Beyond diagnosis: a network approach to the emotional and control processes involved in the binge eating spectrum disorders

Abstract

Binge spectrum eating disorders (BSED) are increasingly prevalent, particularly among young adults, and are associated with significant physical and psychological comorbidities. Despite their rising prevalence, the mechanisms underlying symptom maintenance and interrelations remain poorly understood. This study aimed to visualize the complex interactions among eating-related severity, biological factors, and psychological processes in patients across the BSED spectrum. Network analysis was applied to a sample of N = 187 patients with BSED (119 women, 68 men), aged 18-45 years. Several nodes occupied prominent positions within the network. Food cues, followed by decision-making deficits, hunger, and stress, showed the highest centrality, indicating strong connections with other influential nodes and a key role in maintaining the network's overall structure. Food cues also acted as a crucial bridge linking different components of the network. These findings highlight the central role of food-related reactivity in BSED. Integrating assessment of food cues into clinical assessment could improve identification of patients at higher risk for symptom escalation. Moreover, targeting food cue reactivity in interventions (through techniques such as cue exposure, mindfulness-based strategies, or personalized behavioral interventions) may enhance treatment efficacy by directly addressing a central mechanism in the maintenance of BSED.