Bulimia, anorexia, binge eating, and 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 biological as well as psychologically driven.
Much of the research confirms this. Today, we are viewing the human brain in real-time and bearing witness to the neural reward pathways of addictive substances as they are introduced into the bodies of volunteers. Indeed, a graphic display of these differences between a Food Addict and their non-addict peers has been demonstrated repeatedly within the peer-reviewed medical literature.
This means that the more a person eats the foods they are addicted to, the stronger their cravings for those foods become. This is due to chemical processes that change the brain in a way that reinforces cravings and interfere with clear thinking, impulse control, and decision-making.
Worse, tolerance [needing more to achieve the same effect] increases, making it harder to abstain from the food or foods you are addicted to. The cravings associated with addiction are so intense, and thinking is so impeded, that psychological therapy and other training to cope with feelings tend to be much less effective, or ineffective, 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.
Petitions before the World Health Organization and the American Psychiatric Association urge the inclusion of food as a substance use disorder. Consider the following lines of reasoning to clarify the spirit of the arguments:
Is the problem is semantics?
Here’s a way of looking at the difference between an eating disorder [such as anorexia or bulimia] and Food Addiction:
As such, those who have a history of binge eating, binge eating and purging [bulimia], compulsive overeating, and some forms of anorexia [usually purging types] often need to identify and abstain from “trigger foods.” Hence, a combination of biological and emotional triggers tends to drive these.
“Eating disorders are typically associated with various maladaptive patterns of behavior related to food, its 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 using or abusing compensatory agents and behaviors such as purging, compulsive exercising, periods of self-imposed starvation, and so on.” [M. Lerner 2010, 2024, A Guide to Eating Disorders and Food Addiction]
Given the debate as to why an eating disorder develops, it is more likely that the answer is not a simple “one size fits all.”
The mainstream professional community believes the answers are hidden within the emotional psyche of the sufferer. Whether anorexic, bulimic, or a binge eater, the persistence of self-medicating vis-à-vis overeating, starving, or purging is thought to be a misguided attempt to control unwanted emotions or, in many cases, avoid the pain of experiencing past, present, or future trauma. This belief attributes disordered eating as an attempt at regulating emotions regardless of their origins.
A growing number of professionals, myself among them, believe the biological piece to the puzzle has long been ignored or at best minimized. Recognizing how both emotional and biological
factors interact to drive an eating disorder is tantamount to successful treatment.
Although recovery from an eating disorder is possible by learning to better manage a particular issue or stressors – namely by “resolving” the emotional trigger[s], it is also possible that such recovery will be short-lived. In other words, this same person may have only solved half or a quarter of the problem, and the physical piece [reactivity to trigger foods] needs to be identified and eliminated to achieve long-term recovery.
One might consider addressing both until science finds a reliable means to determine this. Stated another way, if years of “therapy” yield a short-lived remission, look to the food or biological remedy. If adherence to a food plan devoid of probable trigger foods yields little progress, consider the emotional baggage that must be addressed. In either case, the answer will present itself if one keeps an open mind.
People who treat both eating disorders and Food Addiction and are well-versed in the addiction field will tell you both disorders exist for a majority of their clients, with varying proportions at various times. This is what makes treating Food Addiction and related food/eating disorders so complex and so challenging.
As is often the case when both conditions are present, chemical dependence on food substances [or mood-altering effects of dieting and starvation] usually interferes with a person’s judgment and self-control. Much like treating any form of addiction, abstinence from the offending substance[s] would seem logical.
There are two caveats: Abstinence is the beginning of long-term recovery, not the end game. Space is likely needed for harm reduction when considering the expectations for progress and a good outcome — perfection with any food plan can be counterproductive and contribute to “all or none thinking.”
Hence, a simple way to think of harm reduction is to strive for progress toward the ideal yet plan for contingencies. In other words, minimize harm by decreasing the frequency, amount, and duration of any unplanned lapses or minor deviations back into ED behaviors or trigger foods. In time, the eating disorder behaviors may stop despite the occasional imperfections around the prescribed food plan.
Food Addiction might well be thought of as a substance use disorder, with the substance being individually identified food substances such as sugar, salt, certain fats, highly processed foods, and so on. Much like other substance use disorders, the substances may vary from alcohol to narcotics to behavioral addictions such as gambling and sex.
Eating disorders might be considered an umbrella under which Food Addiction, as well as related eating disorders, may be grouped or separately defined. Almost without exception, identification and abstention from certain food substances are a prerequisite to overcoming Food Addiction.
As noted, this might not ALWAYS be the case with individuals harboring an eating disorder diagnosis or history. However, most abstinent food plans are at least healthy and serve as part of an ongoing recovery lifestyle. What are often called “abstinent food plans” typically consist of more nutritious whole foods, eliminating ultra-processed foods, and ensuring reasonable and healthy amounts of these foods.
Many people who fit the medical criteria for binge eating disorder, bulimia, and/or specific variants of anorexia also appear to fit the description of a Food Addict. How much and how many Food Addicts manifest an eating disorder, or what I would consider “dually diagnosed,” may be a subject for future study.
By analogy, some alcoholics also are dually addicted and can be identified as “addicts and alcoholics.” Some Food Addicts may well be recognized as a “bulimic and a Food Addict.” To be clear, the concept is more important than the limits set forth with language and semantics. The implications are a matter of securing effective treatment.
Lerner founded and is CEO of Milestones In Recovery in Cooper City, Fla. He is a member of the Food Addiction Institute board of directors.