Understanding the link between interoceptive deficits and binge eating symptoms among adolescents: A serial mediation analysis

Maria Di Nardo, Daniela Marchetti, Mario Fulcheri, Maria Cristina Verrocchio


The aim of this study was to assess relevant psychological predictors of binge eating behaviors in a non-clinical sample of Italian male and female adolescents. To do so, 120 adolescents aged 17-21 years participated in a cross-sectional study. Cognitive-affective components of binge eating symptoms (BES) were assessed with the Binge Eating Scale. Difficulty recognizing and accurately identifying internal emotional states was assessed with the Interoceptive Deficits (ID) subscale of the Eating Disorders Inventory-3. Body uneasiness (BU) was measured using the Body Uneasiness Test. Negative affectivity (PA, NA) was assessed with the Positive and Negative Affect Schedule. Based on Pearson’s correlations results, we conducted a mediation model analysis to examine whether the ID-BES relationship was mediated by NA and BU. Examined relationships were preserved after controlling for the effect of age, gender and BMI. The current study’s findings contribute to clarify the role that BU-related NA may play on ID in the appearance of BES and provide preliminary support for the potential role of NA and BU as self-regulatory mechanisms involved in this association. 


Interoceptive deficits; Binge eating behaviors; Body uneasiness; Adolescence; Negative affectivity; Clinical psychology.

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American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., DSM‐5®). Washington, DC.

Bottera, A. R., Kambanis, P. E., & De Young, K. P. (2020). The differential associations of shame and guilt with eating disorder behaviors. Eating Behaviors, 39, 101427. 10.1016/j.eatbeh.2020.101427

Brown, T. A., Vanzhula, I. A., Reilly, E. E., Levinson, C. A., Berner, L. A., Krueger, A., Lavender, J. M., Kaye, W. H., & Wierenga, C. E. (2020). Body mistrust bridges interoceptive awareness and eating disorder symptoms. Journal of Abnormal Psychology, 129(5), 445–456. 10.1037/abn0000516

Brunault, P., Gaillard, P., Ballon, N., Couet, C., Isnard, P., Cook, S., Delbachianf, I., Réveillère, C., Courtois R., (2016). Validation de la version française de la Binge Eating Scale: étude de sa structure factorielle, de sa consistance interne et de sa validité de construit en population clinique et non clinique. Encephale 42(5), 426–433. 10.1016/j.encep.2016.02.009

Cruz-Sáez, S., Pascual, A., Wlodarczyk, A., & Echeburúa, E. (2020). The effect of body dissatisfaction on disordered eating: The mediating role of self-esteem and negative affect in male and female adolescents. Journal of Health Psychology, 25(8), 1098-1108. 10.1177%2F1359105317748734

Cuzzolaro, M., Vetrone, G., Marano, G., & Garfinkel P.E. (2006). The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale. Eating and Weight Disorders, 11(1), 1-13. doi:10.1007/BF03327738

Duarte, C., Pinto-Gouveia, J., and Ferreira, C. (2015). Expanding binge eating assessment: validity and screening value of the Binge Eating Scale in women from the general population. Eating Behavior, 18, 41–47. 10.1016/J.EATBEH.2015.03.007

Fraticelli, F., Marchetti, D., Polcini, F., Mohn, A. A., Chiarelli, F., Fulcheri, M., & Vitacolonna, E. (2016). Technology-based intervention for healthy lifestyle promotion in Italian adolescents. Annali dell'Istituto Superiore Di Sanità, 52(1), 123-127. 10.4415/ANN_16_01_20

Fuller-Tyszkiewicz, M., McCabe, M., Skouteris, H., Richardson, B., Nihill, K., Watson, B. & Solomon D. (2015). Does body satisfaction influence self-esteem in adolescents’ daily lives? An experience sampling study. Journal of Adolescence, 45, 11-19. 10.1016/j.adolescence.2015.08.009

Garner, D. M. (2004). The Eating Disorder Inventory-3: Professional manual. Odessa, FL: Psychological Assessment Resources Inc.

Gijsbers-van Wijk, C. M.T., & Kolk, A. M. (1996). Psychometric evaluation of symptom perception related measures. Personality and Individual Differences, 20(1), 55-70. 10.1016/0191-8869(95)90023-N

Goldschmidt, A.B., Wall, M.M., Loth, K.A., Bucchianeri, M.M., & Neumark-Sztainer, D. (2014). The course of binge eating from adolescence to young adulthood. Health Psychology, 33(5), 457–460. 10.1037/a0033508

Gormally, J., Black, S., Daston, S., & Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive Behaviors, 7(1), 47–55. 10.1016/0306-4603(82)90024-7

Greeno, C. G., Marcus, M. D., & Wing, R. R. (1995). Diagnosis of binge eating disorder: Discrepancies between a questionnaire and clinical interview. International Journal of Eating Disorders, 17(2), 153–160. 10.1002/1098-108X(199503)17:2%3C153::AID-EAT2260170208%3E3.0.CO;2-V

Gugliandolo, M.C., Costa, S., Cuzzocrea, F., Larcan, R., & Martino G. (2020). Adolescents and Body Uneasiness: the Contribution of Supportive Parenting and Trait Emotional Intelligence. Journal of Child and Family Studies 29 (9), 2453–2462. 10.1007/s10826-020-01779-1

Holmes, M., Fuller-Tyszkiewicz, M., Skouteris, H., & Broadbent, J. (2015). Understanding the link between body image and binge eating: a model comparison approach. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 20(1), 81-89. 10.1007/s40519-014-0141-4

Imperatori, C., Innamorati, M., Lamis, D.A., Contardi, A., Continisio, M, Castelnuovo, G., Manzoni, G. M., & Fabbricatore, M. (2015). Factor structure of the binge eating scale in a large sample of obese and overweight patients attending low energy diet therapy. European Eating Disorders Review, 24, 174-178. 10.1002/erv.2384

Kessler, R.C., Berglund, P.A., Chiu, W.T., Deitz, A.C., Hudson, J.I., Shahly, V., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M.C., Benjet, C., Bruffaerts, R., de Girolamo, G., de Graaf, R., Haro, J. M., Kovess-Masfety, V., O’Neill, S., Posada-Villa, J., Sasu, C., Scott, K., Viana, M. C., & Xavier, M. (2013). The prevalence and correlates of binge eating disorder in the world health organization world mental health surveys. Biological Psychiatry, 73 (9), 904–914. 10.1016/J.BIOPSYCH.2012.11.020

Kittel, R., Brauhardt, A., & Hilbert, A. (2015). Cognitive and emotional functioning in binge-eating disorder: A systematic review. International Journal of Eating Disorders, 48(6), 535-554. 10.1002/eat.22419

Kristin D. (2011). Self-Compassion, Self-Esteem, and Well-Being. Social and Personality Psychology Compass, 5(1), 1-12. 10.1111/j.1751-9004.2010.00330.x

Lattimore, P., Mead, B.R., Irwin, L., Grice, L., Carson, R., & Malinowski, P., (2017). ‘I can’t accept that feeling’: relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder, Psychiatry Research, 247, 163–171. 10.1016/j.psychres.2016.11.022

Marano, G., Cuzzolaro, M., Vetrone, G., Garfinkel, P.E., Temperilli, F., Spera, G., Dalle Grave, R., Calugi, S., Marchesini, G., & QUOVADIS Study Group (2007). Validating the Body Uneasiness Test (BUT) in obese patients. Eating and Weight Disorders, 12(2), 70-82. 10.1007/BF03327581. PMID: 17615491.

Martin, E., Dourish, C.T., Rotshtein, P., Spetter, M.S., & Higgs, S., (2019). Interoception and disordered eating: A systematic review. Neuroscience & Biobehavioral Reviews, 107, 166-191. 10.1016/j.neubiorev.2019.08.020

Marzilli, E., Cerniglia, L., & Cimino, S. (2018). A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies. Adolescent Health, Medicine and Therapeutics, 5(9), 17-30. 10.2147%2FAHMT.S148050

McElroy, S. L., Guerdjikova, A. I., Mori, N., Munoz, M. R., & Keck, P. E., Jr. (2015). Overview of the treatment of binge eating disorder. CNS Spectrums, 20(6), 546-556. 10.1017/S1092852915000759

Merlo, E. M. (2019). Adolescent phobia as a "mask object". Mediterranean Journal of Clinical Psychology, 7(1). 10.6092/2282-1619/2019.7.2241.

Micali N., Ploubidis G., De Stavola B., Simonoff E., Treasure J., (2014). Frequency and Patterns of Eating Disorder Symptoms in Early Adolescence. Journal of Adolescent Health, 54(5) 574-581. 10.1016/j.jadohealth.2013.10.200

Mitchison, D., Hay, P., Griffiths, S., Murray, S.B., Bentley, C., Gratwick-Sarll, K., Harrison, C., & Mond, J. (2017). Disentangling body image: The relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents. International Journal of Eating Disorders, 50(2), 118– 126. 10.1002/eat.22592.

Mustelin, L., Kaprio, J., & Keski-Rahkonen, A. (2018). Beyond the tip of the iceberg: Adolescent weight development of women and men with features of binge eating disorder. Eating Behaviors, 30, 83-87. 10.1016/j.eatbeh.2018.06.004

Napolitano, M.A., & Himes, S. (2011). Race, weight, and correlates of binge eating in female college students. Eating Behaviors, 12(1), 29-36. 10.1016/j.eatbeh.2010.09.003.

Neumark-Sztainera D., Levineb M., Paxtonc S., Smolakb L., Pirand N. & Wertheimc E. (2006). Prevention of Body Dissatisfaction and Disordered Eating: What Next?. Eating Disorders, 14(4), 265-285. 10.1080/10640260600796184

Nicholls, W., Devonport, T.J., & Blake, M. (2016). The association between emotions and eating behaviour in an obese population with binge eating disorder. Obesity Reviews, 17(1), 30-42. 10.1111/obr.12329

Olatunji, B. O., Levinson, C., & Calebs, B., (2018). A network analysis of eating disorder symptoms and characteristics in an inpatient sample. Psychiatry Research 262, 270-281. 10.1016/j.psychres.2018.02.027

Pace, C. S., & Muzi, S., (2019). Binge-eating symptoms, emotional-behavioral problems and gender differences among adolescents: A brief report. Mediterranean Journal of Clinical Psychology, 7(2). 10.6092/2282-1619/2019.7.2161.

Preti, A., de Girolamo, G., Vilagut, G., Alonso, J., de Graaf, R., Bruffaerts, R., Demyttenaere, K., Pinto-Meza, A., Haro, J. M., Morosini, P. (2009). The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. Journal of Psychiatric Research, 43 (14), 1125–1132. 10.1016/J.JPSYCHIRES.2009.04.003

Rawana, J., & Morgan, A. (2014). Trajectories of depressive symptoms from adolescence to young adulthood: the role of self-esteem and body-related predictors. Journal of Youth and Adolescence, 43(14), 597-611. d10.1007/s10964-013-9995-4

Sehm, M., & Warschburger, P. (2015). The specificity of psychological factors associated with binge eating in adolescent boys and girls. Journal of Abnormal Child Psychology, 43(8), 1563-1571. 10.1007/s10802-015-0026-7

Sehm, M., & Warschburger, P. (2018) Prospective Associations Between Binge Eating and Psychological Risk Factors in Adolescence. Journal of Clinical Child & Adolescent Psychology, 47(5), 770-784. 10.1080/15374416.2016.1178124

Settineri, S., Frisone, F., Alibrandi, A., & Merlo, E. M. (2019). Emotional suppression and oneiric expression in psychosomatic disorders: Early manifestations in emerging adulthood and young patients. Frontiers in Psychology, 10, 1897. 10.3389/fpsyg.2019.01897.

Smink, F.R., van Hoeken. D., Oldehinkel, A.J., & Hoek, H.W. (2014). Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents. International Journal of Eating Disorders, 47(6), 610–619. 10.1002/eat.22316

Stice, E., Gau, J.M., Rohde, P., & Shaw, H. (2017). Risk Factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of Abnormal Psychology, 126(1), 38-51. 10.1037%2Fabn0000219

Stice, E., Marti, C.N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 45–457. 10.1037/a0030679

Timmerman, G.M. Binge Eating Scale: Further Assessment of Validity and Reliability. Journal of Applied Biobehavioral Research. 1999;1(1):1–12. 10.1111/j.1751-9861.1999.tb00051.x

Vicario, C. M., Nitsche, M. A., Salehinejad, M. A., Avanzino, L., & Martino, G. (2020). Time processing, interoception, and insula activation: A mini-review on clinical disorders. Frontiers in Psychology, 11, 1893. 10.3389/fpsyg.2020.01893

Wassenaar, E., Friedman, J., & Mehler, P. S. (2019). Medical complications of binge eating disorder. Psychiatric Clinics of North America, 42(2), 275-286. 10.1016/j.psc.2019.01.010

Wichstrøm, L. (1998). Self-concept development in adolescence: do American truths hold for Norwegians? In E. Skoe, & A. von der Lippe (Eds.), Personality development in adolescence. A cross national and lifespan perspective (pp. 98-122). London, UK: Routledge.

DOI: https://doi.org/10.6092/2282-1619/mjcp-2564


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