What's The Relationship Between Eating Disorders And Addiction?

Eating disorders and substance abuse disorders may be found in completely different chapters of the diagnostic and statistical manual of mental disorders, but they have much more in common than you may think at first glance. 

A look at the nature of addiction

The American Society of Addiction Medicine's very long definition of addiction starts with an angle more people should consider when thinking about what it means to be addicted."Addiction," they say, "is a primary, chronic disease of brain reward, motivation, memory and related circuitry."

While in the clutches of an addiction, which can be a substance addiction or a behavioral addiction, addicts will experience symptoms we're all familiar with. They'd include:

• Using a substance (alcohol, marijuana, cocaine, etc) or engaging in an addictive behavior (gambling, sex, shopping, gaming, etc) more often, for longer periods of time, in higher doses, or in riskier ways than intended. 
• Trying to cut down or stop using the substance or engaging in the behavior unsuccessfully. 
• Being preoccupied with the substance or behavior — craving it when it's not there, and spending large amounts of time using, trying to get a hold of, or recovering from, the substance or behavior. 
• Noticing that the addiction negatively impacts personal relationships and responsibilities, and sometimes engaging with the object of addiction in circumstances where it's especially hazardous. This would include driving or operating heavy machinery while intoxicated, for instance, but also gambling money that's not yours. 
• Some addictions induce physical dependence, while others don't. In either case, the addict may need to take the addiction to increasingly extreme levels to achieve the same "buzz", and become very anxious, down, or aggressive when they don't have access or try to abstain. 

Could some eating disorders BE addictions?

I've recently written about addictions to all sorts of things, from the usual suspects — alcohol, cigarettes, caffeine, illegal drugs, and prescription drugs — to those not recognized in the current version of the diagnostic manual of mental disorders. The latter would include addictions to shopping, gaming, plastic surgery, work, suntanning, anger, and of course food. 

While writing, I was struck by the similarity between eating disorders and addiction. This led me further down a very interesting rabbit hole. Could some eating disorders also actually be described as addictions? Several studies have indeed come to the conclusion that eating disorders can share important characteristics with both substance and behavioral addictions.

Research has found that:

• Binge eating disorder (BED) is often treated as an addiction, with 26.9 percent of clinicians reporting that they always or frequently refer clients with BED to therapies designed to help addicts reach remission. 
• A further 15.4 percent of clinicians refer other patients with eating disorders to services designed for addicts. 
• Binge eating may hijack opioid and dopamine systems within the body, just like substance and behavioral addictions do. 
• A rather high 92.4 percent of people with BED met DSM criteria for substance addiction if they were modified to replace words like "alcohol" and "marijuana" with those relating to binge eating. 

Binge eating disorder is a complex condition, but there's no doubt that it shares numerous characteristics with addiction. It could easily be described as one. What about anorexia, though? In this case, the case cannot be made that it resembles a "food addiction". Could people suffering from anorexia nervosa rather be addicted to the feelings associated with restricting their food intake, and in many cases seeking an extreme calorie deficit through excessive exercise?

Research has looked into this, too. People with anorexia, one study found:

• Describe losing control of their habits, just like addicts do. 
• Are preoccupied with their anorexia, spending large periods of time engaging in anorexia-related behaviors. (These may include exercise, counting calories, weighing in, hiding the eating disorder from others, and so on.)
• Attempt to change their habits, but often find themselves unable, much like addicts. 
• Experience relationship difficulties or mental health problems as a result of their eating disorder, but still can't change their habits.
• Experience extreme reactions when they attempt to change their habits or are told to do so — akin to cravings for continued anorexic behavior. 

In some cases, eating disorders and substance abuse disorders quite literally overlap — some alcohol addicts will, for instance, eat less to compensate for the calories they took in while drinking alcohol to prevent weight gain. This phenomenon has been dubbed "drunkorexia". 

How commonly do people with eating disorders also have substance use disorders?

Maybe more often than you think. Research found that around half of people with eating disorders also abuse either alcohol or an illegal drug — a much higher rate than the nine percent seen in people without eating disorders. They are also more likely to smoke. Conversely, around 35 percent of people suffering from a substance use disorder have a comorbid eating disorder. It is possible that eating disorders and substance addictions have overlapping underlying causes — like genetic factors, traumatic and other adverse experiences, and mental health struggles.