Changes in Comorbid Obsessive-Compulsive and Restrictive Eating Disorder Symptoms in Eating Disorder Focused Family...

Restrictive eating disorders (EDs) are highly comorbid with obsessive-compulsive disorder (OCD), and comorbidity is associated with worsened outcomes. However, it is unclear if (1) Maudsley family therapy (FT-AN) for restrictive EDs reduces comorbid OCD symptoms, and (2) if higher baseline OCD symptoms merely reflect higher severity or are associated with inhibited ED treatment.

Participants with restrictive EDs (Anorexia Nervosa, Atypical Anorexia Nervosa, or other specified feeding and eating disorders) received FT-AN as part of an intensive day program or outpatient services in London from mid-2024 through January 2026. Nonparametric Wilcoxon signed-rank tests examined pre/post differences in ED, OCD, and general impairment symptomology. Linear regressions investigated the effect of baseline OCD scores on changes in ED symptoms across treatment.

Across FT-AN, ED pathology and weight improved while OCD pathology and general impairment did not. After excluding likely under-reporters, OCD symptoms and overall functioning did significantly improve. More severe OCD impairment at baseline did not impair, and in fact was related with more ED improvement. However, more severe ED and OCD symptoms at baseline were both associated with less change in weight. Together, these results suggest that worsened outcomes among patients with OCD represent higher initial severity rather than treatment inhibition.

FT-AN's effects on ED symptoms are likely not directly inhibited by, but also do not appear to fully target, OCD symptoms. Future research should examine efficacy and optimal timing of incorporating OCD-specific treatments into care.