3
and super-sized convenience meals triggers the binges in the same way as the drink offered
to the alcoholic or line of cocaine to the drug addict.
So for the addict, abstinence from trigger foods is the answer. A diet would work about as
well as the advice to an alcoholic of, “Drink in moderation,” which is to say that it doesn’t work
at all. And yet the eating disorders field is far from adopting an abstinence model for treating
binge eating disorder, bulimia, or compulsive overeating.
What Can We Do?
For eating disorders, typically we treat the psychological issues with mindfulness techniques,
cognitive behavioral therapy, psychodynamic therapy, family systems therapy and trauma-
based therapies. A team approach is used, calling in a therapist, nutritionist, medical doctor,
and other supportive therapies all working together on a food plan, behavior, and emotional
and spiritual healing. Group therapy might be recommended, and any given session could
include all sorts of individuals with different diagnoses—from anorexia and bulimia to binge
eating disorder.
However, the obese compulsive overeater or food addict might not quite belong. The
anorexic, bulimic, and binge eater may be treated to understand their issue is, “What’s eating
you?”… while the food addict needs more help with, “What are you eating?” At some point,
the problem must be called what it is. We can weigh what the science tells us about sugary,
highly-refined wheat and fatty foods being addictive with a client’s behavior. If there’s ad-
dictive behavior with these foods, why hesitate to call it an addiction? One is not just a little
addicted to alcohol—you either have a client with an addiction or prescribe tips to strengthen
willpower and manage intake. However, exercising more willpower never resolves addiction.
The food addict needs traditional therapy to deal with emotional and cognitive issues.
Twelve-step groups like Overeater’s Anonymous and Food Addicts in Recovery Anonymous
help addicts face that there is something wrong with them when it comes to food. The com-
pulsive overeating is seen as, and called, a disease. The science is shown to clearly identify
different reactions in the pleasure centers of the brain between self-identified food addicts
and otherwise normal individuals. All of this is just the beginning of addressing what we are
starting to understand about food addiction.
Pursuing a Big Fix
Even in 12-step groups, there are different opinions on the issue of food. One camp of doc-
tors, therapists, and counselors believes in a one-size-fits-all food plan where the addict
weighs and measures everything to be eaten and is forbidden even hints of sugar or refined
carbohydrates. Another camp believes everyone is different and food plans can be tailored
based on individual levels of sensitivity and need for structure.
The different courses of treatment will probably continue along with varying diagnoses,
especially since, to date, the American Psychiatric Association (APA) has dismissed “food
addiction” as a substance disorder for the new Diagnostic and Statistical Manual of Mental
Disorders (DSM-5)—even as food addiction professionals compare the criteria and see the
problem as identical. One saving caveat is the DSM-5 will include Binge Eating Disorder as a
newly accepted diagnosis.
In the meantime, it is the clients who will suffer. If a diagnosis of, and traditional therapy
treatment plan for, binge eating disorder doesn’t address what is potentially a food addiction,
clients often won’t pursue another diagnosis. Clients may try something we have already seen
as an attempt to solve overeating and diet failures: gastric bypass surgery.
The desire in our culture to be thinner, weigh less, and look slim—searching for a quick
fix—is so strong that people would rather risk their lives than consider the shame of claiming
an addiction, so addictions remain untreated. When victims opt for surgery, they can no lon-
ger obsess over and compulsively use food, so they turn to other things for a fix: sex (affairs,
pornography, masturbation) and alcohol being the most common, according to a study from
the Radcliffe Institute for Advanced Study in July 2012. The dysfunction occurs when people
continue to struggle with weight and addiction, in spite of attempts to address the core is-
sues.
We need to help our clients realize that the way to begin moving forward from an issue or
problem is to first acknowledge there is one.
Rhona Epstein, Psy.D., C.A.C.,
is a licensed psychologist, certified addictions
counselor, and marriage and family therapist in the Philadelphia area. For more
than 25 years, she has led seminars, conferences, and therapeutic workshops to
help people overcome food addiction and its underlying issues. Rhona received
her doctorate in clinical psychology from Chestnut Hill College and master’s
degree in counseling psychology from Temple University. She is passionate, from
personal experience and recovery from food addiction, about addressing the needs of the
whole person (mind, body, and spirit).
