Eating disorders are not just about food. That much has been clear for decades, but researchers are still working to untangle the complex psychological, cultural and physiological roots of afflictions such as binge-eating disorder (BED) and bulimia. Now a growing body of work is finding that disordered eating is connected to attention deficits and poor self-awareness.

In one recent study, psychologists at Geneva University in Switzerland tested the cognitive abilities of three groups—obese individuals with BED, obese individuals without BED and a normal-weight control group. They found that obese participants had difficulties with inhibition and focusing their attention. These cognitive deficits were most severe in the BED group, which points to a “continuum of increasing inhibition and cognitive problems with increasingly disordered eating,” the authors wrote in the journal Appetite last August.

A different study in the August issue of the Western Journal of Nursing Research found that low executive function—the cognitive capacity for self-understanding and self-regulation—is correlated with both obesity and symptoms of ADHD. And several other studies have linked distraction with overeating. The study found that focusing on one’s meal was linked to eating less later in the day—although for someone with ADHD, such focus can prove challenging.

Taken together, these results suggest that treatment for binge eating may need to include strengthening mental functions such as attention and self-awareness.

Exploring the influence of ethnic identity on self-understanding could also help prevent eating disorders, suggests a study last September in the Journal of Black Studies. Using surveys, the study found that African-American women with higher levels of ethnic identity were less likely to develop binge eating and bulimia, whereas for Caucasian women, higher levels of ethnic identity posed a greater risk of disordered eating. Study author Mary Shuttlesworth, a doctoral candidate in psychology at the University of Maryland, explains that Caucasian ideals tend to emphasize thinness and focus strictly on appearance, whereas African-American beauty ideals often include “other aspects of the self aside from physical appearance; acceptance of different body shapes and sizes; and allowing beauty to encompass personality, style or attitude.” She suggests that prevention programs could focus on building in all people, regardless of race, the elements characteristic of African-American ethnic identity.