Emotional eating across different eating disorders and the role of body mass, restriction, and binge eating

• Published in: The International journal of eating disorders Vol. 54; no. 5; pp. 773 - 784
• Main Authors: Reichenberger, Julia, Schnepper, Rebekka, Arend, Ann‐Kathrin, Richard, Anna, Voderholzer, Ulrich, Naab, Silke, Blechert, Jens
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-05-2021; Wiley Subscription Services, Inc
• Subjects: Anorexia Nervosa; Binge eating; Binge-Eating Disorder; Body Mass Index; Bulimia Nervosa; Eating behavior; Eating disorders; emotional eating; Emotions; Feeding and Eating Disorders; Female; Happiness; Humans; obesity; Original; questionnaire; bulimia nervosa; questionnaire; emotions; emotional eating; binge-eating disorder; anorexia nervosa; obesity
• ISSN: 0276-3478; 1098-108X
• DOI: 10.1002/eat.23477

Objective
Different subtypes of eating disorders (ED) show dysfunctional eating behaviors such as overeating and/or restriction in response to emotions. Yet, systematic comparisons of all major EDs on emotional eating patterns are lacking. Furthermore, emotional eating correlates with body mass index (BMI), which also differs between EDs and thus confounds this comparison.
Method
Interview‐diagnosed female ED patients (n = 204) with restrictive (AN‐R) or binge‐purge anorexia nervosa (AN‐BP), bulimia nervosa (BN), or binge‐eating disorder (BED) completed a questionnaire assessing “negative emotional eating” (sadness, anger, anxiety) and “happiness eating.” ED groups were compared to BMI‐matched healthy controls (HCs; n = 172 ranging from underweight to obesity) to exclude BMI as a confound.
Results
Within HCs, higher BMI was associated with higher negative emotional eating and lower happiness eating. AN‐R reported the lowest degree of negative emotional eating relative to other EDs and BMI‐matched HCs, and the highest degree of happiness eating relative to other EDs. The BN and BED groups showed higher negative emotional eating compared to BMI‐matched HCs. Patients with AN‐BP occupied an intermediate position between AN‐R and BN/BED and reported less happiness eating compared to BMI‐matched HCs.
Discussion
Negative emotional and happiness eating patterns differ across EDs. BMI‐independent emotional eating patterns distinguish ED subgroups and might be related to the occurrence of binge eating versus restriction. Hence, different types of emotional eating can represent fruitful targets for tailored psychotherapeutic interventions. While BN and BED might be treated with similar approaches, AN‐BP and AN‐R would need specific treatment modules.