Integrating maintaining theories for addiction and binge-eating pathology: A review of affective and reward-based theories

Binge eating disorder (BED) is characterized by recurrent binge eating episodes. Many factors have been analyzed in the maintenance of binge eating disorder, but current treatments still fall short of optimal success rates, with approximately half of individuals with BED relapsing following intervention. Perhaps partially due to the many shared vulnerabilities and high rates of comorbidity, interventions of BED have increasingly incorporated strategies utilized in substance use disorder treatment and indeed, there are many overlapping components in prevailing theories of BED and addiction. Despite interventions increasingly sharing mechanisms, there is lacking an in-depth review of conceptualization overlaps and differences. Although there are many reviews of models for BED and substance use disorders, none to-date compare and contrast the models of the most analyzed maintenance factors across both disorders: affect-based models and reward-based models. This narrative review, incorporating key and currently influential models that have been included in reviews with empirical support from the last 15 years, explores these models in-depth and provides critical analysis of where they differ and overlap to inform future interventions. Affect-based models largely evolved separably, however, most contemporary reward-based models of BED borrow concepts historically explored in addiction. Clinical implications, including refinement of treatment for individuals with BED or BED and concurrent problematic substance use are discussed.