Sex and age effects on binge eating spectrum disorders in young adults: a path analysis

Binge spectrum eating disorders (BSED) are heterogeneous conditions characterized by recurrent binge eating and associated features. While demographic factors are known to influence eating disorder expression, the specific contributions of sex and age remain unclear. This study examined the impact of sex and age on the clinical presentation of BSED in young adults and explored the underlying pathways using path analysis.

The sample comprised 187 young adults (119 women, 68 men; 20-45 years) diagnosed with bulimia nervosa (BN, N = 41), binge eating disorder (BED, N = 35), night eating syndrome (NES, N = 30), or OSFED with binge episodes (N = 81). Measures included eating disorder symptomatology, emotion regulation, impulsivity, drive-to-eat behaviors (food cues, food craving and hunger), and psychological state (anxiety-depression, obsessive-compulsive and perceived stress).

Sex and age differences were observed only for hunger and food cue responsiveness, with women reporting higher hunger and younger men higher cue responsiveness; no differences emerged for emotion regulation, impulsivity, or psychopathology. Path analysis revealed direct and indirect effects of sex and age on drive-to-eat behaviors and psychopathology, with emotional regulation mediating pathways in women and impulsivity mediating pathways in older adults, linking appetite-related responses to higher psychological distress and eating disorder severity.

Sex and age shape the clinical expression of BSED in young adulthood. Understanding how these demographic factors interact with psychological and behavioral characteristics may enhance assessment and support the development of tailored interventions across the binge eating spectrum.