Food as a Drug: The Addictions Model of Weight and Disordered Eating

1. Presented by: Pamela K. Orgeron, Updated November 2017 Food as a Drug: The Addictions Model of Weight and Disordered Eating

2. Topics Covered: • Food as a Drug • Food Addiction and Drug Addiction Similarities • Classifications of Eating Disorders • Etiology of Disordered Eating • Prevention of Disordered Eating.

3. Food as a Drug Similar to alcohol with an alcoholic, food also may be an addictive agent in the life of an individual. Minirth, Meier, Hemfelt, Sneed, and Hawkins (1990, p. 60) give six-steps in the downward spiral of developing an addiction. Figure below depicts this process.

4. When does eating become an addiction? DeGoede (1998) reported:Enjoying good food and looking forward to an excellent meal is certainly not a bad thing, in fact it is part of a quality life. But if we find ourselves obsessively thinking about our next meal, eating faster than those around us, choosing certain places to go solely for the food, and placing ourselves at risk with extremes in weight, then our obsession with eating is dysfunctional and addictive and ultimately creates health and body image problems. (p. 65)

5. Food Addiction & Drug Addiction Similarities • A formerly pleasurable activity becomes a must (Orford, 2001). • Strong cravings accompany the experience (Orford). • loss of control in spite of harm (Orford). • Dopamine deficiencies exist (Holden, 2001). • similar personality factors (e.g.: impulsiveness & low self-esteem • comorbidity (dual diagnosis) also common (Poston and Haddock, 2000).

6. Disordered Eating • As defined by Thunberg (1992), disordered eating encompasses a continuum from single dieting to the clinical diagnosis of anorexia and bulimia. According to Scarano and Kalodner-Martin (1994), the continuum of eating disorders places “normal” eating at one end, bulimia at the opposite end, and subclinical forms of unhealthy, eating patterns fall intermittently on the continuum” ┌──────┬─────┬─────┬──────┐ nondieter dieter problem subclinical clinical “normal” dieter eating disordered eating disorders

7. Classifications of Eating Disorders • anorexia nervosa • avoidant/restrictive food intake disorder • binge-eating disorder • bulimia nervosa. (From DSM-V)

8. AnorexiaNervosa • symptoms • refusing to maintain the minimally healthy body weight for age and height • fearing weight gain, even though underweight • being disturbed by one’s body weight or shape • being influenced by body weight or shape on self-evaluation • Denying the seriousness of the current low body weight. • two subtypes • restricting type—starve bodies • binge-eating/purging type.

9. Avoidant/Restrictive Food Intake Disorder • *Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). • *Significant nutritional deficiency. • *Dependence on enteral feeding or oral nutritional supplements. • *Marked interference with psychosocial functioning. (APA, 2013, p. 334) • The problem is not the result of a lack of food or a culturally appropriate custom; the behaviors cannot be attributed to a diagnosis of anorexia or bulimia; there’s no disruption in a person’s body weight or shape; and the symptoms are not attributable to a medical condition or other mental illness. (Orgeron, 2017, p. 13)

10. Binge-eating Disorder • recurrent episodes of binge eating. • Binges are associated with at least 3 of the following: • eating faster than usual • eating beyond fullness • eating large portions when not hungry • eating privately from embarrassment • depression, guilt, etc. after overeating. • Binge creates marked distress. • occurs at least once weekly for 3 months. • Symptoms do not meet anorexia/bulimia criteria.

11. Bulimia Nervosa • symptoms • recurring incidents of binge eating • recurrent use of self-induced vomiting, laxatives, fasting, exercise, etc. • Binges & compensatory behaviors occur at least once weekly for 3 consecutive months. • The person’s body shape and weight determines his or her self-evaluation. • The behaviors do not occur exclusively during incidents of anorexia.

12. Other Specified Feeding or Eating Disorder • night-eating syndrome • pica • rumination disorder • unspecified feeding or eating disorder (From DSM-V)

13. Night-eating Syndrome • little/no appetite at breakfast. • Most of daily food intake occurs after dinner but before breakfast. • Person is aware and remembers the eating. • produces guilt & shame • causes sleep disturbances. • Symptoms not better attributed to another mental or medical condition, or as a medication side effect.

14. Pica • primary feature: eating one or more nonnutritive substances persistently for a period of at least 1 month. • Substances vary with age: • infants & younger children—paint, plaster, string, hair • older children—animal droppings, sand, insects, leaves, pebbles • teenagers & adults—clay or soil.

15. Rumination Disorder • repeatedly regurgitating & rechewing food. • Behavior exists for a period of at least 1 month following normal functioning period. • not attributed to esophageal reflux or other medical condition.

16. Unspecified Feeding or Eating Disorder This refers to: • presentations in which symptoms characteristic of a feeding or eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class. (APA, 2013, p. 354)

17. Other Related Cases • muscle dysmorphia (bigorexia) • nocturnal sleep-related eating disorder • Gourmand syndrome • Prader-Willi syndrome. (From Orgeron, 2017)

18. Muscle Dysmorphia (Bigorexia) • opposite of anorexia • obsess about being too thin when they may be big in reality • abuse exercise & steroids to build what they feel are inadequate muscles. • “The APA (2013) now classifies muscle dysmorphia as a type of body dysmorphic disorder, included in the obsessive-compulsive and related disorders section of the DSM-5.” (Orgeron, 2017, p. 20)

19. Nocturnal Sleep-Related Eating Disorder • more of a sleep disorder. • People have episodes of eating in a state between awake and asleep. • unaware of eating, do not remember eating the next morning, & may eat unusual combinations of food or non-food items, such as soap they have sliced like they slice cheese.

20. Gourmand Syndrome • preoccupation with fine food, including its purchase, preparation, presentation, and consumption. • Injury to right side of brain is believed to cause disorder. • rare: only 34 reported cases in medical literature.

21. Prader-Willi Syndrome • cause: genetic defect (physiological brakes controlling appetite and hunger are defective) • may be misdiagnosed as bulimia (Symptoms here are physiological where with bulimia symptoms are psychosomatic.). • As the child ages, possible indicators of PWS include constant food cravings with rapid weight gain; hypogonadism (underproduction of sex hormones); problems with the endocrine system; mental retardation; speech and motor problems; and behavior and sleep disorders. (Mayo Clinic Staff, 2017b)

22. Commonly asked: • Is obesity an eating disorder? (Comer, 2001) • Obesity alone is not sufficient evidence to diagnose an eating disorder. • Multiple factors, including genetic and biological factors, contribute to the obesity problem in society. • Overlapping patterns do exist between obesity, anorexia, and bulimia.

23. Overlapping Patterns BetweenObesity, Anorexia, and Bulimia (From Comer, 2001, p. 327)

24. Etiology of Disordered Eating • sociocultural factors • individual factors • family factors • biological factors.

25. Sociocultural Factors • messages from the media • prejudice against obesity.

26. Individual Factors • personal history of dieting • using food as a drug (similar to a person abusing alcohol) • poor body image.

27. FamilyFactors • prior emotional, sexual, or physical abuse in the family • dysfunctional parenting • “clean plate” club • “you must eat” syndrome • using food for comfort, as rewards or as part of celebration rituals • overeating to please others.

28. Biological Factors • variations in the chemical sequence of the agouti-related protein (AGRP) gene that helps regulate hunger. The AGRP gene reduces the activity of melanocortin-4 receptor in the brain (National Alliance for the Mentally Ill, 2001). • relatives of persons with eating disorders 6 times more prone to develop the same disorder (Comer, 2001) • low levels of serotonin activity (Comer) • weight set point theory (Thompson, 2001).

29. Prevention of Disordered Eating • primary prevention • prevents eating disorders before they start. • secondary prevention • keeps those in early stages from progressing • involves knowing the “warning signs”. • tertiary prevention • diagnosis & treatment of persons with full-blown eating disorders.

30. Basic Principles of Prevention(Minirth, Meier, Hemfelt, Sneed, & Hawkins, 1990) • Do • Use commonsense in making food selections. • Learn about problems related to food & eating. • Use behavioral incentives other than food. NEVER use food as a reward. • Stay physically active. Find an exercise you enjoy. • Maintain a balanced diet with more fiber & less fat. • Have a support group. • Use discipline in moderation. Avoid extremes. • Don’t • Never base self-worth on looks.

31. The Role of the Educator(From Renfrew Center, 2017) • Teach students about eating disorders. • Plan activities during Eating Disorders Awareness Week scheduled in February every year. • Understand the role of the media. • Start peer support groups. • Set an example. • Don’t allow school activities promoting weight loss or emphasizing appearance (e.g.: school beauty pageants) • Be a healthy role model to students. • Confront students with suspected eating disorders.

32. Confronting Students with Suspected Eating Disorders • Confront privately initially. • Allow adequate time to avoid rushing & using the wrong words. • Point out specific observations arousing your concern. • Communicate compassion & concern throughout the confrontation. • Do not diagnose or become the student’s therapist. • Avoid arguing. • Focus on the student’s health, not appearance. • Know about community resources where help is available. (Michael Levine & Linda Smolak, cited by Orgeron, 2017, p.127)

33. Do diets work? • No, diets have a 95% failure rate. In other words, 95% of those persons who lose weight, gain it back plus more.

34. Solutions to Minimizing Eating Problems • Dominant Themes Reflected in Research: • permanent change--maintaining a permanently healthy lifestyle • on-demand eating--eating what you want whenever you are physically hungry and stopping when you are full.

35. A Spiritual Path to Disordered Eating Recovery • The way back may involve many external controls and disciplines outside. But in the end, the only way out will be when God himself through Jesus Christ becomes our satisfying soul food and contentment in him becomes the governor and the regulator of all our appetites and desires. (Piper, 2015, ¶ 17)

36. Bibliography American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Comer, R. J. (2001). Abnormal psychology (4th ed.). New York: Worth. DeGoede, D. L. (1998). Belief therapy: A guide to enhancing everyday life. Lake Elsinore, CA: E. D. L. Holden, C. (2001). ‘Behavioral’ addictions: Do they exist? Science, 294, 980-982. Mayo Clinic Staff. (2017b) Prader-Willi syndrome: Symptoms and causes. Retrieved April 21, 2017 from https://www.mayoclinic.org/diseases-conditions/prader-willi-syndrome/symptoms-causes/syc-20355997 Minirth, F. B. , Meier, P. D., Hemfelt, R., Sneed, S., & Hawkins, D. (1990). Love hunger. Nashville: Thomas Nelson.

37. Bibliography continued National Alliance for the Mentally Ill (2001). Eating disorders news item: Variation in gene that regulates food intake found in people with anorexia. Originally retrieved through https://www.nami.org/ (Now available https://www.eurekalert.org/pub_releases/2001-04/MP-Viag-0404101.php). Orford, J. (2001). Addiction as excessive appetite. Addiction, 96, 15-31. • Orgeron (aka, Owens), P. K. (2017). Food as an Idol: Finding Freedom from Disordered Eating. Madison, TN: ABC’s Ministries. Poston, W. S. C., II, & Haddock, C. K. (2000). Food as a drug. New York: Haworth. • Renfrew Center Foundation for Eating Disorders (2002). Home page. [On-line]. Available: http://renfrewcenter.com/

38. Bibliography continued Renfrew Center Foundation for Eating Disorders. (2017a). Steps to help professionals make a difference in schools. Retrieved April 3, 2017 from http://renfrewcenter.com/resources/for-schools Scarano, G. M., & Kalodner-Martin, C. R. (1994). A description of the continuum of eating disorders: Implications for intervention and research. Journal of Counseling and Development, 72, 356-361. Thompson, c. (2001). Set point. Retrieved January 28, 2002 from http://www.mirror-mirror.org/set.htm Thunberg, K. C. (1992). The Relationship Between Sexual Abuse and Eating Problems (Doctoral dissertation, Hofstra University, 1992). Dissertation Abstracts International, 53 (03), 762A.7. ***

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