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

214-503-7100

Jessica@UnderstandingNutrition.com

www.UnderstandingNutrition.com

Jessica Setnick Blog Interview

This is the second in my blog interview series. This time it is Jessica Setnick, MS, RD/LD, CSSD who was a guest professional on one of our tele-classes in November.

Jessica Setnick Blog Interview

1. Your website, http://www.understandingnutrition.com/ shows your passion for helping folks with eating disorders.  Where does this passion come from?

It is a combination of wanting to help others and wanting to understand the human condition in some way that would help me understand myself. I learn so much from my patients, and the continuing education that I have pursued has been as applicable to myself as it is to my work. The other aspect is that I feel that I have been given a gift, a gift that I may not have identified on my own, but that the incidents of my life brought to my attention. I am grateful to have found the intersection of what I like to do, that I am good at, that helps people, that I can do for a living. It is my mission and I wouldn’t feel complete if I didn’t act on it. Over time my mission has evolved into helping other professionals to help solve eating disorders, and most recently into helping build a treatment center, Ranch 2300, to do the same.

2. What is your philosophy on effective eating disorders treatment?

Ah, my philosophy. My philosophy on effective treatment starts with my philosophy on eating disorders themselves. I believe that the nomenclature we use for eating disorders stinks. I think it was developed to facilitate research and description but it does not describe the human experience. So we are not treating individuals with eating disorders as well as we could be because the research is based on artificial distinctions. Anyone who is familiar with the field realizes that two people with “anorexia” might have very different situations – different causes, different skill deficits, different needs – but yet we continue to look for the one “best” treatment. There might be two people whose eating disorders look very different, but they have a lot in common. The treatment must be individualized to what each person needs. But I think that if we did a better job of describing eating disorders, such as “Depression-related eating disorders” and “Anxiety Spectrum Eating Disorders” and “Post-traumatic eating disorders” instead of the way we do now, we could also do a better job of recommending treatments rather than the trial-and-error approach.

The most important factor in treatment that lasts is recovery protection, ie the systems and skills that someone needs in order to thrive outside of a treatment setting. That has been the most fun part of designing Ranch 2300 – thinking of all the skills that someone needs to “make it” in recovery, and figuring out ways to teach those skills in the safe environment of treatment.

3. What is your opinion on full recovery?

I prefer to use the word “remission,” since it seems to fit the paradigm of eating disorders better than recovery. I feel recovery can begin the very day someone realizes their eating disorder is killing them and they want to change, but that is no guarantee of a change in the parameters we tend to measure. On the other hand, an individual may be weight-restored and seem to be “in recovery” while internally they are not recovered at all.

Remission indicates that while bodies heal faster than minds, both the body and mind have recovered to the point that eating disorders stay in the thought stage only and do not transmit into behaviors that are problematic. In other words, I believe that I am in remission because when I have eating disorder thoughts, I am able to manage them before they lead to behaviors, and on occasion under extreme duress when I have an eating disorder behavior, it is no more severe nor lasting than the average American. It does not lead to guilt or shame, or a repetitive cycle, and I use it as a clue that life is not in balance and a cue to re-evaluate my situation.

My opinion on Remission is that it takes up to 7 years of compliance with treatment from the day an individual with an eating disorder enters treatment to advance to the stage of Remission, where the eating disorder is genuinely and for all practical purposes “in the past.”

4. How have people used your boot camp to treat their eating disorder?

Well I did not intend it for that purpose, it is a training program for professionals treating eating disorders. But after some of the workshops, professionals who attended would come forward and tell me that after attending the weekend they recognized their own eating disorder, or recognized that it was no longer congruent with their lives, and they asked me to help them find treatment in their area.

5. What do you tell people who care about someone with an eating disorder to say to encourage their loved one to seek treatment?

I care about you is a good start. I care about you and I would like to help you find treatment is even better. I care about you and I have made an appointment with a counselor to talk about how hard it is to watch someone I love hurt themself is the best way of all. Because then you are not only expressing yourself, expressing how deeply this is important to you, and how you are willing to stick by this person “in sickness and in health,” but you are also role-modeling self-care and reaching out for help, two things that everyone with an eating disorder needs to see more of.