Indirect relationship between alexithymia and binge eating disorder in the context of obesity

BACKGROUND & AIMS: Alexithymia is a personality trait characterized by difficulties in identifying and describing emotions. It is associated with impaired emotional regulation, maladaptive coping strategies, and various psychiatric and metabolic conditions. In individuals with obesity, alexithymia may contribute to binge eating disorder (BED), but available evidence remains limited and inconsistent. The objective of this retrospective cross-sectional study was to examine the association between alexithymia and BED in patients with obesity, taking into account co-variables influencing these two components. METHODS: A sample of 1.456 patients with obesity (148 with BED and 1.308 without BED) was evaluated using: Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory II score (BDI II), Impulsive Behavior Scale (UPPS), Short Physical Performance Battery (SPPB), and biological analyses were performed. Hypotheses were tested using both univariate and multivariate modeling analyses. RESULTS: Alexithymia scores were higher in BED patients (61.0 ± 12.7 vs 58.5 ± 11.8, p = 0.001), and a greater proportion of them had a positive alexithymia score (55.4% vs 42.9%, p = 0.004) in univariate analysis. Mean depression scores were also higher (23.7 ± 11.9 vs 15.8 ± 10.7, p < 0.001), with an increased prevalence of severe depression (39.2% vs 15.8%, p < 0.001). However, the multivariate model analysis on BED did not confirm a significant link with alexithymia (OR:1.45, 95% CI:0.88 to 2.41, p = 0.149), but did with depression (OR:1.04, 95% CI:1.02 to 1.06, p = 0.001). CONCLUSIONS: These results suggest that the apparent association between alexithymia and BED in individuals with obesity is substantially attenuated after adjustment for other psychological factors, particularly depressive symptoms. These data underscore the importance of a multidimensional approach to understanding and treating these conditions, emphasizing the necessity of primary prevention and early screening for emotional disorders. However, given the retrospective cross-sectional and single-center design, causal inferences cannot be drawn.