Fear of Food in Eating Disorders: Its Role in Eating Disorder Symptomatology, Psychopathology, and Early Outpatient Treatment

Anxiety is known to be correlated with eating disorder (ED) symptoms, but less is known about anxiety in terms of fear of food in EDs. The study aims to compare different ED groups, investigate early changes in fear of food following cognitive-behavioral-based treatment (CBT) with integrated nutritional rehabilitation and counseling and test whether changes in fear of food are associated with changes in eating symptomatology and general psychopatology. ED outpatients (n = 282) and controls (n = 68) were assessed with the Fear of Food Measure (FOFM), Eating Attitude Test-40 (EAT-40), and Eating Disorder Inventory-3 (EDI-3 risk and General Psychological Maladjustment, GPM). MANOVA with post hoc comparisons was run to compare controls and ED subgroups in FOFM. Paired sample t-test evaluated FOFM changes between baseline and mid-treatment. Multiple regression analyses were conducted to test whether changes in FOFM were associated with changes in EAT-40, EDI-3 risk, and EDI-3 GPM. Results demonstrated all EDs exhibited significantly higher FOFM scores compared to controls. In EDs, AN and BN showed significantly greater scores in FOFM-anxiety about eating (AE) and FOFM-food avoidance behaviors (FAB) compared to BED and OSFED. Significant changes in all FOFM subscale scores were observed in patients who completed mid-treatment (n = 79). FOFM-AE emerged as the most significant predictor of early improvements not only in EAT-40 total and EDI-3 risk scores but also in EDI-3-GPM scores. Results indicate that fear of food is a transdiagnostic construct characterizing all EDs, in particular AN and BN. Outpatient interventions assessing and targeting early fear of food, in particular in anxiety about eating, may help improve prognosis and support recovery in EDs. The role of fear of food in general psychopathology, beyond EDspecific symptoms, represents a valuable addition to the field and highlights the interplay between fear-related and ED symptoms, providing new directions for future ED research and treatment.