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"Addiction" versus "Dependence"
Replies
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The latest MFP blog email had a post on addiction.
5 Steps to Take Control of Food Addiction
Addiction does not always have to involve an addictive substance or drug, as the term can be used to describe an excessive behavior such as compulsive eating. While there are different schools of thought and the scientific literature in the area of food addiction is still in the beginning stages, many experts believe that addiction to food really isn’t about the food.
To elaborate further, foods do not have addictive properties that make someone depend on them, unlike chemical substances. Food addiction has more to do with how a person behaves around food, what they think about food, and the way habits are formed with food. The habits are the real source of the addiction.
Food can become a way to cope with emotional matters, and the repetition of this coping mechanism can breed an addiction. By using food as a means to deal with anxiety, stress, grief, and the like, the body becomes conditioned to crave that process to feel relief.
People often associate pleasure with foods that contain fat, sugar and salt. As innocent as it may seem, this starts at a young age when candy and soda are given as a “treat” or “reward” for good behavior, grades or a celebration. Research studies have shown the reward centers of the brain to light up and release dopamine when pleasurable foods are consumed. Could this be that we’ve conditioned our bodies to react this way?
The Slippery Slope of Food Addiction
Someone doesn’t just decide that he or she wants to feel out of control with food. It’s often a slippery slope that leads a person into an addiction with food. Below are some of the warning signs and common traits among people suffering from a food addiction:
Read more: http://blog.myfitnesspal.com/5-steps-to-take-control-of-food-addiction/2 -
What I have said is that there are those who show up on MFP saying that it's impossible for them to lose weight because they're addicted to sugar. Deny it if you like but it happens frequently.
I never said they have a legitimate excuse (they don't) but they do try to claim their supposed addiction as a valid excuse for why they're overweight.
Again, just so that you don't misunderstand me or forget what I said again:
They try to use their supposed addiction to sugar as an excuse but it is not a legitimate excuse at all, even if it were real.
Claiming an addiction as a reason that they are overweight is completely different than saying that it is impossible to lose weight because they are addicted. A person saying the reason that they're drunk all the time is because they are an alcoholic would not necessarily be incorrect.
That, to me, sounds like an excuse and a bad reason. If someone said that to me I would disagree and call it out as an excuse (precisely what I would say would depend on the context). So maybe we are just coming at this from different places.
(Also, there's no such thing as being addicted to food.)I am still skeptical of the idea that people come unsolicited to weight loss forums to proclaim an excuse for not losing weight. I think the fact that they post it on a forum is an appeal for help rather than a call for absolution.
I've seen many posts that seem to fall in that category. What I think it is is they are being told by people in their life or their internalized understanding of society that they SHOULD lose weight. They feel bad/guilty about not losing weight. They don't feel like they can lose weight, because they aren't ready and don't want to do what they must do (eat less, move more, maybe structure their eating and plan better, stop just eating whatever they feel like and using food for self comfort, etc.), and so they pretend to be trying to lose weight but really just make excuses. I recall one post that was basically: "I am addicted to sugar yet live with my parents (or boyfriend or kids, I forget) so HAVE to have sugary treats around and eat them, but if I didn't have them in the house I'd go out and buy them." That sounds like an excuse--setting herself up for "I tried, but it didn't work, I'm too 'addicted.'"
(I gave advice in that one and did not argue, in accordance with my policy, but I could tell from the first message she was going to run off and was not ready.)0 -
KarenHatch1 wrote: »I can't speak for anyone else, but my experience for the last 50 years or more is one of "food thinking". While everyone else is playing tag football or volleyball at the company picnic, I am eyeballing the food being set out and feeling a bit desperately competitive to get into the line without appearing too eager so I don't miss out on anything. I have eaten many times when I wasn't hungry. If there is leftover food that I like, it occupies my thoughts until it is eaten or out of the house. I have put perfectly good food down the garbage disposal, depriving other family members, rather than have it call to me. If there are goodies at work, I have to stay out of the break room and I am aware, despite being very busy at work, of the food sitting there.
With the exception of dumping the food, I can relate to all of these and had to come up with strategies to deal with and change these things. I don't consider that akin to an addiction. There are some similarities (as both are related to habit in part), but it's still so different.1 -
Calling bad habits addiction seems a really stupid idea to me (it does not shock me that the MFP blog would take this position). Pretty much everything bad that people do is an addiction, then.2
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lemurcat12 wrote: »WinoGelato wrote: »I'm late to the game and so this may have been covered and I missed it, but the OP seems to put things into one of two categories: addiction (in my mind a debilitating and all consuming physiological component) or dependence (relying heavily on a substance or a habit to satisfy a particular need). What I see often in these forums, when a person claims they are addicted to sugar or food, is more of what I would call a behavioral compulsion tied to a very strong craving. Often, if the OP is interested in discussing in detail their particular challenges, it seems that the issues arise in under certain situations (stress, boredom, depression) and are related to a particular food (M&Ms) but not an overarching substance (ie all sugar) which indicates to me neither addiction, nor dependence are the correct terminology for what they are experiencing.
What I usually try to offer with posts like those is to acknowledge that those desires can make the poster feel out of control and like the food has power over them, similar to what an addict describes, but when a person analyzes the situational and emotional triggers they often realize that these are more of a factor than the food itself. To me, it is empowering to acknowledge that the food itself is not addictive, or that they aren't dependent on it; but that they can work through these emotional and habitual triggers and learn to either avoid the food altogether, or eventually learn to moderate it. I don't try to diminish what they are going through, but instead try to offer them some alternatives (Cognitive Behavioral Therapy is a good one for someone who is really struggling with these triggers) so that they may get at the root cause of the issue.
I think that words and the way we use them do matter, and that by letting something slide when someone says they are "addicted to food" or "sugar is worse than heroin" while it may seem harmless, it can in fact perpetuate that person's learned helplessness.
Since I've gotten distracted into rather bizarre tangents (my own fault), I just want to say that this is precisely my own view as well, and thank you for putting it so well.
And yet, no one seems to want to discuss the points I was trying to make in my post.0 -
kshama2001 wrote: »The latest MFP blog email had a post on addiction.
5 Steps to Take Control of Food Addiction
Addiction does not always have to involve an addictive substance or drug, as the term can be used to describe an excessive behavior such as compulsive eating. While there are different schools of thought and the scientific literature in the area of food addiction is still in the beginning stages, many experts believe that addiction to food really isn’t about the food.
To elaborate further, foods do not have addictive properties that make someone depend on them, unlike chemical substances. Food addiction has more to do with how a person behaves around food, what they think about food, and the way habits are formed with food. The habits are the real source of the addiction.
Food can become a way to cope with emotional matters, and the repetition of this coping mechanism can breed an addiction. By using food as a means to deal with anxiety, stress, grief, and the like, the body becomes conditioned to crave that process to feel relief.
People often associate pleasure with foods that contain fat, sugar and salt. As innocent as it may seem, this starts at a young age when candy and soda are given as a “treat” or “reward” for good behavior, grades or a celebration. Research studies have shown the reward centers of the brain to light up and release dopamine when pleasurable foods are consumed. Could this be that we’ve conditioned our bodies to react this way?
The Slippery Slope of Food Addiction
Someone doesn’t just decide that he or she wants to feel out of control with food. It’s often a slippery slope that leads a person into an addiction with food. Below are some of the warning signs and common traits among people suffering from a food addiction:
Read more: http://blog.myfitnesspal.com/5-steps-to-take-control-of-food-addiction/
The blog also posted this lovely assortment of woo, derp and broscience...
http://blog.myfitnesspal.com/67-science-backed-weight-loss-strategies/4 -
Carlos_421 wrote: »kshama2001 wrote: »The latest MFP blog email had a post on addiction.
5 Steps to Take Control of Food Addiction
Addiction does not always have to involve an addictive substance or drug, as the term can be used to describe an excessive behavior such as compulsive eating. While there are different schools of thought and the scientific literature in the area of food addiction is still in the beginning stages, many experts believe that addiction to food really isn’t about the food.
To elaborate further, foods do not have addictive properties that make someone depend on them, unlike chemical substances. Food addiction has more to do with how a person behaves around food, what they think about food, and the way habits are formed with food. The habits are the real source of the addiction.
Food can become a way to cope with emotional matters, and the repetition of this coping mechanism can breed an addiction. By using food as a means to deal with anxiety, stress, grief, and the like, the body becomes conditioned to crave that process to feel relief.
People often associate pleasure with foods that contain fat, sugar and salt. As innocent as it may seem, this starts at a young age when candy and soda are given as a “treat” or “reward” for good behavior, grades or a celebration. Research studies have shown the reward centers of the brain to light up and release dopamine when pleasurable foods are consumed. Could this be that we’ve conditioned our bodies to react this way?
The Slippery Slope of Food Addiction
Someone doesn’t just decide that he or she wants to feel out of control with food. It’s often a slippery slope that leads a person into an addiction with food. Below are some of the warning signs and common traits among people suffering from a food addiction:
Read more: http://blog.myfitnesspal.com/5-steps-to-take-control-of-food-addiction/
The blog also posted this lovely assortment of woo, derp and broscience...
http://blog.myfitnesspal.com/67-science-backed-weight-loss-strategies/
Different author.
Do you have a problem with the content of the link I posted, or just the URL?0 -
What I have said is that there are those who show up on MFP saying that it's impossible for them to lose weight because they're addicted to sugar. Deny it if you like but it happens frequently.
I never said they have a legitimate excuse (they don't) but they do try to claim their supposed addiction as a valid excuse for why they're overweight.
Again, just so that you don't misunderstand me or forget what I said again:
They try to use their supposed addiction to sugar as an excuse but it is not a legitimate excuse at all, even if it were real.
Claiming an addiction as a reason that they are overweight is completely different than saying that it is impossible to lose weight because they are addicted. A person saying the reason that they're drunk all the time is because they are an alcoholic would not necessarily be incorrect. That person saying that they can't get sober because they are an alcoholic would be wrong.
I am still skeptical of the idea that people come unsolicited to weight loss forums to proclaim an excuse for not losing weight. I think the fact that they post it on a forum is an appeal for help rather than a call for absolution.
With the possible exception of the example lemurcat posted, which I would need to reread to be sure, I agree that people starting threads that mention addiction are looking for help rather than absolution and are not disavowing responsibility.2 -
lemurcat12 wrote: »KarenHatch1 wrote: »I can't speak for anyone else, but my experience for the last 50 years or more is one of "food thinking". While everyone else is playing tag football or volleyball at the company picnic, I am eyeballing the food being set out and feeling a bit desperately competitive to get into the line without appearing too eager so I don't miss out on anything. I have eaten many times when I wasn't hungry. If there is leftover food that I like, it occupies my thoughts until it is eaten or out of the house. I have put perfectly good food down the garbage disposal, depriving other family members, rather than have it call to me. If there are goodies at work, I have to stay out of the break room and I am aware, despite being very busy at work, of the food sitting there.
With the exception of dumping the food, I can relate to all of these and had to come up with strategies to deal with and change these things. I don't consider that akin to an addiction. There are some similarities (as both are related to habit in part), but it's still so different.
Lemurcat, Have you been successful in changing your food thinking? If so, please share, as I would like very much to change this thought pattern. As far as I can determine, it started around the age of 4 and worsened during my teen years. I am not obsessive about anything else. My parents and siblings were/are normal and have never had a problem with food or weight. Thanks!1 -
lemurcat12 wrote: »Calling bad habits addiction seems a really stupid idea to me (it does not shock me that the MFP blog would take this position). Pretty much everything bad that people do is an addiction, then.
Maybe I should call it obsession instead of addiction. I do know that some bariatric endocrinologists are using Naltrexone along with other medications for "food thinking".0 -
WinoGelato wrote: »lemurcat12 wrote: »WinoGelato wrote: »I'm late to the game and so this may have been covered and I missed it, but the OP seems to put things into one of two categories: addiction (in my mind a debilitating and all consuming physiological component) or dependence (relying heavily on a substance or a habit to satisfy a particular need). What I see often in these forums, when a person claims they are addicted to sugar or food, is more of what I would call a behavioral compulsion tied to a very strong craving. Often, if the OP is interested in discussing in detail their particular challenges, it seems that the issues arise in under certain situations (stress, boredom, depression) and are related to a particular food (M&Ms) but not an overarching substance (ie all sugar) which indicates to me neither addiction, nor dependence are the correct terminology for what they are experiencing.
What I usually try to offer with posts like those is to acknowledge that those desires can make the poster feel out of control and like the food has power over them, similar to what an addict describes, but when a person analyzes the situational and emotional triggers they often realize that these are more of a factor than the food itself. To me, it is empowering to acknowledge that the food itself is not addictive, or that they aren't dependent on it; but that they can work through these emotional and habitual triggers and learn to either avoid the food altogether, or eventually learn to moderate it. I don't try to diminish what they are going through, but instead try to offer them some alternatives (Cognitive Behavioral Therapy is a good one for someone who is really struggling with these triggers) so that they may get at the root cause of the issue.
I think that words and the way we use them do matter, and that by letting something slide when someone says they are "addicted to food" or "sugar is worse than heroin" while it may seem harmless, it can in fact perpetuate that person's learned helplessness.
Since I've gotten distracted into rather bizarre tangents (my own fault), I just want to say that this is precisely my own view as well, and thank you for putting it so well.
And yet, no one seems to want to discuss the points I was trying to make in my post.
Shush!! You!! I'm in the process of crafting a scientific-y argument NOT ONLY that I am addicted, specifically, to Panera Cinnamon Crunch bagels slathered in honey-walnut cream cheese, and Oreos (but not to that vomitous mass known as "any cookie containing peanut butter"), BUT ALSO that I am addicted to my bed, specifically, on Saturday mornings, cuddled up in all the wonderful snuggly softness when I *could* get my kitten up and take my poor neglected children to the park, or, say, go for a run or do the laundry. Seriously, my bed is worse than crack AND heroin, it is that awesome. The horror...the horror...
Regrettably I am married to a forensic professional in one of the hardest of hard sciences, so I doubt he will be as understanding as the nice friendly therapist who lets me talk about it and weekly extracts a nominal copay and considerable insurance dollars on my addiction counseling. There just happens to be a lot of profit in "perpetuating learned helplessness", and more power to the smart person who can exploit one of Murphy's key laws.2 -
This content has been removed.
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kshama2001 wrote: »Carlos_421 wrote: »kshama2001 wrote: »The latest MFP blog email had a post on addiction.
5 Steps to Take Control of Food Addiction
Addiction does not always have to involve an addictive substance or drug, as the term can be used to describe an excessive behavior such as compulsive eating. While there are different schools of thought and the scientific literature in the area of food addiction is still in the beginning stages, many experts believe that addiction to food really isn’t about the food.
To elaborate further, foods do not have addictive properties that make someone depend on them, unlike chemical substances. Food addiction has more to do with how a person behaves around food, what they think about food, and the way habits are formed with food. The habits are the real source of the addiction.
Food can become a way to cope with emotional matters, and the repetition of this coping mechanism can breed an addiction. By using food as a means to deal with anxiety, stress, grief, and the like, the body becomes conditioned to crave that process to feel relief.
People often associate pleasure with foods that contain fat, sugar and salt. As innocent as it may seem, this starts at a young age when candy and soda are given as a “treat” or “reward” for good behavior, grades or a celebration. Research studies have shown the reward centers of the brain to light up and release dopamine when pleasurable foods are consumed. Could this be that we’ve conditioned our bodies to react this way?
The Slippery Slope of Food Addiction
Someone doesn’t just decide that he or she wants to feel out of control with food. It’s often a slippery slope that leads a person into an addiction with food. Below are some of the warning signs and common traits among people suffering from a food addiction:
Read more: http://blog.myfitnesspal.com/5-steps-to-take-control-of-food-addiction/
The blog also posted this lovely assortment of woo, derp and broscience...
http://blog.myfitnesspal.com/67-science-backed-weight-loss-strategies/
Different author.
Do you have a problem with the content of the link I posted, or just the URL?
I have a problem with the content. Replace "food addiction" with "eating addiction" and some of my objections go away, but I also struggle with the presentation. Yes, we do reward ourselves with palatable foods, but just because we celebrate birthdays with cake doesn't mean we're in danger of becoming addicted to cake. I also am bothered by the "checklist" they give as signs of "food addiction" since a lot of people could diagnose themselves as "food addicts" when there's many other explanations for their behaviors and feelings. That list:
Changes in mood - may or may not be associated with food at all, moods are complex
Labeling food as “good” and “bad” - happens commonly because foods are presented as "good" and "bad" in the media
Restrictive dieting - happens commonly because we're told we must do this to lose weight
Eating in secret or sneaking food - is a sign of disordered eating that should be addressed
Feeling out of control with food - may or may not be a sign of disordered eating; dependent on circumstances and length of issue
Rewarding/treating yourself with food - culturally common
Thinking about food all the time - may or may not be eating addiction; intensity of thoughts/context of calorie intake not discussed
Feeling unsatisfied even after meal times - was the meal nutritionally balanced and aligned with cravings?
Weight fluctuations and/or difficulty managing weight - lack of accurate tracking, medical conditions
Body dissatisfaction - reinforced by media
Feeling disgusted, guilty or upset after eating - related to all eating disorders, not specific to eating addiction
Feeling stressed or tension that is only relieved by eating - sign of disordered eating, assuming no calorie deficit
If most or all of these apply and you're not in a significant calorie deficit, then yes, eating addiction is certainly possible. But if you're a Cosmo-reading woman with 30 lbs to lose going "OMG I feel dissatisfaction with my body and diet restrictively! I must be a food addict!" ...Nope.
We get in the habits of eating certain foods. But within 2-3 weeks of adherence, most people can change those habits and our cravings. The adherence is the hard part, and this comes back to availability - it's a mental struggle to not eat the bagels in the break room and the candy your mom leaves sitting out when you're used to doing it, and these habit foods are available to us all the time. But it would also be a mental struggle for me to not brush my teeth every day. Habits and patterns do not make an addiction.
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“An addiction is present when the need for something is so great that a person obsesses over it, and it begins to interfere with their daily living,” says Dr. Maleeha Ahsan, a psychiatrist with Advocate Good Samaritan Hospital in Downers Grove, Ill.
The American Psychological Association further defines addiction as having two stages:
Dependence – We cannot go about our day without said substance or habits.
Tolerance – In the case of drug addiction, tolerance is the stage at which larger doses of the drug are needed for the same effect. With behaviors this can mean obsessing over something more and more.
---
Now, if we really want to delve into what behavioral addiction is or isn't, and when does it cross from a habit to an addiction, here's an article that seems like it will make some good debate fodder:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354400/
"Behavioral addictions such as gambling, overeating, television compulsion, and internet addiction are similar to drug addiction except that the individual is not addicted to a substance, but he/she is addicted to the behavior or the feeling experienced by acting out the behavior...However, the physical signs of drug addiction are absent in behavioral addiction.[19] One of the precursors of behavioral addiction is the presence of psychopathologies such as depression, substance dependence or withdrawal, and social anxiety as well as a lack of social support."4 -
mskessler89 wrote: »kshama2001 wrote: »Carlos_421 wrote: »kshama2001 wrote: »The latest MFP blog email had a post on addiction.
5 Steps to Take Control of Food Addiction
Addiction does not always have to involve an addictive substance or drug, as the term can be used to describe an excessive behavior such as compulsive eating. While there are different schools of thought and the scientific literature in the area of food addiction is still in the beginning stages, many experts believe that addiction to food really isn’t about the food.
To elaborate further, foods do not have addictive properties that make someone depend on them, unlike chemical substances. Food addiction has more to do with how a person behaves around food, what they think about food, and the way habits are formed with food. The habits are the real source of the addiction.
Food can become a way to cope with emotional matters, and the repetition of this coping mechanism can breed an addiction. By using food as a means to deal with anxiety, stress, grief, and the like, the body becomes conditioned to crave that process to feel relief.
People often associate pleasure with foods that contain fat, sugar and salt. As innocent as it may seem, this starts at a young age when candy and soda are given as a “treat” or “reward” for good behavior, grades or a celebration. Research studies have shown the reward centers of the brain to light up and release dopamine when pleasurable foods are consumed. Could this be that we’ve conditioned our bodies to react this way?
The Slippery Slope of Food Addiction
Someone doesn’t just decide that he or she wants to feel out of control with food. It’s often a slippery slope that leads a person into an addiction with food. Below are some of the warning signs and common traits among people suffering from a food addiction:
Read more: http://blog.myfitnesspal.com/5-steps-to-take-control-of-food-addiction/
The blog also posted this lovely assortment of woo, derp and broscience...
http://blog.myfitnesspal.com/67-science-backed-weight-loss-strategies/
Different author.
Do you have a problem with the content of the link I posted, or just the URL?
I have a problem with the content. Replace "food addiction" with "eating addiction" and some of my objections go away, but I also struggle with the presentation. Yes, we do reward ourselves with palatable foods, but just because we celebrate birthdays with cake doesn't mean we're in danger of becoming addicted to cake. I also am bothered by the "checklist" they give as signs of "food addiction" since a lot of people could diagnose themselves as "food addicts" when there's many other explanations for their behaviors and feelings. That list:
Changes in mood - may or may not be associated with food at all, moods are complex
Labeling food as “good” and “bad” - happens commonly because foods are presented as "good" and "bad" in the media
Restrictive dieting - happens commonly because we're told we must do this to lose weight
Eating in secret or sneaking food - is a sign of disordered eating that should be addressed
Feeling out of control with food - may or may not be a sign of disordered eating; dependent on circumstances and length of issue
Rewarding/treating yourself with food - culturally common
Thinking about food all the time - may or may not be eating addiction; intensity of thoughts/context of calorie intake not discussed
Feeling unsatisfied even after meal times - was the meal nutritionally balanced and aligned with cravings?
Weight fluctuations and/or difficulty managing weight - lack of accurate tracking, medical conditions
Body dissatisfaction - reinforced by media
Feeling disgusted, guilty or upset after eating - related to all eating disorders, not specific to eating addiction
Feeling stressed or tension that is only relieved by eating - sign of disordered eating, assuming no calorie deficit
If most or all of these apply and you're not in a significant calorie deficit, then yes, eating addiction is certainly possible. But if you're a Cosmo-reading woman with 30 lbs to lose going "OMG I feel dissatisfaction with my body and diet restrictively! I must be a food addict!" ...Nope.
We get in the habits of eating certain foods. But within 2-3 weeks of adherence, most people can change those habits and our cravings. The adherence is the hard part, and this comes back to availability - it's a mental struggle to not eat the bagels in the break room and the candy your mom leaves sitting out when you're used to doing it, and these habit foods are available to us all the time. But it would also be a mental struggle for me to not brush my teeth every day. Habits and patterns do not make an addiction.
---
“An addiction is present when the need for something is so great that a person obsesses over it, and it begins to interfere with their daily living,” says Dr. Maleeha Ahsan, a psychiatrist with Advocate Good Samaritan Hospital in Downers Grove, Ill.
The American Psychological Association further defines addiction as having two stages:
Dependence – We cannot go about our day without said substance or habits.
Tolerance – In the case of drug addiction, tolerance is the stage at which larger doses of the drug are needed for the same effect. With behaviors this can mean obsessing over something more and more.
---
Now, if we really want to delve into what behavioral addiction is or isn't, and when does it cross from a habit to an addiction, here's an article that seems like it will make some good debate fodder:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354400/
"Behavioral addictions such as gambling, overeating, television compulsion, and internet addiction are similar to drug addiction except that the individual is not addicted to a substance, but he/she is addicted to the behavior or the feeling experienced by acting out the behavior...However, the physical signs of drug addiction are absent in behavioral addiction.[19] One of the precursors of behavioral addiction is the presence of psychopathologies such as depression, substance dependence or withdrawal, and social anxiety as well as a lack of social support."
Word.
I share the same issues with the content of the article.
I was also pointing out that just because something makes it onto the MFP blog doesn't mean it's not a bunch of bologna.3 -
My most recent source for the definitions I provided come from the U.S. NIH National Institute on Drug Abuse. I suppose I probably first learned the distinction in Undergrad and/or grad school.
These definitions are NOT diagnoses. When assessing someone with alcohol issues, I too would use 303.9 when the individual met the criteria. Probably more often I used Alcohol Abuse (305.00).
If the primary issue was eating-disorder related, I would refer to a specialized program.
I worked in a clinical setting for about fifteen years total; mostly in a psychiatric partial hospitalization program. I ran the program for 6 1/2 of those years. Obviously this is not something I can prove on an internet board; so people can chose to believe what they wish.
What is perplexing about the definitions of abuse and dependence? Do you believe them to be incorrect?
I am not sure I know what it means to be "perplexed on a clinical level."
2 -
I often see someone post that he or she is addicted to a food. When this happens, someone invariably responds with something like ________ addiction is "not a thing." (I suppose sugar is the most common example.)
When this happens, the person responding is confounding two related but different clinical concepts.
ADDICTION occurs when someone carves something so strongly that they consume the substance, or repeat the behavior, even when that substance or behavior is doing substantial harm. Note that the craving alone does not suggest an addiction. It is the inability to fight off this craving even though satisfying the craving causes damage.
Physical DEPENDENCE occurs when someone would experience withdrawal symptoms when stopping the substance. (In many cases, the user will also build tolerance over time, and need more of the substance to be satisfied._ In the case of drug dependence, withdrawal can even be life threatening. In other situations, such as caffeine, for example, withdrawal may mean a couple days of headaches.
A person can, of course, be addicted AND dependent. Drug addiction often falls into this category. But a person can be addicted and NOT dependent. There is, for example, extensive psychiatric literature on the treatment of gambling addiction. Obviously, physical dependence does not play a role here.
Dependence can occur without an addiction. I know many people who consumer caffeine daily in moderation who would get mild withdrawal headaches if they were to stop. Nevertheless, their pattern of use does not suggest they are doing themselves harm, so there is no addiction present.
So when someone says they are addicted to food, I am disinclined to immediately correct them. When people post this, they are not usually asking for their definitions to be corrected. They are usually seeking strategies to avoid overindulging.
Hmm.
Since you mentioned the two clinical definitions of addiction and dependence...I have to ask:
What is the clinical definition of addiction (not dependence) and the diagnostic criteria you use to make that diagnosis?
When I spent almost a decade as a clinician and someone came in who was an alcoholic aka addicted to alcohol...I diagnosed them as Alcohol Dependence 303.90. What clinical criteria, not a layman's terminology are you using to define addiction?
I someone came in and defined themselves as a food addict, I would gather their described symptoms and then look for a diagnosis along the eating disorder categories or see if the dysfunctional food behaviors may be a symptom of another disorder.
Thanks in advance for clarifying as the initial post left me perplexed on a clinical level.
Sorry, I should have quoted the post to which I was responding above.0 -
My most recent source for the definitions I provided come from the U.S. NIH National Institute on Drug Abuse. I suppose I probably first learned the distinction in Undergrad and/or grad school.
These definitions are NOT diagnoses. When assessing someone with alcohol issues, I too would use 303.9 when the individual met the criteria. Probably more often I used Alcohol Abuse (305.00).
If the primary issue was eating-disorder related, I would refer to a specialized program.
I worked in a clinical setting for about fifteen years total; mostly in a psychiatric partial hospitalization program. I ran the program for 6 1/2 of those years. Obviously this is not something I can prove on an internet board; so people can chose to believe what they wish.
What is perplexing about the definitions of abuse and dependence? Do you believe them to be incorrect?
I am not sure I know what it means to be "perplexed on a clinical level."
If the general definition exists, yet no one will ever be diagnosed as having a food addiction, (because DSM does not define food addiction specifically), where does this land us?0 -
Carlos_421 wrote: »mskessler89 wrote: »kshama2001 wrote: »Carlos_421 wrote: »kshama2001 wrote: »The latest MFP blog email had a post on addiction.
5 Steps to Take Control of Food Addiction
Addiction does not always have to involve an addictive substance or drug, as the term can be used to describe an excessive behavior such as compulsive eating. While there are different schools of thought and the scientific literature in the area of food addiction is still in the beginning stages, many experts believe that addiction to food really isn’t about the food.
To elaborate further, foods do not have addictive properties that make someone depend on them, unlike chemical substances. Food addiction has more to do with how a person behaves around food, what they think about food, and the way habits are formed with food. The habits are the real source of the addiction.
Food can become a way to cope with emotional matters, and the repetition of this coping mechanism can breed an addiction. By using food as a means to deal with anxiety, stress, grief, and the like, the body becomes conditioned to crave that process to feel relief.
People often associate pleasure with foods that contain fat, sugar and salt. As innocent as it may seem, this starts at a young age when candy and soda are given as a “treat” or “reward” for good behavior, grades or a celebration. Research studies have shown the reward centers of the brain to light up and release dopamine when pleasurable foods are consumed. Could this be that we’ve conditioned our bodies to react this way?
The Slippery Slope of Food Addiction
Someone doesn’t just decide that he or she wants to feel out of control with food. It’s often a slippery slope that leads a person into an addiction with food. Below are some of the warning signs and common traits among people suffering from a food addiction:
Read more: http://blog.myfitnesspal.com/5-steps-to-take-control-of-food-addiction/
The blog also posted this lovely assortment of woo, derp and broscience...
http://blog.myfitnesspal.com/67-science-backed-weight-loss-strategies/
Different author.
Do you have a problem with the content of the link I posted, or just the URL?
I have a problem with the content. Replace "food addiction" with "eating addiction" and some of my objections go away, but I also struggle with the presentation. Yes, we do reward ourselves with palatable foods, but just because we celebrate birthdays with cake doesn't mean we're in danger of becoming addicted to cake. I also am bothered by the "checklist" they give as signs of "food addiction" since a lot of people could diagnose themselves as "food addicts" when there's many other explanations for their behaviors and feelings. That list:
Changes in mood - may or may not be associated with food at all, moods are complex
Labeling food as “good” and “bad” - happens commonly because foods are presented as "good" and "bad" in the media
Restrictive dieting - happens commonly because we're told we must do this to lose weight
Eating in secret or sneaking food - is a sign of disordered eating that should be addressed
Feeling out of control with food - may or may not be a sign of disordered eating; dependent on circumstances and length of issue
Rewarding/treating yourself with food - culturally common
Thinking about food all the time - may or may not be eating addiction; intensity of thoughts/context of calorie intake not discussed
Feeling unsatisfied even after meal times - was the meal nutritionally balanced and aligned with cravings?
Weight fluctuations and/or difficulty managing weight - lack of accurate tracking, medical conditions
Body dissatisfaction - reinforced by media
Feeling disgusted, guilty or upset after eating - related to all eating disorders, not specific to eating addiction
Feeling stressed or tension that is only relieved by eating - sign of disordered eating, assuming no calorie deficit
If most or all of these apply and you're not in a significant calorie deficit, then yes, eating addiction is certainly possible. But if you're a Cosmo-reading woman with 30 lbs to lose going "OMG I feel dissatisfaction with my body and diet restrictively! I must be a food addict!" ...Nope.
We get in the habits of eating certain foods. But within 2-3 weeks of adherence, most people can change those habits and our cravings. The adherence is the hard part, and this comes back to availability - it's a mental struggle to not eat the bagels in the break room and the candy your mom leaves sitting out when you're used to doing it, and these habit foods are available to us all the time. But it would also be a mental struggle for me to not brush my teeth every day. Habits and patterns do not make an addiction.
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“An addiction is present when the need for something is so great that a person obsesses over it, and it begins to interfere with their daily living,” says Dr. Maleeha Ahsan, a psychiatrist with Advocate Good Samaritan Hospital in Downers Grove, Ill.
The American Psychological Association further defines addiction as having two stages:
Dependence – We cannot go about our day without said substance or habits.
Tolerance – In the case of drug addiction, tolerance is the stage at which larger doses of the drug are needed for the same effect. With behaviors this can mean obsessing over something more and more.
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Now, if we really want to delve into what behavioral addiction is or isn't, and when does it cross from a habit to an addiction, here's an article that seems like it will make some good debate fodder:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354400/
"Behavioral addictions such as gambling, overeating, television compulsion, and internet addiction are similar to drug addiction except that the individual is not addicted to a substance, but he/she is addicted to the behavior or the feeling experienced by acting out the behavior...However, the physical signs of drug addiction are absent in behavioral addiction.[19] One of the precursors of behavioral addiction is the presence of psychopathologies such as depression, substance dependence or withdrawal, and social anxiety as well as a lack of social support."
Word.
I share the same issues with the content of the article.
I was also pointing out that just because something makes it onto the MFP blog doesn't mean it's not a bunch of bologna.
So much this.
I've never seen more derp-filled-yet-trying-to-be-credible drivel anywhere.
Except maybe Facebook.
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goldthistime wrote: »My most recent source for the definitions I provided come from the U.S. NIH National Institute on Drug Abuse. I suppose I probably first learned the distinction in Undergrad and/or grad school.
These definitions are NOT diagnoses. When assessing someone with alcohol issues, I too would use 303.9 when the individual met the criteria. Probably more often I used Alcohol Abuse (305.00).
If the primary issue was eating-disorder related, I would refer to a specialized program.
I worked in a clinical setting for about fifteen years total; mostly in a psychiatric partial hospitalization program. I ran the program for 6 1/2 of those years. Obviously this is not something I can prove on an internet board; so people can chose to believe what they wish.
What is perplexing about the definitions of abuse and dependence? Do you believe them to be incorrect?
I am not sure I know what it means to be "perplexed on a clinical level."
If the general definition exists, yet no one will ever be diagnosed as having a food addiction, (because DSM does not define food addiction specifically), where does this land us?
For someone needing treatment, the available eating disorder would likely apply (i.e. binge eating disorder). Similarly, the existence of gambling addictions is widely acknowledged, but the applicable DSM V diagnosis is, I believe, "Gambling Disorder."
Clinicians do assess for food addiction.
For those interested, here is a link to the Yale Food Addiction Scale: http://fastlab.psych.lsa.umich.edu/yale-food-addiction-scale/.
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KarenHatch1 wrote: »lemurcat12 wrote: »KarenHatch1 wrote: »I can't speak for anyone else, but my experience for the last 50 years or more is one of "food thinking". While everyone else is playing tag football or volleyball at the company picnic, I am eyeballing the food being set out and feeling a bit desperately competitive to get into the line without appearing too eager so I don't miss out on anything. I have eaten many times when I wasn't hungry. If there is leftover food that I like, it occupies my thoughts until it is eaten or out of the house. I have put perfectly good food down the garbage disposal, depriving other family members, rather than have it call to me. If there are goodies at work, I have to stay out of the break room and I am aware, despite being very busy at work, of the food sitting there.
With the exception of dumping the food, I can relate to all of these and had to come up with strategies to deal with and change these things. I don't consider that akin to an addiction. There are some similarities (as both are related to habit in part), but it's still so different.
Lemurcat, Have you been successful in changing your food thinking? If so, please share, as I would like very much to change this thought pattern. As far as I can determine, it started around the age of 4 and worsened during my teen years. I am not obsessive about anything else. My parents and siblings were/are normal and have never had a problem with food or weight. Thanks!
Mostly, although I can certainly still fall back into bad patterns.
What's helped me the most is rechannelling it and having a plan and strict schedule.
When I first started, I was super motivated, and that helped. I initially assumed that with stuff like emotional eating and food at work calling to me I'd have to break my attraction to those foods, so I started with a strict no added sugar/paleo-esque thing, and while I don't really recommend that it gave me something different to focus on so when I'd want something it was easy to say "not part of how I eat" but think about how to meet the cravings with other acceptable options. I was just really excited to have a plan so I was able to obsess about my plan instead of food--if I wanted to think about food I'd plan a recipe or dinner or think about what tastes I wanted to recreate. When I had those feelings/obsessions, I'd also journal or (if possible) forced myself to go workout or something. Like if I was at the picnic I'd force myself to get busy with other things and try and lose myself in those. I'd say "I'll do this" (work on something, or do an activity) and then I can see how I feel.
But what ultimately turned out to be even more significant is that I had to plan out my eating since I was doing 1250 calories. I therefore was eating three set meals, and dealt with wanting to eat between them with raw vegetables and planning for later meals and just journaling (not really hungry, why do I want to eat?). What I learned from this is that I eat according to schedule really easily -- if I allow myself to graze I will misuse food and be thinking about what's available and if I can grab something without anyone noticing that I'm eating it or how much I can eat without it seeming excessive -- pretty disordered kinds of thoughts. If I eat according to schedule I tend to not think about foods at non eating times.
Doing this has helped a lot even at home. I can keep ice cream no problem, since I know I eat it after dinner in a serving size. More will be available tomorrow. Baked goods are harder, since my mind starts going into "they will go bad, they will go bad," so I make them when there's a group, or if I have leftovers bring them to work, or I wait for special occasions and plan so I can eat what I like.
I've found that if I let myself graze the thoughts come back. It's really habit-oriented, plus using food for pleasure and a personal issue with "if some is good more is better," plus it all being tied up in feeling judged for what I eat so wanting to get away with eating without being caught which tends to channel it into sneaky thoughts which I think plays into the obsession. Really one thing I learned from quitting booze (which has some overlapping issues even though to me it's not the same) is a commitment to not falling into that trap of secrecy. I am going to think about food super logically and log what I eat (when in those patterns) and eat openly. (I still struggle with this sometimes, as even though I've lost the weight I think people are thinking "she's going to get fat again" every time I eat a cookie or something.)
Ugh, there's more to it, but that's a start.3 -
lemurcat12 wrote: »I was just really excited to have a plan so I was able to obsess about my plan instead of food--if I wanted to think about food I'd plan a recipe or dinner or think about what tastes I wanted to recreate. When I had those feelings/obsessions, I'd also journal or (if possible) forced myself to go workout or something. Like if I was at the picnic I'd force myself to get busy with other things and try and lose myself in those. I'd say "I'll do this" (work on something, or do an activity) and then I can see how I feel.
I've also struggled with thinking about food all the time. I'm trying to get it under more control using similar techniques as you described. I would say that the delaying technique ("I can put this off for a while if I do something else to distract myself.") is super helpful for me! I learned to do that as a money technique originally, to help my stay within my budget. I find that if I tell myself that I can indulge in something later, I'll lose interest by the time "later" comes around.
@KarenHatch1 Good luck!
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@lemurcat12 @gnarlykickflip Thank you. Both of your posts really resonate with me. It does help me to calm down to remind myself that there will always be donuts or sub sandwiches or chips or carrot cake or whatever. It's not like I will never get to eat those things again. Sometimes I pretend that all the food in the break room has botulism or E. coli! LOL!2
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lemurcat12 wrote: »
Claiming an addiction as a reason that they are overweight is completely different than saying that it is impossible to lose weight because they are addicted. A person saying the reason that they're drunk all the time is because they are an alcoholic would not necessarily be incorrect.
That, to me, sounds like an excuse and a bad reason. If someone said that to me I would disagree and call it out as an excuse (precisely what I would say would depend on the context). So maybe we are just coming at this from different places.
(Also, there's no such thing as being addicted to food.)
A reason is not an excuse. Perhaps my point would be better illustrated if someone were to say the reason they are unable to drink is because they are an alcoholic. Would you call that out as an excuse?
(There are behavioral addictions related to eating food.)
I think maybe we must bring our own projections into our interpretations because I read more into that.I am still skeptical of the idea that people come unsolicited to weight loss forums to proclaim an excuse for not losing weight. I think the fact that they post it on a forum is an appeal for help rather than a call for absolution.
I've seen many posts that seem to fall in that category. What I think it is is they are being told by people in their life or their internalized understanding of society that they SHOULD lose weight. They feel bad/guilty about not losing weight. They don't feel like they can lose weight, because they aren't ready and don't want to do what they must do (eat less, move more, maybe structure their eating and plan better, stop just eating whatever they feel like and using food for self comfort, etc.), and so they pretend to be trying to lose weight but really just make excuses. I recall one post that was basically: "I am addicted to sugar yet live with my parents (or boyfriend or kids, I forget) so HAVE to have sugary treats around and eat them, but if I didn't have them in the house I'd go out and buy them." That sounds like an excuse--setting herself up for "I tried, but it didn't work, I'm too 'addicted.'"
(I gave advice in that one and did not argue, in accordance with my policy, but I could tell from the first message she was going to run off and was not ready.)
My interpretation:I am addicted to sugar yet live with my parents (or boyfriend or kids, I forget) so HAVE to have sugary treats around and eat themI know I am addicted, so I would solve that issue by getting it out of my house, but I can't really do that because I live with other non-addicted people.
My interpretation:but if I didn't have them in the house I'd go out and buy themBut who am I kidding, even if they weren't in the house, I would go out and buy it.
To me, that sounds like the presentation of a problem as a preface to a request.4 -
goldthistime wrote: »My most recent source for the definitions I provided come from the U.S. NIH National Institute on Drug Abuse. I suppose I probably first learned the distinction in Undergrad and/or grad school.
These definitions are NOT diagnoses. When assessing someone with alcohol issues, I too would use 303.9 when the individual met the criteria. Probably more often I used Alcohol Abuse (305.00).
If the primary issue was eating-disorder related, I would refer to a specialized program.
I worked in a clinical setting for about fifteen years total; mostly in a psychiatric partial hospitalization program. I ran the program for 6 1/2 of those years. Obviously this is not something I can prove on an internet board; so people can chose to believe what they wish.
What is perplexing about the definitions of abuse and dependence? Do you believe them to be incorrect?
I am not sure I know what it means to be "perplexed on a clinical level."
If the general definition exists, yet no one will ever be diagnosed as having a food addiction, (because DSM does not define food addiction specifically), where does this land us?
For someone needing treatment, the available eating disorder would likely apply (i.e. binge eating disorder). Similarly, the existence of gambling addictions is widely acknowledged, but the applicable DSM V diagnosis is, I believe, "Gambling Disorder."
Clinicians do assess for food addiction.
For those interested, here is a link to the Yale Food Addiction Scale: http://fastlab.psych.lsa.umich.edu/yale-food-addiction-scale/.
Fascinating stuff. I cut and pasted from the Excel spreadsheet the diagnostic criteria questions if anyone is interested.
1. I find that when I start eating certain foods, I end up eating much more than planned.
2. I find myself continuing to consume certain foods even though I am no longer hungry.
3. I eat to the point where I feel physically ill.
4. Not eating certain types of food or cutting down on certain types of food is something I worry about.
5. I spend a lot of time feeling sluggish or fatigued from overeating.
6. I find myself constantly eating certain foods throughout the day.
7. I find that when certain foods are not available, I will go out of my way to obtain them. For example, I will drive to the store to purchase certain foods even though I have other options available to me at home.
8. There have been times when I consumed certain foods so often or in such large quantities that I started to eat food instead of working, spending time with my family or friends, or engaging in other important activities or recreational activities I enjoy.
9. There have been times when I consumed certain foods so often or in such large quantities that I spent time dealing with negative feelings from overeating instead of working, spending time with my family or friends, or engaging in other important activities or recreational activities I enjoy.
10. There have been times when I avoided professional or social situations where certain foods were available because I was afraid I would overeat.
11. There have been times when I avoided professional or social situations because I was not able to consume certain foods there.
12. I have had withdrawal symptoms such as agitation, anxiety, or other physical symptoms when I cut down or stopped eating certain foods. (Please do NOT include withdrawal symptoms caused by cutting down on caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)
13. I have consumed certain foods to prevent feelings of anxiety, agitation, or other physical symptoms that were developing. (Please do NOT include consumption of caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)
14. I have found that I have elevated desire for or urges to consume certain foods when I cut down or stop eating them.
15. My behavior with respect to food and eating causes significant distress.
16. I experience significant problems in my ability to function effectively (daily routine, job/school, social activities, family activities, health difficulties) because of food and eating.
17. My food consumption has caused significant psychological problems such as depression, anxiety, self-loathing, or guilt.
18. My food consumption has caused significant physical problems or made a physical problem worse.
19. I kept consuming the same types of food or the same amount of food even though I was having emotional and/or physical problems.
20. Over time, I have found that I need to eat more and more to get the feeling I want, such as reduced negative emotions or increased pleasure.
21. I have found that eating the same amount of food does not reduce my negative emotions or increase pleasurable feelings the way it used to.
22. I want to cut down or stop eating certain kinds of food.
24. I have tried to cut down or stop eating certain kinds of food.
25. I have been successful at cutting down or not eating these kinds of food.
27. How many times in the past year did you try to cut down or stop eating certain foods altogether?
The scale questions fall under specific criteria that resemble the symptoms for substance dependence as stated in the Diagnostic and Statistical Manual of Mental Disorders IV-R and operationalized in the Structured Clinical Interview for DSM-IV Axis I Disorders.
1) Substance taken in larger amount and for longer period than intended Questions #1, #2, #3
2) Persistent desire or repeated unsuccessful attempts to quit Questions #4, #22, # 24, #25 3) Much time/activity to obtain, use, recover Questions #5, #6, #7
4) Important social, occupational, or recreational activities given up or reduced Questions #8, #9, #10, #11
5) Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous) Question #19
6) Tolerance (marked increase in amount; marked decrease in effect) Questions #20, #21
7) Characteristic withdrawal symptoms; substance taken to relieve withdrawal Questions #12, #13, #14
8) Use causes clinically significant impairment or distress Questions #15, #16
I didn't include the actual scoring information because I'm not so sure that we want to assist people in self diagnosing, but I thought the specific questions were important to our discussion.
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This content has been removed.
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Carlos_421 wrote: »Word.
I share the same issues with the content of the article.
I was also pointing out that just because something makes it onto the MFP blog doesn't mean it's not a bunch of bologna.
Agreed.
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goldthistime wrote: »Fascinating stuff. I cut and pasted from the Excel spreadsheet the diagnostic criteria questions if anyone is interested.
Thanks. That's an interesting list.0 -
My next question was whether YFAS is considered to be valid by the scientific community. Here is the first link:
http://www.sciencedirect.com/science/article/pii/S1471015313000032
The Yale Food Addiction Scale (YFAS), recently validated in college students and binge eaters, is a means to assess “food addiction” in accordance with DSM-IV criteria for substance dependence. Using online survey methodology, we aimed to validate the use of the YFAS among weight loss surgery (WLS) patients. Participants completed measures about pre-WLS food addiction (YFAS), emotional and binge eating, behavioral activation and inhibition, and pre- and post-WLS substance use. A sample of 67 WLS patients (59.7% Roux-en-Y) was recruited; participants were 62.7% female, 86.6% Caucasian, had a mean age of 42.7; and 53.7% met the criteria for pre-WLS food addiction. Convergent validity was found between the YFAS and measures of emotional eating (r = .368, p < .05) and binge eating (r = .469, p < .05). Discriminant validity was supported in that problematic substance use, behavioral activation, and behavioral inhibition were not associated with YFAS scores. Incremental validity was supported in that the YFAS explained a significant proportion of additional variance in binge eating scores, beyond that predicted by emotional eating (EES) and disordered eating behavior (EAT-26). Those meeting the food addiction criteria had poorer percent total weight loss outcomes (32% vs. 27%). There was a nonsignificant trend towards those with higher food addiction being more likely to admit to post-WLS problematic substance use (i.e., potential “addiction transfer”; 53% vs. 39%). Results support the use of the YFAS as a valid measure of food addiction among WLS patients. Future research with a larger sample may shed light on potentially important relationships between pre-surgical food addiction and both weight and substance use outcomes.3 -
And another, though I won't bother cutting and pasting the abstract this time. http://www.ncbi.nlm.nih.gov/pubmed/19121351
I should note that all of this is from 2009, and in 2010 I saw a review asking whether Food Addiction was true or false (in other words the fact that YFAS exists is not proof positive that Food Addiction exists).
Lastly, this 2014 discussion http://www.ncbi.nlm.nih.gov/pubmed/25205078 says what people like lemurcat12 already seemed to know, '"Eating addiction", rather than "food addiction", better captures addictive-like eating behavior'.
Here is the abstract:
"Food addiction" has become a focus of interest for researchers attempting to explain certain processes and/or behaviors that may contribute to the development of obesity. Although the scientific discussion on "food addiction" is in its nascent stage, it has potentially important implications for treatment and prevention strategies. As such, it is important to critically reflect on the appropriateness of the term "food addiction", which combines the concepts of "substance-based" and behavioral addiction. The currently available evidence for a substance-based food addiction is poor, partly because systematic clinical and translational studies are still at an early stage. We do however view both animal and existing human data as consistent with the existence of addictive eating behavior. Accordingly, we stress that similar to other behaviors eating can become an addiction in thus predisposed individuals under specific environmental circumstances. Here, we introduce current diagnostic and neurobiological concepts of substance-related and non-substance-related addictive disorders, and highlight the similarities and dissimilarities between addiction and overeating. We conclude that "food addiction" is a misnomer because of the ambiguous connotation of a substance-related phenomenon. We instead propose the term "eating addiction" to underscore the behavioral addiction to eating; future research should attempt to define the diagnostic criteria for an eating addiction, for which DSM-5 now offers an umbrella via the introduction on Non-Substance-Related Disorders within the category Substance-Related and Addictive Disorders.1 -
My most recent source for the definitions I provided come from the U.S. NIH National Institute on Drug Abuse. I suppose I probably first learned the distinction in Undergrad and/or grad school.
These definitions are NOT diagnoses. When assessing someone with alcohol issues, I too would use 303.9 when the individual met the criteria. Probably more often I used Alcohol Abuse (305.00).
If the primary issue was eating-disorder related, I would refer to a specialized program.
I worked in a clinical setting for about fifteen years total; mostly in a psychiatric partial hospitalization program. I ran the program for 6 1/2 of those years. Obviously this is not something I can prove on an internet board; so people can chose to believe what they wish.
What is perplexing about the definitions of abuse and dependence? Do you believe them to be incorrect?
I am not sure I know what it means to be "perplexed on a clinical level."
Perplexed on a clinical level because you referenced the clinical definition of addiction vs dependence. I know the clinical definitions of abuse and dependence, but not for addiction. I have always found when medical providers are discussing addiction it is at a layman's level and they are really describing dependence.
I asked you to define how you would clinically define it since your whole post was about addiction vs dependence and you referenced both in the clinical sense. That is how I was perplexed and why I asked. In my clinical training and experience someone who has an addiction is diagnosed with dependence. Someone who has a problem relationship with a substance but at this time is not an addict probably abuse. Layman's alcoholic vs. problem drinker, etc.
Food. In my clinical experience is not an addiction, but I want to not muddy the water of your thread with my clinical experience and practice.
@shell1005 Sorry, I am a newbie, I am sure others know what clinical experience and practice you speak of - are you a nutritionist? Or counselor? Physician perhaps?0
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