Loss of control in binge‐eating disorder: Fear and resignation

• Published in: The International journal of eating disorders 2023-06, Vol.56 (6), p.1199-1206
• Main Authors: Perelman, Hayley, Gilbert, Kelsey, Grilo, Carlos M., Lydecker, Janet A.
• Format: Article
• Language: English
• Subjects: Adult; Bariatric Surgery - psychology; Binge eating; Binge-Eating Disorder - psychology; binge‐eating disorder; body image; Bulimia Nervosa - psychology; depression; Depression - psychology; eating behavior; Eating disorders; fear; Humans; Hyperphagia; loss of control; Male; Psychopathology
• ISSN: 0276-3478; 1098-108X
• DOI: 10.1002/eat.23929

Objective Binge‐eating disorder involves overeating while feeling a loss of control (LOC). Emotions around LOC appear to vary; some patients fear LOC whereas others feel powerless or “resigned” to LOC. This study examined differences in psychopathology among treatment‐seeking patients with binge‐eating disorder categorized with fear of LOC, resignation to LOC, and no fear/resignation of LOC. Method Doctoral research clinicians administered diagnostic and semistructured interviews to characterize psychopathology and establish a diagnosis of binge‐eating disorder in participants (N = 382). The interview assessed fear of LOC in the past month. Further queries assessed whether, in the absence of fear of LOC, patients were resigned to LOC or had no fear/resignation. Results Patients with fear of LOC and resigned to LOC endorsed significantly greater global eating‐disorder psychopathology than patients with no fear/resignation. Patients with fear of LOC reported greater distress about binge eating and greater depression than those with no fear/resignation. Patients resigned to LOC reported significantly more frequent binge‐eating episodes than those with fear of LOC and no fear/resignation. Black individuals and men were more likely to report no fear/resignation than other demographic groups. Discussion This study describes a novel clinical aspect of binge‐eating disorder: resignation to LOC. Findings highlight the importance of including anticipatory cognitive‐affective experiences in treatment formulations and planning. Future research should examine co‐occurrence of these experiences and their association with impairment. Future research should also examine how fear of LOC and resignation to LOC change during treatment and whether they predict or moderate treatment outcomes. Public Significance Adults with binge‐eating disorder have anticipatory cognitive‐affective experiences about loss of control (LOC) over eating (i.e., fear of LOC, resigned to LOC, no fear nor resignation of LOC). Individuals who experience fear of LOC and those who are resigned to LOC had more severe psychopathology than those without fear/resignation. Binge‐eating disorder has the highest prevalence of the eating disorders; thus, findings have high public significance in guiding clinicians' treatment planning.