How problem eating is addictive

The New York Times describes the new movement uniting the obese and people with eating disorders.  The issue that unites them is binge eating—an addictive behavior.  Not all obese people are binge eaters and not all binge eaters are obese.  But many people who binge eat become obese, while binge eating is a primary characteristic of anorexiaand bulimia.

Stanton Peele, Ph.D., J.D., lectures internationally on the meaning, treatment, and future of addiction. All Treatment awarded him the Best Academic Addiction Blog for 2012. Dr. Peele has developed the on-line Life Process Addiction Program(link is external). His most recent book (with Ilse Thompson) is Recover! Stop Thinking Like an Addict and Reclaim Your Life with The Life Process Program. Since the publication of Love and Addiction in 1975, Dr. Peele has been a pioneer in applying addiction beyond the area of drugs and alcohol, social-environmental causes of addiction, harm reduction, and self-cure of addiction.

Editor:  Saad Shaheed

Binge eating is addictive because it is an example of experiences people turn to and depend on as a way of dealing with life problems, just as people drink and turn to drugs. Binge eating is best understood psychologically, according to those who are part of this movement:

Still, despite differences in physical characteristics and symptoms, those suffering from an eating disorder like anorexia or bulimia and those with obesity have “shared psychological components, commonalities and underpinnings,” said Dr. Scott Kahan, director of the Strategies to Overcome and Prevent (STOP) Obesity Alliance. . . .

“Low self esteem is extremely common in both, as is body dissatisfaction. They are both very much environmentally driven. Both place excessive emphasis on appearance and body size. In the same way, many of the same psychological underpinnings play into both.”

As I wrote for Psychology Today, the magazine:

Addiction is the search for emotional satisfaction—for a sense of security, a sense of being loved, even a sense of control over life. But the gratification is temporary and illusory, and the behavior results instead in greater self-disgust, reduced psychological security, and poorer coping ability. That’s what all addictions have in common.

There is no place where this cycle is clearer than in the case of binge eating. Binge eating points clearly to the nature of the addictive experience as a self-feeding negative relationship to an object, activity, or involvement.  As one woman spoke of joining obese binge eaters and those with eating disorders: “The problem [for either the anorexic or bulimic, or the obese, binge eater] is not the food; the problems are the issues in your life, and you turn to food because you can’t handle them.”

And, now, these two groups, newly introduced to each other—but still uncomfortable together, like drug addicts and alcoholics—need to see the resemblance of binge-eating to standard addictive experiences.  Of course, what we recognize to be addictive is being enlarged and redefined all the time.  DSM-5 now includes gambling among the addictions.  But many think that this category should include sex and love and video games and other Internet-based excesses, from pornography to social networking.

What hinders the recognition of food as addictive is American psychiatry’s black-and-white tendency to decide some “things” are addictive, as it does when it creates lists of addictive drugs. And, so, it must undergo contortions in order to identify as addictive something that has not traditionally been labeled that way.  When DSM-5 decided on the identity of a single behavioral addiction, gambling, the head of the substance use disorder subgroup, Charles O’Brien, justified the choice this way: “substantive research” indicates that “pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system.”

But sex and binge eating are not included in the addiction section of DSM-5.  For one thing, it just seems hard to put “food” and “sex”—universal appetites—on a list of addictive things.  Thus, in DSM-5, “hypersexuality” was to be included as a separate condition, and then at the last moment was excluded, while binge-eating has its own separate designation.  As I argued in Psychology Today,

DSM-5 further muddies understanding of addiction in its handling of two other non-drug appetites—“hypersexuality” and “binge eating.” Neither is regarded as an addiction. Is this because they do not follow the same “neural reward pathways” as drugs and gambling? Binge-drinking can bring on addiction, but not binge-eating? How come? And is gambling really more neurologically, or intensely, rewarding than sex?

The last-minute rejection of either calling sex addictive or the inclusion of hypersexuality gives the appearance of DSM-5 as a hasty late-night college assignment whose authors could have said something entirely different if they turned the paper in a week later.  As I said in Psychology Today in 2010, several years before it appeared: “In the future, DSM-5 will be looked on as a document of the moment, not as a successful delineation of addictive disorders. Indeed, DSM-5’s current proposals on addiction will not stand the test of even the short time it takes until its scheduled publication.”

And one way it failed was in making binge eating and addiction two separate entitites because it was unable to see that they fall in the same psychological category.

Courtesy: PsychologyToday

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