Eating, Anxiety, Depression, Thoughts and Binge Eating Disorder

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While experts know that binge eating disorder (BED) is a severe eating disorder characterized by episodes of binge eating (eating a large amount of food in a short period of time) followed by negative feelings and emotions, very little research has explored the underlying psychopathological elements causing these binge eating behaviors.

In other words, the complex connection between eating, anxiety, depression, thoughts, and binge eating disorder has not been fully understood. However, a recent study using network analysis techniques discovered two surprising BED characteristics that may prompt the development of more effective treatments for binge eating disorder.

Traditional Psychotherapeutic Treatments

Due to a lack of research surrounding the psychopathology of BED, traditional therapeutic approaches used in the treatment of binge eating disorder often prove inadequate. For example, the current guidelines recommend cognitive behavioral therapy (CBT) as the preferred therapy for treating patients with BED.

However, approximately 50 percent of BED patients do not fully respond to CBT treatment [1,2,3]. One reason for this may be CBT’s emphasis on the overvaluation of body weight and shape (i.e., judging one’s self-worth in terms of shape and weight).

While overvaluation of body weight and shape is a core element in eating disorders like anorexia and bulimia, experts have found that only a small percentage of individuals with BED report this psychopathology [4]. Meaning many patients with BED are being treated for thoughts and behaviors that are irrelevant to their specific illness.

In short, due to a lack of knowledge surrounding the psychopathology of binge eating disorder, CBT and other traditional therapeutic approaches used to treat BED often fail to address the root causes of binge eating behaviors. Therefore, more research is needed to:

1) Uncover the key psychopathological elements of BED

2) Develop new therapeutic approaches that specifically target the complex psychological elements of BED.

New Study Uncovers Central Features of Binge Eating Disorder

Woman struggling with binge eating disorderTo this end, a study was recently conducted on 155 patients with BED at the Outpatient Unit for Clinical Research and Treatment of Eating Disorders in Catanzaro, Italy. The aim of this study was to investigate the underlying connection between eating, anxiety, depression, thought processes, and binge eating disorder in order to uncover new ways to treat BED with more effective psychotherapeutic interventions [5].

Using a network analysis (NA) method, the researchers examined how factors like emotion regulation, metacognition, anxiety, and depression are related to and interact with binge eating behaviors. Interestingly, the researchers discovered that eating symptoms, anxiety, and depression were not significant factors among BED patients [6].

Rather, the predominant elements of BED were difficulty with impulse control and impaired metacognition. For the purposes of this study, metacognition is defined as “a psychological function that plays a key role in identifying mental states and ascribing them to oneself and others, reflecting and reasoning on mental states and, finally, using this information to manage interpersonal conflicts” [7].

In other words, the central feature found among BED patients was not eating psychopathology or anxiety and depression, as one might suspect. Instead, the study suggests that the fundamental characteristics of BED are difficulty recognizing and regulating one’s emotions and impaired impulse control [8].

This means binge eating itself may be a consequent behavior (i.e., a response), while factors such as lack of emotional self-regulation and difficulties with impulse control could be the vulnerability elements of BED.

In light of these findings, the researchers contend that psychotherapeutic treatments for patients with BED should seek to address and improve metacognition (the awareness and understanding of one’s own thought processes) and emotion regulation (the ability to manage one’s emotional responses in a normal, healthy way).

They conclude that therapies such as metacognitive interpersonal therapy “could be a promising aid in clinical practice to develop an effective treatment for BED” [9].


[1] Grilo CM. Psychological and behavioral treatments for binge-eating disorder. J Clin Psychiatry. 2017;78:20–4 Available from:

[2] Hay P. A systematic review of evidence for psychological treatments in eating disorders: 2005-2012. Int J Eat Disord. 2013;46:462–9 Available from:

[3] Brownley KA, Berkman ND, Peat CM, Lohr KN, Cullen KE, Bann CM, et al. Binge-Eating Disorder in Adults. Ann Intern Med. 2016;165:409 Available from:

[4] Grilo CM. Why no cognitive body image feature such as overvaluation of shape/weight in the binge eating disorder diagnosis? Int J Eat Disord. 2013;46:208–11 Available from:

[5] Aloi, M., Rania, M., Carbone, E.A. et al. Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study. J Eat Disord 9, 22 (2021).

[6] ibid.

[7] ibid.

[8] ibid.

[9] ibid.

About the Author:

Sarah Musick PhotoSarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published March 9, 2021, on
Reviewed & Approved on March 9, 2021, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.