Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex.

BACKGROUND: Several studies have suggested a relevant overlap between eating disorders and sexual dysfunction involving the emotional component of body image esteem and dissociative experiences. AIM: To evaluate the common maintaining factors of sexual dysfunction and vulnerability to pathologic eating behaviors and their relation to a physiologic stress response. METHODS: In the present cross-sectional study, we evaluated a non-clinical sample of 60 heterosexual women (25-35 years old) for dissociation during sex with a partner, body image disturbance, and tendency toward pathologic eating behaviors. We also evaluated the stress-induced hypothalamic-pituitary-adrenal axis activation in response to a sexual stimulus and its association with binge eating and dissociation. OUTCOMES: Participants completed the Clinician-Administered Dissociative States Scale, the Sexual Satisfaction Scale-Women, the Body Esteem Scale for Adolescents and Adults, and the Eating Attitudes Test Short Version. Furthermore, we assessed cortisol levels before, during, and after exposure to explicit sexual stimuli shown within a laboratory setting. RESULTS: Dysfunctional body image esteem and a tendency toward binge-eating behaviors were associated with greater sexual distress in women. In particular, body esteem was significantly associated with greater dissociation during sex with a partner. Moreover, women who reported greater dissociation during sex with a partner and a tendency toward binge-eating behaviors showed higher levels of cortisol in response to sexual stimuli. CLINICAL IMPLICATIONS: These results support further research based on trans-diagnostic treatments targeted to dissociation and body image esteem, which could lessen sexual dysfunction and vulnerability to pathologic eating behaviors. STRENGTHS AND LIMITATIONS: Despite the small sample and self-reported questionnaires, this is the first study to consider the association of the stress response during sexual stimuli with sexual distress and with pathologic eating behaviors adopting a dimensional approach. CONCLUSION: Body uneasiness and dissociation represented factors underlying pathologic eating behaviors and sexual dysfunction. Women reporting a tendency toward binge-eating episodes and dissociation during sexual experiences represented a subpopulation with a higher stress response during sexual stimuli. Castellini G, Lo Sauro C, Ricca V, Rellini AH. Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex. J Sex Med 2017;14:1036-1045.

Childhood Adversity, Cortisol Levels, and Psychosis: A Retrospective Investigation.

Although it has been proposed that the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may act as a possible pathway linking early life stress to psychosis, this relationship has not yet been fully confirmed. This study aimed to investigate the relationship between childhood adversity (CA), cortisol levels, and psychosis. Eighty-five patients with psychosis and 170 control subjects were enrolled in the study. CA was evaluated using the Florence Psychiatric Interview, and Childhood Experience of Care and Abuse Questionnaire. Positive symptoms (PS) were assessed using the Positive and Negative Syndrome Scale. Cortisol levels were evaluated in saliva samples. Patients experienced more CA and showed higher cortisol levels than controls. Patients with CA showed higher morning cortisol levels and more severe PS than those without CA. Patients with higher morning cortisol levels showed severe delusions. These findings suggest that both CA and dysregulation of the HPA axis could be related to psychosis.

The eating disorder examination: reliability and validity of the Italian version.

OBJECTIVE: To examine the psychometric characteristics of the Italian language version of the latest edition of the eating disorder examination (EDE). METHODS: An Italian version of the EDE (17th edition) was designed and administered to 185 in- and outpatients with eating disorders and 60 age-matched controls. Its internal consistency, inter-rater reliability, short-term (7-23 days) test-retest reliability and criterion validity were evaluated. RESULTS: Internal consistency was high for all four original EDE subscales. Inter-rater reliability was excellent for global EDE scores and original subscales (≥0.93), and for eating disorder behaviours (≥0.89). Test-retest reliability was good for global EDE scores and original subscales (0.57-0.80), objective bulimic episodes and days, vomiting episodes, laxative and diuretic misuse episodes, and excessive exercising (≥0.82), but unsatisfactory for subjective bulimic episodes and days. Patients with eating disorders displayed significantly higher EDE scores than age-matched controls, demonstrating the good criterion validity of the instrument. CONCLUSIONS: The Italian version of the EDE 17.0D has adequate psychometric properties and can therefore be recommended for examining Italian patients with eating disorders in clinical and research settings.

Course and moderators of emotional eating in anorectic and bulimic patients: a follow-up study.

Emotion dysregulation has been found to be associated with specific eating attitudes and behavior in Eating Disorder (ED) patients. The present study evaluated whether emotional eating profile of ED patients changes over time and the possible effects of a psychotherapeutic intervention on the emotional eating dimension. One hundred and two ED patients (28 with Anorexia Nervosa restricting type [AN-R], 35 with Anorexia Nervosa binge/purging subtype [AN-B/P] and 39 with Bulimia Nervosa [BN]) were evaluated at baseline, at the end of a Cognitive Behavioral Therapy, at 3 and 6 year follow-up. The Structured Clinical Interview for DSM IV Axis I Disorders, the Emotional Eating Scale (EES) and several self-reported questionnaires for eating specific and general psychopathology were applied. A control group of 86 healthy subjects was also studied, in order to compare psychopathological variables at baseline. A significant EES total score reduction was observed among AN-B/P and BN patients, whereas no significant change was found in the AN-R group. Mixed Models analyses showed that a significant effect on EES total score variation was found for cocaine or amphetamine abuse (b = .25; p < .01). Patients who assumed these substances reported no significant EES reduction across time, unlike other patients. The present results suggest that ED patients with a history of cocaine or amphetamine abuse represent a sub-population of patients with lasting dysfunctional mood modulatory mechanisms.

Gender differences in depression and anxiety: the role of age.

Although females run greater risk for affective disorders, the greater vulnerability of women for these disorders varies with the age. The present study evaluates the lifetime incidence of depressive and anxiety disorders by age and gender in a community sample (2363 subjects; 54.6% females), representative of the general population (Sesto Fiorentino Study). Lifetime prevalence of affective disorders resulted higher in females. The age-sex pattern for affective disorders was observed only before menopause.

Childhood sexual abuse moderates the relationship between sexual functioning and eating disorder psychopathology in anorexia nervosa and bulimia nervosa: a 1-year follow-up study.

INTRODUCTION: Sexual dysfunctions that affect all aspects of sexuality are common in patients with eating disorders. However, only few studies have provided longitudinal information on sexual functioning in patients with eating disorders. AIM: To evaluate the longitudinal course of sexual functioning, and how changes in psychopathology and history of childhood abuse interact with sexual functioning in patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHODS: A total of 27 patients with AN and 31 with BN were assessed at baseline and at 1-year follow-up after a standard individual cognitive behavioral therapy (CBT). MAIN OUTCOME MEASURES: Subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Female Sexual Function Index (FSFI), Eating Disorder Examination Questionnaire, Beck Depression Inventory, Spielberg's State-Trait Anxiety Inventory, Symptom Checklist-90, and Childhood Experience of Care and Abuse Questionnaire. RESULTS: After treatment, both patients with AN and BN showed a significant improvement in the FSFI total score (P < 0.01 for both AN and BN) and all FSFI subscales, without significant between groups differences. Patients reporting childhood sexual abuse did not show a significant improvement in sexual functioning (ß = 0.05; P = 0.58). Reduction in eating disorder severity was directly associated with FSFI improvement, but only in those subjects with no history of sexual abuse (ß = 0.28; P = 0.01). CONCLUSIONS: Eating disorder-specific psychopathology could be considered as a specific maintaining factor for sexual dysfunction in eating disorders subjects. Subjects reporting a history of childhood sexual abuse represent a subpopulation of patients with a profound uneasiness, involving body perception, as well as sexual functioning, which appeared not to be adequately challenged during standard CBT intervention. The results, though original, should be considered as preliminary, given the relatively small sample size.

Gender identity disorder and eating disorders: similarities and differences in terms of body uneasiness.

INTRODUCTION: Subjects with gender identity disorder (GID) have been reported to be highly dissatisfied with their body, and it has been suggested that the body is their primary source of suffering. AIMS.: To evaluate quality and intensity of body uneasiness in GID subjects, comparing them with a sample of eating disorder patients and a control group. To detect similarities and differences between subgroups of GID subjects, on the basis of genotypic sex and transitional stage. METHODS: Fifty male-to-female (MtF) GID (25 without and 25 with genital reassignment surgery performed), 50 female-to-male (FtM) GID (28 without and 22 with genital reassignment surgery performed), 88 eating disorder subjects (26 anorexia nervosa, 26 bulimia nervosa, and 36 binge eating disorder), and 107 healthy subjects were evaluated. MAIN OUTCOME MEASURES: Subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the Symptom Checklist (SCL-90), and the Body Uneasiness Test (BUT). RESULTS: GID and controls reported lower psychiatric comorbidity and lower SCL-90 General Severity Index (GSI) scores than eating disorder subjects. GID MtF without genital reassignment surgery showed the highest BUT values, whereas GID FtM without genital reassignment surgery and eating disorder subjects showed higher values compared with both GID MtF and FtM who underwent genital reassignment surgery and controls. Considering BUT subscales, a different pattern of body uneasiness was observed in GID and eating disorder subjects. GID MtF and FtM without genital reassignment surgery showed the highest BUT GSI/SCL-90 GSI ratio compared with all the eating disorder groups. CONCLUSIONS: GID and eating disorders are characterized by a severe body uneasiness, which represents the core of distress in both conditions. Different dimensions of body uneasiness seem to be involved in GID subsamples, depending on reassignment stage and genotypic sex. In eating disorder subjects body uneasiness is primarily linked to general psychopathology, whereas in GID such a relationship is lacking.

Latent profile and latent transition analyses of eating disorder phenotypes in a clinical sample: a 6-year follow-up study.

The DSM-IV classification of Eating Disorders (EDs) identifies clinical entities showing considerable overlap and diagnostic instability across time. Latent profile analysis (LPA) allows the identification of underlying groups of individuals according to their patterned responses across a set of features. LPA was applied to data regarding EDs symptoms of a clinical sample of 716 EDs patients, with a current DSM-IV diagnosis of threshold and subthreshold EDs. Latent transition analysis (LTA) was used to examine the longitudinal stability of the obtained profiles. The latent profiles were compared for psychopathological variables and long-term outcomes (recovery, relapse), based on a 6-year follow-up after a cognitive behavioural treatment. Five different phenotypes were identified: "severe binging", "moderate binging", "restricted eating", "binge and moderate purging", and "binge and severe purging". The relevance of this characterization was confirmed by the differences in terms of psychopathological features and outcomes. Over the long term, a three-profile solution was adopted, clustering the subjects into "binge eating", "binge eating and purging", and "restricted eating". Latent profiles showed a moderate stability over the 6-year period, with probability estimates of stability within status over time of 0.57 for "binge eating", 0.40 for "binge eating and purging", and 0.41 for "restricted eating". The implications for DSM 5 were discussed, and the relative high rate of transition within phenotypes confirmed the significant instability of EDs phenomenology.

Psychopathological and clinical features of remitted anorexia nervosa patients: a six-year follow-up study.

OBJECTIVE: Remission from anorexia nervosa (AN) is a controversial issue, as remitted individuals have been found to show residual anorectic attitudes and concerns about weight and shape. The aims of this study were to evaluate the psychopathological features of remitted AN subjects 6 years after the end of a cognitive behavioural therapy and the predictors of reduction in psychopathology. METHODS: The sample was composed of 134 AN subjects, evaluated at baseline, at the end of treatment, 3 and 6 years after the end of treatment, by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and several self-reported questionnaires. RESULTS: Remitted patients at 6 years of follow-up still showed higher eating and shape concerns, compared with healthy controls. Duration of illness, obsessive-compulsive and depressive symptoms were moderators of change in psychopathology across time. DISCUSSION: Psychopathological features represent an enduring trait for AN patients. General psychopathology showed different effects on symptoms reduction across time.

Anorectic and bulimic patients suffer from relevant sexual dysfunctions.

INTRODUCTION: Sexual life is often impaired in anorexia nervosa (AN) and bulimia nervosa (BN), and few studies have evaluated the possible relationships between body image concerns, eating disorder psychopathology, and sexual functioning in these syndromes. AIM: To evaluate sexual functioning in AN patients, BN patients, and healthy controls, and to define the predictors of sexual dysfunction in the AN and BN groups. METHODS: Eighty-eight eating disorders patients (44 AN, 44 BN) referring to the Outpatient Clinic for Eating Disorders of the University of Florence, and 72 healthy females were evaluated. MAIN OUTCOME MEASURES: The subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, the Female Sexual Function Index (FSFI), the Eating Disorder Examination Questionnaire, the Emotional Eating Scale, the Beck Depression Inventory, the Spielberg's State-Trait Anxiety Inventory, the Barratt Impulsiveness Scale, and the Symptom Checklist 90. RESULTS: AN restricting/type patients had lower FSFI total scores (median; quartiles: 4.8; 2.1-15.4), compared with AN binge/purging type (28.3; 20.6-30.7) and BN patients (20.1; 3.8-30.3). Multiple linear regression analysis showed that shape concern was associated with sexual dysfunction in AN restricting type patients (ß=-0.61, P<0.01), whereas emotional eating (ß=-0.42, P<0.01), and subjective binge eating (ß=-0.55, P<0.01) were significantly associated with FSFI scores in AN binge/purging type and BN patients. CONCLUSIONS: Considering the sample size, the present results must be considered as preliminary. Sexual dysfunction was found to be a relevant concern in both AN and BN patients and was associated with different pathological eating behaviors. Sexual functioning should be carefully investigated in eating disorders patients, and treatments focused on shape concern, emotional eating, and binge eating could improve the sexual life of AN and BN patients.

The role of life events and HPA axis in anxiety disorders: a review.

Stressful life events and dysfunctional Hypothalamic Pituitary Adrenal (HPA) axis have been implicated in the pathogenesis of psychiatric disorders, including anxiety disorders. This paper attempts to review the existing literature on childhood traumata, recent life events, HPA axis functioning and their relationship in Post-Traumatic Stress Disorder, Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Social Phobia. Preclinical and clinical models will be analyzed. Stressful life events seem to have a role in the onset and in the course of these disorders and HPA axis abnormalities have been reported in almost all anxiety disorders. The hypothesis that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology, will be evaluated.

Generalized anxiety disorder: is there any specific symptom?

OBJECTIVE: The main aim of the present research was to evaluate the coherence of generalized anxiety disorder (GAD) psychopathological pattern, the robustness of its diagnostic criteria, and the clinical utility of considering this disorder as a discrete condition rather than assigning it a dimensional value. METHOD: The study was designed in a purely naturalistic setting and carried out using a community sample; data from the Sesto Fiorentino Study were reanalyzed. RESULTS: Of the 105 subjects who satisfied the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the diagnosis of GAD, only 18 (17.1%) had no other comorbid DSM-IV disorder. The most frequent comorbid condition was major depressive disorder (70.4 %). Only 2 of the GAD diagnostic symptoms (excessive worry and muscle tension) showed a specific association with the diagnosis itself, whereas the others, such as feeling wound up, tense, or restless, concentration problems, and fatigue, were found to be more prevalent in major depressive disorder than in GAD. CONCLUSION: Our study demonstrates that GAD, as defined by DSM-IV criteria, shows a substantial overlap with other DSM-IV diagnoses (especially with mood disorders) in the general population. Furthermore, GAD symptoms are frequent in all other disorders included in the mood/anxiety spectrum. Finally, none of the GAD symptoms, apart from muscle tension, distinguished GAD from patients without GAD.

Different moderators of cognitive-behavioral therapy on subjective and objective binge eating in bulimia nervosa and binge eating disorder: a three-year follow-up study.

BACKGROUND: Different studies considered the mechanisms involved in the maintenance of binge eating in bulimia nervosa (BN) and binge eating disorder (BED), suggesting different pathways. The present 3-year follow-up study evaluated the relationships between psychopathological variables, and objective and subjective binge eating episodes in the two syndromes. METHODS: 85 BN and 133 BED patients were studied. Objective and subjective binge eating, and psychopathological data were collected in a face-to-face interview, and by means of different self-reported questionnaires. The same assessment was repeated at baseline (T0), at the end of an individual cognitive-behavioral treatment (T1), and 3 years after the end of treatment (T2). RESULTS: At baseline, BN and BED patients showed different emotions associated with binge eating: anger/frustration for BN and depression for BED patients. Objective binge eating frequency reduction across time was associated with lower impulsivity and shape concern in BN patients, and with lower emotional eating and depressive symptoms in BED patients. Lower subjective binge eating frequency at baseline predicted recovery, in both BN and BED patients. Recovery was associated with lower impulsivity and body shape concern at baseline for BN patients, and lower depression and emotional eating for BED patients. CONCLUSIONS: Eating psychopathology, psychiatric comorbidity, impulsivity and emotional eating have a different pattern of association with objective and subjective binge eating in BN and BED patients, and they act as different moderators of treatment. A different target of intervention for these two syndromes might be taken into account, and subjective binge eating deserves an accurate assessment.

Emotional eating in anorexia nervosa and bulimia nervosa.

OBJECTIVES: The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa. METHODS: The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES). RESULTS: No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint. CONCLUSION: Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients.

Childhood stressful events, HPA axis and anxiety disorders.

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.

Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study.

OBJECTIVE: To evaluate in a 6-year follow-up study the course of a large clinical sample of patients with eating disorders (EDs) who were treated with individual cognitive behavior therapy. The diagnostic crossover, recovery, and relapses were assessed, applying both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the DSM-V proposed criteria. Patients with EDs move in and out of illness states over time, display frequent relapses, show a relevant lifetime psychiatric comorbidity, and migrate between different diagnoses. METHOD: A total of 793 patients (including anorexia nervosa, bulimia nervosa, binge eating disorder, and EDs not otherwise specified) were evaluated on the first day of admission, at the end of treatment, 3 years after the end of treatment, and 3 years after the first follow-up. Clinical data were collected through a face-to-face interview; diagnosis was performed by means of the Structured Clinical Interview for DSM-IV and the Eating Disorder Examination Questionnaire was applied. RESULTS: A consistent rate of relapse and crossover between the different diagnoses over time was observed. Mood disorders comorbidity has been found to be an important determinant of diagnostic instability, whereas the severity of shape concern represented a relevant outcome modifier. Using the DSM-V proposed criteria, most patients of EDs not otherwise specified were reclassified, so that the large majority of ED patients seeking treatment would be included in full-blown diagnoses. CONCLUSIONS: Among EDs, there are different subgroups of patients displaying various courses and outcomes. The diagnostic instability involves the large majority of patients. An integration of categorical and dimensional approaches could improve the psychopathological investigation and the treatment choices.

Comparison of individual and group cognitive behavioral therapy for binge eating disorder. A randomized, three-year follow-up study.

Few long-term follow-up studies evaluated the response to psychotherapeutic interventions in binge eating disorder (BED). The effectiveness of individual and group cognitive-behavioral therapy, and the possible predictors of outcome were evaluated in a randomized controlled trial. At the beginning, at the end of treatments, and three years after the end of treatments, 144 patients affected by threshold or subthreshold BED were assessed using a clinical interview and self-reported questionnaires evaluating the eating attitudes and behavior, emotional eating, and general psychopathology. The following outcome measures were considered: recovery at 3-year follow-up, weight loss, treatment resistance, relapse, and diagnostic change. Both treatments showed similar response in terms of all outcome measures in the long-term, and determined a significant reduction of binge eating frequency, and a mild reduction of weight. The absence of a history of amphetamine derivatives consumption, lower emotional eating and binge eating severity at baseline were predictors of full recovery in the long-term. A low Emotional eating was found to be the only predictor of weight reduction. Overweight during childhood, full blown BED diagnosis, and high emotional eating were predictors of treatment resistance. Treatments considering the relationships between binge eating and emotional eating could improve the outcome of BED patients.

Sexual function in obese women with and without binge eating disorder.

INTRODUCTION: Binge eating disorder (BED) is highly prevalent among individuals seeking treatment for obesity. No controlled studies assessing the sexual functioning of these patients have been published so far. AIM: To investigate the sexual functioning of a clinical sample of obese women affected by BED, comparing them with obese non-BED patients (Ob), and with normal weight controls. METHODS: A consecutive series of 107 obese BED and 110 obese non-BED patients referring for the first time to the Clinic for Obesity of the University of Florence, together with a control group of 92 normal weight subjects, were studied. MAIN OUTCOME MEASURES: Patients were studied by means of the Structured Clinical Interview for DSM-IV and the Female Sexual Function Index (FSFI). Moreover, several self-reported questionnaires assessing the eating specific and general psychopathology were used. RESULTS: BED and obese non-BED probands reported a lower sexual activity compared to controls, in terms of absence of sexual intercourse rate, and sexual intercourse frequency. BED patients showed lower FSFI total and subscales scores compared to Ob, and Ob probands reported lower scores compared to controls. According to the multiple linear regression analysis, emotional eating was the main determinant of FSFI scores (FSFI total score, desire, arousal, lubrication, orgasm, satisfaction) for both BED and Ob patients, while impulsivity (inversely associated with FSFI total, orgasm, and pain) and shape concern (inversely associated with arousal, lubrication, orgasm) were main determinants for BED patients only. CONCLUSIONS: BED patients, compared to obese non-BED and controls, have worse sexual functioning, which is associated with high levels of emotional eating, impulsivity, and shape concerns. The relationship between sexual functioning and eating psychopathology should be carefully addressed in obese patients with and without BED.