Understanding the Relationship Between Avoidant/Restrictive Food Intake Disorder and Obsessive–Compulsive Symptoms: A Systematic Review

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Abstract
Background: It is well documented in the scientific literature that obsessive–compulsive disorder (OCD) and various eating disorders may present overlapping psychopathological traits. Exploring these aspects could help to identify underlying features that connect different diagnostic categories. However, evidence is lacking regarding certain less-studied eating disorders, such as avoidant/restrictive food intake disorder (ARFID). The aim of this review is to investigate the presence of comorbidity between OCD and ARFID and, consequently, the psychopathological similarities between these disorders. Methods: A systematic review of the PubMed/MEDLINE, Scopus and PsycInfo databases was conducted. To ensure methodological rigor, the review process followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Results: After removing duplicates and applying the exclusion criteria, nine studies were included. Results indicated that although ARFID presents with primarily food-related symptomatology, the two disorders demonstrate both overlapping and distinct psychopathological characteristics. A tendency toward comorbidity is evident; however, symptom presentation appears to be influenced by age. Specifically, lower obsessive–compulsive comorbidity is observed during childhood and adolescence. Nevertheless, OCD in younger populations is more frequently associated with a fear-driven ARFID profile compared to older individuals. The co-occurrence of these conditions complicates treatment; OCD-related symptoms often show limited responsiveness to conventional approaches used for eating disorders. Conclusions: ARFID and OCD share partially overlapping psychopathological features, with comorbidity patterns varying by age. Recognizing these shared and disorder-specific traits—and investigating them through longitudinal studies—may guide more targeted, personalized interventions and improve treatment outcomes.
Funding Information
  • Ministero della Salute

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