What is food addiction and how is it different than an eating disorder?

Food addiction has yet to be acknowledged as a legitimate phenomenon the way drug addiction has. There is, however, a growing number of folks who do indeed see it as a bona fide addiction. Among these are a group of professionals, scientists, and “recovered food addicts” themselves. One grass roots group has offered the following:
“Food addiction is a disease typified by loss of control over the ability to stop eating certain foods. Scientifically, food addiction is a cluster of chemical dependencies on specific foods or food substances. After the ingestion of highly palatable foods such as those containing significant amounts of sugar, flour, and highly processed foods, the brains of some people develop a physical craving for these foods. In addition, the more processed a food or substance is the greater it’s addictive potential. Over time, the progressive eating of these foods distorts a person’s thinking and leads to negative consequences they do not want but cannot stop.” *[paraphrased from the Food Addiction Institute]
As noted, the phrase “food addiction” does not equate with the term “drug addiction.” Further, recognizing FA as an illness or disease is even a greater stretch. Serving as a “devil’s advocate” these may be two positions to consider:

The “Naysayers:” -Drugs, alcohol, and compulsive gambling involve substances and/or behaviors that are not necessary for life. Food is.
The “Believers:” –But so is water and air – However, people do not consume water & air beyond their biological needs or in ways that threaten their survival. So perhaps the problem is semantics. By way of analogy…
drug addiction = not all drugs are addictive
food addiction = not all foods are addictive

So, does that mean emotions don’t play a part in all this? Simply stated, we don’t know to what degree FA is governed by cravings triggered by “addictive foods” and how much is a matter of emotional eating. Is it “either or” or can it be both?
The following is a set of assumptions by the “FA community” as a way of looking at the difference between FA and an eating disorder [such as anorexia or bulimia].
Food Addiction ALWAYS involves a need to identify and abstain from offending food substances much like an alcoholic must abstain from alcohol and related substances. [biological triggers]

Food addiction might well be thought of as a substance use disorder, with the substance being individually identified food substances such as sugar, flour, certain fats, highly processed foods, and so on. Much like other substance use disorders, the substances [in this case food substances] may vary somewhat between people - yet generally lead to a “craving” that exceeds a “want” and becomes a “need.”

Eating Disorders DO NOT ALWAYS necessitate an abstinent stance from certain food substances common to FA. However, it’s important to recognize eating disorders and FA can exist together at the same time with the same person.
In other words, like the alcoholic for whom other addictive substances [drugs] are often interchangeable, so too it is the case for many people who meet the criteria for both an ED and FA.

Eating disorders or FA might then be considered an umbrella from which either may be grouped together or separately viewed. Despite this, identification and complete abstention from certain food substances are a pre-requisite to overcoming a FA yet this may or may not necessarily be the case for some forms of disordered eating. Indeed, some eating disorders such as restricting forms of anorexia are apt to be a “stand alone” ED while other forms such as binging and purging types of this illness fit both bills. – it’s the wisdom to know the difference” that’s the challenge.

What are eating disorders?

Eating disorders are typically associated with various maladaptive patterns of behavior related to food, it’s consumption, and the ensuing effects on a person’s emotional and physical well-being. It may, or may not, include attempts to offset the “consequences” of these behaviors by the use or abuse of compensatory agents and behaviors such as purging, compulsive exercising, periods of self-imposed starvation, and so on.

The medical and psychiatric communities categorize these disorders as separate entities, each with a distinct set of symptoms and characteristics. Familiar to most are: Anorexia [self-imposed starvation], Bulimia [binge eating and purging], Binge Eating Disorder [binge eating w/o purging]. A growing number of professionals have come to recognize people tend to exhibit elements of each of these disorders during various periods in the course of their struggle. In other words, periods of binge eating followed by periods of restricting, followed by periods of exercising and/or purging ad infinitum. In fact, when untreated, many people will cycle through just about all the various ED behaviors aligned with each subtype of eating disorder. As such, it would not be unusual for someone to begin with anorexia and evolve into a bulimic pattern, still later attempt to control the binge eating by adherence to a starvation / restricting stance. In essence, “switching deck chairs on the Titanic thinking they will avoid drowning”.
Given the debate as to what causes someone to develop an eating disorder, the cause[s] are not as simple as “one size fits all.” Historically, most clinicians treating these disorders believe the answers are hidden within the emotional psyche of the sufferer. Whether anorexic, bulimic, or a binge eater, the persistence of self- medicating vis a vis overeating, starving, or purging is thought to be an attempt to control unwanted emotions or, in many cases, avoid the pain of experiencing past, present, or future trauma. Simply stated, this belief attributes disordered eating to an underlying psychiatric or emotional illness.

An ever growing, albeit minority of professionals, believe the biological piece to the puzzle needs to be given ample consideration. As such, treatment begins with a search for the emotional AND biological factors interacting to drive an eating disorder. It may be a few people will recover from an eating disorder simply by gaining the insight and skills to better manage a particular issue or traumatic event – namely by “resolving” or “working through” their emotional baggage. Too often, however, this same person may have only solved part of the puzzle with psychotherapy or counseling yet the physical piece [reactivity to addictive foods] remains undetected or ignored. In order to “close the circle” it may be prudent to consider both the nature of the [food] substances as well as the nature or emotional makeup of the person. Until science can come up with a reliable means to determine just what drives the ED, one might consider addressing both. In other words, if years of talk and related therapies yield little in the way of remission, look to the food or biological remedy to be added to the mix. Likewise, if adherence to a food plan eliminating probable trigger foods and controlling for portions still falls short, then look toward the emotional baggage as a suspect. In either case, the answers will come if approached with an honest, open, and willing mind.

Summary Notes: Food for Thought

Almost without exception, identification and complete abstention from certain food substances are a pre-requisite to overcoming a food addiction. As noted, this might not ALWAYS be the case for everyone with an eating disorder diagnosis or history. However, most abstinent food plans are at the very least healthy and can serve as part of an on-going and positive lifestyle. In effect, they do no harm. What are often referred to as “abstinent foods” typically consist of nothing more than healthy whole foods and tend to eliminate highly processed and artificial substances and are devoid of harsh impact to the body’s insulin and blood sugar regulation. Added to this is controlling for reasonable and healthy amounts of these [abstinent] foods. I like to think of it as “better living WITHOUT chemistry.”

As such, those who have a history of binge eating, binge eating and purging [bulimia], compulsive overeaters, and some forms of anorexia [usually purging types] would do well to identify and abstain [if not seriously limit] indulging in “trigger foods.” In other words, they may harbor BOTH a biological as well as emotional set of triggers.
At the risk of being redundant, suffice it to say the following:
Many people who fit the medical criteria for binge eating disorder, bulimia, and/or certain variants of anorexia also appear to fit the description of a food addict. How much and how many FAs overlap with an ED [aka “dually diagnosed”] is not known. This continues to be a source of speculation and some debate. To be clear, the concept is what matters rather than the limits set forth with language and semantics. The implications are a matter of securing effective treatment.

“The Mechanics” of Disordered Eating-
What the Science Says

Bulimia, anorexia, binge eating, food addiction – all involve either an acquired or pre-existing [sometimes genetic] dysfunction of the reward system in the brain. The phenomena of “craving”, compulsion, obsessive rumination about a substance, and so on are all biologically as well as psychologically driven. Much of the research confirms this. Today we can map the brain and see the neural reward pathways, the specific “feel good” chemical reactions, and the resulting structural changes in the brain. Indeed, there exists a graphic display of the differences between the chemical responses of an “addict” and his/her non-addict peers. This holds true for someone with an ED, FA, or both.
This means that the more a person eats the foods they are “addicted” to the stronger their cravings for those foods become. As an added note: restricting anorexics find starvation and compensatory behaviors intended to offset weight gain can also regulate moods and emotional states by effecting brain chemistry and neural reward pathways. In all instances the chemical processes going on in the brain demand “more” of the addictive substances or behaviors over time. These chemical processes not only change the brain in a way that reinforces cravings, they interfere with clear thinking. Adding insult to injury, the phenomenon of tolerance [needing more to achieve the same effect] takes place. This makes it all the harder to abstain from eating the food or foods you are addicted to [or restricting]. The cravings associated with addiction are so strong and thinking is so impeded that psychological therapies tend to be much less effective or totally ineffective, especially if used exclusively. Therefore, trying to teach someone with food addiction to eat their trigger foods moderately is almost always unsuccessful. Moderation is not the appropriate treatment for food addiction. When moderation is prescribed to the food addict, it can cause harm and needless suffering.

But These Two Things Often Co-Exist...

Addiction specialists, especially those experienced with identifying eating disorders, are quick to concede FA and ED often are more similar than different: albeit presenting themselves with different behavioral patterns at different times. This is what makes treating food and eating related disorders so complex and so challenging.
As is so often the case when both conditions are present, chemical dependencies on specific food substances [or the mood-altering effects of dieting or starvation] typically interferes with a person’s thinking, judgment, and self-control. Focusing on “abstinence first” would then seem logical. There is, however, one caveat-namely abstinence is but the beginning of the recovery process, not the end game. Failing to deal with “the whole enchilada” -physical, psychological, emotional, and ultimately spiritual [aka existential if you prefer] usually is the difference between a brief remission and a life-long reprieve. This holds true for the food addict, someone with an ED diagnosis, or any addictive or chronic illness for that matter.
It is important to understand proponents of one side or the other [addictive foods versus psychiatric illness debate] tend to be fighting a territorial and rhetorical battle. And that battle is totally abstracted from what is actually going on with most of their clients and patients. There is a need for many of us to avoid falling into the trap of black and white thinking and begin to see the various shades of gray. We are ahead of the game when we remain teachable and not entrenched in defending
any one position.

Marty Lerner, PhD.
CEO, Milestones in Recovery

Author's Bio: 

Dr. Lerner is the founder and CEO of the Milestones in Recovery in Cooper City, Florida. A graduate of Nova Southeastern University, Dr. Lerner is a licensed and board certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He has appeared on numerous national television and radio programs that include The NPR Report, 20/20, Discovery Health, and ABC’s Nightline as well authored several publications related to eating disorders in the professional literature, national magazines, and newspapers including USA Today, The Wall Street Journal, New York Times, and Miami Herald. An active member of the professional community Florida, Dr. Lerner makes his home in Ft. Lauderdale with his wife Michele, daughters Janelle and Danielle, and their dog, Reggie.