*4.2. Strengths and Weaknesses*

The results must be viewed in the context of some limitations. First, compared with the AN and BN groups, the BED group was small (*n* = 15), which could have minimized the power of the study. Second, the cognitive distortions that usually affect ED patients, notably AN patients, could have skewed the way they answered the questionnaires. Some items, such as "I continued to eat certain foods even though I was no longer hungry", "I spend a lot of time feeling sluggish or fatigued from overeating", "I felt so bad about overeating that I didn't do other important things", *or* "I didn't do well at work or school because I was eating too much", could have been coded as positive by the patients because of difficulties in recognizing sensations of hunger or satiety and because of particular beliefs about eating. However, as previously stated, the YFAS does not measure objective overeating but a particular relationship with food and eating; thus AN patients could satisfy the criteria for FA even if it is quite difficult to determine whether this tendency stems from starvation or a natural affinity for eating. Other limitations include the cross-sectional design of the study and the definition of the FA concept in itself, which is still a debated topic (i.e., does the YFAS truly measure what it is designed to measure?).

These limits are compensated by the strengths of the study. First, we want to emphasize the sample size. Two hundred and one patients were recruited, and such a large number allowed for a good representativeness of patients seeking treatment for ED. Moreover, ED diagnoses were established by structured clinical interviews and were based on DSM criteria. All patients were assessed at the beginning of the care in our specialized department. Finally, to the best of our knowledge, only a few studies have evaluated FA in AN [20,21], and we provided original results.
