Preoccupation in bulimia nervosa, binge-eating disorder, anorexia nervosa, and higher weight

Int J Eat Disord. 2022 Jan;55(1):76-84. doi: 10.1002/eat.23630. Epub 2021 Oct 28.


Objective: Preoccupation (excessive and constant thoughts) about shape/weight and food/eating is thought to be prominent in individuals with eating disorders but has received much less research than overt behavioral features. This study examined the significance and distinctiveness of different foci of preoccupation in individuals categorized with different forms of eating disorders and in individuals with higher weight.

Method: Participants (N = 1,363) completed a web-based survey with established measures of eating-disorder psychopathology and depression. The current study compared preoccupation among individuals with core features of bulimia nervosa (BN; n = 144), binge-eating disorder (BED; n = 576), anorexia nervosa (AN; n = 48), and higher body weight (body mass index [BMI] ≥ 25) without eating-disorder features (higher weight [HW]; n = 595). Associations of each type of preoccupation with other eating-disorder psychopathology and depression were examined both between and within study groups.

Results: Preoccupation with shape/weight and with food/eating showed a graded pattern of statistically significant differences: AN and BN had higher preoccupation than BED, which was higher than HW. Within BN, BED, and AN study groups, correlation magnitudes of shape/weight and food/eating preoccupation with eating-disorder psychopathology and depression did not differ significantly. Within the HW group, shape/weight preoccupation was significantly more strongly correlated than food/eating preoccupation with overvaluation, body dissatisfaction, and depression.

Discussion: The preoccupation cognitive style, as well as focus, appears associated with other facets of eating-disorder psychopathology and depression. If results are confirmed among individuals with formal diagnoses, clinicians addressing maladaptive cognitions in cognitive-behavioral therapy should consider the role of preoccupation. Future research should investigate whether preoccupation predicts or moderates eating disorder treatment outcomes.

Keywords: anorexia nervosa; binge-eating disorder; body image; bulimia nervosa; cognitive; eating disorders; obesity; preoccupation; weight.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anorexia Nervosa* / psychology
  • Binge-Eating Disorder* / diagnosis
  • Binge-Eating Disorder* / psychology
  • Body Image / psychology
  • Bulimia Nervosa* / diagnosis
  • Bulimia Nervosa* / psychology
  • Humans
  • Overweight / psychology