**1. Introduction**

Even though food addiction (FA) has not being included as a formal mental disorder in the Diagnostic and Statistical Manual (DSM-5) [1], it is a concept of ongoing scientific interest and debate. According to the FA model, some foods, especially palatable ones, may be involved in producing both overeating and addictive-like behaviours, thus, phenomenological similarities with addictive disorders could been found [2].

FA has been mentioned as a potential subtype of obesity [3–5], and has been associated with Eating Disorders (ED), mainly in binge spectrum disorders as bulimia nervosa (BN) [6,7] and binge eating disorder (BED) [8,9]. It has been associated with higher body mass index (BMI), binge-eating episodes, higher eating psychopathology, more impulsive

**Citation:** Munguía, L.; Gaspar-Pérez, A.; Jiménez-Murcia, S.; Granero, R.; Sánchez, I.; Vintró-Alcaraz, C.; Diéguez, C.; Gearhardt, A.N.; Fernández-Aranda, F. Food Addiction in Eating Disorders: A Cluster Analysis Approach and Treatment Outcome. *Nutrients* **2022**, *14*, 1084. https://doi.org/10.3390/ nu14051084

Academic Editor: Zoltan Pataky

Received: 24 January 2022 Accepted: 2 March 2022 Published: 4 March 2022

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personality traits, and craving for highly palatable food [10–12], as well as poorer response to therapy [13,14].

Additionally, other predictors of developing severe symptomatology of food addiction are presenting dysfunctional personality traits, high emotional dysregulation, and high general psychopathology [15,16], and be women [17].

In a previous study, our group has assessed the heterogeneity within a group of subjects with positive FA (FA+) and have identified differential phenotypes and subgroups among the participants [18] considering general psychopathology, ED severity and personality traits. In the prior study, a sample of ED and obesity patients was included, and three clusters were obtained: (a) dysfunctional cluster (mainly represented by OSFED and BN), (b) moderate cluster (mainly represented by BN and BED patients) and (c) functional cluster (mainly represented by obesity and BED patients).

The obtained results of this study shed some light on the different clinical profiles within patients with ED and obesity who had FA+. However, there is a lack in the literature on how the treatment could be influenced by these severity and cluster groups. To have a deeper understanding of the FA construct, evidence related with treatment outcome could help to fill that gap, by knowing the relationship between treatment outcome, FA, psychopathological dimensions, and other variables.

Thus, based onto the prior study, the aim of the present research is to explore treatment response to Cognitive Behavioural Therapy in the ED sample of the different FA clusters found in the previous study [18]. We hypothesize that the functional cluster, will present better treatment outcomes and lower dropout rates than the moderate and dysfunctional ones. As well, due to belonging to a specific cluster provides information on the patients' profile in a broad collection of clinical measures, and that the present study only consider ED patients from the original sample, the analysis form the previous research, regarding psychopathological status, the personality traits, ED severity and the diagnostic subtype, will be done as well in this study.
