The Difference between Eating Disorders and Addiction

The comparison between eating disorders and addiction is increasingly prevalent in the media understanding of these illnesses. Unfortunately, this link negates the main difference that makes eating disorders a very different type of illness and confuses the public understanding of eating disorders. 

Addictive behavior represents a problem in the brain’s reward system. The addictive behavior strengthens the reward circuit of brain chemistry in addicts so that the actions become impossible to avoid.

However, the stimulus, namely drug or alcohol use, is an action not necessary for human life and survival. We can live without those substances. The cravings for the chemical reward are strong, but the behaviors do not tap into the more basic human functions.

Eating disorders are connected to one of the most basic human necessities. Some essential activities are hardwired into the brain and escape conscious intention and thoughts.

Breathing, sleeping, walking and eating represent some of these basic needs for human life. Since we share these needs with other mammals, our brains are wired into the more primitive and essential parts of our brain which perform these actions without any conscious thought. We just do them.

And so eating disorder behaviors, even if they do trigger the reward system, are also linked to some of the most essential brain functions. When an activity is unconscious, changing it takes much more work and attention. It’s one of the reasons people in recovery from an eating disorder describe feeling so exhausted. They are struggling against the most automatic workings of their mind, a very different experience from addiction.

It’s important to reiterate that this fact doesn’t change that recovery does happen. It makes it more challenging in some ways, but full recovery is a reality for many people.

The most essential piece of information is to recognize that eating disorders are not addictions. Often the behaviors do highlight the brain’s reward system, but the true nature of recovery is about changing ingrained, automatic brain systems.

Medications for Binge Eating Disorder

There are several medications that are used for Binge Eating Disorder with mixed results. As opposed to other eating disorders, people with binge eating disorder often seek urgent pharmacological help hoping it sustains longstanding recovery.

The pharmaceutical industry has targeted weight as a primary focus for medication research with limited results. Many of those medications are also tested for Binge Eating Disorder (BED). Inevitably, people with this disorder assume it’s reasonable to seek medications to solve the issue.

However, BED is very similar to other eating disorders. The eating disorder thoughts and behavior cycles are generally consistent so treatment is also not very different. Medications can have some benefit, but therapy and nutrition work are crucial as well.

What is confusing is that there is a small subset of people with BED whose food cravings are different from binge urges. Typically, binge urges are a powerful pull to eat quickly in a way that numbs emotions and calms anxiety. However, a small number of people have food cravings and need certain foods to satisfy the desire for a certain taste and experience rather than block their feelings. Occasionally medications do seem to block these cravings.

Topamax, Wellbutrin, the discontinued Meridia and Naltrexone are medications known, in rare circumstances, to stop binges for people with BED with food cravings rather than binge urges effectively and for a long period of time. Other medications such as Vyvanse may do so temporarily but do not seem to last longer than a year or two at most.

The desire for a permanent fix is strong for people with any eating disorder including BED. It’s rare to find that relief, especially one with such an immediate effect. I hesitate to ever suggest this as an option to expect since it is very rare, but it’s important to understand the different forms of BED and the reasonable expectations and limitations of medication treatment for BED.

The misleading pharmaceutical industry has lumped BED treatment with weight loss medications and encouraged these patients to believe in a quick fix, much to their detriment. These patients need to understand how unlikely a quick fix is and instead seek an overall treatment plan as for any eating disorder.

Stimulant Use and Abuse for People with Eating Disorders

The link between eating disorders and Attention Deficit Disorder is unclear and tenuous. There is no research-based connection in the psychiatric literature, but many patients with eating disorders seek stimulants, the standard ADD medication, because this class of medication causes decreased appetite and weight loss. And some patients end up abusing these drugs too. The line between diagnosis, treatment and abuse is complicated.

An important caveat is that stimulants like Adderall are prevalent among young people. Some are prescribed for actual ADD, some find doctors who will dole out the drugs for academic or recreational use and some buy it illegally. The result is that many young people have tried a stimulant at some point in their lives.

Subsequently, people with eating disorders can experiment and find that these medications are aids in their plight to eat less and maintain a low weight or lose weight. They can find some way to keep a supply and take the medications whether or not a doctor manages the medication. 

On the other hand, there are a handful of patients whose ADD seems to be the root cause of their eating disorder. One symptom of ADD is feeling overstimulated by daily life. Some people find that restricting food, binging or purging eases the overwhelmed feeling and helps the ADD. When given a stimulant, these people experience a lot of relief in general and from their eating disorder.

The resulting situation is complicated. It’s important to be sure that ADD is not a primary cause of the eating disorder. Those people need stimulants, but that is the minority.

Other people need an open conversation about the risks of stimulant use and why taking it can lead to insomnia, tax the cardiovascular system or cause abuse. 

And some people simply use the stimulant as a crutch and find that they have the ability to stop the medication and continue with their lives and recovery.

Because stimulants are a fact of modern-day life, no hard and fast rule will suffice. These drugs are too easy to get and too easy to become intertwined with the reality of an eating disorder. Instead, recovery needs to lead to open discussions about these medications and to a path to stop these drugs unless they really are necessary. 

Assessing the Labeling of Foods as Healthy or Unhealthy

There is a new government regulation of food labeling that will deem foods healthy or unhealthy. The intent of this new plan is to attempt to persuade people to avoid more processed foods and the illnesses that come from overconsumption of those foods. However, this new tack is a double-edged sword.

The benefit of this agenda is to educate people otherwise unaware of some necessary nutrition facts. One of the few tenets from nutrition studies is that eating too much processed food has long-term health repercussions. The food industry offers tasty, cheap food accessible to everyone without warning against the potential results of eating too much of their products.

The government plans to present warnings to the public about these foods to continue a public health campaign to decrease the power these companies wield over unsuspecting customers. Certainly no one could have predicted the overall success the public health campaign against the very powerful tobacco industry, so why question this initiative.

The difficult question is where to draw the line about labeling foods. For people stuck in an eating disorder or very restrictive eating, labeling is likely to only encourage and sustain the eating disorder symptoms. Labels will only make it harder to change ingrained behaviors around food and very rigid eating. 

Ultimately, the problem with labeling stems from the wide range of disordered eating in our society from the effects of a nefarious food industry to the power of the exercise and diet industries to fuel an obsession with thinness.

Since the companies market differently to different demographics, no government decision will help all sides of the problem.

Perhaps the balanced approach to labeling foods would be to also attempt to regulate the exercise and diet industries, not just the food industry. The industrial wellness complex, as it has been called, needs attention from all sides. Regulating one side may help one set of people while hurting others.