Question: Are Eating Disorders Addictions?
Answer:
That depends on your definition of "addiction." In general, an addiction is the compulsive use of a substance or behavior even in the face of evidence that it is harmful. Addictions usually involve tolerance (a diminishing effect of the substance or behavior over time) and can produce serious physical and emotional symptoms in withdrawal (the removal of the substance or behavior).
Evidence Against Eating Disorders As Addictions
Eating disorders differ from many addictions in that the focal substance in question -- food -- is necessary for life. A person can quit drinking alcohol or taking heroin and (once withdrawal symptoms end) not need it anymore physically. Not true with eating problems: Those with eating disorders will always have to deal with food.
One hallmark of a substance addiction is that there are generally profound withdrawal symptoms on a person when he stops using the substance. These symptoms can range from sweating to hallucination to, at times, death. But what if we remove the disordered eating from the life of a woman with bulimia? If she continues to eat normally, she will for the most part feel better right from the beginning. She will have some anxiety, but her physical health should begin to improve right away.
The same is true for anorexia. A return to a normal eating pattern might not be possible for a person in late-stage anorexia, since his body may be unable to handle digestion of a normal amount of food so soon. But the body itself will not demand a return to a lack of food.
Also, substance addictions involve tolerance -- the need for more and more of the substance to achieve a desired effect. Anorexia, however, involves wanting less and less. One might say that a woman with anorexia can need more and more weight loss, but she can't do more than eating nothing. In other words, she can't increase the rate of weight loss at will.
Those with bulimia do have the option of increasing their rate of binging and purging or the amount of food they eat in each binge. And these variables are likely to increase as bulimia progresses. But the question arises again: If this is a sign of addiction, to what is the person with bulimia addicted, and how does the dependence happen in the body?
Evidence for Eating Disorders As Addictions
Those with eating disorders, in general, aren't addicted to food in the same way that an alcoholic is addicted to alcohol. Since anorexia involves avoidance of food, we can't say it is an addiction to chemicals in food. And with bulimia, food is only in the body temporarily. Binge-eating disorder may be most similar to alcoholism in that both involve ingesting substances (and hopefully leaving them there).
But similarities are there. Those who are addicted to substances are dependent on chemical reactions in the brain. These chemical interactions initiated by alcohol or cocaine, for example, create the dynamics of dependence and tolerance that exist in addictions. Strictly speaking, it isn't the substances themselves, but the effects they have.
The same is true for eating disorders. Brain chemistry changes when a woman with anorexia refuses food and logs another day with a tiny number of calories. Binging and purging leaves a man with bulimia in a far different mental state than the one he was in before eating. People with eating disorders see these changes as desirable, or at least more desirable than staying where they were before they engaged in the behaviors.
Common addictions and eating disorders are also alike in that their damage is mostly ignored while the addictions/disorders are active. For example, a person hooked on heroin will ignore health problems just as a person with anorexia will. The same goes for emotional and social damage: Depression, anxiety, and broken relationships are all tolerable as long as the eating disorder remains intact.
Researchers have tried at least one anti-addiction drug with eating disorders. Naltrexone is normally used in the treatment of alcohol dependence, but it has also shown some signs of success in normalizing eating patterns in anorexia and bulimia.
Verdict: Are Eating Disorders Addictions?
For now, we really don't know. If eating disorders don't meet the definition of an addiction, it may be that they aren't addictions, and it may also be that our definition of addiction is not big enough or accurate enough. In any case, the debate itself demonstrates how close eating disorders come to being addictions.
Sources:
Marrazzi, M. A.; Bacon, J. P.; Kinzie, J. Naltrexone use in treatment of anorexia nervosa and bulimia nervosa. International Clinical Psychopharmacology 10 (1995): 163-172.
Natinal Eating Disorders Association. Bulimia nervosa. Accessed 1 January 2008.
Natinal Eating Disorders Association. Statistics: Eating disorders and their precursors. Accessed 1 January 2008.
Psychology Today. Treating anorexia like addiction. Accessed 1 January 2008. Vandereycken, Walter. The addiction model in eating disorders: Some critical remarks and a selected bibliography. International Journal of Eating Disorders 9 (1990): 95-101.
