The Food Fights: DSM-V Binge Eating Disorder vs. Food Addiction

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.

The Food Fights: DSM-V Binge Eating Disorder vs. Food Addiction 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?

    Tired of addiction calling the shots?

    Addiction treatment changes lives. Call for a free benefits check.

    • 877-671-1785

    Brought to you by Elements Behavioral Health

    4 Responses to The Food Fights: DSM-V Binge Eating Disorder vs. Food Addiction

    1. Avatar
      Mary March 5, 2015 at 11:53 am #

      I have read your book and I think I am a food addict. However, how can I tell for sure it is not binge eating disorder? I have tried to eat all foods, including trigger foods, in moderation but that seems to be impossible for me. Also, my eating has gotten much worse since I kicked a long-standing coffee/caffeine addiction. Is this (along with positive answers to most of the items on the questionnaire in your book) enough to confirm that my problem is food addiction rather than binge (psychological) eating?

      • Avatar
        Tom T April 7, 2015 at 12:19 am #

        Mary, it would be best to get a direct reply from Dr Tarman, but I think your experience clearly shows that you definitely have some degree of food addiction. I would think that your best treatment approach would be to address your situation as both an addiction AND look at the psychological aspects from a BED perspective. You need to have a 2 pronged approach to have success imho. The coffee/caffeine issue is interesting too. Definitely it is a mood altering substance, but is so deeply ingrained in our culture as a routine pick me up, yet can easily become over-used/abused and depended upon. In all addictions I believe there is often a tendency for an addicted individual to substitute a new substance/addiction when kicking an old habit – so to speak. That is where looking at the psychological aspects of your substance use/addiction can be of benefit to understand the underlying cause(s) and potentially achieve long term stable recovery.

    2. Avatar
      Tom T April 6, 2015 at 11:57 pm #

      Interesting debate about how food is primarily either a physically addictive substance (like drugs) or psychological problem of bingeing. I think there is a large overlap, very large. I am not an addiction specialist, but I am a fat guy who definitely has a problem with food. To me it’s becoming increasingly clear that flour, sugar, and processed/highly palatable foods have some physically addictive qualities that should not be ignored by people with obesity and medical problems related to obesity and over eating/food obsession. That said, the psychological aspects at play in this complicated process cannot be ignored or minimized either. Addiction advocates who stress long term food abstinence (FA) would be wise to have a greater focus on the psychological aspects that draw people in to food addiction. Interestingly the people I have encountered in FA with long term food abstinence have often had previous addiction /recovery experience in AA or NA where the path to success has included psychological based addiction treatment in addition to the 12 step program. I have seen some of Phil Werdell’s presentations where he utilizes a 3 step or 3 tier process the eventually leads to food addiction. He states that emotional eating or binge eating is usually a precursor to food addiction, and that effectively treating food addiction requires patients to address their emotional eating and binge eating first. Once the binge/emotional eating is thoroughly explored and addressed for the individual – the addiction part of avoiding all flour/sugar/binge foods becomes much less difficult and the likelihood of long term success becomes readily achievable. Ignoring the psychological issues involved with emotional/binge eating often leads to a scenario of short term success and significant fluctuations in body weight correlated with the individuals level of stress or lack of support over time.
      Given that BED is now a formally recognized (and financed/health insurance covered) diagnosis; it would seem prudent to simply use that categorical diagnosis as an effective means to treat those patients that can benefit from being treated (millions of them – myself included) and add in the addiction aspects as part of the comprehensive treatment program. I am having a hard time visualizing food addicted patients that have no psychological aspects of BED related to their obesity.

    3. Avatar
      Dr Vera Tarman May 10, 2015 at 4:17 pm #

      Hi Mary
      Tom did a great job explaining the food addiction angle. Thank you!
      The key is to recognize that the fundamental problem is the reaction to the food substance – introduce the chemical concoction ie sugar and fat combo and the person develops enhanced craving for more of the food rather than satisfaction.
      This occurs regardless of emotional status…. However Tom is right, the work of STAYING sober requires work – often psychological. This is where 12 step communities or other support groups become crucial to maintain sobriety and then move towards achieving serenity. If you don’t like to work with groups, find a therapist!
      What you have asked is if your enhanced food cravings are an indication of addiction, once you have stopped the coffee… I would say that there is not yet enough information to know which you are .. BED or FA? You could still be either or actually be both.
      Vera Tarman, MD

    Leave a Reply

    • 877-825-8131