Do Individuals Consulting for Binge Eating Behaviors Have Similar Psychosocial Functioning Across Different Eating Disorders?

Research Article

Int J Nutr Sci. 2022; 7(2): 1067.

Do Individuals Consulting for Binge Eating Behaviors Have Similar Psychosocial Functioning Across Different Eating Disorders?

Sinturel S¹, Gagnon C², Bournival C¹, Guèvremont G³ and Aimé A2,4*

1Clinique des Troubles de l’Alimentation, 1555 boulevard de l’Avenir, suite 206, Laval (QC), H7S 2N5, Canada

2Clinique Imavi, 733 boulevard St Joseph, suite 200, Gatineau (QC), J8Y 4B6, Canada

3Clinique MuUla, 74 rue Holtham, Hampstead (QC), H3E 3N4, Canada

4Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Campus de Saint-Jérôme, Canada

*Corresponding author: Aimé A Université du Québec en Outaouais, Campus de Saint-Jérôme, Département de Psychoéducation et de Psychologie, 5 rue Saint-Joseph, Saint-Jérôme, Québec, J7Z 0B7, Canada

Received: November 04, 2022; Accepted: December 16, 2022; Published: December 22, 2022


Although common characteristics have been highlighted between different Eating Disorders (ED), most existing classifications continue to consider them as separated diagnoses and to put forward their differences. The aim of this study was to verify if similarities and differences in terms of psychosocial functioning could be found between five groups of individuals, who reported binge eating behaviors. Nine hundred and seventy-eight patients consulting for ED problems in three different private clinics completed online questionnaires after a first psychological consultation. Based on their responses to the Eating Disorder Examination Questionnaire (EDE-Q6), participants were included in five clinical groups: bulimia nervosa, binge eating disorder, anorexia nervosa binge eating/purging type, other specified feeding or eating disorders, and no binge eating behaviors. They filled out online questionnaires assessing perfectionism, self-esteem, body esteem, depression, anxiety, alexithymia, fear of negative appearance, and weight stigmatization. Significant differences were observed between the ED groups and the no binge eating behaviors’ group. Although the various ED subtypes did not differ on any of the variables studied, some clinical profiles seemed to emerge. The results support a transdiagnostic and dimensional approach to ED.

Keywords: psychosocial functioning, eating disorders, subtypes, binge eating behaviors, similarities and differences


Binge eating behavior, characterized by the consumption of a large quantity of food in a relatively short period and a feeling of loss of control, is associated with a strong feeling of distress, which can lead to a desire to seek help [1]. This behavior is widespread in the non-clinical female population but is also common in people with Eating Disorders (ED), such as Bulimia Nervosa (BN), Binge Eating Disorder (BED), Anorexia Nervosa Binge eating/Purging type (ANBP), or Other Specified Feeding or Eating Disorders (OSFED) [2].

Previous research has shown that binge eating behaviors are associated with functional impairment and comorbid psychopathology [3]. For example, the intensity of depressive symptoms correlates with disordered eating severity [4]. The Perfectionist Model Of Binge Eating (PMOBE) has been suggested as a framework to help better understand how some personality traits and contextual conditions may play a role in the occurrence of binge eating behaviors [3]. Building on the three-factor interactive model of binge eating [5], the PMOBE states that two pathways should be considered in order to explain binge eating behaviors. In the first pathway, socially prescribed perfectionism would lead first to interpersonal difficulties, then to depressive affect, and finally, to binge eating behaviors as a maladaptive coping response. In the second pathway, socially prescribed perfectionism would lead to lower interpersonal esteem and then to food restriction, which would in turn accentuate the risk of presenting binge eating behaviors [3].

In individuals with Eating Disorders (ED), the transdiagnostic model of ED has been suggested by Fairburn et al. [6]. This model posits that individuals with ED have extreme concerns about their weight and shape, which lead them to be affected by slight weight changes, to scrutinize their body, and to compare their appearance with other people [6]. To reach a desired weight and shape, they tend to place rigid and inflexible demands on themselves, especially through dietary restrictions. However, intense dietary restrictions and emotions place them at a higher risk of resorting to binge eating and compensatory behaviors. In line with the transdiagnostic approach, Vervaet et al. [7] identified common vulnerability factors in a sample of 2,302 patients seeking help for ED in a specialized center. They found that hypervigilance and inhibition of emotions and feelings to avoid making mistakes, disconnection and rejection, impaired autonomy, anxiety, and perfectionism were key factors associated with ED. Moreover, recognition and identification of appetite and emotional cues were compromised in the patients they studied. Emotion regulation processes in individuals with ED have also been highlighted by other researchers [8,9].

Hilbert et al. [10] argued that some risk factors of ED may be general, whereas others may be more specific, and that diagnosis-specific risk profiles should be identified. While comparing individuals with AN, BN, and BED, they observed both differences and similarities. In terms of similarities, they suggested possible shared etiological pathways between BN and AN and similar behavioral profiles (e.g., strict food restriction behavior), but also between BN and BED (e.g., recurrent binge eating). In terms of differences, they found that the AN and BED diagnoses seemed more distant and distinct, and that the BN diagnosis seemed to occupy an intermediate position between AN and BED. For their part, Boujut et al. [11] observed that major depressive disorder and specific phobias were found more frequently in AN than in BN. Although the differences were not significant, the authors highlighted trends and suggested that the risks of comorbid anxiety and depressive symptoms were unevenly distributed between the various forms of ED. Danner et al. [12] found differences regarding emotional regulation and impulse control between the restrictive AN subtype and other ED, such as AN Binge-Purging subtype (ANBP), BN, and BED. They noted the importance of considering ED types in emotional regulation research rather than all ED as part of a same group.

Available studies where the psychosocial functioning of individuals with different types of ED was compared have limitations that should be considered. In fact, most of the samples used were relatively small [11,12] or were composed solely of a clinical population recruited in hospital settings [7]. Additionally, available studies tend to only focus on AN and BN [9] and few include the diagnostic of OSFED, despite it representing a large proportion of the persons who have ED [12].

The aim of this study was to assess shared and specific risk factors among individuals with four different types of ED (BN, BED, ANBP, and OSFED) and who all share a tendency for Binge Eating Behaviors (BEB), a core feature of ED. A fifth group, composed of individuals consulting for eating and weight preoccupations but not reporting any BEB, was included. Six variables likely to contribute to BEB and ED were assessed: Perfectionism, self-esteem, body esteem, depressive symptoms, fear of negative appearance, and internalized weight stigma. Anxiety symptoms were also included since anxiety was found to be an important factor in the development and maintenance of BEB [13,14]. Finally, alexithymia was considered because emotional regulation difficulties in people with ED have been observed in previous studies [6,8,9].



The sample consisted of 978 participants (n = 915 women) seeking help for eating and weight preoccupations at three private clinics in Québec, Canada (i.e., Gatineau, Longueuil, Montréal). The participants were categorized into five groups based on their answers to the Eating Disorder Examination Questionnaire-6 (EDEQ-6) [15]. The following question of the EDEQ-6 allowed to determine whether or not they reported binge eating behaviors: “Over the last 28 days, on how many days have you eaten an unusually large amount of food and have had a sense of loss of control?”. Participants reporting no Binge Eating Behaviors (BEB) were included in the control group: no BEB (n = 200). In total, 215 participants were classified in the BN group, 25 in the ANBP group, 346 in the BED group, and 192 in the OSFED group. The participants’ average age was 35.60 years (SD = 12.25; Mage women = 35.35; Mage men = 39.14) and their mean body mass index (BMI = kg/m²) was 31.51 (SD = 9.44; MBMI for women = 31.21; MBMI for men = 35.98).


After a first individual meeting with a psychologist or a psychotherapist, the participants were asked to complete online questionnaires. The questionnaire completion was voluntary and lasted 60 minutes on average. Each participant could get a feedback on their individual results. This clinical study was approved by the Ethic Committee of the Université du Québec en Outaouais (Protocole number: 219-193).


Disordered Eating Behaviors

The Eating Disorder Examination Questionnaire (EDE-Q) [15,16] measures behaviors and attitudes typically associated with eating problems, in the last 28 days. It has 28 items, but only six were used for this study, to evaluate the presence and frequency of binge eating and purging behaviors.


The French version of the Rosenberg self-esteem scale (RSES) [17,18] was used in this study to assess the degree of global self-esteem. This questionnaire contains 10 items (e.g., “I feel that I have a number of good qualities”) that are answered on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree).In this study, the subscale showed good internal consistency (a = .89).

Body Esteem

The Body Esteem Scale (BES) [19] is a 23-item scale that measures body esteem in adolescents and adults. It has three subscales: BE-Appearance (appreciation of self-appearance), BEWeight (satisfaction with one’s own weight), and BE-Attribution (evaluations attributed to others about one’s body and appearance). Only the first two subscales of the BES were used in this study: BE-Appearance (10 items, e.g., “I worry about the way I look”) and BE-Weight (8 items, e.g., “I am satisfied with my weight”). The response scale consists of a 5-point Likert scale ranging from 0 (never) to 4 (always). In this study, the two selected subscales showed good internal consistency (Cronbach’s alpha = 0.90 for BE-Appearance and 0.87 for BE-Weight).


The T-Anxiety Subscale of the State-Trait Anxiety Inventory (STAI) [20,21] contains 20 items that measure relatively stable aspects of anxiety proneness (e.g., “I worry too much over something that really doesn’t matter”). The response scale consists of a 4-point Likert scale ranging from 0 (almost never) to 4 (almost always). In this study, the subscale showed excellent internal consistency (a = 0.92).

Weight Stigma

The Weight Self-Stigma Questionnaire (WSSQ) [22] assesses two aspects of internalized weight stigma: self-devaluation (e.g., “I caused my weight problems”) and fear of enacted stigma (e.g., “I feel insecure about others’ opinions of me”). Each subscale contained six items rated on a 5-point Likert scale ranging from 1 (completely disagree) to 5 (completely agree). In this study, the self-devaluation subscale showed good internal consistency (a =0.82) and the fear of enacted stigma subscale showed acceptable internal consistency (a =0.79).


The Frost Multidimensional Perfectionism Scale (FMPS) [23] assesses perfectionism. It covers six dimensions: Concern over making mistakes (9 items), Personal standards (7 items), Parental expectations (5 items), Parental criticism (4 items), Doubts about actions (4 items), and Organization (6 items). This questionnaire contains 35 items (e.g., “People will probably think less of me if I make a mistake” and “I have extremely high goals”) that can be answered on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). In this study, the internal consistency of the FMPS is excellent (a =0.91).

Fear of Being Negatively Evaluated

The Fear of Negative Appearance Evaluation Scale (FNAES) [24] assesses participants’ fears of having their physical appearance negatively evaluated by others. The French version of this questionnaire [25] contains five items (e.g., “I am concerned about what other people think of my appearance”) answered on a 5-point Likert scale ranging from 1 (not at all) to 5 (extremely). In this study, the FNAES showed excellent internal consistency (a = 0.94).


The Toronto Alexithymia Scale (TAS-20) [26] assesses difficulties identifying and describing emotions. This questionnaire contains 20 items (e.g., “I am often confused about what emotion I am feeling”). The response scale consists of a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). In this study, a good internal consistency was found for this questionnaire (a = 0.85).

Depressive Symptoms

The Center for Epidemiologic Studies - Depression Scale (CES-D) [27,28] is a 20-item measure that assesses depressive symptoms over the past week with items phrased as self-statements (e.g., “I felt hopeful about the future”). Ratings are based on a 4-point Likert scale ranging from 0 (rarely or none of the time [less than 1 day]) to 3 (most or all of the time [5–7 days]).In this study, the subscale showed acceptable internal consistency (a = 0.72).

Data Analysis

A multivariate analysis of variance (MANOVA) was performed in IBM SPSS 26 to test differences in psychosocial characteristics between the five groups (0- absence of BEB, 1- ANBP, 3- BN, 4- BED, 5- OSFED). Next, a discriminant function analysis was used to assess the participants’ clinical profiles based on the combination of the dependant variables.


Psychosocial Differences between Groups

When Pillai’s trace was used, the MANOVA indicated a statistically significant effect of the five groups on psychosocial characteristics, V = 0.29, F(40,3728) = 7.252; p < 0.001. Separate univariate ANOVAs (Table 1) performed on the outcome variables revealed which groups differed significantly from one another. Compared to participants with a diagnosis of BN, BED, or OSFED, patients without BEB presented a more positive body esteem related to their appearance (F(4,938) = 12.360; p < 0.001; η² = 0.05) and their weight (F(4,938) = 9.; p < 0.001; η² = 0.07) and less self-devaluation because of their weight (F(4,938) = 20.915; p < 0.001; η² = 0.08). Moreover, compared to all four ED groups (ANBP, BN, BED, and OSFED), participants with no BEB were less likely to report experiences of stigmatization with regard to their weight (F(4,938) = 9.622; p < 0.001; η² = 0.04) or fear of being negatively evaluated because of their appearance (F(4,938) = 14.163; p < 0.001; η² = 0.06). They also reported higher self-esteem (F(4,938) = 16.701; p < 0.001; η² = 0.07), less difficulty identifying and verbally expressing their emotions (F(4,938) = 26.958; p < 0.001; η² = 0.10), less perfectionism (F(4,938) = 11.784; p < 0.001; η² = 0.05), less anxiety (F(4,938) = 22.456; p < 0.001; η² = 0.09), and less severe depressive symptoms (F(4,938) = 24.759; p < 0.001; η² = 0.10).