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Pathological Eating Disorders and Poly-Behavioral Addictions

Pathological eating disorders and poly-behavioral addiction (also referred to as a "compulsive relationship with food") have some similarities but also many differences. Both, for example, are physical, emotional, and social problems that can result in significant distress and dysfunction. On the surface they also seem somewhat similar as they both involve compulsive behavior around food or substances. But they differ in significant ways: one is primarily psychological while the other is primarily physical.

Poly-behavioral Addiction, Sex Addiction, Gambling, Food Addiction, Religious Addiction, Alcoholism, Drug Addiction, Internet Addiction
 

This article will break down these two terms by explaining what each pathological disorder entails so that we can see how the disorders compare and contrast with one another. We will attempt to see the parallels and differences between the disorders by looking at them both in the context of their respective physiologies, how they were originally identified in science, how they are currently classified, and other notable characteristics.

Pathological eating disorder is defined as a pattern of dysfunctional eating that is characterized by either binge eating or excessive restriction with associated distress such as depression and/or anxiety. While pathological eating disorder is most commonly identified by its association with loss of control, food addiction occurs when:

a person's relationship with food (or substances) includes thoughts, feelings and behavior that are excessive relative to the individual's typical pattern; continuous engagement in behaviors out of control (i.e. eating/drinking) occurs in an attempt to alleviate or prevent an adverse emotional state; the behaviors are experienced as involuntary and can be associated with a strong sense of shame and self-loathing; the person continues to engage in the behaviors despite significant life problems that are a direct consequence of their addictive relationship with the substance (e.g. weight gain, financial loss, broken relationships); and when long-term abstinence from engaging in these behaviors becomes unbearable.

 

Since pathological eating disorders were originally conceptualized within a psychiatric/behavioral framework, it has been more difficult for them to achieve formal recognition as "true" addiction. One reason is that they do not produce tolerance or withdrawal symptoms. The DSM-5 does include binge eating disorder, but this is classified as an "eating disorder not otherwise specified" and therefore not given the same status as other eating disorders. On the other hand, the physical effects of obesity clearly support the notion that some people can become addicted to food. In fact, for many people, obesity is a sign of addiction because it involves compulsive overeating or sugary/fatty foods that produce pleasure sensations that are similar to reward from addictive substances such as alcohol and drugs.

 

Despite this difference in concept, both addictions share similar levels of impairment and degree of denial among those who are in denial about their problem with food or other substances.

 

In addition to the physical side of addiction, food can be psychologically addictive as well. Some people eat when they are lonely, depressed, or anxious. They use food to deal with stress and to distract themselves from negative emotions. For example, people may feel guilty after a binge because they have temporarily distracted themselves from their problems with food, only later realizing that the guilt is related to their binging.

Secondary addictions are common in people who are obese or have an eating disorder because there is often a co-occurring substance abuse disorder (SUD). People who have multiple addictions are more likely to relapse – whether it is through food or a drug.

Treating the food addiction component can be just as challenging as treating the drug addiction in that the person must recover from both components. Recovery can present additional challenges as well such as weight gain, withdrawal/detoxification, and treatment of comorbid psychiatric disorders. The right treatment plan will consider all of these issues.

Third party counseling can be helpful to include spouses/support groups and therapists to help with this recovery process. It is important that at least one therapist with expertise in eating disorders and addiction be part of any treatment plan because these factors impact each other and must be addressed through a combined treatment approach.

Many people believe that they can quit any time they want, but it takes considerable work and effort to overcome an addiction to food. It is important to not be alone during this process. Having a support network in place or a therapist can help you through those difficult times.

While food addiction does not have the formal recognition of substance abuse disorders, it serves as an important reminder of how intimately food and substance abuse are linked.

Here is more material from that article:

Although obesity has long been a controversial topic in the medical and psychological community, new research is shedding light on food addiction, a condition that can cause overeating and overeating behaviors despite negative consequences.

In fact, researchers at the University of Cambridge recently found that sugar-related compounds in the brain are responsible for feelings of euphoria produced by food. This in turn helps explain why most people eat to avoid feelings of depression.

But it is important to define addictive foods so those suffering from this disorder can not be confused with those who have a healthy weight or food addiction. The difference lies primarily in the amount and types of food an individual has an issue with rather than whether they are using foods as part of a substance abuse problem. One may have a "food addiction" without having a substance abuse problem, or vice versa.

Conversely, although substance abuse and food addiction are not identical conditions, their effects on the brain and body can be so similar that confusion occurs between the two. This could explain why there are still people in denial about their obesity who continue to binge on food despite problems that result from negative behaviors such as depression and anxiety.

The following are some of the signs of an addiction to food:

1. Highly restricted diet.

2. Obsession with certain foods, such as chocolate.

3. Binge-eating episodes (eating large quantities of food in a short period of time).

4. Frequent trips to the refrigerator late at night or early in the morning.

5. Eating despite being full and not hungry (this may be confused with bulimia).

6. Loss of control when eating, often eating until forced to vomit or use laxatives to stop (this may be confused with bulimia).

7. Compulsive overeating and loss of control that is not relieved by bingeing (bulimia is also an example of binge/purge type behaviors).

8. Preoccupation with food and eating (this may be confused with anorexia).

9. Frequent dieting or attempts to lose weight.

10. Negative impact of eating on personal and professional relationships, such as marriage.

11. Loss of control around situations that contain food, such as parties, restaurants, and vacations near beaches where the sight of a swimsuit may trigger an urge to binge eat or use laxatives.

12. Food hoarding or stealing in order to eat without anyone knowing that the person has binged or is eating more than usual (may be misdiagnosed as bulimia). 

13. Eating to deal with emotions or feelings of depression or anxiety.

14. A compulsion to overeat at family functions (e.g., birthday parties) and rituals around holidays, such as Thanksgiving and Easter, that involve eating rich foods.

These signs indicate a food addiction, which is different than a normal relationship with food but the same as an addiction to drugs or alcohol addiction in that the person is unable to control their behavior despite negative consequences of their actions.

As an alternative view, some individuals see binge eating as the "normal" form of caloric intake and are unaware of this pattern until dieting has led to binges. In that case, poor eating and dieting habits may be more a marker for other issues such as depression or anxiety. 

At the same time, addiction to food has become a serious health problem in the United States. For example, "nearly one-half of America's population is overweight…and an estimated 16 million adult Americans" suffer from some type of eating disorder (Bulik et al., 2004). 

Many people believe that they can quit any time they want, but it takes considerable work and effort to overcome an addiction to food because it interacts with so many aspects of daily life. It is important not to be alone during this process. Having a support network in place or a therapist can help you through those difficult times.

Food addiction does not have the formal recognition of substance abuse disorders, but it serves as an important reminder of how intimately food and substance abuse are linked. 

References:

Bulik, Cynthia M. "Introduction." In Food Addiction , edited by Cynthia M. Bulik and Andrew Serpell, pp.1-7. Boca Raton, FL: Brown Walker Press, 2009.

Bulik, Cynthia M., Katherine Halmi, and Lili Wang. "Distinctive Features of Food Addiction vs Other Addictions." In Food Addiction , edited by Cynthia M. Bulik and Andrew Serpell, pp.36-69.

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