Eating Disorders as an Addiction

Practitioners in the field of mental health and addiction have long understood the addictive nature of eating disorders and a growing body of evidence and research supports the undeniable parallels between eating disorders and addictive conditions, such as drug addiction and alcoholism.  In fact, the American Society of Addiction Medicine now holds a wider definition of addiction to include not only drugs and alcohol, but also “process” addictions, such as food.

A process addiction refers to compulsive behaviors, such as compulsive gambling, sexual addiction, eating disorders and spending addictions. They represent conditions in which a person is dependent on some type of behaviors, such as gambling, food restriction, binging, shopping, or sexual activity. Process addiction is often used as a blanket for any behaviors that does not involve an addictive chemical. This is ironic as there are actual chemical processes that occur during the behaviors which are very similar to the chemical changes that take place during substance abuse.

Behaviors such as self-starvation, frequent bingeing and purging, or compulsive exercise can be so self-perpetuating that that they represent a form of addiction. This point is very important because the way we think about a problem shapes the way we try to solve it.

So let’s look at addiction, whether to substances such as alcohol, or to behaviors, such as with compulsive gambling.

Let’s start with some definitions from the web:

  • An illness in which a person seeks and consumes a substance, such as alcohol, tobacco, or a drug, or engages in a behavior despite the fact that it causes harm.
  • dependence on a substance (such as alcohol or other drugs) or an activity to the point that stopping is very difficult and causes severe physical and mental reactions.
  • an uncontrollable compulsion to repeat a behavior regardless of its negative consequences.
  • Other important activities frequently put off or 
neglected as a result of this behaviors.
  • Significant emotional energy spent and preoccupation with the behaviors or substance.

So, if we combine the main points from those definitions, we come close to the core elements of addiction.

  1. Addiction involves a compulsive behavior that leads to negative consequences.

  1. Despite the negative consequences, the behaviors persist, leading to more negative consequences.

  1. A lack of control

In short, addiction appears to be a condition in which addicted people become tricked into believing that something harmful is actually beneficial, and in extreme instances, that something harmful is vitally necessary – as necessary as breath to a drowning man.

Let’s look at how Eating Disorders also fit those criteria.

People with eating disorders:

  • Have difficulty controlling “use” of food or behaviors
  • Have difficulty controlling “use” of food or behaviors
  • Have an uncontrollable compulsion to repeat their behaviors regardless of its negative consequences.
  • Put off or neglect other important activities frequently as a result of this behaviors .
  • Experience a preoccupation with the “substance,” which in this case is food.
  • Expend significant emotional energy and preoccupation with the behaviors or substance.

It is very clear that the behaviors around food that people with Eating Disorders feel compelled to repeat falls into the category of Process Addictions, but could Eating Disorders also have a physical component, as in the addiction to addictive substances?

When we look at addiction to substances, we consider both a physical and psychological element.

Being physically addicted to something, for example alcohol, means the body has adapted to the chronic use of a particular substance to such a degree that in its absence the body can’t function properly or doesn’t feel right. As a result, the alcoholic, for instance, compulsively seeks out alcohol to avoid the painful bodily sensations of withdrawal.

There can be a physical addiction to something we put into our bodies from the outside – such as nicotine or prescription drugs, or to the chemicals our own bodies produce when engaging in or even planning certain behaviors, such as a sex addict’s ‘thrill of the chase’ of the next liaison or the adrenaline high experienced by a gambler on a winning streak. Would that also be true of chemicals produced in the body by eating certain foods, starving oneself or over-exercising?

We know, for instance, that starving, bingeing and exercise all serve as drug delivery devices since they increase circulating levels of endorphins that are chemically identical to opiates. For instance, sometimes people with anorexia say that their self-starvation brings on an altered state they liken to being “high” and just as one drink can trigger an alcoholic into further drinking, a “trigger” food (such as unrefined carbohydrates – as in white bread, or sugar) can induce episodes of binge eating. Just like with alcohol or drug addiction, the action of ingesting certain substances, causes alterations to the brain chemistry, to which we can become dependent. For instance, binging then purging depress levels of serotonin in the brain, which is an important regulator of cravings for carbohydrates and which also regulates our mood. Binge-purging also affects the opioid (endorphins and dopamine) centers of the brain; this is a system governing self-worth, pain control and emotional balance. After purging, there may be transient feelings of euphoria, which contribute to the addictive nature of the illness. But these feelings may be replaced by confusion and hunger as endorphin levels fall.

Both bulimics and binge eaters have a tendency to self-medicate through overeating and/or purging. In fact, a similar mechanism exists for those turning to restricting their food intake by self-induced starvation (anorexia). We know, for instance, that foods which are high glycemic (e.g. sugar and flour products, highly processed simple carbohydrates) trigger a reaction in the body of many binge eaters to “over secrete” insulin. The effect is a rapid rise in blood sugar followed by an increase in serotonin and beta endorphin levels. Unfortunately, this reaction causes a rapid drop in these levels shortly after – the result being a “withdrawal-like” syndrome marked by depression, anxiety, insomnia, fatigue, and a craving of the substance (high glycemic foods) to relieve the distress.

If this sounds familiar to the alcoholic, it’s no coincidence. Alcohol converts to pure sugar as it is digested in the stomach. Alcoholics who abstain from drinking and find themselves craving sugar, caffeine, and nicotine do so because these substances tend to alleviate some of the same symptoms associated with both alcohol and, yes, sugar withdrawal. Consider the physical elements these addictions have in common alongside having learned to self-medicate depression through substances and compulsive behaviors and the parallels become obvious.

The addictive is complex and has several influencing factors. An individual’s mental state, genetics, social status and past experiences influence the addict and the timeline of their addiction. However, it is well known both for substance and process addictions that a person’s reward center in their brain is stimulated causing release of chemicals into the body and brain, which drive addictive behaviors. Put simply, this chemical charge feels good. So the addict keeps chasing the “high” whether it be the up and down roller coaster of the binge-purge cycle or the highs and lows of cocaine addiction.

Most people enjoy this type of “natural high” in one way or another. Many people gamble for fun or enjoy very large meals and ‘comfort eat’. This is how it can begin for the addict. However, someone with a genetic predisposition to addiction, a vulnerability to certain substances, will keep doing the same ‘feel good behaviors’ over and over. This can have very damaging consequences.

Most people, including professionals in the field, are often unaware of the ‘chemical’ addiction that is present in most behaviors related addictions. It is easier to comprehend the chemical addiction of a person who abuses drugs, alcohol or medication, while the dependency on the physical effects of putting other things in our bodies, such as with food, or from engaging in certain behaviors, is often ignored. It is not as simple as ‘just stopping’ or ‘willpower’. There are real chemical and biological changes which occur in the brain of someone who has an Eating Disorder, and, therefore, an addiction.

Despite the fact that many of the best treatment centres for Eating Disorders understand the link between Eating Disorders and Substance Addiction, until a decade ago, there was almost no scientific evidence that food addiction existed as a chemical dependency. Today, the evidence is abundant, far more than when alcohol and street drugs were categorised as narcotics and as addictive diseases.

There is a bibliography of 2743 peer reviewed articles and books on food ad- diction at the Food Addiction Institute website (foodaddictioninstitute.org). There is also a new medical textbook, Food and Addiction: A Comprehensive Handbook, Brownell and Gold (eds), Oxford Press, 2012.

Therefore, from what we see now, Eating Disorders are best understood as a cluster of several different biochemical food dependencies. Some of the most convincing evidence includes genetic evidence, brain imaging, evidence of opioid dependency, and evidence of cross-addiction from alcohol to food, evidence of malfunction of serotonin, evidence of overeating stimulated by endorphins, evidence of hyposensitivity to insulin and addiction, and inclusion of food as an addictive substance in models of chemical dependency.

However, it is in the psychological addiction where similarities are most obvious to those who suffer from Eating Disorders.  Being psychologically addicted means that we come to rely upon the feelings (or lack of feelings) that engaging in a certain activity or consuming a certain substance give us. 
 Bingeing and purging can bring on a feeling of “release.” Starving ourselves can give us a feeling of control, of a sort of virtuous power over our feelings and the way we look. And when we are not engaging in these addictive activities, we experience psychological pain, such as where workaholics, for example, work compulsively to keep uncomfortable emotions such as depression or anxiety at bay. Thus, psychological addictions are unconscious strategies for avoiding emotional pain whereas physical addictions involve compulsive behaviors to avoid the physical pain of withdrawal. In either case, addicted persons act compulsively to avoid immediate pain.

A vicious cycle takes place as the addict uses to avoid the consequences of not using. This results in a progressive increase in dependence on an addictive substance and behaviors, causing increasing physical and emotional consequences of the lifestyle of addiction that develops, resulting in trauma, loss, guilt, shame and an erosion of a person’s identity (sense of self), relationship with others and self-esteem. This is often referred to as a spiritual degeneration, as one increasingly finds oneself behaving in ways that don’t fit with your deeper values and sense of what is right, rewarding and meaningful.

It is very rare that somebody becomes immediately addicted to anything. Addiction is a gradual process of becoming more and more emotionally, psychologically and physically addicted to something as time goes on. There is general consensus, however, that although the condition can be seen to be progressive in this sense, the process only really goes in one direction. If you have reached the point where your addiction can be considered chronic (dominating your life with increasingly negative physical, social, relational, financial, etc. consequences), then you are highly unlikely to start becoming less and less addicted. It is a safe bet, in the vast majority of cases that if your addiction has taken you to the point of crisis, then you will always have a problem with that particular substance or behaviors   and even similar ones.

We can certainly see how eating disorders can be seen as a way of avoiding difficult feelings, of distracting oneself from emotional pain, memories or thoughts. We can also see how this may start as a distracting behavior   that temporarily makes us feel better, that develops into a habit, and then into an obsession or compulsion. Eating disorders certainly progress until they dominate our lives and cause terrible consequences to ourselves and our loved ones. Just like other addictions, therefore, they can be seen as an attempt at self-healing that fails. While these behaviors are self-protective by intent, they become self-destructive by consequence.

In substance and behaviors addiction – and Eating Disorders are clearly both – as the addiction progresses, addicts typically require more of the behaviors   (bingeing, purging, restricting, etc.) and substances (refined carbohydrates and sugar) to produce the same reinforcing effect. This has direct parallels in the core eating-disorder behaviors such as dieting, over-exercising and binge eating, all of which tend to become increasingly excessive over time.

Therefore, as well as including guidelines to help you make the changes to your diet at this first and crucial step (see ADDICTION REHAB CENTERSEATING DISORDERS RECOVERY GUIDEBOOK STAGE 1 abstinent eating), it will also be important to develop a routine, as all changes are easier when they become part of a helpful pattern of new behaviors .

All people with Eating Disorders suffer from the same addiction, although this may seem like a bold statement on the surface. For people with Binge Eating Disorder and Bulimia it is simpler to see the addictive quality of certain foods and their behaviors   around it. However, this is also the case with those who are in the Anorexic phase of an Eating Disorder. Most casual observers do not understand that anorexics do feel hungry, that they crave sugar and other foods high in refined carbohydrates such as cakes, bread and biscuits. It is their attempts to control such cravings, their deep-rooted fear of succumbing to them, and the consequences it will have on their bodies and emotions, that drives them to deny food altogether.

This is also reflected in the fact that it is so hard to categorize people with addictions relating to food into specific types of Eating Disorders. People with Bulimia will have experienced anorexia at some point in their lives – often early in their addiction – while anorexics have almost universally binged and purged. Different categories of Eating Disorders really correspond to different phases of the addiction, through which people will pass at any one time, depending on their situations and the way they are trying to cope with their disorder.

It is hardly surprising, therefore, given the fact that Eating Disorders are a form of addiction, that traditional substance misuse is so common among people with Eating Disorders. The most comprehensive study was conducted through the National Center on Addiction and Substance Abuse at Columbia University (CASA) in 2003. The three-year study was jointly released through the president of CASA and the United States Secretary of Health, Education and Welfare. In it, they learned that just about one-half of those who struggle with an Eating Disorder also are involved in drug or alcohol abuse as opposed to the nine percent of the general public who abuse substances. Looking at it from the other direction, close to 35 percent of those who misuse substances also have an eating disorder as compared to around three percent of the general public who suffer with the condition. This means that when a person is discovered to be battling anorexia or bulimia, for example, it is likely that the person is also addicted to smoking, indulges in binge drinking or uses illegal drugs.

Denial of the problem is also a common feature of both substance use and eating disorders. The first stage to Recovery, therefore, is to accept your inability to eat certain foods the way normal eaters can do with impunity. Just as importantly, a person who suffers from an Eating Disorder must accept that their thinking about addictive foods has been so distorted by the disease that their judgment about these foods is unreliable even after they are in recovery.

Just like with all addictions, the first step is to understand your condition. This is why we are explaining it in so much detail here. Recovering from an eating disorder is much like recovery from any addition. Once you have accepted, in your mind and in your heart, that you are suffering from an addiction, not just a willpower problem, and have asked for the help you need, effective treatment begins with following a set of directions.

Addictions all have in common a degree of physical and psychological issues which separate the “addict” from the “non-addict.” It involves the willingness, right from the start, to choose to stop; to become abstinent. From a medical perspective, abstinence refers to the simple cessation of addictive substances, and addictive or compulsive behaviors associated with an eating disorder. On the physical side, a necessary first step is to eliminate or seriously limit refined carbohydrates (e.g. sugar, flour) from your diet and that abstinent eating isn’t just avoiding sugar and refined carbohydrates, but also to eat three balanced regular sized meals a day. It therefore involves both new routines and new content. To be sure, this does not always mean to eat less, it means to eat differently. Not overwhelmingly differently from anyone else who is following a healthy diet. In fact, a good way to look at it is that, except for the avoidance of sugar and white flour, an anorexic and an over eater and a bulimic should all be happy to exchange plates with each other at dinner, and indeed also with other addicts or anyone else.