Discussion
binge eating behaviors, obsessive rumination, self-blame, anxiety, sexual difficulties, overeating behaviors, depressive, psychiatric, ADHD, depression, Eating Disorder, DSM-5, binge eating
RECRUITMENT
The study sheds light on a variety of positive aspects of the sexuality of women with binge eating episodes. We found that most participants were sexually active in the year prior to the study. The mean age of the first consensual sexual intercourse (Although sexual functioning, pleasure and satisfaction were low, sexual motivation was high among participants. The findings concerning participants’ negative self-perceptions toward sexuality are coherent with the documented association between binge eating, low self-esteem and overwhelming bodily shame [In line with findings suggesting that women with binge eating differ in terms of relation to their body [The second profile was comprised of women with a weaker sexual self-concept, more sexual difficulties, external sexual motivation, and a negative relationship to the body in sexuality. These sexual dispositions are akin to the sexual disinvestment tendencies of women with AN. The two profiles did not vary in terms of self-reported ED, BMI, depressive, anxious, and ADHD symptoms, and history of violence. This suggests that the severity of these factors may not account for the difference in sexual dispositions. Two mechanisms involved in binge eating may contribute to explaining this difference. First, cognitive restraint, i.e., the obsessive rumination about food even when it is not translated into actual restrictive behaviors, could contribute to distinguishing the profile more akin to AN. Indeed, women who are more obsessed with eating may be less invested in sexual fantasizing and less aware of their sexual needs and desires. Second, rumination about body image may interfere with the positive experience of sexuality and lead to sexual avoidance, which may in turn negatively affect the sexual self-concept. This must be verified in future studies integrating standardized measures of ED-specific and general psychiatric symptoms.On the whole, the copresence of self-reported psychiatric symptoms did not have a marked impact on the sexual dispositions of women with binge eating episodes. Comorbid symptoms of depression were associated with lower sexual internal control, which is consistent with tendencies observed relative to general locus of control [Some considerations limit the generalization of findings, notably the homogeneity of the sample (cisgender, heterosexual, white women, with a higher weight) and the absence of a formal ED diagnosis. Initial plans for recruitment and data collection targeted the clientele of a BED in-group treatment program at a community clinic specializing in the treatment of EDs. Due to the COVID-19 pandemic, these plans had to be adapted to an online platform. Whereas admission in BED treatment is based on a thorough 1-h interview that assesses whether participants meet all DSM-5 criteria for BED, this screening procedure could not easily be converted to an online self-report questionnaire. Nonetheless, close to half (47.04%) of the sample reported frequent binge eating episodes that were sustained over the previous 5 years, in the absence of comorbid ED symptoms. Most of them reported a higher weight, which is closely linked to binge eating, especially in the absence of compensatory behaviors, as it is the case in BED. In addition, the chronicity of binge eating episodes was targeted in inclusion criteria, but it was not defined in terms of episodes per week. Therefore, it is possible that individuals experiencing less frequent episodes of binge eating or repeated episodes of a limited duration, more akin to the diagnosis of Other Specified Feeding or Eating Disorder or to non-clinical binge eating, were incorporated in the sample. Sample composition is, therefore, not based on a clear diagnostic group. In addition, a significant percentage of the sample reported food restriction (24.51%), compensatory behaviors (6.32%), or both (22.13%) at least once in the last 5 years. The two profiles of sexual dispositions identified in the study did not vary significantly according to the presence of food restriction and/or compensatory behaviors, but it is nonetheless possible that the presence of symptoms overlapping other EDs influenced the findings. This issue constitutes an important limitation of this study in terms of internal validity. However, the present sample does reflect the natural clientele of community and private organizations that offer help to people with binge eating, which strengthens the external validity of the study. As initially planned, data collection included pharmacology as well as the use of standardized psychiatric measures for anxiety, depression, and ADHD, which are highly comorbid with EDs [Certain limitations associated with online studies must be considered in the interpretation of the present findings. First, the study was conducted as most of the population was confined or working from home, due to the sanitary measures imposed during the pandemic. While this situation may have increased the visibility of the publicity for the project, it is possible that the sample may not be entirely representative of non-internet users, individuals without high-speed internet, individuals who were highly solicited as part of their work outside of home (e.g., nurses), individuals living in rural areas, and individuals with less education or a lower income. Second, participants may have misrepresented their identity or characteristics, or answered in socially desirable ways. Third, individuals who respond to invitations to participate in online surveys—in this case without monetary compensation—may differ from those who do not. Fourth, the conditions in which participants completed the questionnaire could not be controlled, which may add statistical noise. Replication of the study, both in-person and online, could help reduce these potential biases.Findings support the need to investigate how sexuality interacts with binge eating behaviors and body image issues in view of incorporating it in ED treatment. Since different profiles emerge from our results, more attention should be given to personal experiences of sexuality, while avoiding one-size-fits-all approaches to prevent any feelings of not being understood. For example, individuals with binge eating, especially those who are more positively disposed toward sexuality, sexual activities could be useful in providing embodied experiences of comfort and pleasure. Such experiences could fight against the shame and self-blame related to overeating behaviors that are fused within the person’s sense of identity [