Beyond the Eating Disorder: Common Co-Occurring Conditions Parents Should Know
Eating disorders are never just about food. Parents often find themselves overwhelmed not only by the visible symptoms, but also by the emotional and psychological challenges that accompany them. What may start as mealtime distress or food avoidance is often tied to deeper issues beneath the surface.
When your child is diagnosed with an eating disorder, it’s easy to focus entirely on the symptoms you can see—meal refusal, weight changes, bingeing, or compulsive exercise. But what many parents don’t realize right away is that eating disorders rarely exist in isolation. For most kids and teens, the eating disorder is just one piece of a much larger mental health picture. Anxiety, depression, obsessive-compulsive tendencies, and trauma histories are all common threads we see woven through the experience of disordered eating.
Understanding these co-occurring conditions doesn’t mean you have to take on more or fix everything overnight. But it can help you understand your child’s behaviors with more clarity—and advocate for treatment that addresses the full scope of what they’re struggling with. The more you understand what’s driving your child’s behaviors, the more confident and grounded you’ll feel when advocating for their care. Even if you’re not the one delivering therapy or creating a treatment plan, your insights as a parent help shape what recovery looks like. And that matters—a lot. In this post, we’ll walk through the most common comorbidities seen in eating disorders and what parents should know about navigating them alongside recovery.
Anxiety: The Hidden Engine Behind So Many Eating Disorders
Anxiety is by far one of the most common co-occurring conditions in kids and teens with eating disorders. For many families, it was present long before food became an issue. You may remember your child being highly sensitive, worried about rules, afraid of making mistakes, or needing constant reassurance. These traits often feel familiar in hindsight—but when anxiety begins to attach itself to food, eating, or body image, it can escalate quickly.
In restrictive eating disorders like anorexia, anxiety often manifests as a fear of weight gain, fear of losing control, or intense distress around uncertainty. In binge-purge presentations, anxiety may show up as a racing mind, difficulty regulating emotions, or using food behaviors to cope with overwhelming feelings.
Anxiety can also show up in more physical ways too—recurring stomachaches, headaches, difficulty sleeping, or needing excessive reassurance throughout the day. Some children experience panic attacks before meals or report feeling “sick” at school to avoid food-related stress. Others may exhibit social anxiety, becoming extremely self-conscious about eating in front of peers or participating in group activities. Recognizing these varied presentations can help you advocate more precisely for the type of support your child needs.
Treatment for anxiety should go hand-in-hand with eating disorder treatment. While nutritional rehabilitation is the first priority, learning to tolerate discomfort and face fear without using disordered behaviors is essential for long-term recovery. Therapies like CBT, DBT, and Exposure and Response Prevention (ERP) can be powerful tools once basic safety and nourishment are in place.
For parents, one of the most helpful shifts is to recognize that your child’s resistance to food isn’t always about the food. It’s often about the fear underneath. Supporting them through anxious moments—not just changing the disordered behaviors—can make a huge difference in helping them feel seen and safe.
OCD and Rigid Thinking: When Food Becomes a Compulsion
Obsessive-Compulsive Disorder (OCD) is another condition that frequently coexists with eating disorders—particularly with anorexia nervosa and ARFID. Many kids and teens with OCD-like traits experience an overwhelming need for rules, routines, and control. When these patterns shift their focus onto food or the body, they can evolve into rigid eating behaviors that are hard to interrupt.
Sometimes, the OCD is clearly distinct: a child may have contamination fears, counting rituals, or compulsions unrelated to food. But often, the obsessive thinking blends with the eating disorder itself. You might see your child cutting food into perfect shapes, needing to eat at exact times, or feeling distressed if meals aren’t prepared “just right.” These are more than preferences—they’re compulsions aimed at reducing a specific kind of internal discomfort.
In some cases, obsessive-compulsive tendencies can take the form of magical thinking—a belief that something terrible will happen to them or to their loved ones, if they don’t perform certain rituals, like eating in a specific order or avoiding “unsafe” foods. These thoughts may seem irrational to others, but to your child, they feel very real. This type of compulsive behavior is often misunderstood as stubbornness or defiance, when in reality it’s rooted in fear.
Exposure and Response Prevention (ERP), a gold-standard treatment for OCD, may be integrated into eating disorder recovery work. It helps kids practice tolerating uncertainty, breaking rituals, and choosing flexibility over rigid control. The overlap between OCD and eating disorders requires careful clinical attention, because treating one without the other often leads to a return of symptoms.
As a parent, it’s helpful to understand that some “rules” your child clings to may not be about calories or weight—they may be about calming intrusive thoughts or avoiding imagined harm. The goal of treatment isn’t just to get rid of the behaviors, but to help your child feel safe without them.
Depression: When Motivation Disappears
It’s not uncommon for kids in eating disorder recovery to seem flat, irritable, or emotionally numb. While this can sometimes be due to malnutrition or the strain of early refeeding, it’s also possible that your child is experiencing clinical depression alongside their eating disorder.
Depression often shows up in eating disorder recovery as hopelessness, fatigue, lack of motivation, and disconnection from things that once brought your child joy. It can be hard to tell the difference between depression and an eating disorder “shut down,” but either way, the emotional withdrawal deserves care.
If your child is in treatment and seems to be going through the motions without engagement—or is expressing thoughts of worthlessness, despair, or self-harm—be sure the treatment team knows. Sometimes, medications like SSRIs are considered alongside therapy to help lift the fog of depression enough to allow other work to continue.
It’s important to note that depression can be both a contributor to and a result of the eating disorder. For some kids, disordered eating begins as a way to numb sadness or feel something when they’re otherwise shut down. For others, malnutrition itself worsens depressive symptoms by impairing brain function and emotional regulation.
Parents often feel helpless when their child’s spark disappears, but just being present, calm, and consistent matters. Don’t force cheerfulness or pressure positivity. Instead, focus on staying emotionally available and encouraging open dialogue when your child is ready.
Trauma: The Unseen Wounds Beneath the Surface
Trauma is a word that gets used in many ways, but when we talk about trauma as it relates to eating disorders, we mean any experience that overwhelms a child’s capacity to cope and leaves a lasting imprint of fear, shame, or helplessness.
This could be:
Medical trauma (e.g., painful procedures, choking, or invasive treatments)
Bullying, especially weight-based teasing
Loss of a caregiver or loved one
Emotional neglect or chronic invalidation
Physical or sexual abuse
Trauma doesn’t cause eating disorders on its own—but it can fuel them. Some kids turn to food restriction or bingeing as a way to feel control when everything else feels chaotic. Others use eating behaviors to numb out, escape, or express internal pain they don’t have the words for.
If trauma is present, it’s essential that your child’s treatment plan includes trauma-informed care. This doesn’t mean diving into the trauma right away—in fact, doing so too early can be destabilizing. But it does mean that providers understand how trauma impacts the nervous system, and that they approach recovery with safety, choice, and compassion.
For parents, this means being curious rather than reactive. If your child is highly sensitive, easily startled, or unusually resistant to support, consider whether there’s something deeper driving their responses. And know that healing is still possible, even if the pain didn’t start with the eating disorder.
Other Overlapping Traits Parents May Notice
Not every child will meet the criteria for a formal diagnosis like OCD or depression, but many still struggle with overlapping traits—difficulty with focus, emotional regulation, impulsivity, or sensory sensitivity. These challenges can sometimes resemble ADHD or neurodivergence, even if no diagnosis is present. If you’re noticing patterns that affect your child’s ability to cope, communicate, or connect with others, it’s worth bringing those concerns to the treatment team. Recovery is most effective when it addresses the full picture—not just what shows up around food.
Why Treating the Whole Person Matters
Eating disorder symptoms are often just the tip of the iceberg. Beneath the surface, your child may be struggling with intense anxiety, intrusive thoughts, low self-worth, or past pain that hasn’t been processed. Treating the food symptoms alone—while necessary—won’t be enough to build lasting recovery if the root issues remain unaddressed.
A comprehensive treatment approach should include:
Medical stabilization and nutritional rehabilitation
Psychological therapy that addresses co-occurring conditions
Family involvement to create a safe and structured environment
Skills for emotional regulation, identity development, and communication
If your child is in treatment and progress feels slow or incomplete, it may be time to ask whether co-occurring conditions are being addressed effectively. Sometimes, a shift in therapy modality, additional testing, or a consultation with a psychiatric provider can unlock the next stage of healing.
What This Means for You as a Parent
As a parent, you are not expected to diagnose your child—but you are often the first to notice when something seems off. If you sense that your child’s struggles go beyond food, speak up. Share what you’re observing with the treatment team, even if you’re not sure what it means.
You might say:
“They seem much more anxious now that they’re eating more—what could that be about?”
“I’ve noticed a lot of rituals and rigidity even outside of food—could this be OCD?”
“She talks about feeling numb and disconnected all the time—should we explore depression?”
Your perspective matters. You see your child in ways the providers can’t, and your observations can shape the direction of treatment in powerful ways. You might worry you’re overreacting—or not reacting enough. You may catch yourself wondering whether a behavior is “just being a teenager” or something more serious. These feelings are normal. There’s no handbook for parenting through an eating disorder, and no perfect script for supporting recovery. What matters most is that you’re present, curious, and willing to speak up—even if you don’t have the words quite right.
At the same time, give yourself grace. It can be overwhelming to hear that there are more layers to untangle. But more clarity also means more pathways to healing. You don’t have to fix everything, but staying open, informed, and connected to the team can help ensure your child gets the care they need.
Eating disorders can be a symptom of a different problem
Eating disorders are complex, and they rarely occur in isolation. Anxiety, OCD, depression, and trauma are all common companions—and they deserve just as much attention as the food and body-related symptoms. When co-occurring conditions are addressed alongside the eating disorder, recovery becomes more than symptom management—it becomes true healing.
As you walk this road with your child, know that every layer you uncover is an opportunity—not a setback. With the right support, your child can heal not just their relationship with food, but their sense of self, safety, and emotional balance.
Recovery is rarely a straight line—and even when things feel slow or unclear, that doesn’t mean progress isn’t happening. Some of the most important shifts in healing are subtle: your child beginning to share a little more, resisting a little less, or simply showing up to treatment. These moments matter. Keep looking for them, and hold onto the bigger picture, even when day-to-day progress is hard to measure.
If you’re feeling uncertain or overwhelmed, you’re not alone. Join our free Facebook group, The Parent Support Network for Eating Disorder Recovery, to connect with other families, access expert guidance, and find hope in the shared journey toward lasting recovery.