Wednesday, February 22, 2012

Are Eating Disorders Addictions?

Recently there was an insightful and respectful discussion about whether or not some eating disorders can be considered addictions on a closed group on Facebook for Therapists, MD's, Nutritionists and Coaches Specializing in Eating Disorders.

Dr. Cynthia Bulik posted the question in response to a query.  She shared her wisdom and suggested "we find a new word that captures the essence and uniqueness of the power that food can have over us."

In response to the many folks who contributed to the discussion about behavioral addictions among other things, Jessica Setnick had a response that I feel is worth sharing here.  It really says what I have thought all along but I didn't have the words for it. I copied this from her post on Facebook so I apologize for the tiny font and the paragraphs are mine to make it easier to read.

Knowing that none of us have all the answers, I have the utmost respect for other points of view, but I think exactly the opposite. 

I think that there are subgroups of what are now communally referred to as "eating disorders" and that is why studying treatment approaches and even drug trials provide such equivocal results. I think that eating disorders are in most cases NOT their own kind of disorder, but the eating-related SYMPTOM of some underlying issue. I think that is exactly why the DSM does a terrible job of attempting to define eaitng disorders, because it only uses the symptoms as definitions, rather than the root cause, which could be genetic, hormonal (whether innate or environmentally affected after birth), neurochemical (again either innate or modified by experience), learned behavior, or something else. In other words, 

I believe that there ARE anxiety-related eating problems, depression-related eating problems, post-traumatic eating problems, purely biochemical eating problems (PANDAS being the most obvious), obsessive-compulsive eating problems, and addictive eating problems. And though they all "look" the same, as defined by starving, binge eating, purging, or other behaviors and thought patterns, they in fact stem from different biological/biochemical processes, and therefore respond to treatment quite differently. 

In this framework, I believe there are addiction-related eating problems. This sub-type may be more frequent in those who also have other addictions. Isn't it interesting that some individuals with eating disorders are addicted to other chemicals and behaviors and some are not at all? 

We know that different foods are digested and absorbed differently by different people, why do we continue to deny that they can be metabolized differently and reacted to in the brain differently? 

I too learned in dietitian school that you can't be addicted to something that you need every day, like oxygen, but I differ now in my thinking - I think that I AM addicted to oxygen! I think that I do need it every day, every minute in fact, and that when I don't have it, I feel terrible and would do absolutely anything to get it. Including things I would never do in other circumstances, just like someone who steals money to get drugs, or food to binge on. 

I think that grouping a number of people together who are all coughing, and studying their response to cough drops is going to lead to confusing results. Because some of those people might have TB, and the cough drop will have no effect. And some of those people might be choking on a chicken bone, and adding a cough drop will make them much worse. So when you group a bunch of patients together who are all vomiting after eating, and the intervention only works on some of them, isn't it possible that there are several sub-groups and the intervention is 100% successful on one of the sub-groups and 0% successful on others? And yet we continue to insist on these definitions based on outcome behaviors rather than on etiology.

 I wish that the eating disorder community could look at things more like Irene Chatoor (sp?) with the feeding disorders. I think that is a much better model for us with much better potential to identify treatment or even a cure. 

The anxiety-related eating disorders perhaps will be treated effectively with anti-anxiety medications and CBT, while the depression-related eating disorders perhaps will be treated with anti-depressants and exercise, eg yoga. PANDAS will be treated with antibiotics and nutrition plus other possible therapies, and addictive eating will be treated with a 12-step model. 

Learned behavior eating disorders will be improved as our society becomes less obsesses and teaches better media literacy skills. I am speculating here. But it makes so much sense to me when I have seen patients who fit the exact same profile under our current nomenclature, and yet one is vomiting her food because after finding out she is pregnant after a gang rape she feels dirty ever time she eats, and the other is vomiting because she wants to make the cheerleading team. 

Two patients who are starving themselves, one because she feels guilty for being on drugs when her mother was dying of cancer and believes that if she eats then someone else in her family will die, and another who is petrified to be obese ever again after a painful childhood of abuse and bullying. We know these individuals don't need the same treatment, 

why do we insist that they have the same disease? If none of the current paradigms we have fit correctly, why not try a whole new one?

Jessica Setnick, MS, RD, CSSD, CEDRD
Author of The American Dietetic Association Pocket Guide to Eating Disorders
National Director of Training and Education for Ranch 2300 Collegiate Eating Disorders Treatment Program

6510 Abrams Road, Suite 302
Dallas, Texas 75231

1 comment:

Rodney Knight said...

Most people who are victims of anorexia or bulimia are reluctant to seek eating disorder treatments. The reason behind this is that they are ashamed of the fact. People with these kinds of disorder should know that it is a common disorder and be cured with the help of proper treatment at a rehab center that offers eating disorders treatment.
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