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Are Eating Disorders Addictions?

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Eating Disorders, Addictions and Substance Use Disorders

Abstract

Eating disorders overlap with substance use disorders and addictions in many important ways, including clinical phenomenology, comorbidity, pathophysiology, neurobiology, and treatment approaches. Evidence is reviewed for and against the contention that the eating disordered behaviors of dieting, binge eating, purging, and exercising are potentially addictive behaviors. In addition, abuse of and dependence upon substances meant to inhibit appetite (stimulants), reduce caloric absorption (laxatives, lipase inhibitors), decrease water weight (diuretics), or induce vomiting (ipecac) are characteristic features of eating disorders with bulimic features. The phenomenology of the eating disorders is viewed in light of the DSM-5 criteria for an addictive disorder and the new description of an addiction recently published by the American Society of Addiction Medicine. Both sets of criteria support the conclusion that eating disordered behaviors can be phenotypically conceptualized as addictive. On the other hand, eating disorders exhibit clinical characteristics not seen in classical substance use disorders or addictions, including distortions in body size and shape as well as intense fear of gaining weight. The therapeutic implications of treating eating disorders as addictive disorders are discussed. Taken together, eating disorders may be conceptualized as addictive disorders in at least a subset of individuals, but further research is required to determine if tolerance and withdrawal occur in humans.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA

    Timothy D. Brewerton

  2. The Hearth Center for Eating Disorders, Columbia, SC, USA

    Timothy D. Brewerton

  3. Timothy D. Brewerton, MD, LLC, 216 Scott Street, Mt. Pleasant, SC, 29464, USA

    Timothy D. Brewerton

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  1. Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA

    Timothy D. Brewerton

  2. Psychiatry and Behavioral Neurosciences, University of South Florida, Bloomfield Hills, Michigan, USA

    Amy Baker Dennis

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Brewerton, T.D. (2014). Are Eating Disorders Addictions?. In: Brewerton, T., Baker Dennis, A. (eds) Eating Disorders, Addictions and Substance Use Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45378-6_13

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