RESEARCH ARTICLE Loss of Control over Eating: A Description of the Eating Disorder/ Obesity Spectrum in Women Cynthia Villarejo 1 , Susana Jiménez-Murcia 1,2,3 , Eva Álvarez-Moya 2 , Roser Granero 2,4 , Eva Penelo 4 , Janet Treasure 5 , Núria Vilarrasa 6,7 , Mónica Gil-Montserrat de Bernabé 8 , Felipe F. Casanueva 2,9 , Francisco J. Tinahones 2,10 , José Manuel Fernández-Real 2,11 , Gema Frühbeck 2,12 , Rafael de la Torre 2,13 , Cristina Botella 2,14 , Zaida Agüera 1,2 , José Manuel Menchón 1,3,15 & Fernando Fernández-Aranda 1,2,3 * 1 Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain 2 CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain 3 Clinical Sciences Department, University of Barcelona, Spain 4 Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Spain 5 Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, King’s College London, London, UK 6 Endocrinology and Clinical Nutrition Unit, University Hospital of Bellvitge- IDIBELL, Barcelona, Spain 7 CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain 8 Dietetics and Nutrition Unit, University Hospital of Bellvitge, Barcelona, Spain 9 Laboratory of Molecular and Cellular Endocrinology, Research Area, Complejo Hospitalario Universitario de Santiago de Compostela, Spain 10 Service of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain 11 Service of Diabetes, Endocrinology and Nutrition, Institut d’Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain 12 Department of Endocrinology & Nutrition, University of Navarra, Pamplona, Spain 13 Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM-Hospital del Mar Research Institute, Barcelona, Spain 14 University Jaume I, Castellón, Spain 15 CIBER, Salud Mental (CIBERSAM), Instituto Carlos III, Spain Abstract Goals: This study aimed to analyse the association, commonalities and differences between obesity and eating disorders (ED). Method: A total of 150 female patients [50 obese with bulimia nervosa (OB + BN), 50 obese with binge eating disorders (OB + BED), 50 obese without eating disorders (OB)] and 50 female healthy-eating/weight control (CG) volunteers participated in this study. Assessment: All participants were assessed by the Eating Disorders Inventory-2 (EDI-2), the Symptom Checklist-Revised (SCL-90-R) and the Temperament and Character Inventory-Revised. Results: In general, all the groups differed significantly and showed linear trends (OB + BN > OB + BED > OB > CG) on general and eating psychopathology (SCL-90-R and EDI-2). Regarding personality traits, statistically significant differences across all four groups were found on Harm Avoidance and Self-Directedness. Whereas some symptoms were shared in extreme weight conditions, others were specifically related to ED. Conclusions: The presence of binge and purge symptomatology in obese patients is clinically relevant. These findings help to understand the relationship between Obesity and ED. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords obesity; eating disorders; binge eating; abnormal eating behaviour; classification *Correspondence Fernando Fernández-Aranda, PhD, FAED, Department of Psychiatry and CIBEROBN, University Hospital of Bellvitge, c/Feixa Llarga s/n, 08907-Barcelona, Spain. Tel. +34-93-2607227; fax. +34-93-2607193. Email: ffernandez@bellvitgehospital.cat Published online 12 November 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.2267 Introduction People with low control of eating, who often have a weight above normal, are now classified within the eating disorder (ED) spec- trum. Obesity is a specific risk factor for both binge eating disorder (BED) and bulimia nervosa (BN; de Zwaan, 2001; Fairburn, Welch, Doll, Davies, & O’Connor, 1997), and individuals with obesity often also have an ED (Müller et al., 2012; Villarejo et al., 2012). There are common risk factors for obesity and ED (mainly bulimic-type), such as impulsivity (Rosval et al., 2006), reward sensitivity (Davis et al., 2008), lower Self-directedness (Fassino et al., 2002a; Sullivan, Cloninger, Przybeck, & Klein, 2007), unhealthy weight control be- haviours and psychiatric comorbidities (namely, depression and impulse control disorders; Erermis et al., 2004; Fernandez-Aranda 25 Eur. Eat. Disorders Rev. 22 (2014) 25–31 © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.