Eating Causes Clinically Significant Distress: Food Addiction as a Disordered Belief in Anorexia Nervosa?
Abstract
:1. Introduction
2. Case Report
3. Results
4. Discussion
Substance Use Disorder | Binge Eating Disorder | Bulimia Nervosa | Anorexia Nervosa | mYFAS 2.0 Version | YFAS Criteria | Critical Analysis | |
---|---|---|---|---|---|---|---|
DSM-5 Criteria | |||||||
Definition | (A) A problematic pattern of use leading to impairment manifested by at least two of the following criteria. | (A) Recurrent episodes of binge eating. An episode of binge eating is characterized by the following features. | (A) Restriction of caloric intake from requirements, leading to being significantly underweight. | 1. I ate to the point where I felt physically ill | Substance taken in larger amount and for longer period than intended | Loss of control results from (1) physiological aspects of food deprivation, (2) food prohibition cognitions, and (3) forms of coping with stressors and/or presence of anxiety and/or mood symptoms/disorders [9]. In binge eating episodes, not only palatable foods are consumed, but also raw foods, isolated ingredients, or unconventional mixtures (non-specific), which would not be explained by their “addictive” properties [27]. | |
Consumption greater than planned | Criterion 1. Often consumed in larger quantities or for a longer period than intended. | A1. Ingestion, in a given period (e.g., within 2 h), of an amount of food that is definitely greater than most people would consume in the same period under similar circumstances. | Presence of binge eating in binge/purge suptype. | ||||
Inability to slow down or stop | Criterion 2. There is a persistent desire or unsuccessful efforts to reduce or control use. | A2. Feeling of lack of control over eating during the episode (e.g., feeling unable to stop eating or control what and how much one is eating). | (B) Intense fear of weight gain or of gaining weight, or persistent behavior that interferes with weight gain, even though weight is significantly reduced. | 11. I tried and failed to cut down on or stop eating certain foods. | Persistent desire or repeated unsuccessful attempts to quit. | Unsuccessful attempts to cease the consumption of these foods are targeted by treatment. Does this question address inappropriate attempts at dietary restriction that reflect ED distorted cognitions? | |
Time | Criterion 3. A lot of time is spent on activities necessary to obtain, use, or recover its effects. | D. The binge episodes occur on average at least once a week for three months. | C. Binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for three months. | 2. I spent a lot of time feeling sluggish or tired from overeating. | Much time/activity to obtain, use, and recover. | As the number of binge eating or compensatory behaviors increases, the greater severity of ED, according to the DSM, can compromise time for daily activities and result in the possibility of self-assessment of FA. | |
Craving | Criterion 4. Craving or a strong desire or need to use. | - | - | - | 10. I had such strong urges to eat certain foods that I couldn’t think of anything else. | Craving, or a strong desire or urge to use. | Individuals with BED/BN have high FC levels, but one must consider the obsessive thoughts about food and food restriction that influence FC itself (which has several physiological determinants) [28]. FC intensity may predict binge eating episodes by correlating with stress and anxiety and may increase after monotonic eating, restrictive diets, and/or fasting. |
Impairment | Criterion 5. Recurrent use resulting in failure to perform important roles at work, school, or at home. | B. Binge eating episodes are associated with three (or more) of the following: B1. Eating faster than normal B2. Eating until you feel uncomfortably full B3. Eating large amounts of food in the absence of physical sensation of hunger | B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications | 7. My overeating got in the way of me taking care of my family or doing household chores. | Failure to fulfill major role obligations (e.g., work, school, home). | The functional impairment is given by how much the ED has occupied the areas of the individual’s life and involves all the psychopathology of the ED, not only the binge eating episodes. Excessive chemical substance use compromises cognition and motor behavior and promotes risk behaviors, which do not occur after binge eating. In the case of AN, normal portions are considered excesses, biasing the responses. | |
Social impairment | Criterion 6. Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by its effects. | B4. Eating alone because one is ashamed of how much one is consuming. B5. Feeling disgusted with oneself, depressed or very guilty afterward. | D. Self-evaluation is inappropriately influenced by shape and weight. | 13. My friends or family were worried about how much I overate. | Continued use despite social or interpersonal problems. | Social impairment in substance use disorders involves psychopharmacological mechanisms. Withdrawal or impairment from social activities is common for most mental disorders. In the case of AN where “binge eating” is reported, the issue reflect distorted self-criticism [29]. | |
Work/activities impairments | Criterion 7. Important social, professional, or recreational activities are abandoned or reduced due to excessive use. | 3 I avoided work, school, or social activities because I was afraid I would overeat there. | Avoidance of places that may represent triggers are common for ED and chemical dependence, as well as the stigma and fear of losing control. Especially in EDs, the fear of getting fat because of being able to consume something outside of what is “allowed” and not only the fear that binge eating will occur or the emergence of cravings and consumption outside of the planning is biased by ED cognitions. | ||||
Physical impairment | Criterion 8. Recurrent use in situations where this represents danger to physical integrity. | Criteria B1 and B2 | (C) Disturbance in the way one’s own weight or body shape is experienced, undue influence of weight or body shape on self-assessment, or lack of recognition of the severity of being underweight. | 12. I was so distracted by eating that I could have been hurt (e.g., when driving a car, crossing the street, operating machinery). | Use in physically hazardous situations | Binge eating can have a dissociative effect associated but incomparable to the pharmacological effects of the action of a chemical substance. Food, unlike alcohol, does not alter cognitive and motor functions while driving a car or crossing a street. | |
Use despite the consequences | Criterion 9. The use is continued despite the consequence of having a persistent or recurring physical or psychological problem that tends to be caused or exacerbated. | C. Marked suffering due to binge eating | 8. I kept eating in the same way even though my eating caused emotional problems. | Use continues despite knowledge of adverse consequences (e.g., emotional problems or physical problems) | Psychological and environmental aspects maintain the symptoms in ED, but there are no psychopharmacological mechanisms. It is common in EDs to think binge eating should cease at the expense of weight gain and/or health problems. | ||
Tolerance | Criterion 10. Tolerance, defined by any of the following: a. Need for progressively larger amounts to achieve intoxication or the desired effect. b. Markedly less effect with continued use of the same amount. | - | - | Restrictive subtype: Not involved in binge/purge behaviors in the past three months. Weight loss only with diet, fasting, and/or excessive exercise. | 9. Eating the same amount of food did not give me as much enjoyment as it used to. | Tolerance (marked increase in amount; marked decrease in effect) | The psychopathology and presence of other comorbid disorders and their manifestations in conjunction with physical symptoms of dietary restriction can trigger binge eating. Pleasure in eating may be compromised in EDs regardless of quantities, but by the relationship of disgust, fear, and dissatisfaction or “failure” from eating [30]. |
Withdrawal | Criterion 11. Abstinence, manifested by any of the following: a. Withdrawal syndrome b. Consumed to relieve withdrawal symptoms. | - | - | 4. If I had emotional problems because I hadn’t eaten certain foods, I would eat those foods to feel better. | Characteristic withdrawal symptoms; substance taken to relieve withdrawal | The use of food to cope with anxiety/depression symptoms cannot be confused with withdrawal and FC. There is confusion between the physical symptoms of food restriction (increased food cravings), which can be self-described as withdrawal. | |
Severity | Presence of 2 or 3 symptoms: Mild: 2 or 3; Moderate: 4 or 5; Severe: 6 or more. | Binge eating episodes per week: Mild: 1 to 3; Moderate: 4 to 7; Severe: 8 to 13; Extreme: 14 or more. | Episodes of inappropriate compensatory behaviors per week: Mild: 1 to 3; Moderate: 4 to 7; Severe: 8 to 13; Extreme: 14 or more. | The severity criteria are based on BMI and for children on percentile. The severity level can be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision. | 5. My eating behavior caused me a lot of distress. #6. I had significant problems in my life because of food and eating. These may have been problems with my daily routine, work, school, friends, family, or health. | Use causes clinically significant impairment or distress | The severity of a mental disorder should preferably be assessed by a clinical observer, as patients tend to overestimate or deny the severity in both cases [31]. |
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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mYFAS2.0 | Threshold for Meeting the Criterion | Symptoms Count | YFAS Criteria |
---|---|---|---|
(1) I ate to the point where I felt physically ill. | 5 (0) | 0 | Substance taken in a larger amount and for a longer period than intended. |
(2) I spent a lot of time feeling sluggish or tired from overeating. | 6 (3) | 0 | Much time/activity to obtain, use, recover. |
(3) I avoided work, school or social activities because I was afraid I would overeat there. | 3 (1) | 0 | Important social, occupational, or recreational activities given up or reduced. |
(4) If I had emotional problems because I had not eaten certain foods, I would eat those foods to feel better. | 5 (1) | 0 | Characteristic withdrawal symptoms; substance taken to relieve withdrawal. |
(5) My eating behavior caused me a lot of distress. | 6 (5) | 1 | Use causes clinically significant impairment or distress. |
(6) I had significant problems in my life because of food and eating. These may have been problems with my daily routine, work, school, friends, family, or health. | 6 (3) | 0 | |
(7) My overeating got in the way of me taking care of my family or doing household chores. | 3 (1) | 0 | Failure to fulfill major role obligation (e.g., work, school, or home). |
(8) I kept eating in the same way even though my eating caused emotional problems. | 5 (6) | 1 | Use continues despite knowledge of adverse consequences (e.g., emotional problems or physical problems). |
(9) Eating the same amount of food did not give me as much enjoyment as it used to. | 6 (5) | 1 | Tolerance (marked increase in amount; marked decrease in effect). |
(10) I had such strong urges to eat certain foods that I couldn’t think of anything else. | 5 (3) | 0 | Craving, or a strong desire or urge to use. |
(11) I tried and failed to cut down on or stop eating certain foods. | 6 (1) | 0 | Persistent desire or repeated unsuccessful attempts to quit. |
(12) I was so distracted by eating that I could have been hurt (e.g., when driving a car, crossing the street, or operating machinery). | 3 (2) | 1 | Use in physically hazardous situations. |
(13) My friends or family were worried about how much I overate. | 3 (7) | 1 | Continued use despite social or interpersonal problems. |
After computing the threshold for each question, if the score for the symptom criterion is >1, then the criterion has been met and is scored as 1. If the score = 0, then the symptom criterion has not been met and is scored as 0. | 4 | +FA | |
4 or 5 symptoms and clinical significance | Moderate Food Addiction |
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de Oliveira, J. Eating Causes Clinically Significant Distress: Food Addiction as a Disordered Belief in Anorexia Nervosa? Obesities 2023, 3, 207-217. https://0-doi-org.brum.beds.ac.uk/10.3390/obesities3030017
de Oliveira J. Eating Causes Clinically Significant Distress: Food Addiction as a Disordered Belief in Anorexia Nervosa? Obesities. 2023; 3(3):207-217. https://0-doi-org.brum.beds.ac.uk/10.3390/obesities3030017
Chicago/Turabian Stylede Oliveira, Jônatas. 2023. "Eating Causes Clinically Significant Distress: Food Addiction as a Disordered Belief in Anorexia Nervosa?" Obesities 3, no. 3: 207-217. https://0-doi-org.brum.beds.ac.uk/10.3390/obesities3030017