Unique and Shared Symptoms Across Food Addiction and Binge-Eating Measures: A Content Analysis

We aimed to determine if the high co-occurrence rates between food addiction (FA) and binge-spectrum eating disorders (BSEDs) are partially due to their respective measures assessing similar symptoms. Specifically, we aimed to clarify whether the Yale Food Addiction Scale 2.0 (YFAS 2.0) assesses a distinct symptom profile from common BSED measures (e.g., measures of binge-eating disorder (BED) or bulimia nervosa). Because FA does not include compensatory behaviors, our comparison focused specifically on FA and binge-related features of BSEDs.

We conducted a content analysis on the YFAS 2.0 and five of the most cited BSED measures. Five trained coders inductively assigned symptom codes to every item from each measure. Because FA does not include compensatory behaviors, we removed compensatory-behavior items from the BSED measures prior to coding to focus on binge-related content. We then calculated Jaccard similarity coefficients to quantify symptom overlap between measures.

The YFAS 2.0 showed very low symptom overlap with the BSED measures (Jaccard range = 0.08-0.19). However, nearly half (47%) of its symptoms were captured by at least one BSED measure. The symptoms assessed by the YFAS 2.0 and not the BSED measures tended to focus on the impairment and consequences of eating behavior, whereas the BSED measures focused more on the cognitive features of eating behavior.

This comparison revealed both differences and similarities between FA and BSED measures. Although the YFAS 2.0 showed limited overlap with any single BSED measure, about half of its symptoms were represented in at least one BSED measure, indicating partial shared content. The FA and BSED measures also reflect different theoretical emphases, with FA focusing on impairment and BSEDs emphasizing cognitive and behavioral features. Further clarifying how FA and BED relate will require integrating measurement patterns with evidence on mechanisms and clinical course.