The purpose of this study was to explore how obese women with and without binge eating disorder (BED) experience overeating in relation to the DSM-5 symptoms of addiction. Findings from this study demonstrate that food addiction can occur in obese individuals with and without BED. It is important that health care professionals identify individuals who may require a specific treatment approach that incorporates techniques used in the treatment of addictions.
There have been various attempts to explain why some people chronically overeat and seem unable to restrain their food intake. One explanation relates directly to the markedly “toxic,” and dramatically changed, food environment in recent years (Horgen & Brownell, 2002). The likelihood of a pattern of excessive consumption developing is greatly increased in the current marketplace with its superfluity, and ready availability, of highly processed, and hyper-palatable foods—particularly those rich in sugar, fat,
and salt—compared to previous generations (Gearhardt, Davis, Kushner, & Brownell, 2011).
A growing body of clinical and neurobiological evidence has shown how persistent overeating can lead, in vulnerable individuals, to a pattern of compulsive behaviour similar to that seen in drug abuse and other addiction disorders (Davis & Carter, 2009; Gold, Graham, Cocores, & Nixon, 2009; Volkow & O’Brien, 2007; Wise, 2006).
Proponents of the view that food can be addictive base their arguments on a compelling body of animal research (Avena, Gold, Kroll, & Gold, 2012; Avena & Hoebel, 2003; Avena, Rada, & Hoebel, 2008; Colantuoni et al., 2002; Johnson & Kenny, 2010). Notwithstanding the robust evidence of sugar/fat dependence in
rodents, there are few parallel findings in human research. Notable exceptions have identified brain areas responsive to both food and drug cravings (Pelchat, 2009). Other researchers have recently advanced the field by developing a measure operationalizing “food addiction” using the Diagnostic and Statistical Manual-IV-TR (DSM-IV-TR; American Psychiatric Association [APA], 2000) diagnostic criteria for substance dependence (Gearhardt, Corbin, & Brownell, 2009).
There were visible qualitative differences in how the women experienced their symptoms. Overall, the BED group described their overeating as an addictive process to a greater degree than their non-bingeing counterparts, as indicated by endorsing a greater number and frequency of the 11 DSM-5 symptoms. This study suggests that obese women with BED are more likely to meet criteria for a food addiction diagnosis based on the revised criteria for substance use disorder (SUD) in the DMS-5.
A Qualitative Study of Binge Eating and Obesity From an Addiction Perspective
Curtis C, Davis C.
For this qualitative study, telephone interview confirmed eligibility and informed consent and all demographic information was acquired. A structured clinical interview was carried out by a trained PhD student to confirm BED status. A diagnosis of BED was given to participants who met the criteria provided in the main body of the DSM-IV where BED is defined as: “recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.” Participants had to report at least weekly objective binge episodes over the previous 3 months, but over this period they must not have vomited, fasted, or taken laxatives or diuretics as a means of controlling their shape or weight.
12 obese women with BED and 12 without BED took part in the study. The 2 groups were matched closely for BMI, age, and cigarette smoking.
The results of this study suggest that obese women with BED are more likely to meet criteria for a food addiction based on the revised criteria for SUD in the DMS-5. This conclusion converges with previous research using DSM-IV diagnostic standards (Cassin & von Ranson, 2007). On the other hand, studies using the YFAS have found a substantially lower incidence of food addiction in those with BED (Davis et al., 2011; Gearhardt et al., 2012). Therefore, future research should compare the self-report YFAS with a DSM-based clinical interview to establish the accordance rate of these two assessment tools. This will better establish the salient clinical characteristics of the food-addiction construct. Findings from this and other studies (Davis et al., 2011; Gearhardt et al., 2012) also demonstrate that addictive tendencies towards food do not only characterise BED but can occur in other individuals who struggle with overeating.
Curtis, Claire, and Caroline Davis. “A Qualitative Study of Binge Eating and Obesity From an Addiction Perspective.” Eating Disorders, vol. 22, no. 1, Jan. 2014, pp. 19–32. DOI.org (Crossref), https://doi.org/10.1080/10640266.2014.857515.