Influence of Weight on Shared Core Symptoms in Eating Disorders: Support or Challenge for a Transdiagnostic Perspective?
Body-image disturbance is equally severe across AN, BN, and BED once BMI is accounted for—assess and treat it in BED too.
01Research in Context
What this study did
Schmitz et al. (2016) asked if body-image problems are the same across anorexia, bulimia, and binge-eating disorder. They compared adults with each diagnosis while holding body weight steady. This let them see if the symptom itself differs or just looks different because of weight.
What they found
Once BMI was accounted for, body-image disturbance was equally severe in all three groups. Eating behaviors still differed, but the shared core of body distress stayed the same. The data support a partial transdiagnostic view.
How this fits with other research
Azim et al. (2025) also found symptom clusters that cut across labels, but in kids with neurodevelopmental conditions. Both papers say assess domains, not just diagnoses.
Lillis et al. (2011) linked weight loss to reduced binge eating in an ACT workshop. Catalina’s work adds that body-image pain is present even when weight is high, so treat the image too, not just the scale.
Zhou et al. (2018) theorized that anorexia and autism share temperamental traits. Catalina gives empirical backing that core eating-disorder symptoms can be transdiagnostic, supporting the idea of shared targets.
Why it matters
If you serve clients with any eating disorder, screen body-image distress even when BMI is high. Use the same body-image tools for anorexia, bulimia, and binge-eating. Target the shared pain first; then tailor protocols for specific eating patterns.
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02At a glance
03Original abstract
In terms of the transdiagnostic model of eating disorders, Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED) share the same distinctive psychopathology. However, empirical evidence showing similarities between these eating disorder diagnoses for core symptoms is scarce, and the role of weight status is unclear. Data from a total of 168 female participants were collected between April 2004 and April 2008, at an outpatient unit specialized in eating disorder treatment. Core symptoms of eating disorders were measured via self-report questionnaires. In particular, women with BED and BN showed similar patterns of core symptomatology compared with AN. However, when body mass index (BMI) was considered in the analyses, there were no differences between the three diagnostic groups in relation to body image. Differences in eating behavior are not solely triggered by weight differences, whereas body image disturbances are a transdiagnostic phenomenon among EDs and should also be considered in the treatment of BED.
Behavior modification, 2016 · doi:10.1177/0145445516643487