Developmental pathways and treatment of OCD and anorexia: the role heightened performance monitoring and overcontrol

The National Institute of Mental Health awarded The Washington University $131,569 on September 18, 2025, under the Mental Health Research Grants program (CFDA 93.242) to examine developmental pathways linking obsessive-compulsive disorder and anorexia nervosa and to test a mechanism-based psychosocial treatment for this comorbidity. The project uses longitudinal community data and real-world clinical samples to identify specific mechanisms underlying anorexia-OCD progression and comorbidity that could be targeted in treatment, with results intended to inform development of transdiagnostic interventions and identify at-risk individuals. The award supports trainee development in childhood psychopathology of anorexia and OCD, clinical translational research, advanced analytics and data science, scientific rigor and reproducibility, and skills for independent investigation. Performance takes place in University City, Missouri, with a project completion date of September 30, 2026.

Abstract

Anorexia nervosa (an) is one of the deadliest psychiatric illnesses, and prognosis is worsened when comorbid with obsessive-compulsive disorder (OCD). Further, childhood OCD typically onsets before an, indicating a possible developmental trajectory with childhood OCD preceding and predicting an onset. Therefore, identifying and characterizing the mechanisms that underly the an/OCD developmental progression and an/OCD comorbidity is imperative for developing effective, targeted interventions for these difficult-to-treat psychiatric presentations. The overarching aim of this proposal is to use both a large, longitudinal, community dataset and a real-world clinical sample to (a) examine the developmental trajectory of an/OCD comorbidity, including specific mechanisms that could be targeted in treatment and (b) examine a mechanism-based psychosocial treatment for this comorbidity. Results will help identify at-risk individuals and inform the development of targeted and effective transdiagnostic interventions. This project will also achieve the following training goals: (1) develop expertise in childhood development of an and OCD psychopathology, (2) gain expertise in clinical translational work, (3) learn advanced analytic techniques and data science skills, (4) gain skills to be an independent investigator, including training in scientific rigor and reproducibility, professional development, and scientific communication. The assembled training team has extensive expertise in an, OCD, treatment research, and advanced statistics, and will support the applicant in developing the skills and knowledge needed to achieve her career goals of developing an independent program of research examining an/OCD psychopathology and treatment.