coming out can feel intimidating, as you’re sharing such a vital part of who you are. You might experience fear, panic, or doubt. While these feelings are real, know that you don’t have to navigate them alone. Tips for emotional resilience: Practice conversations ahead of time with a therapist or supportive friend so you feel ready when the time comes to share. Choose a time and place where you feel safe and in control. Use affirming statements, like, “I deserve to be loved for who I am.” Coping with negative responses: Set emotional boundaries with people who aren’t supportive. Create an emotional safety plan: know who you can call, where you can go, and what can help soothe you in moments of distress. After Coming Out: Processing and Healing Coming out, no matter how it went, deserves to be celebrated. An act of strength and authenticity like coming out is no small feat, so be proud of yourself for sharing who you are. Even so, the emotional aftermath can be complicated. You might feel joy and empowerment or loss and grief, especially if relationships shift. Healing strategies: Acknowledge your courage . Even difficult conversations are acts of strength. Rebuild your safety if you've experienced rejection. This might mean changing your environment or seeking new support systems. Release guilt or shame. Being who you are is never something you should feel ashamed or guilty for. Support networks can make a huge difference. Seek out different forms of support like: LGBTQIA+ support groups (in-person or online) Peer mentors or community leaders Allies, friends, or family who affirm and respect your identity Therapeutic options to deal with stress, grief, or isolation associated with coming out: EMDR (Eye Movement Desensitization and Reprocessing) can help process trauma. Narrative therapy helps you rewrite your story in your own empowering voice. Coming Out More Than Once: Navigating the Long Game Coming out isn’t just a single milestone, it’s a recurring process. You might come out again and again: to a healthcare provider, a neighbor, a partner, or a friend. It can feel exhausting or unfair to have to come out more than once, but each time, you’ll continue to find more strength, confidence, and understanding for yourself. Other tips for coming out: Focus on cultivating a strong inner identity that doesn’t rely on external validation. You know who you are, and you don’t need to prove yourself to anyone. Create a personal toolkit of coping and grounding strategies to deal with stress or burn-out associated with coming out. Thrive Wellness offers a free breathing exercise guide to help relieve anxiety and calm the nervous system. Download it here . Find affirmation and support through community. This can look like finding a chosen family, looking up to queer role models, attending events that celebrate the LGBTQIA+ community and its history, and working on embracing authenticity and having pride in who you are. Remember, there’s no one-size-fits-all approach to coming out, and it’s never too late to share who you are. Whether you're preparing to come out, in the midst of sharing your truth, or processing what came after, know that you are worthy of love, safety, and joy. Your truth is worth celebrating, today and everyday! For support during the coming out process and beyond, reach out to our team of affirming, inclusive, and compassionate mental and physical health care providers. We're here for you.