Food Addiction versus Bing Eating Disorder
Updated: Apr 7, 2021
There is a fundamental reason to know the difference between Binge Eating Disorder and Food Addiction. Both are likely to cause severe obesity, but their causes, symptoms and treatment are very different. The treatment part is the most important thing to understand about this though, because those with BED need to moderate their intake of sweets and/or carbs and/or their pleasure foods, while food addicts need to eliminate their intake of sweets, carbs or trigger foods. The main thing for readers to know is that clearly the treatment for BED is opposite to the treatment for Food Addiction – so that’s why it’s important to understand which you have – if you mess up the treatment, you likely won’t succeed with your weight loss goals.
There is a lot of explaining here, so let’s get to it.
Food Addiction in theory is a neurochemical response to certain foods. That is, if your brain gets a taste of certain foods, you uncontrollably want more and more and more of them. Those who have a food addiction often feel “taken-over” or possessed by their cravings, as if another person, or force even, inside of them compels them to get food. The amount of guilt or shame their feel immediately after eating their trigger foods, or foods that satisfy them is relatively small. However, the global guilt and shame they feel about their lives and how food “rules” their lives, or the monster inside of them is immense. Food addicts cannot go without eating their trigger foods. Often a question I will ask them is “Have you ever eaten food out of the garbage, or cut-away moldy pieces of your pleasure food?” Sometimes I ask “What would happen if you go without your trigger food?” Some say that the voice inside of them gets so overwhelming that they are driven nearly crazy by it. Other say that they can’t answer the question because they prepare so methodically for their addiction it never happens.
BED on the other hand is largely a psychological disorder. Usually a cluster of symptoms accompany binge eating including:
1. Extreme guilt and shame that can last for days after the binge, and have the potential to drive the next binge;
2. Body dysmorphia or a strong focus on and or shame around appearance;
3. A strong focus on weight outcomes;
4. Calorie tracking; 5. Low self-esteem;
6. A history of trauma (where trauma is defined subjectively by a client as an event, experience, emotion and/or outcome that has caused moderate to severe psychopathology); and
7. Skipping meals to try to lose weight and/or engaging in over-exercise, purging and (in some cases extreme) calorie restriction to make-up for the increase in calories caused by their binges.
It should be noted that the above symptoms are the ones that I consider mutually exclusive from one another. However, there are numerous overlapping symptoms between Food Addiction and Binge Eating Disorder, including:
1. Eating until past the point of full
2. Dissociating from the eating episode or the events immediately preceding it.
3. Eating very rapidly
4. Engaging in these behaviours multiple times a day to about 2-3 times a week
5. Avoiding eating in front of others
6. Eating what others would consider to be a large quantity of food
7. Having health impacts of obesity
8. A feeling of using food to relax or escape
9. Previous history of addiction
The notion of previous addiction history is an interesting one, in that it is NOT always indicative of a food addiction. However, people who have battled previous addictions (usually to drugs, alcohol, smoking or gambling) will often get extremely sad, angry or agitated when they realize they engage in the same behaviours with food. Often they are unaware that the same dynamics that have ruled their addiction to alcohol, for example, rule their addiction to food. When I point this out to them, the realization is often exceptionally unsettling.
Pointing things out to a client brings-up another very important point – sometimes it can take me up to 3-4 sessions to determine someone’s status in regard to their problematic food intake. As you can see, there are many overlapping symptoms – and it is entirely possible (though somewhat rare) to have both conditions operating. Moreover, during the initial sessions of psychotherapy, many individuals talk about more than just their issues with food. What I am saying here is that you, yourself, have to be careful in assessing the situation you are in. However, one thing I have noticed is that food addicts often react very positively to the suggestion that they eliminate their trigger foods, or set incredibly strict boundaries with food - like never eating their trigger foods again. They seem to gravitate towards the fact that they realize that they will never be able to eat the same way again. On the contrary, those with BED react with extreme negativity to the possibility of never having, say a butter tart, ever again.
This gets into the reason why knowing which camp you fall into with your food habits is so important. If you are a binge eater, the standard treatment is moderation, whereas if you are a food addict the standard treatment is elimination. Many times this is why people fail with their revised eating attempts – they get the relationship with food mixed-up. Binge eaters sometimes try to eliminate all pleasure foods from their eating, which will doom them to failure. Each day that goes by is like a tug on a slingshot that will eventually snap. Food addicts sometimes try moderation, and all they are doing are eating foods that will trigger them to eat even more. Both set up people for failure.
It is important to note that “food addiction” or addiction to sugar is not considered an official diagnosis by the medical and or psychiatric or clinical psychology community, whereas Binge Eating Disorder is. I say that because I strongly believe in medical science, and I strongly believe in such full disclosure to my clients. It is beyond my training to understand why this is the case – I guess there has not been enough biological or neurological proof to establish the fact that there is an addictive reaction to some foods in some people. However, as a clinician, whose job it is to listen very, very closely to my clients (in fact, I think my job is to listen more closely to them than anyone in their life currently does), there are some clients that I listen to where the standard BED criteria simply do not fit. I therefore believe that I am not doing my job for my clients if I ignore the fact that in doing the most fundamental aspect of my job that I encounter some clients who simply do not fit the definition of BED.
Finally, my knowledge of food addiction occurred somewhat randomly. I tell my clients that I am a disordered eater, and that I moderate my sugar and flour intake. The slingshot effect of eliminating these foods will be deadly to me. When I entered into the field of obesity treatment, I encountered a group run by Tony Vassallo in Toronto. Tony is a recovering food addict, and had formed a relationship with other recovered food addicts in the Toronto area, including Dr. Vera Tarman, an internationally recognized expert in food addiction. At first I didn’t believe them as well – especially that it was prudent to eliminate all trigger foods from a diet. However, I learned to respect their ethics, knowledge, wisdom and plain street-smarts. Now I consider myself fortunate to be one of the few psychological providers in the Toronto area that will recognize the food addiction AND eating disorder paradigms, and assess individuals into the category I think is more appropriate for them. Most providers tend to work in one camp or the other, and I think that is a disservice to clients, unless such practitioners properly and objectively assess their clients into either camp.
If there are any medical or allied professionals out there who deal in obesity, you owe it to yourself to understand the food addiction paradigm, but more importantly, you owe it to your patients to listen to their symptoms and classify them appropriately. The food addiction paradigm just fits so well for a number of obese clients such that I think we have to include it as part of any intake or assessment we do, and treat it as an addiction when our patients and clients exhibit it.