Eating disorders are typically associated with various maladaptive patterns of behavior related to food, it’s consumption, and the ensuing effects on a person’s emotional and physical wellbeing. 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 / psychiatric community categorize these disorders as separate entities, each with a distinct set of symptoms and levels of severity. More familiar to most are: Anorexia [self-starvation], Bulimia [binge eating and purging], Binge Eating Disorder [binge eating w/o purging]. In truth, professionals have come to recognize people tend to exhibit elements of each of these disorders during various periods of time in the course 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 than likely the answer is not a simple “one size fits all” answer. Most professionals 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 pursuit of self-medication vis a vis over-eating, starvation, or purging is a misguided attempt to control unwanted emotions or, in many cases, avoid the pain of experiencing past, present, or future trauma. Like most compulsive or, if you will, addictive patterns [whether with substances or behaviors] eating disorders tend to, at first, work. That is to say they accomplish the goal and meet the expectations of those beginning to engage in a maladaptive relationship with food and/or dieting. In the later stages of these disorders 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 call, “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.
There are, however, a growing number of professionals treating these disorders for whom there exists a biological piece to the puzzle that begs to be addressed. The collective experience of treating literally thousands of people with all different subtypes of disordered eating suggests the problem and solution begins with considering what emotional factors and what biological factors [properties of certain foods, genetic predisposition, etc.] interact to drive an eating disorder. It may be some will resolve and remit from an eating disorder by learning to better manage a particular issue or stressors that propelled them into the realm of an eating disorder. It may also be this same person may have only solved half or a quarter of the puzzle and the physical piece [allergic or sensitivity to trigger foods] needs to be eliminated in order to become free of their disorder. Until science can come up with a reliable means to determine this, one would be wise to cover both bases or by trial and error reach a means by which to self-diagnose their limitations from both ends. In other words, if years of “therapy” yields 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 towards the emotional baggage that needs to be addressed. In either care, the answer will come if you look honestly for it with an open mind.

What is food addiction and how is it different than an eating disorder?

Food Addiction [FA] has been viewed primarily as a concept yet to be fully recognized and accepted by the professional community. The definition proposed by those having experience with this is summarized as follows:
 “Food addiction is a disease resulting in 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 in general; after the ingestion of highly palatable foods such as sugar, excess fat and/or salt the brains of some people develop a physical craving for these foods. 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 viable 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
*[Narrative taken from slide presentation to National Association of Addiction Counselors, 2018, Denver Colorado- M. Lerner, PhD.]

At this juncture, we are left with the question: “Does that mean emotional eating” is not an element to be given consideration to driving addictive eating – aka food addiction?” The answer is likely to be similar to the one alluded to with eating disorders – namely we do not know how much of a food addict’s illness is driven by the biological dependency on certain food substances and to what degree can it be driven by emotions [a given affective state] independent of adherence to an abstinent stance from offending food substances.
To delineate between an eating disorder such as anorexia or bulimia from food addiction would follow the following assumptions:
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 triggering addictive eating among food addicts.
c. HOWEVER, many people with eating disorders, in particular those who have a history of binge eating, binge eating and purging, [bulimia], compulsive overeaters, and some forms of anorexia [usually purging types] do need to identify and abstain from “trigger foods”. In other words, they may harbor a biological as well as emotional set of triggers.

Food addiction might well be thought of as a substance use disorder, with the substance being individually identified food substances such as sugar, flour, salt, certain fats, and so on. Much like other substance use disorders, the substances may vary from alcohol to narcotics, to behavioral [aka process] addictions such as gambling and so on.
Eating disorders might be considered an umbrella from which food addiction, as well as related eating disorders, may be grouped yet delineated. As a rule, identifying and complete abstention from certain food substances are a pre-requisite to overcoming a food addiction. As noted, this might not ALWAYS be the case with some individuals harboring an eating disorder diagnosis or history.

Author's Bio: 

BIO – Marty Lerner, Ph.D.

Dr. Lerner is the founder and CEO of the Milestones in Recovery’s Eating Disorder Program located in Cooper City, Florida. 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 that include The NPR Report, 20/20, Discovery Health, and ABC’s Nightline as well 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, Orlando and Hollywood Sun Sentinels. An active member of the professional community here in South Florida since finishing his training, Dr. Lerner makes his home in Davie with his wife Michele and daughters Janelle and Danielle and their dog, Reggie.

Professional Memberships:

- American Psychological Association [APA]
- Florida Psychological Association [FPA]
- National Eating Disorders Association [NEDA]
- National Association for Anorexia and Associated Disorders [ANAD]
- Binge Eating Disorders Association [BEDA]
- National Association for Anorexia and Bulimia [ABA]
- Florida Medical Professional Group [FMPG]
- National Association of Cognitive Therapists
- International Association of Eating Disorder Therapists [IADEP]

Prior and Current Affiliations:

- Founder and director of Pathways Eating Disorders Program [1987-1994]
- Clinical Director, Eating Disorders Unit at Glenbeigh Hospital, Miami, Fla.
- Clinical Director, Eating Disorders Unit at Humana Hospital Biscayne, Miami, Fla. [1982-1987]
- Founder and CEO, Milestones In Recovery’s Eating Disorders Program, Cooper City, Fla. [1999- current]
- Florida Physicians Resource Network [2005-current]