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Eating Disorders & Food Addiction

Am I In Relapse??

Hi. I’m Emily. I normally would say “and I’m a food addict” as part of this introduction, but sitting here writing this right now as I am laying on my bed…I truly forget if I am or not. I feel scared as I write that statement. Why is this? Well, about two months ago I wrote another article with all of the background information on my disease and I explained very clearly why I am a food addict, click the link to that article: But today, I actually am unsure if I am or not. So why is this all relevant? It is the main reason why in a couple of days I am re-entering an ACORN Primary Intensive event. I picked up the food last week. I have been in relapse for about a week and I am in strong denial once again about my disease.


The Missing Piece in Response to the Obesity Epidemic: Diagnosing and Treating Food Addiction

1st Annual Food Addiction Conference
Downloadable / Viewable Reference Documents

UMASS Department of Psychiatry
UMASS Department of Psychiatry

Anorexia & Food Addiction

© Phil Werdell, M.A.

The common image of food addicts is that they are overweight. A majority of those for whom the disease of food addiction has progressed certainly are obese – and/or morbidly (i.e., life threateningly) obese. Yet there are many food addicts who are a normal weight. Some of these healthy looking food addicts are bulimic. Others just have a metabolic system that keeps them appearing “normal,” even when they are bingeing abnormally. There is also a small but important group of food addicts who are dangerously thin. Most of these are food addicted and anorexic. Even some overly thin folks who are unable or unwilling to eat enough to come up to a healthy weight are also chemically dependent on food and have a history of progressive food addiction which much be addressed before they can have a full, healing long-term recovery.

How can an anorexic know if they are food addicted?

One obvious sign of food addiction is a history of out of control eating – usually bingeing, sometimes purging and almost always becoming overweight by traditional medical standards.
Restricting food begins as a way of compensating for a binge. Then regular fasting becomes a strategy for periodic weight loss after gaining by overeating. It is only as the anorexia progresses that such a person stays thin – and then becomes unhealthily thin – and begins to “look like an anorexic.”

A second indication that an anorexic is also chemically dependent on food is a desire to eat a lot more than they are eating – especially sweets and “junk foods” – as well as the strong desire to control their weight and body size by undereating. If there is a history of craving sugar, flour, and fat, this is a reason to consider the possibility of food addiction as a second diagnosis. These cravings can be current, but do not have to be.

All anorexics obsess about their bodies and greatly fear getting fat. It is less known that many anorexics also obsess about food. This often manifests as calorie counting, a list – often quite long – of “bad food” and a preoccupation with eating in a way that they can control what they do – and more importantly, do not – put in their mouths. What is less common is a constant or frequent obsession about wanting to eat sweets, snack foods or just “more” of any food. Especially if this sometimes gets so strong that it seems like “I just have to have it,” there is good reason to assume this person is food addicted as well as anorexic.

Of course, anorexics should use the whole range of diagnostic indicators of food addiction to ascertain if they are chemically dependent on food. There are the traditional indicators of food addiction denial: lying to others and themselves about what they eat, breaking their own moral code – e.g. stealing food or stealing to get food, seeing their powerlessness over food progress over time, feeling numb or high or drugged after eating, experiencing symptoms of detoxification – e.g. anxiety, depression, sleepiness, inability to sleep – when eliminating a binge food altogether. Few food addicts have all of these symptoms; at least they are not able to see them in their own experience at first. So, just one or two obvious signs of food addiction are enough to at least investigate further.

Anorexia is traditionally understood as a psycho-social disorder. It is now also being treated effectively as an addictive disease. (See text at Anorexics and Bulimics Anonymous). In this view of anorexia, the drug which becomes addictive isthe illusion of control. Whether being treated as a primarily psychological problem or a more complex addictive illness, the anorexic needs to learn to counter irrational thinking about body image and food and address unresolved trauma from the past. Many – if not most – anorexics that are treated in either modality are not food addicted.

Those who are chemically dependent on food can best be seen as having more than one illness. Those who are addicted need to abstain from their food drug(s) of choice as well as become willing and able to eat more food and often a wider variety of foods. If they have a history of bingeing on sugar, it is questionable for them to try to learn to eat sweets in moderation.

On the other hand, many anorexic food addicts who were addicted to fat, go to the extreme of not eating anything with fat in it at all. Since everyone needs some fat in their diet to enable them to digest other foods, these food addicted anorexics do need to learn to eat fat in moderation. The recovery of those with both food addiction and anorexia can be quite complicated and difficult.

In general, it is our experience that people with advanced anorexia and food addiction need more time and support in recovery than those who are only chemically dependent on food. Anorexia has its own denial, and the food addicted anorexic can have special problemS breaking food addictive denial. The illusion of control in anorexia – and often bulimia – makes it doubly difficult to accept real powerlessness over food. There are also many cases of people who were anorexic and bulimic in their youth and then became compulsive overeaters. If they are food addicted, they often need a great deal of help to break through their biochemical food dependent denial.

There are mutual support fellowships for pure anorexics. There is also a growing welcome for anorexics and bulimics in the oldest and largest food related 12 Step fellowship, Overeaters Anonymous (OA). There are also Twelve Step fellowships separate from OA that focus just on people with eating disorders; besides Anorexics and Bulimics Anonymous (ABA), there is the newer Eating Disorder Anonymous (EDA).

All of these fellowships tend to suggest food plans which include all food in moderation, though ABA very specifically supports those who abstain from specific foods, i.e., food addicts.

This is the key to those who are dually diagnosed with anorexia and food addiction: they need to surrender control of both their obsession with not “getting fat” and their specific food drugs. They need to learn to not restrict and to not overeat. They need to eliminate and detoxify from food(s) upon which they have become chemically dependent and deal with unwanted feelings and irrational thoughts that lead them to starve themselves. Moreover, as physical recovery begins, there are always deeper emotional and spiritual issues which, if not dealt with thoroughly, can lead to relapse down the line.

How SHiFT Helps Food Addicts

Food addicts come to SHiFT because they are aware of their food addiction and know SHiFT’s history of support for food dependency recovery. Some are often surprised when they discover they are also anorexic. It is hard for this group to understand that all anorexics are not dangerously thin. In fact, we find that there is at least a little bit of anorexia under most progressed food addicts. It is the part of their illness in which they have spent so much time trying to control their eating. It is the part of their recovery which stays rigid and perfectionistic long after the first year of abstinence. The lack of joy and true happiness in this “controlled physical recovery” leads many to relapse after a few years.

More difficult is the anorexic food addict who is dominated by the restrictive side of their eating disorder. For some it takes much longer than seven days – the length of the SHiFT residential Acorn Primary Intensive© – to be able eat a healthy amount and mix of food. If they are willing to try, we will often accept them and support them as long as they do not need hospitalization or direct medical supervision.

One suggestion we have for those who think they might fit into this category is to read the first 137 pages of Anorexics and Bulimics Anonymous; if you are willing to try this approach to dealing with your anorexia and abstain from your likely addictive foods, the Primary Intensive© will probably be helpful.

Cross Addictions

© Phil Werdell, M.A.

The Problem of Cross Addictions

Let us begin by looking at the easier part of the problem: food addicts who are cross addicted and already abstinent and in recovery from other chemical dependent substances. Three of those most frequently encountered are nicotine, alcohol and street drugs.

Smokers and Food Addiction

A very common issue of cross-addiction that is usually not talked about in these terms is “shifting” from nicotine to food as a drug of choice. We see it all the time. Someone works hard to put down cigarettes. It might take more that one, maybe as many as a dozen attempts. As soon as there is a period of abstinence from cigarettes, though, the prior smoker starts to gain weight. Some go back to smoking to keep cigarettes as a part of their weight control regime. If they have a commitment to their health that moves them to stop smoking again, then their weight becomes a problem again.

While there was still an argument about whether or not cigarettes were addictive – much less dangerous to your health, almost no one noticed the cross addiction “shift” from nicotine to food. With the major changes in consciousness and in public health policies about smoking, there are more and more people getting the support they need to stop smoking. Health professionals working in chemical dependency treatment are more likely to be conversant with the addictive nature of nicotine. We can now see that the weight gain that sometimes follows abstinence from cigarettes may be a cross addiction.

One small fact that is seldom mentioned is that tobacco is often cured in sugar. This makes it a natural entry-level drug for sugar addiction.

Alcoholics who are also Food Addicts

There are many who come to Overeaters Anonymous (OA) from other 12 Step programs, especially Alcoholics Anonymous (AA), that have substantial time sober from alcohol and other addictive substances. In fact, they often come to OA or one of the other food–related 12 Step fellowships because they find themselves reacting to food just like they had reacted to alcohol or their drug of choice many years before. In early recovery, many AA’s are often counseled by their sponsors to not worry if they are craving sugar or gaining weight. In fact, the recovery text, Alcoholics Anonymous suggests that a newly sober drinker carry come candy in their pockets to help relieve urges to drink. Especially if their chemical dependency on alcohol or drugs had been progressing for years, it certainly looked like drugs and alcohol could killed them long before food.

Food addiction also progresses as a chemical dependency, so the dangers of addictive eating can easily increase over time. Many recovering alcoholics first try to work on their eating within AA. just as they work on other life problems using the 12 Steps, and many are successful.

Many are not. Often they will identify sugar, flour or fat as a substance that is acting in their bodies like a narcotic. They do this just because of their long time experience using and recovering from alcoholism and/or drug addiction. However, when they decide to abstain from their self-assessed food addiction, they are not able to do it. It is difficult to move from the “all or nothing” model of no alcohol to a structured eating plan. This is doubly a problem for those who have already decided to recover from nicotine addiction.

This group has special problems, some of which are addressed in Judi Hollis’s excellent publication When AA’s go to OA. It is humbling to come into a new fellowship with years of sobriety in AA and have to start recovery over from the beginning in OA. It is confusing when the AA newcomers observe a large variety of food plans and perspectives on abstinence in OA.

We think there is another problem: for many alcoholics: food is an earlier and primary addiction. What is alcohol but grain and a form of sugar? The most common addictive foods are sugar and flour. A majority of these sober alcoholic food addicts can quickly remember using and abusing food years before they picked up alcohol.

Not only does this mean that their detoxification from food is likely to be worse than their detox from alcohol, it means that they have to deal on a whole new level with mental-emotional and spiritual developmental problems that began earlier.

It is often said that emotional development stops – or is at least serious curtailed – from the age that a person begins using a substance addictively. Thus, early developmental issues such as trust vs. mistrust must be revisited as one begins to recover, and there are often very basic emotional skills which were stunted in infancy and now must be developed as an adult. When raw emotions came up in early alcohol recovery, one could still use food to cope. Now, for many, there is nothing.

It is true that when the alcoholic says they don’t drink, they do drink water, fruit juice, coffee, tea and other beverages. This is more like the food addict’s abstinence: no binge foods, but other foods are OK. However, the person addicted to food in volume does have a qualitatively different problem being abstinent. This is why many food addicts commit their entire meals daily – sometimes even meal by meal – to their sponsors.

Food abstinence is different from abstinence from other substances in that the food addict still needs to eat several times a day. It is not possible to just “not be around food” the way it is possible to avoid alcohol or smoking.

Drug Addicts who are also Food Addicts

Some alcoholics put on a “beer belly,” but there are few heroin or cocaine addicts who are overweight. So, it is often a surprise to a recovering drug addict when they cross over and start eating and putting on weight out of control. As we shall see, foods can break down in the digestive symptom into bio-chemical compounds that are similar to the opioids in narcotics. The dosage and effect of using morphine, heroin or cocaine is much stronger, but once these are out of their blood, some physically sober drug addicts can get high and chemically addicted just by using more and more food.

Not all narcotics users get hooked on food when they become drug free. In fact, a majority do not, at least at first. For those who do, though, this is a very serious problem. Not only do they then engage all the medical risks of obesity – and of bulimia and anorexia with they try to purge or restrict to control their weight, but active food addiction can be a trigger back into hard drugs.

Then there is the case of marijuana. While there is an argument yet about whether or not this drug is physically addictive, it clearly can be psychologically addictive, and for many it triggers the well known “munchies” and minimizes resistance to a variety of acting out behaviors. For the food addict whose disease is advanced, this is a serious problem. Often they cannot stay food abstinent unless they abstain from marijuana, too. For those unwilling or unable to do this, this means they are likely to eat, and addictive eating for a food addict means to die.

Food Addicts Not Yet Abstinent in Another Addiction

There is a different – and equally important – set of problems that occur when a food addict is actively using other substances or processes while being abstinent from food.

For some food addicts, this is not a large issue. For example, many food plans ask for abstinence from alcohol or caffeine. There are food addicts who can tell immediately that they are not normal drinkers of alcohol or caffeine, but they are not as important “food drugs” for them as, possibly, sugar, flour, fat or volume. So, these food addicts are quick to accept abstinence from liquor and coffee.

Other food addicts are much more attached to these other edible addictions. They are, at first, not willing to even consider putting down alcohol or caffeine. As they do consider the possibility, they are in the stage of bargaining. “I’ll just have an occasional glass of wine with diner.” “I need my cup of coffee in the morning.” If and when they do become willing to abstain, they fall off the wagon on this one food substance over and over.

For some food addicts this is a grave problem because alcohol or caffeine – another addiction – can turn into a “gateway drug” leading to serious food bingeing and long periods of relapse.