What is food addiction and how is it different than an eating disorder?
Food addiction has been viewed as a concept yet to be fully recognized and accepted by most people. It’s been described as follows by a group of professionals identified with it’s being a bona fide addiction:
“Food addiction is a disease typified by loss of control over the ability to stop eating certain foods. Scientifically, food addiction is a cluster of chemical dependencies on specific foods or food substances. After the ingestion of highly palatable foods such as those containing significant amounts of sugar, flour, excess fat, and/or salt, the brains of some people develop a physical craving for these foods. In addition, the more processed a food or substance is the greater its addictive potential. Over time, the progressive eating of these foods distorts a person’s thinking and leads to negative consequences they do not want but cannot stop.”
No doubt the phrase “food addiction” has not been equated with the phrase “drug addiction” in so far as being accepted as either an illness or a credible concept. However, the following line of reasoning may help to clarify the spirit with which food addiction is a legitimate entity.
The “Naysayers:” -Drug addiction, alcohol dependency, and process addictions [e.g. compulsive gambling] are substances and behaviors that are not necessary for life. Food is.
The “Believers:” –But so is water and air – However, people do not consume water & air beyond their biological needs or in ways that threaten their survival. So perhaps the problem is semantics
drug addiction = not all drugs are addictive
food addiction = not all foods are addictive
So, does that mean “emotional eating” doesn’t play a part in all this? The fact is we simply do not know how much food addiction is about cravings triggered by “addictive foods” and how much is purely emotional eating. Is it “either” or can it be both?
The following is suggested as a way of looking at the difference between an eating disorder [such as anorexia or bulimia] and food addiction.
a. Food Addiction ALMOST ALWAYS involves a need to identify and abstain from offending food substances much like an alcoholic must abstain from alcohol and most mind-altering [related] substances. [biological triggers]
b. Eating Disorders DO NOT ALWAYS necessitate an abstinent stance from foods such as those that trigger addictive eating. At the same time, many people with an eating disorder diagnosis also suffer from food addiction as part of their ED.
c. As such, those who have a history of binge eating, binge eating and purging [bulimia], compulsive overeaters and some forms of anorexia [usually purging types] do, IN FACT, need to identify and abstain from “trigger foods”. In other words, they may harbor BOTH a biological as well as emotional set of triggers.
What are eating disorders?
Eating disorders are typically associated with various maladaptive patterns of behavior related to food, its consumption, and the ensuing effects on a person’s emotional and physical well-being. It may, or may not, include attempts to offset the “consequences” of these behaviors by the use or abuse of compensatory agents and behaviors such as purging, compulsive exercising, periods of self-imposed starvation, and so on.
The medical and psychiatric community categorizes these disorders as separate entities, each with a distinct set of symptoms and characteristics. More familiar to most are: Anorexia [self-imposed starvation], Bulimia [binge eating and purging], and Binge Eating Disorder [binge eating w/o purging]. In practice, professionals have come to recognize people tend to exhibit elements of each of these disorders during various periods of their struggle. In other words, periods of binge eating followed by periods of restricting, followed by periods of exercising and/or purging. In fact, when untreated, many people will tend to cycle through a variety of behaviors more aligned with each different subtype of eating disorder – perhaps beginning with anorexia and evolving into a bulimic pattern and later a misguided attempt to control the binge eating by adherence to a starvation / restricting stance. In essence, “switching deck chairs on the Titanic thinking they will avoid drowning”.
Given the debate as to what causes someone to develop an eating disorder, it is more likely the answer is not a simple “one size fits all” answer. Most clinicians treating these disorders appear to believe the answers are hidden within the emotional psyche of the sufferer. Whether anorexic, bulimic, or a binge eater, the persistence of self-medicating vis a vis overeating, starving, or purging is thought to be a misguided attempt to control unwanted emotions or, in many cases, avoid the pain of experiencing past, present, or future trauma. Stately simply, this belief attributes disordered eating to an attempt at regulating emotions and in response to negative feelings.
Like most compulsive or, if you will, addictive patterns [whether with substances or behaviors] eating disorders tend to be perceived as having more benefit than consequence. In other words, they work – at first. In the later stages, they tend to not work as well but appear to offer a better alternative than abandoning them. Sooner or later one can find him or herself at, what some refer to as, “the jumping-off point.” This is when one believes they can no longer live with, and no longer live without, their eating disorder. It is at this stage when people often seek treatment or resign themselves to living with the tyranny of their illness.
An increasing number of professionals treating these disorders believe the biological piece to the puzzle is needed to be addressed. Treatment begins with considering what emotional factors and how biological factors [properties of certain foods, genetic predisposition, etc.] interact to drive an eating disorder. Although recovery from an eating disorder is possible by learning to better manage a particular issue or stressors – namely by “resolving” the emotional trigger[s], it is also possible such recovery will be short-lived. In other words, this same person may have only solved half or a quarter of the puzzle and the physical piece [allergy or reactivity to trigger foods] needs to be identified and eliminated to achieve long-term recovery. Until science can come up with a reliable means to determine this, one might consider addressing both. Stated another way, if years of “therapy” yield little in the way of remission, look to the food or biological remedy. If adherence to a food plan devoid of probable trigger foods yields little progress, look then toward the emotional baggage that needs to be addressed. In either case, the answer will come if you look honestly for it with an open mind.

But These Two Things Often Co-Exist...
People who treat both eating disorders and food addiction and are well versed in the addictions field will tell you most of their clients suffer from the coexistence of both disorders – albeit with varying proportions at various times. This is what makes treating food addiction and related food/eating disorders so complex and so challenging.
As is so often the case when both conditions are present, chemical dependency on food substances [or mood-altering effects of dieting and starvation] usually interferes with a person’s judgment and self-control. Much like treating any form of “addiction,” abstinence from the offending substance[s] would seem logical. There are two caveats: abstinence is but the beginning of long-term recovery, not the end game and there is a need to incorporate the concept of “harm reduction” when considering expectations of progress and outcome. Suffice it to say perfection with any food plan can be counter-productive for most people and contribute to “all or none thinking. Hence, a simple way to think of harm reduction is to strive for progress toward the ideal yet plan for contingencies. In other words, minimize harm by decreasing the frequency, amount, and duration of any unplanned lapses back into ED behaviors or trigger foods. In time, the eating disorder behaviors may stop despite the occasional imperfections around the prescribed food plan.

Food addiction might well be thought of as a substance use disorder, with the substance being individually identified food substances such as sugar, salt, certain fats, highly processed foods, and so on. Much like other substance use disorders, the substances may vary from alcohol to narcotics, to process addictions such as gambling and sex.
Eating disorders might be considered an umbrella from which food addiction, as well as related eating disorders, may be grouped together or separately defined. Almost without exception, identification and complete abstention from certain food substances are prerequisites to overcoming food addiction. As noted, this might not ALWAYS be the case with some individuals harboring an eating disorder diagnosis or history. However, most abstinent food plans are at the very least healthy and serve as part of an ongoing recovery lifestyle. What is often referred to as “abstinent food plans” typically consist of nothing more than healthy whole foods eliminated from highly processed and artificial ingredients. Added to this is controlling for reasonable and healthy amounts of these foods.
At the risk of being redundant, suffice it to say the following:
Many people who fit the medical criteria for binge eating disorder, bulimia, and/or certain variants of anorexia also appear to fit the description of a food addict. How much and how many “FAs” overlap, or what I would consider “dually diagnosed.” This continues to be a source of speculation and some debate.
By analogy, some alcoholics also are dually addicted and can be identified as “addicts and alcoholics” and some food addicts may well be identified as “bulimics and food addicts” To be clear, the concept is what matters rather than the limits set forth with language and semantics. The implications are a matter of securing effective treatment.

Author's Bio: 

Dr. Lerner has been the founder and CEO of the Milestones in Recovery’s Eating Disorder Program since 1999. A graduate of Nova Southeastern University, Dr. Lerner is a licensed and board-certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He has appeared on numerous national television and radio programs including The NPR Report, 20/20, Discovery Health, and ABC’s Nightline as well as authored several publications related to eating disorders in the professional literature, national magazines, and newspapers including USA Today, The Wall Street Journal, New York Times, Miami Herald, the Orlando News and Hollywood Sun Sentinel. An active member of the professional community here in South Florida since finishing his training, Dr. Lerner makes his home in Fort Lauderdale with his wife Michele, daughters Janelle and Danielle, and their dogs, Willow and Tucker. He is an avid tennis player, holds a private pilot’s license, and spends a part of his free time hiking in the mountains near Asheville, North Carolina.