For those of us working in the field of food addiction, the DSM-1V (Diagnostic and Statistics Manual) has been a poor reflection of our clinical reality. The highly controversial DSM-V, expected to be released in May 2013, may not be much of an improvement for the food addict.
Food addiction is not a medically recognized diagnosis under the DSM-1V schema. This has left dire consequences for the food addict. Without official recognition, treatment for food addiction has not been funded by any insurance provider, nor has it been offered by any major health care provider: nutritionists, dieticians, physicians have not yet recognized its existence nor proposed our recommended treatment (abstinence from triggering addictive foods) as a healthy solution.
We have not been alone in our discontent over this diagnosis tool of the American Psychiatric Association. There has been a great deal of advocacy towards reforming the DSV-1V, and there has been ongoing controversy over the proposed DSM-Vs anticipated changes. Advocates of various hitherto excluded disorders (such as food addicts) have attempted to get their concerns included into the psychiatric cannons of treatment, while others have been eager to challenge the overarching ambition of psychiatry to medicalize (with the implicit intention to treat with pharmaceuticals) much of normal behaviour.
Those working in the eating disorders field have achieved landmark success in getting “Binge Eating Disorder” recognized as a clinical entity that exists apart from Anorexia or Bulimia. This diagnosis may now include persons who suffer from the uncontrollable urge to eat large amounts of food (usually in intermittent sessions) without having to include many of the weight restricting behaviours that bulimics or anorexics engage in, i.e. vomiting, over exercise, use of laxatives. Thus many of those who are obese can now get treatment, outside of bariatric surgery, that can be funded.
Does this help the food addict? The big question is this: Are all food addicts also suffering from binge eating disorders? While there is likely a high degree of overlap in these two groups, indeed many food addicts binge eat when in active addiction, it is important to note that they are NOT necessarily suffering from the same condition of Binge Eating Disorder. They are not the same thing. They may appear to look the same on the outside: a person overeating a large amount of food without control – but the reasons behind this behaviour are fundamentally different. The food addict is dancing to a different drummer, though the tune may look the same.
The person who is suffering from a Binge Eating Disorder is responding to social and emotional psychological cues that have disinhibited the eating behaviour. Something has prompted the person, such as previous emotional trauma stemming from childhood, sexual abuse, or current environmental stresses, to over eat in an attempt to self medicate their emotional distress.
The food addict, alternatively, is responding to the cravings created by the physical quality of food itself. If the food addict does not pick up the first taste of sugar (or any other their trigger foods), they may not need to over eat, regardless of emotional state – calm or distressed, emotional internal or external havoc.These states of mind do not create the overpowering drive to overeat. Certainly emotions can trigger a person to want to eat, but the control is lost truly when the food has ignited the reward pathway in the limbic brain. It is not what is eating you (Binge Eating Disorder), but what you are eating (Food addiction) that is the problem.
This distinction is important. Treatment for a person suffering from the new Binge Eating Disorder category is to heal the depression, anxiety, post traumatic stress, so that the person does not need to self medicate with food or abnormal eating behaviours. Treatments include cognitive therapy, mindfulness and medications. They are taught how to eat all foods moderately, in the hopes that they were join “normal society” once their psychological conditions have been addressed, even resolved. The food addict, on the other hand, will never eat a “normal diet” and while psychological issues are important to sustain long term recovery, the essential first treatment for the food addict is to stop the drug that is creating the loop of addictive eating: sugar, refined starches, other trigger foods. Treatment includes abstinence from the triggering foods, peer support to encourage ongoing vigilance, and often a spiritual dimension needs to be tapped into to maintain long term recovery.
Without a diagnosis of Food Addiction, nothing much has changed with the proposed changes for 2013. We will have many food addicts funnelled under the new categorization of Binge Eating disorder, and they will probably be given treatment that could ultimately undermine their recovery. Modified diets do not work for the food addict. Advances have been made but for food addiction, still more work needs to be done.
I would like to acknowledge the painstaking work of Phil Werdell (see foodaddictioninstititute.org) for his work in lobbying the APA for food addiction’s inclusion into the new DSM-V. He is a true pioneer: far sighted, dedicated and persistent.