Eating Disorders like Anorexia Nervosa Are Not Addictions

Eating disorders such as anorexia or bulimia are often referred to as an "addiction." Is there any truth to it? Are these disorders really a form of addiction? Well, not really!

The treatment of anorexia and other eating disorders is a highly specialised field. Unless you have been directly involved with it over a long period of time, it can be extremely difficult to understand the "eating disorder voice" and how distressing the illogical and distorted thought processes can be to the anorexic individual.

What approach does anorexia nervosa treatment need to take?

Assuming that eating disorders are addictions, it would only stand to reason that the addictions model of treatment would be the most effective. Some would argue that it is the only effective method of treatment. Those who follow this model believe that eating disorders are simply variants of substance abuse addictions. The problem with this model is that it lumps all eating disorders together into the same category – whether the issue is anorexia, binge eating, compulsive overeating, or bulimia. It leaves no room to consider the fact that each of these is an illness unto itself. They are all different in their aetiology (causes and origins).

Furthermore, the addictions model of treatment suggests that all types of eating disorders and substance abuse are virtually the same in the way they begin, and the way they should be treated. The addictions model focuses on the ‘addictive personality’ and abstinence. Where disordered eating is concerned, one’s relationship with food is seen as an addiction. Groups such as Overeaters Anonymous (OA) are based on this method, and abstinence from binge eating is required – just as abstinence from alcohol is required in Alcoholics Anonymous (AA). In some cases, OA groups insist on abstinence from "trigger foods" such as chocolate or sugary foods. These methods of treatment, however, are not widely advocated by those specialising in eating disorder treatment in London, and there are several reasons for this.

First, any treatment method that requires abstinence will only serve to promote the concept of dieting in the mindset of anorexics. This is where it becomes imperative that the treatment provider be familiar with the differences amongst the types of eating disorders, and the "eating disorder voice." Knowing how cognitive distortions may come into play with regards to dieting vs. abstinence is essential. This is something that the addictions model of treatment completely ignores. Secondly, the addictions model of treatment does not address the core clinical features of most eating disorders, such as irrational thoughts about food and weight, distorted body image, or any psychobiological connections regarding self-starvation. Application of the addictions model as one of the treatments for anorexia also fails to address issues such as personal identity, control issues, or emotional sensitivity.

There is no way how the statement that we see and hear so often – "eating disorders are addictions" – can possibly be true. There are too many major differences between anorexia and substance abuse, and just as many differences amongst the various types of eating disorders for everything to be treated equally.

Ellern Mede Eating Disorder Services is widely regarded as the UK’s most specialist provider of intensive inpatient and outpatient treatment for children and young people.