Exploring the dissociation-binge eating relationship in eating disorders: a scoping review.

Abstract

Binge eating (BE) is a core symptom across multiple eating disorders (ED), yet differences in dissociative experiences between ED subtypes-and the psychological processes linking them-remain insufficiently understood. This scoping review synthesized evidence on the association between dissociation and BE in ED populations, focusing on ED diagnosis, symptom severity, potential confounders, and underlying mechanisms. Following PRISMA ScR guidelines, we searched five databases (CINAHL, EMBASE, PsycINFO, PubMed, and Web of Science) on July 23, 2025. Two independent reviewers screened and selected empirical and theoretical studies on dissociation and BE in clinical ED samples. Data extraction included study characteristics, settings, measures, and reported associations. Thirty studies (23 empirical, 7 theoretical) met the inclusion criteria. Most empirical work reported significantly higher dissociation scores in EDs featuring BE compared with healthy controls, with positive correlations between dissociation and BE symptoms, but inconsistent associations with compensatory behaviors. Within ED subtypes, restricting type anorexia nervosa consistently showed lower dissociation than binge eating/purging anorexia, bulimia nervosa, and binge-eating disorders. Dissociation was a significant mediator of the relationship between trauma and BE. Dissociation was associated with BE, independently of the intensity of negative affects before BE. Theoretical literature outlined four principal models explaining the dissociation-BE link. Current evidence suggests that dissociation is more specifically related to BE than to compensatory behaviors, potentially acting as a mediator between trauma and eating behavior. Despite some limits (heterogeneity in diagnostic criteria, self‑report measures, predominance of cross‑sectional designs), integrating dissociation into the comprehensive models of BE may inform assessment and intervention.