Work

Toward a triadic approach in eating disorders: investigating the contribution of the reflexive, affective and interoceptive systems in a clinical data cohort

Year: 2026

Type: article

Abstract: Eating disorders (ED) are disabling conditions increasingly conceptualized as addictive disorders. While food addiction (FA) is well documented in bulimia nervosa (BN) and binge-eating disorder (BED), its mechanisms in anorexia nervosa (AN) remain unclear. The triadic model of addiction—encompassing reflexive, affective, and interoceptive systems—offers a relevant framework to investigate FA across EDs. The current study aimed to test to what extent these three components of addiction contribute to FA in patients with ED. The sample included 115 patients (mean age = 28.41 years, SD = 11.64; 91% female) diagnosed with either AN (restrictive: n = 38; binge-eating/purging type: n = 32), BN (n = 29), or BED (n = 16). Participants completed the Emotional Appetite Questionnaire, the interoceptive subscale of the Eating Disorder Inventory-2, the Detail and Flexibility Questionnaire, and the Yale Food Addiction Scale 2.0. In the present analyses, FA was operationalized using the continuous total score reflecting FA symptom severity. Additional analyses using the symptom-count and diagnostic scoring procedures yielded comparable results. Linear and multinomial logistic regressions were used to test the associations between FA and the three systems, and their ability to distinguish diagnostic groups. When considered separately, interoceptive difficulties (r = .54), negative emotions (r = .47), and cognitive inflexibility (r = .33) were all associated with higher FA (all ps < 0.001). However, in the joint model, only interoception (β = 0.39, p < .001) and negative emotions (β = 0.33, p = .005) remained significant predictors, whereas cognitive flexibility had no significant effect. These effects did not differ significantly between diagnostic groups. The affective system predicted diagnostic (χ²(3) = 21.78, p < .001), but the effect was inconsistent and the overall predictive value was modest (McFadden’s R² = 0.11, classification accuracy = 50%). Interoceptive and affective systems appear to significantly predict FA across various ED; the reflexive system, as currently measured, seems to play a more limited role. These results highlight the need for more sensitive assessment tools and refined models of ED-related addictive dimensions. Trial Registration NCT03160443, first post 2017-05-03. Management and care for eating disorders (ED) remain difficult, and the success rate for anorexia nervosa remains low. One of the reasons given for this difficulty is the substantial variability in the profile of individuals. Therefore, a major challenge is to better characterize these disorders. A growing body of evidence points toward addictive behavior patterns among patients with eating disorders, encouraging further research to explore how psychological and cognitive processes involved in addictive behaviors can influence ED behaviors. In this perspective, the current study tested, in a population of 115 patients with ED, a triadic model that is increasingly used to help understand addictive processes. The aim was to understand the articulation between the cognitive control, emotional, and interoceptive systems. The findings showed that interoceptive and emotional difficulties are the strongest and most consistent predictors of food addiction. By contrast, cognitive flexibility did not retain predictive value when these factors were accounted for. Moreover, the model’s ability to differentiate diagnostic categories was limited, further supporting a transdiagnostic perspective. These results reinforce the hypothesis that processes involved in addictive behaviors can be central to ED and suggest the need to refine both our conceptual frameworks and assessment tools. This work can be seen as preliminary groundwork for future longitudinal and transdiagnostic studies investigating the triadic model in ED.

Source: Journal of Eating Disorders

DOI: 10.1186/s40337-026-01602-0