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

Abstract

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.

Keywords: anorexia nervosa; binge-eating disorder; bulimia nervosa; emotional eating; emotions; obesity; questionnaire.

FIGURE 1

Mean scores of the Salzburg Emotional Eating Scale (SEES) separately for eating disorder groups. AN‐R, Anorexia Nervosa, restrictive subtype; AN‐BP, Anorexia Nervosa, binge‐purge subtype; BN, Bulimia Nervosa; BED, Binge‐Eating Disorder. The scale ranges from “eating much less than usual” (=1) to “eating much more than usual” (=5) with 3 marking the middle point of “eating as much as usual” (=3); solid line. Error bars indicate one standard error of the mean [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Spearman's rank correlation of the subscales of the Salzburg Emotional Eating Scale with body mass index (BMI) in healthy individuals including individuals with underweight, normal weight, overweight and obesity

FIGURE 3

Mean scores of the Salzburg Emotional Eating Scale (SEES) as a function of the whole restrictive‐subtype Anorexia Nervosa (AN‐R) group and the mild/moderate subgroup (AN‐R_mm), the whole binge‐purge‐subtype Anorexia Nervosa (AN‐BP) group and the mild/moderate subgroup (AN‐BP_mm), and BMI‐matched healthy individuals HC_{ANmm_matched}. The scale ranges from “eating much less than usual” (=1) to “eating much more than usual” (=5) with 3 marking the middle point of “eating as much as usual” (=3); solid line. Error bars indicate one standard error of the mean [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Mean scores of the Salzburg Emotional Eating Scale (SEES) as a function of the Bulimia Nervosa (BN) group, the Binge‐Eating Disorder (BED) group and their respective weight‐matched healthy individuals groups (HC_{BN_matched} and HC_{BED_matched}, respectively). The scale ranges from “eating much less than usual” (=1) to “eating much more than usual” (=5) with 3 marking the middle point of “eating as much as usual” (=3); solid line. Error bars indicate one standard error of the mean [Color figure can be viewed at wileyonlinelibrary.com]