Separating the signal from the noise: How psychiatric diagnoses can help discern food addiction from dietary restraint
By David A. Wiss & Timothy Brewerton
While there is disagreement regarding food addiction, it appears that much of the controversy pertains to the treatment (lacking data) rather than the existence of the problem (robust data). More specifically, nutrition interventions for individuals with food addiction and co-occurring eating disorder characterized by high levels of dietary restraint are less clear than for individuals with food addiction and no history of restrictive eating disorder. Individualized treatment might be helpful based on the existence of food addiction, but only after it has been determined that the food addiction signal represents an addiction to food (true positive), rather than a consequence of dietary restraint, food insecurity or insufficiency, or other forms of deprivation or food-related neglect (false positive).
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Abstract
Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations.
There is an ongoing debate regarding the value of a food addiction “diagnosis” among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives.
Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions.
The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or “the signal”) from the more classic eating pathology (true negatives, or “restraint”) that can potentially elevate food addiction scores (false positives, or “the noise”). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.
