Is It OCD, Perfectionism, or Both? Why It Matters in Eating Disorder Recovery

Many people with eating disorders get labeled as perfectionists. Sometimes that's accurate. Sometimes it's only part of the story.

In this episode of the Dr. Marianne-Land Podcast, I explore the overlap between OCD and eating disorders, perfectionism, anxiety, autism, ADHD, and the cognitive effects of malnutrition. I explain why similar behaviors can have very different underlying causes and why understanding those differences can change the course of eating disorder treatment and recovery.

If you've ever found yourself stuck in food rules, body checking, repetitive thoughts, calorie calculations, reassurance-seeking, or endless self-doubt, this episode offers a more nuanced way to understand what's happening beneath the surface. Rather than focusing only on what behaviors look like, I discuss why identifying their function leads to more effective and compassionate care.

What You'll Learn

In this episode, you'll learn how perfectionism differs from OCD in eating disorder recovery and why the distinction matters. I discuss why intrusive thoughts, compulsive checking, and reassurance-seeking are often mistaken for perfectionism, how anorexia nervosa and other restrictive eating disorders can increase obsessive thinking, and why starvation affects cognitive flexibility and mental rigidity. I also explain how autism, ADHD, sensory needs, and routine dependence can sometimes resemble OCD while reflecting very different underlying experiences. Finally, I share why understanding the function of eating disorder behaviors helps clinicians, individuals, and families choose more effective treatment approaches.

OCD, Perfectionism, and Eating Disorders

Perfectionism has long been associated with anorexia nervosa, bulimia nervosa, and other eating disorders. At the same time, many people who believe they're simply perfectionists may also experience OCD, significant anxiety, or both. Looking only at outward behaviors can miss what is actually maintaining the cycle of restriction, compulsions, fear, and distress.

In this episode, I discuss why food-related rituals, repeated checking, body checking, calorie counting, and reassurance-seeking may look similar across different conditions while serving very different purposes. Understanding those differences helps people receive more individualized, neurodivergent-affirming care instead of one-size-fits-all treatment.

Why Neurodivergence Makes the Picture More Complex

Autism, ADHD, ARFID, sensory processing differences, and nervous system regulation can all influence eating behaviors, routines, and food preferences. Predictability and consistency often help neurodivergent people reduce overwhelm and make eating feel safer. Those experiences are not automatically signs of OCD or perfectionism.

I explain why clinicians need to understand the role of sensory processing, cognitive load, executive functioning, and nervous system regulation before drawing conclusions about repetitive eating behaviors. This perspective supports more accurate assessment and more compassionate eating disorder treatment.

Why This Matters for Recovery

Recovery looks different depending on what's driving the behavior. Someone whose eating disorder is fueled primarily by perfectionism may need different interventions than someone struggling with OCD, autism, or multiple overlapping conditions. When treatment targets the underlying process instead of the surface behavior alone, recovery often becomes more individualized, effective, and sustainable.

Understanding the "why" behind eating disorder behaviors creates opportunities for greater self-compassion and more meaningful healing.

This Episode Is For You If...

This episode is for anyone recovering from anorexia, bulimia, ARFID, binge eating disorder, or another eating disorder who has wondered whether perfectionism tells the whole story. It's also for autistic, ADHD, and AuDHD individuals, parents, caregivers, therapists, dietitians, physicians, and other professionals who want a more nuanced understanding of OCD, perfectionism, neurodivergence, and eating disorder recovery.

Related Episodes

OCD & Eating Disorders: Why Food Rules, Rituals, & “Not Feeling Right” Take Over on Apple & Spotify.

When Eating Disorders Meet Anxiety, OCD, or Depression: Co-Occurring Challenges & Recovery Strategies on Apple & Spotify.

Obsessions, Compulsions, and Control: How OCD Intertwines With Eating Disorders on Apple & Spotify.

Food, Fear, & Fixation: How OCD Shapes Eating Disorders on Apple & Spotify.

Work With Dr. Marianne Miller

If you're looking for a neurodivergent-affirming eating disorder therapist, I provide therapy for adults and adolescents throughout California and Washington, D.C. I also offer parent consultation and eating disorder coaching worldwide.

My practice specializes in ARFID therapy, anorexia treatment, bulimia treatment, binge eating disorder therapy, autism and ADHD, and neurodivergent-affirming eating disorder care. I use a sensory-attuned, trauma-informed, autonomy-supportive approach that honors each person's unique nervous system and lived experience.

Learn more about therapy, consultation, my ARFID & Selective Eating Course, and additional resources at www.drmariannemiller.com.

If you enjoyed this episode, please follow the Dr. Marianne-Land Podcast, leave a rating or review on Apple Podcasts or on Spotify, and share this episode with someone who may benefit from a more compassionate understanding of OCD, perfectionism, and eating disorder recovery.