ObjectiveThis study aims to evaluate the theory of mind ability in a sample of obese patients with and without binge eating disorder (BED) and to explore the correlations between emotional and clinical assessments. MethodsOverall, 20 non-BED, 16 under-threshold BED and 22 BED obese patients completed a battery of tests assessing social cognition and eating disorder psychopathology. ResultsBinge eating disorder, non-BED and under-threshold-BED obese patients showed similar ability to recognise others' emotions, but BED obese patients exhibited a deficit in recognising their own emotions as demonstrated by more impaired levels of alexithymia and interoceptive awareness and were more depressed. High positive correlations were evident between binging, depression, interoceptive awareness and alexithymia. ConclusionsBinge eating disorder patients have a comparable ability to understand others' emotions but a more impaired capacity to understand and code their own emotions compared with non-BED obese patients. This impairment is highly correlated with depression. Copyright (c) 2017 John Wiley & Sons, Ltd and Eating Disorders Association.