QUESTION: When working with clients, I have noticed that eating disorders appear as addictions. They seem to have the same elements. Have you ever considered treating an ED as an addiction? As a chemical dependency counselor, I frequently encounter patients with EDs, but I have felt at a loss at how to help them as I am quite ignorant about it. I say that, but sometimes I feel I am bordering on one myself as I do sometimes use food to feel better and I sometimes find myself on the guilt and shame roller coaster when I recognize it. It's something of which I've only recently gotten an awareness.

ANSWER: Thank you for such an insightful and open question! You hit the nail on the head when you mention that you see potential addictive elements clearly when you yourself suspect that sometimes you use food for purposes other than that for which it was intended – i.e., to manage stress, etc. And yet what is the difference between disordered eating, such as what you seem to be experiencing with your own relationship with food (only your medical doctor can determine whether you have disordered eating patterns or a true eating disorder), and a clinical eating disorder? For that matter, what is the difference, if any, between an eating disorder and addiction?

With obesity at an all time high (11% of children and over 30% of Americans are clinically obese – which means an individual averages 20% or higher weight than what their ideal body weight should be), and with over 81 million individuals worldwide suffering from anorexia and bulimia, where is the line in the sand between genetics and environment? What is the true meaning of addiction, which in popular terminology can be viewed either as an inability to cease the behavior without help, OR as a choice to abuse a substance for personal reasons? I listened to an excellent talk recently that outlined the difference between dependency and addiction. The speaker suggested that dependency refers to an inability to cease the behavior without help (often given in the form of a combination of medication and treatment), and that addiction refers to deliberate abuse that can be stopped with strenuous self-effort (usually through access of counseling, support groups and sponsorship, such as in the Alcoholics Anonymous system.)

With eating disorders, the fine line exists in the contribution of biology to the onset of clinically diagnosable eating disorders. Research has proven that the development of eating disorders is 56% DNA and 44% environmentally-triggered. In other words, a person can be a ‘carrier’ of the biological predisposition towards the development of an eating disorder, but may not ever develop an eating disorder unless exposed to the right environmental stimuli (poor emotional coping skills development, an overly critical or neglectful caretaker, unavoidable loss or change, abuse, peer pressure, western TV, etc).

It can be quite helpful in treatment settings to address an eating disorder in part as an addictive behavior. The inborn tendency to use food for purposes other than that for which it was intended may, for instance, be #1 on the list (or the only item on the list) of coping skills the person has awareness of to manage life stressors. Expanding the list, introducing supportive relationships (including therapeutic relationships), and committing to a process of proactive change over time plays a LARGE part in recovery from both disordered eating behaviors and a clinical eating disorder. Here is the important difference, however. With eating disorders, the person must be medically stable and be ingesting sufficient nutrients in order for the brain to function competently. In severe cases, malnutrition prevents the person from choosing to cease eating disordered behaviors, and medical stabilization must be achieved before the addictive behavioral elements can be addressed. This falls into the realm of dependency, when the eating disorder can no longer be addressed for its addictive elements alone.

You can read more on my website about the warning signs, triggers, and steps to get help for eating disorders. Above all else, awareness that there is a problem – an individual problem – with food usage is key. Once you are aware that there is a problem, then the next step is to invite your support community and trained professional treatment team to partner with you to facilitate change. Your medical doctor can help determine where you fall on the spectrum, and what kind of help is needed. I would apply the same model to those you work with who may be experiencing dual diagnosis or addiction transference (an example of this phenomenon might be found in someone who has achieved some success in refraining from using drugs, but then develops a binge-eating problem). Addiction transference, in particular, can be seen as a person who may have learned how to physically stop a particular addictive behavior, but does not yet have the mental and emotional tools in place to stop using addictive behaviors themselves as a coping skill. A firm foundation – in any recovery endeavor – must be in place on a spiritual, emotional, mental and physical level before lasting recovery from any type of disorder can be achieved.

Feel free to write with additional questions. I hope my answer is of some help to you in your work!

Warmly,

Shannon

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