Rituals, routines, habits, or compulsions? Exploring frequently occurring and patterned behaviors in eating disorders

This scoping review examines rituals, routines, habits, compulsions, and other frequently occurring patterned behaviors associated with eating disorders. It is based on a content analysis of a systematic MEDLINE (Ovid) and PsychINFO literature search of scientific articles published between 2020 and early 2026.

Terminology used to describe rituals, routines, habits, compulsions, and other frequently occurring patterned behaviors in eating disorder research was rich but inconsistent. Similar behaviors were variably interpreted as features of eating disorders, autism, or the obsessive-compulsive spectrum. These patterned behaviors were commonly interpreted within a cognitive inflexibility framework but were also viewed as compensatory symptoms and habits that become more ingrained over time. Although they often receded with successful treatment, authors highlighted the difficulty of defining, measuring, and managing them. Studies on these behaviors were often cross-sectional and did not consistently assess change. Contextual factors, such as personal meaning, cultural beliefs, and environment, were also noted to shape them.

Rituals, routines, habits, and compulsions might be best understood as transdiagnostic phenomena that reflect shared underlying mechanisms. Future research should standardize terminology and measurement to better understand and address these behaviors in the management of eating disorders.