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Emotional eating is the tendency to overeat in response to negative emotions and has shown to be associated with weight outcomes, both in respect to weight gain over time and difficulties with weight loss and weight loss maintenance. It is thus important to develop treatments to improve weight loss outcomes in emotional eaters. The purpose of this review is to explore adults’ relationship between emotional eating and weight by: (1) describing self-report measures used to assess emotional eating such as the Dutch Eating Behavior Questionnaire (DEBQ), the Three Factor Eating Questionnaire (TFEQ), and the Emotional Eating Scale (EES), (2) exploring the relationship between emotional eating and weight outcomes, namely examining weight gain in longitudinal studies and difficulties with weight loss and weight loss maintenance in intervention studies, and (3) reviewing current interventions that target emotional eating, using techniques such as mindfulness, Acceptance and Commitment Therapy (ACT), Cognitive Behavior Therapy (CBT), and Dialectical Behavior Therapy (DBT). A better understanding of adults’ emotional eating and its impact on weight is important to develop interventions that effectively target weight loss struggles unique to emotional eaters and improve weight outcomes for this population.
Emotional Eating and Weight in Adults: a Review
Mallory Frayn
&Bärbel Knäuper
Published online: 15 March 2017
#Springer Science+Business Media New York 2017
Abstract Emotional eating is the tendency to overeat in re-
sponse to negative emotions and has shown to be associated
with weight outcomes, both in respect to weight gain over time
and difficulties with weight loss and weight loss maintenance. It
is thus important to develop treatments to improve weight loss
outcomes in emotional eaters. The purpose of this review is to
explore adultsrelationship between emotional eating and
weight by: (1) describing self-report measures used to assess
emotional eating such as the Dutch Eating Behavior
Questionnaire (DEBQ), the Three Factor Eating Questionnaire
(TFEQ), and the Emotional Eating Scale (EES), (2) exploring
the relationship between emotional eating and weight outcomes,
namely examining weight gain in longitudinal studies and diffi-
culties with weight loss and weight loss maintenance in inter-
vention studies, and (3) reviewing current interventions that tar-
get emotional eating, using techniques such as mindfulness,
Acceptance and Commitment Therapy (ACT), Cognitive
Behavior Therapy (CBT), and Dialectical Behavior Therapy
(DBT). A better understanding of adultsemotional eating and
its impact on weight is important to develop interventions that
effectively target weight loss struggles unique to emotional
eaters and improve weight outcomes for this population.
Keywords Emotional eating .Wei g ht .Weight loss .Review
Emotional eating is defined as the Btendency to overeat in
response to negative emotions, such as anxiety or irritability^
(van Strien et al. 2007, p. 106). It is a highly prevalent concern
for those who struggle with their weight; it is suggested that
60% or more of individuals who are overweight or obese are
also emotional eaters (Ganley 1989). Emotional eaters are
particularly likely to consume foods high in fat, sugar, and
calories in response to negative emotions (Elfhag and
Rossner 2005). These eating habits in combination with in-
creased body weight place emotional eaters at higher risk for
developing diabetes and heart disease (e.g., Melanson 2007;
Wang et al. 2010). This population also struggles with weight
loss; emotional eaters are half as likely as non-emotional
eaters to achieve the 10% weight loss goal of standard behav-
ioral weight loss treatment (López-Guimerà et al. 2014).
Emotional eating is important to study because of its negative
effects on weight and overall health. Thus far very few inter-
ventions have incorporated the treatment of emotional eating
into weight loss interventions.
The purpose of this paper is to review the relationship be-
tween emotional eating and body weight in adults and to ex-
plore the current treatment options used to address these con-
cerns. To our knowledge, no such review exists. Other reviews
have outlined theoretical perspectives on emotional eating
(e.g., Canetti et al. 2002), have examined the prevalence of
emotional eating in a variety of samples (e.g., Gibson 2012),
and have reviewed studies using a certain treatment approach,
namely mindfulness interventions, for emotional eating (e.g.,
Katterman et al. 2014;OReilly et al. 2014). However, none of
these reviews have attempted to explicate the relationship be-
tween emotional eating and weight, nor have they thoroughly
evaluated treatment options for overweight or obese emotion-
al eaters. This review seeks to fill these gaps in the existing
*Mallory Frayn
Bärbel Knäuper
Department of Psychology, McGill University, Stewart Biology
Building, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1,
Curr Psychol (2018) 37:924933
DOI 10.1007/s12144-017-9577-9
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... In Tuncer and Duman's study (2020), 49% of participants with mental disorders displayed emotional eating behaviors. Some studies in the literature have quantitatively investigated emotional eating behaviors, while others conducted a qualitative in-depth investigation (Bennett et al., 2013;Frayn & Knäuper, 2018). One mixed-method study investigates the eating behaviors of patients with schizophrenia (Frayn & Knäuper, 2018). ...
... Some studies in the literature have quantitatively investigated emotional eating behaviors, while others conducted a qualitative in-depth investigation (Bennett et al., 2013;Frayn & Knäuper, 2018). One mixed-method study investigates the eating behaviors of patients with schizophrenia (Frayn & Knäuper, 2018). However, no studies could be identified in the literature that investigates the emotional eating behaviors of individuals with chronic mental disorders living in the community. ...
... In one qualitative study that investigated students' emotional eating experiences, the students reported that they felt guilty after emotional eating and therefore restricted their food intake (Bennett et al., 2013). In another similar qualitative study, individuals of normal weight reported that they worried about their weight and health after emotional eating and that they restricted their food intake as a compensatory behavior (Frayn & Knäuper, 2018). In a further study, it was observed that the participants experienced feelings of guilt due to uncontrolled carbohydrate consumption during healthy eating (Becker et al., 2019). ...
Purpose: The aim of this study is to understand the emotional eating experiences of individuals with severe mental disorders. Design and methods: The study used a descriptive qualitative design. Data were collected from 19 individuals who displayed emotional eating behavior and a severe mental disorder. Findings: The main themes of this study are "Triggers," "Emotional Eating Process," and "Feelings after Emotional Eating." Participants stated that negative emotions and certain initiating factors were the triggers of their emotional eating; they also experienced feelings of regret and guilt after emotional eating. Practice implications: It was concluded that programs for regulating the eating behaviors of individuals with severe mental disorders should be organized and that psychosocial interventions to prevent emotional eating among these individuals should be integrated into the programs' contents.
... These findings are in line with other studies which found that emotional eating was associated with greater regain (Sainsbury et al., 2019) and that restrained eating is important to weight maintenance (Levinge et al., 2020). Also, emotional eating and internal disinhibition were found to negatively impact weight loss (Frayn & Knäuper, 2018). ...
... In terms of eating behaviors, the participants from the Obesity group or the Overweight reported a significantly higher rate of emotional eating, uncontrolled eating, and less cognitive restraint than those from the Healthy weight group. These findings align with others which showed that emotional eating was linked to higher BMI (Sainsbury et al., 2019) and together with internal disinhibition negatively impacted weight outcomes (Frayn & Knäuper, 2018). We found no significant differences in eating behaviors between obese and overweight groups which suggests that similar cognitive mechanisms are involved in both overweight and obesity-related behaviors. ...
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To improve the long-term results of psychological treatments, it is important to know why some people constantly have a healthy weight and others face difficulties in losing weight or maintaining it. This study aimed to identify psychological factors associated with maintaining or regaining weight loss and determine the psychological characteristics of individuals with different BMI levels. 282 adult participants responded to questionnaires measuring eating behaviors, general and specific irrational beliefs, and self-efficacy. We used MANOVA analysis to identify the differences between the categories of participants. Our results showed that there are differences between the regainers and maintainers VS those with healthy stable weight in terms of self-efficacy (F (2, 84) = 7.17, p = .001), irrationality (F (2, 84) = 8.15, p < .001), and eating behaviors (F (2, 84) = 7.95, p < .001). Furthermore, people with healthy weight had more self-efficacy about their eating behaviors (F (2,273) = 6.49, p = .002), and more cognitive restraint (F (2, 273) = 3.58, p = .029), lower levels of specific irrational beliefs (F (2, 273) = 10.17, p < .000) and emotional eating (F (2, 273) = 20.24, p < .000) than participants with obesity or overweight. Some psychological factors are relevant for weight loss and explain why some people with overweight or obesity find it difficult to lose weight and maintain it.
... Some research (Polivy & Herman, 1999) has suggested that individuals who try to avoid eating certain types or amounts of food and engage in chronic, restrained eating are also likely to feel pulled towards emotional eating as they break their dietary restraint. Further, these two eating styles may reflect disordered eating patterns ranging from chronic dieting to binge eating (Frayn & Knäuper, 2018). However, participants who engaged in more intuitive eating practices were less likely to report engaging in emotional eating and dietary restraint. ...
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Introduction: Restrained, emotional and intuitive eating were examined in relation to each other and as correlates of participants' weight status, body image and self-esteem. In some past research, restrained and emotional eating have been associated with higher weight status and poorer mental health, while intuitive eating is more frequently linked to lower weight status and more positive well-being. However, these eating styles have rarely been examined together and never in a large cross-country sample. Method: Six-thousand two-hundred and seventy-two (6272) emerging adults (M age = 21.54 years, SD = 3.13) completed scales from the Three-Factor Eating Questionnaire, the Eating Disorders Examination Questionnaire, the Intuitive Eating Scale-2, the Multidimensional Body Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, and provided weight and height information that was used to calculate body mass index (BMI). Participants resided in Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States and provided information using an online survey. Results: Path analyses for the entire sample revealed significant pathways between higher intuitive eating and higher body satisfaction and self-esteem, and lower BMIs among participants. Higher levels of restrained and emotional eating were associated with lower body satisfaction and self-esteem, and higher BMIs among participants. Minor cross-country differences were evident in these patterns of relations, but intuitive eating emerged as a consistent predictor across countries. Conclusion: Overall, findings suggest that efforts should be made to increase intuitive eating among emerging adults and to support individual and macrolevel interventions to decrease restrained and emotional eating behaviours.
... Stress can destabilize cognitive self-regulation processes that are responsible for food choices. Failures in inhibitory control can lead to stress-eating behaviors such as emotional eating, i.e., eating as a coping mechanism to soothe negative emotions, which has been blamed for weight gain [21]. Stress has also been found to be linked to reduced physical activity [22] and various adolescent health behaviors [23], increasing the risk for obesity. ...
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Given the evidence on how stress affects weight status in children, this research examined this association among Greek students aged 10–12 years old. Overall, 1452 children and their parents from several urban areas participated in an observational study conducted during the period 2014–2016. Participants completed validated questionnaires. International Obesity Task Force guidelines were used for children’s weight status classification. Descriptive statistics and nested logistic regression models were used. Multivariate correspondence analysis was also used to construct a score to evaluate the children’s stress levels. The overall prevalence of overweight/obesity was 27%. More than 80% of the children appeared to have a medium or high level of stress, mainly due to the school environment. School-related stress increased the odds of obesity in children. The association between stress and overweight/obesity status showed a consistent trend (adjusted odds ratios varied from 1.44 to 1.52, p-values < 0.01). Children’s weight status was associated with several school-related stressors. Although the school environment may play an aggravating role in the weight status of children, family plays a catalyst role in this direction. Therefore, actions have to be promoted in the school community so that children become more health literate on a public health level.
... Frequent engagement in emotional eating is linked to a number of physical and emotional health consequences, such as weight gain over time (Frayn & Knäuper, 2018;Risica et al., 2021), difficulty losing weight during weight loss interventions (Butryn et al., 2009), increased risk of developing an eating disorder (Stice et al., 2002), and other poor health metrics (e.g., inflammation, cardiovascular disease risk; Lopez--Cepero et al., 2018;Schrepf et al., 2014). Despite the growing interest in emotional eating in recent decades, research in this area continues to have a number of notable limitations. ...
Emotional eating is associated with weight gain and difficulty losing weight during weight loss interventions. Theoretical and empirical work suggest boredom may be an important predictor of problematic eating behaviors. Yet, little work has examined the role of boredom in emotional eating. Further, individual differences in the ability to recognize internal cues (i.e., interoception) may alter the impact of boredom on emotional eating. This study hypothesized that boredom proneness would predict unique variance in emotional eating after accounting for negative and positive affect, and that the association between boredom proneness and emotional eating would be stronger among those with poorer interoceptive ability compared to those with better interoceptive ability. Hypotheses were tested in two large samples using multiple linear regression. Participants aged 18–65 were recruited from MTurk (n = 365; 59.2% female) and an undergraduate research pool (n = 461; 52.9% female). Participants completed self-report measures: Boredom Proneness Scale; Dutch Eating Behavior Questionnaire- Emotional Eating; Multidimensional Assessment of Interoceptive Awareness-2; Intuitive Eating Scale-2- Reliance on Hunger and Satiety Cues; and Positive and Negative Affect Schedule. Boredom proneness was a significant predictor of emotional eating in both samples, even accounting for the broad dimensions of negative and positive affect (ps < .001). Interoception did not moderate the association between boredom proneness and emotional eating in either sample (ps > .05), but was an independent predictor of emotional eating (ps < .001). Boredom proneness and interoceptive ability may warrant attention as targets in the prevention and treatment of emotional eating. Future work should continue exploring different emotion categories and different facets of interoception in emotional eating, as well as examine novel mechanisms that could inform intervention efforts.
... Artan vücut ağırlığı ile birlikte bu yeme alışkanlıkları, duygusal yeme davranışına sahip kimseleri diyabet ve kalp hastalıklarına karşı savunmasız konumda bırakmaktadır (Melanson, 2007). Özellikle obeziteye neden olması ve genel sağlık üzerindeki olumsuz etkilerinden ötürü duygusal yeme bozuklukları önem arz etmektedir (Frayn ve Knäuper, 2018). ...
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Duygusal yeme davranışı (DYD), bireylerde olumsuz duygulardaki yoğunlukla beraber gözlemlenmektedir. Bireylerin endişe, stres, korku, yalnızlık vb. durumlarda duygusal yeme davranışının arttığı bilinmektedir. Yine mutluluk da bazı durumlarda duygusal yeme bozukluğuna yol açabilmektedir. Duygusal yeme davranışı, bireyleri olumsuz yönde etkileyebilen önemli bir yeme bozukluğudur. Duygusal yeme davranışı, obeziteye yol açabilmektedir. Duygusal yeme davranışı ile birtakım değişkenler arasındaki ilişkilerin literatürde incelendiği gözlemlenmektedir. Bu çalışmada da duygusal yeme davranışı ile finansal risk toleransı (FRT) arasındaki ilişkinin araştırılması amaçlanmaktadır. Belirtilen bu amaç doğrultusunda ilgili verilere ulaşabilme amacıyla anket çalışması gerçekleştirilmiştir. Kadınların duygusal yeme davranışı ve vücut kütle indekslerinin (VKI) finansal risk toleransını negatif yönde etkilediği tespit edilmiştir. Erkeklerin duygusal yeme davranışı finansal risk toleransını etkilemezken, vücut kütle indeksleri ise finansal risk toleransını olumlu yönde etkilemektedir.
... Our data on emotions, nutrition and physical activity only partially explained this weight gain. First, anxiety, loneliness and boredom could lead to the consumption of palatable food and finally to weight gain [41]. As we have just seen, we did not find a decrease in these feelings after the lockdown. ...
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(1) Background: The lockdown had various consequences on physical activity and food consumption behaviors. The post-lockdown has been much less studied. The aim of this study is to compare behaviors one year after the first lockdown in a group of normal-weight (NW) or overweight French adults (OW). (2) Methods: Over a period of 4 days, both at the beginning of May 2020 (lockdown) and in June 2021 (free living post-lockdown), the same French adults used the WellBeNet smartphone application to record their sedentary behavior, physical activity (PA), food consumption and emotions. (3) Results: One year post first lockdown, the weight and body mass index increased (+1.1 kg; +0.4 kg.m−2, p < 0.01), and sedentary behaviors increased (+5.5%, p < 0.01) to the detriment of light-intensity activities (−3.3%, p = 0.10) in the whole group. Some food categories, such as alcohol, tended to be consumed more (+0.15 portion/day, p = 0.09), while fatty, salty and sugary products decreased (−0.25 portion/d, p = 0.02) but without a change in the food balance score. A higher number of both positive and negative emotions were scored per day (+9.5, p < 0.0001; +2.9, p = 0.03), and the positive ones were perceived stronger (+0.23, p = 0.09). Simultaneously, the desire to eat was lower (−11.6/100, p < 0.0001), and the desire to move remained constant. Sedentary/active behaviors and the desire to eat changed differently in NW and OW adults after the lockdown. (4) Conclusions: In general, the post-lockdown period was less favorable for physical activity practice and resulted in a similar food balance score but was more conducive to mental wellbeing.
Child abuse is known to increase risk for emotional eating (EE) due to emotion regulation (ER) difficulties. The specific ER difficulties that mediate relationships between child sexual abuse (CSA), child physical abuse (CPA), child emotional abuse (CEA) and EE remain unknown. We examined ER difficulties (nonacceptance of emotions, lack of emotional awareness, lack of emotional clarity, difficulties engaging in goal-directed behaviors, limited access to ER strategies, and impulse control difficulties) as mediators of CSA, CPA, and CEA independently with EE. CSA and CEA related to EE via lack of emotional clarity and impulse control difficulties. CPA related to EE via impulse control difficulties. Results indicate ER difficulties that may be beneficial to address in treatment with abuse survivors reporting EE.
Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.
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Introduction: This study was conducted in order to evaluate the effects of stress on eating behavior in cases of uncertainty experienced during the COVID-19 quarantine period.
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The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used instrument for assessment of emotional, external, and restrained eating. Aim of the present study is to (1) analyze its internal structure using exploratory structural equation modeling, (2) to assess its measurement invariance with respect to sex, BMI, age, and level of education, and (3) to evaluate the relations of the factors with these variables. Except that women were slightly over-represented, the sample (n = 2,173) closely followed the socio-demographic characteristics of the overall Dutch population. The three theoretical factors that emerged from the analysis were in close correspondence with the three scales for emotional, external, and restrained eating, Only two items (Item 3 –“Desire to eat when nothing to do…”– and Item 21 –“Resist delicious food”–) presented problematic loadings. The questionnaire showed satisfactory measurement invariance and an expected patterns of mean differences and relations were found. All in all, the results highlight the adequate psychometric properties of the DEBQ.
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Unlabelled: Emotional eating may contribute to variability in weight loss and may warrant specialized treatment, although no randomized studies of specialized treatments exist for individuals who engage in emotional eating. This pilot study tested a new weight loss intervention for individuals who emotionally eat and compared it to the standard behavioral weight loss treatment (SBT). 79 predominantly female (95 %), predominantly African American (79.7 %) individuals who emotionally eat (BMI = 36.2 ± 4.1 kg/m(2)) were randomized to (1) a new enhanced behavioral treatment (EBT), incorporating skills for managing emotions and emotional eating or (2) a SBT. Primary outcomes were weight and emotional eating at 20 weeks. Weight decreased significantly in both groups (SBT: -5.77 kg (-7.49, -4.04); EBT: -5.83 kg (-7.57, -4.09)), with no significant between-group differences. Similar results were produced for emotional eating. Results suggest that SBT may be effective for reducing weight and emotional eating in individuals who emotionally eat, and that adding emotional-eating specific strategies may not provide additional benefits beyond those produced by SBT interventions in the short-term.Registration site: . Registration number: NCT02055391.
The development of the Emotional Eating Scale (EES) is described. The factor solution replicated the scale's construction, revealing Anger/Frustration, Anxiety, and Depression subscales. All three subscales correlated highly with measures of binge eating, providing evidence of construct validity. None of the EES subscales correlated significantly with general measures of psychopathology. With few exceptions, changes in EES subscales correlated with treatment‐related changes in binge eating. In support of the measure's discriminant efficiency, when compared with obese binge eaters, subscale scores of a sample of anxiety‐disordered patients were significantly lower. Lack of correlation between a measure of cognitive restraint and EES subscales suggests that emotional eating may precipitate binge episodes among the obese independent of the level of restraint. The 25‐item scale is presented in an Appendix (Arnow, B., Kenardy, J., & Agras, W.S.: International Journal of Eating Disorders, 17, 00‐00, 1995). © 1995 by John Wiley & Sons, Inc.
Do emotions influence the eating patterns of obese individuals? This paper reviews 30 years of clinical and experimental research in order to answer this question. The result is a picture of considerable complexity in which emotions appear to influence eating by obese subjects, but only if individual variability and several qualities of emotional eating are considered. That is, unlike Kaplan and Kaplan's (1957) simplistic anxiety‐reduction model, current research indicates that individual differences in food choice and in type of emotion precipitating eating need to be considered. In addition, secrecy surrounding the eating and an episodic quality related to overall level of stress need to be taken into consideration. When these parameters are included, it appears that in certain emotional situations obese people eat more than normal‐weight individuals. Such eating appears to have an affect‐reducing effect, especially for negative emotions such as anger, loneliness, boredom, and depression. Problems with current research including methodological shortcomings are discussed.
The development of the Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described. Factor analyses have shown that all items on restrained and external eating each have high loadings on one factor, but items on emotional eating have two dimensions, one dealing with eating in response to diffuse emotions, and the other with eating in response to clearly labelled emotions. The pattern of corrected item-total correlation coefficients and of the factors was very similar for various subsamples, which indicates a high degree of stability of dimensions on the eating behavior scales. The norms and Cronbach's alpha coefficients of the scales and also the Pearson's correlation coefficients to assess interrelationships between scales indicate that the scales have a high internal consistency and factorial validity. However, their external validity has yet to be investigated.
To examine associations between decreased emotional eating and weight loss success; and whether participation in a behavioral weight loss intervention was associated with a greater reduction in emotional eating over time compared to usual care. Secondary data analysis of a randomized controlled trial conducted at two university medical centers with 227 overweight adults with diabetes. Logistic and standard regression analyses examined associations between emotional eating change and weight loss success (i.e., weight loss of ≥7 % of body weight and decrease in BMI). After 6 months of intervention, decreased emotional eating was associated with greater odds of weight loss success (p = .05). The odds of weight loss success for subjects with decreased emotional eating at 12 months were 1.70 times higher than for subjects with increased emotional eating. No differences in change in emotional eating were found between subjects in the behavioral weight loss intervention and usual care. Strategies to reduce emotional eating may be useful to promote greater weight loss among overweight adults with diabetes.
Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression.