February, 28, 2015
When Phil Werdell, director of Acorn Food Addiction Institute, knocked on the door of the DSM-V committee to propose that food addiction be included as bona fide psychiatric diagnosis, he was turned away. Although he came armed with research papers and a gathering of food addiction service providers claiming to have plenty of clinical experience, he was told that there was not enough yet research yet to prove that food addiction exists.
Clinicians from the eating disorder field, he also learned, put in years of research to achieve the Binge Eating Disorder (BED) recognition and inclusion into the DSM-V. Come back in a few years, the letter from the DSM-V committee read, with clinical research that indicates that food addiction is different and warrants a separate category and diagnosis from disorders like bulimia or binge eating disorder.
But, Werdell sputtered, holding his briefcase containing his bibliography of hundreds of academic papers which described food addiction, what to do for the food addicts who need help now and who knew they were not binge eaters?
Indeed. What to do for the food addicts who need help now?
Werdell, who is a contributor to my book, Food Junkies, and other food addiction service providers in the US had been highly motivated to get the DSM-V inclusion of the food addiction diagnosis into the compendium of diagnoses. Acceptance would mean more research and more funding dollars towards services for the food addict. Until this acceptance occurs, however, these clinicians have an interesting dilemma, which could undo many years of work that food addict advocates have put towards this venture.
With the BED inclusion into the DSM-V, food addiction clinicians are confronted with a crucial decision that may be based on expediency rather than accuracy. Should they make food addiction part of new Binge Eating Disorder (BED) diagnosis, seeking to carve their own little niche from a larger and broader category that comes with recognition and funding potential?
They could easily make the argument that there is a small subset of the BED population who are also food addicts. Indeed, the problem of BED looks similar to the symptoms of food addiction (hence the need to scientifically ferret out the distinctions): rapid and persistent eating, eating large amounts despite lack of hunger, eating alone, having marked distress over eating behaviors. One can typically find all of these behaviors in a food addict. This plea could help a lot of food addicts today.
Or should food addiction clinicians insist that food addiction is a separate disorder that includes many of whom have shown no signs of an eating disorder? People like the alcoholics or drug addict who have substituted food for their substance of choice. Or people who continue to obsess about high-caloric, energy- dense foods to the point of insomnia and anxiety – even if they have not binged or given in to their cravings. Services for these food addicts who are not dually diagnosed with BED are unfunded and would remain in short supply.
The decision “to get into the bed” of a BED service program could fracture the food addiction community. While there are many similarities between the two conditions, there is one critical difference and this determines the radically different solutions between both conditions. For the BED patient, the dynamic behind his or her behavior is psychological and for the food addict, the explanation is in the food – the drug that ignites the eating behavior.
This difference between the two is critical and determines a different solution: Eating disorder professionals insist upon a treatment plan that incorporates a psychological approach (cognitive therapy, behavior modification, mindfulness) to help the suffering patient find a way to eat all foods moderately rather than problematically. Alternatively, food addiction professionals insist on identifying and encouraging abstinence from the foods that are creating the ‘addictive’ response, and once those trigger foods are removed (that is stopped, not curbed or moderated), the problems that might lead a person back to the addictive loop can then be dealt with.
Sadly, this division between the understanding of eating disorders and food addiction is not new. As you can read in my book, Food Junkies, you will see that the division between what drives disordered eating (i.e. the eating behavior itself or the ‘drug’ in the food) is as old as Overeaters Anonymous, which started in the 1960s. It morphed into the social service realm when psychologists and therapists began treating eating disorders and other problematic eating in the 1970s and onwards. And now it has appeared in the psychiatric realm of the DSM-V.
Will food addiction clinicians go for the short-term expedient solution that might help many food addicts today, but weaken the long-term political momentum towards establishing food addiction? Or will they instead maintain the long-term ideological position towards a distinct diagnosis that will in – until that time, if ever — leave food addicts out in the cold?