The prevalence of comorbid obsessive-compulsive disorder in individuals with eating disorders: an epidemiological meta-analysis

Abstract

The present study aimed to provide a meta-analytic estimate of the prevalence of obsessive-compulsive disorder (OCD) amongst those with a current primary eating disorder (ED) diagnosis, and to isolate predictors of comorbid OCD. An online search of PubMed and PsycINFO was conducted with a Boolean search phrase incorporating keywords related to OCD, EDs, comorbidity, prevalence, and epidemiology, complemented by reference review and contact with experts in the field. Articles were included if they (a) reported an observational study examining current ED diagnoses, (b) used a semi-structured or structured diagnostic interview for OCD and ED diagnosis, (c) applied DSM or ICD criteria, (d) included adolescent or adult samples (age > 12), (e) included patient or community samples, and (f) reported lifetime or current OCD comorbidity. From the 846 articles identified, 35 lifetime and 42 current estimates of comorbid OCD were calculated. Analyses revealed an aggregate lifetime OCD prevalence of 13.9% CI₉₅% [10.4 to 18.1] and current OCD prevalence of 8.7% CI₉₅% [5.8 to 11.8] across EDs. Moderator analyses revealed the prevalence of OCD to be greatest in anorexia nervosa binge-eating purging type, in patient versus community samples, among those with an earlier age of ED onset, and those with lower mean BMIs. Awareness of the populations at greatest risk of comorbid OCD in EDs will ensure appropriate diagnosis, while facilitating development of treatments targeting their shared etiology.