Background

Little is known about the clinical utility of the behavioral indicators for binge-eating episodes specified in DSM-5 for binge-eating disorder (BED): eating until uncomfortably full, eating large amounts when not hungry, eating more rapidly than usual, eating in secret, and feeling disgust, shame, or depression after the episode. Endorsement of at least three of the five behavioral indicators is required for the BED diagnosis. The association between each of these indicators and eating-disorder psychopathology and depression is unknown. This study aimed to (1) characterize the behavioral indicator rates among participants with overweight/obesity and binge-eating features and (2) examine unique associations between each indicator and eating-disorder psychopathology and depression.

Methods

Participants were 239 adults (77.9% female) with overweight/obesity (BMI 36.7 ± 5.9 kg/m2) seeking treatment in primary care. The Eating Disorder Examination assessed eating-disorder psychopathology, including the behavioral indicators. The Beck Depression Inventory-II assessed self-reported depressive symptoms.

Results

Endorsement rates for the behavioral indicators ranged from 45% (eating in secret) to 70% (eating large amounts when not hungry) and none were associated significantly with BMI. All indicators, except for eating large amounts when not hungry, were associated significantly with higher scores on EDE scales (i.e., maladaptive restraint, overvaluation of shape/weight, dissatisfaction with weight/shape; p’s<.05). The affectively valanced indicators (eating in secret and feeling disgust) were both associated significantly with higher depression scores (p’s<.05).

Conclusions

Findings support the clinical utility of four of the five behavioral indicators as suggested by significant associations with various clinical variables. However, eating large amounts when not hungry was not related to psychopathology suggesting this feature might not be as good a signal for disordered eating severity.