Do Eating Disorders = Addiction?

True or False: A person with an eating disorder is addicted to food...

The answer is: False

Does that surprise you? One of the most frequently encountered misconceptions about binge eating (also called compulsive overeating by some) is that it constitutes an addiction. We hear patients say this about themselves all the time. Amy (not her real name) sat in my office just this week, Kleenex in hand, stained mascara on her cheeks, and raising her voice through her tears managed to say, "I don't know what my problem is. I eat when I am not even hungry and I can't seem to stop myself. I guess everybody has something, you know? Some people drink or smoke...I guess I must just be addicted to food."

It is true that clinically, many of the behaviors associated with eating disorders and substance abuse appear to be similar: patients report the sense of a loss of control, continue in their behaviors despite repeated attempts to change, may lie about their behaviors to avoid detection, and maintain their maladaptive behaviors despite adverse consequences. Given these observable similarities, it is understandable that many professionals have utilized the chemical dependency model to help explain the cycle of behavior frequently associated with eating disorders. However, there is little empirical support for an addictions-based treatment for eating disorders. To date, research does not support the notion of a biologically based addiction to food. Criteria such as physical tolerance, dependence, and withdrawal are not associated with food substances despite the similarities in observable behaviors among some patients.

Twelve-Step Programs: Should they or shouldn't they?

Over-eaters Anonymous (OA) is one of several twelve-step groups that has emerged over the years that attempts to help people with eating disorders. Some patients report benefit from attending groups such as OA because they provide needed structure and social support. Indeed, some patients have co-occurring substance abuse and may benefit from a twelve-step approach for that reason. However, it should be noted that OA may be contraindicated for patients with bulimia or anorexia. The abstinence model promoted by OA, along with its rigid dietary restrictions, may actually perpetuate the cognitive distortions most commonly associated with eating disorder behavior. Additionally, OA reportedly promotes the belief that "compulsive eating is a progressive illness that can't be cured but can be arrested", an assertion not supported by scientific evidence. While your eating disorder clients may need a safe place to share their thoughts and feelings about food with others who have a shared experience, be cautious to ensure that their involvement in a twelve-step program does not perpetuate the very extremes in thinking that you are seeking to help them overcome.