The idea that specific kind of foods may have an addiction potential and that some forms of overeating may represent an addicted behavior has been discussed for decades. In recent years, the interest in food addiction is growing and research on this topic lead to more precise definitions and assessment methods. For example, the Yale Food Addiction Scale has been developed for the measurement of addiction-like eating behavior based on the diagnostic criteria for substance dependence of the fourth revision of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, diagnostic criteria for substance abuse and—dependence were merged, thereby increasing the number of symptoms for substance use disorders (SUDs) in the DSM-5. Moreover, gambling disorder is now included along SUDs as a behavioral addiction. Although a plethora of review articles exist that discuss the applicability of the DSM-IV substance dependence criteria to eating behavior, the transferability of the newly added criteria to eating is
unknown. Thus, the current article discusses if and how these new criteria may be translated to overeating. Furthermore, it is examined if the new SUD criteria will impact future research on food addiction, for example, if “diagnosing” food addiction should also be adapted by considering all of the new symptoms. Given the critical response to the revisions in DSM-5, we also discuss if the recent approach of Research Domain Criteria can be helpful in evaluating the concept of food addiction.
The idea that specific kind of foods may have an addiction potential and that overeating such as in binge-related eating disorders or obesity may represent a form of addicted behavior has been discussed for decades. The term food addiction was first introduced in the scientific literature in 1956 by Theron Randolph . Although comparisons between addiction and eating behavior were sporadically drawn in the following decades [2,3,4,5,6,7,8], approaches to systematically examine and define food addiction were not pursued until the early 2000s. Particularly, a substantial increase in the number of publications using the term food addiction can be observed since 2009 .
This increased scientific interest in this topic was in part driven by the rise of neuroimaging and subsequent findings that obesity and binge eating are associated with alterations in dopaminergic signaling and food-cue elicited hyperactivation of reward-related brain areas which are comparable to processes seen in drug users [10,11]. Those findings were further complemented by animal models showing addiction-like behaviors and neuronal changes in rodents after some weeks of intermittent access to sugar . In the current article, we will not go into further detail about those lines of research and refer the reader to recent works on those topics [13,14,15,16,17]. Instead, we will focus on the phenomenological similarities between substance dependence and some forms of overeating in humans.
Food Addiction in the Light of DSM-5
Meule, A., & Gearhardt, A.
The inclusion of gambling disorder as a behavioral addiction along with SUDs in DSM-5 necessitates a discussion if food addiction more resonates with the criteria used for SUDs or with those used for gambling disorder. The term food addiction a priori implies that consumption of a substance (or in this case, several substances that combine as food) is essential to this kind of addiction. Research into what foods (or ingredients in certain foods) may be addictive is in its nascent stages. It is possible that some symptoms of addiction may be prominent with certain kinds of food. For example, animal models suggest that sugar may be more associated with withdrawal symptoms than fat . It is also possible that there may be symptoms unique to an addictive-response to highly processed foods relative to drugs of abuse, but future research is needed. Besides the potential relevance of specific types of foods/ingredients, however, research has also highlighted that specific eating patterns (or eating topography) may be necessary in order that food develops its addictive properties. Specifically, it has been found that food addiction symptoms particularly can be observed when high-calorie foods are consumed with alternating periods of restriction and bingeing [12,22].
Likewise, food addiction shows parallels to both SUDs and gambling disorder. We would argue, however, that the SUD criteria could more unambiguously be translated to food and eating. For example, gambling disorder includes symptoms that specifically refer to the money lost during gambling (criteria 1, 6, and 9), which hardly can be applied to eating. Thus, although food addiction may represent a mixture of an SUD and a behavioral addiction, we conclude that the DSM-5 SUD criteria rather than those for gambling disorder should guide future research on food addiction.
DSM-IV; DSM-5; substance dependence; substance use disorder; gambling; food addiction; obesity; binge eating; craving; RDoC
Meule, A., & Gearhardt, A. (2014). Food Addiction in the Light of DSM-5. Nutrients, 6(9), 3653–3671. doi:10.3390/nu6093653