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Addiction and Eating Disorders

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Any activity that people find pleasurable might give rise to addiction. Eating is one such pleasurable activity. The DSM-5 (APA, 2013) has a separate category of disorders called Feeding and Eating disorders. However, many people believe that some component of disordered eating has an addictive quality to it.

There is a high rate of substance use disorders in patients with feeding and eating Disorders. Rates for the co-occurrence of substance use disorders and eating disorders with bingeing and/or purging symptoms may be as high as 49% (Lilenfeld & Kaye, 1996). These include:

People with eating disorders often misuse alcohol and other drugs of abuse. They may also abuse substances that we do not usually consider addictive. These are products are used to facilitate purging such as laxatives, diuretics, and the emetic ipecac (induces vomiting). So why do eating disorders and addiction occur together with such frequency? There are several possible explanations:

1. There may be an underlying genetic or biological vulnerability.

2. There are overlapping personality traits related to both eating disorders and addiction. For instance, both disorders reflect impulse control difficulties and include compulsive behaviors.

3. Both disorders may be attempts to self-medicate using food and drugs.

4. Brain chemistry may be involved. Endogenous opioids are naturally occurring opiate-like chemicals produced in the brain. These play a role in the regulation of appetite and alcohol/cocaine consumption. Faulty opioid regulation may therefore contribute to both disordered eating and drug addiction.