Although research in the field of pathological addiction from food is still in the initial phase, in the last 10 years an interesting series of contributions (authors such as Gearhardt, Davis, Kuschner and Brownell) has made it possible to open a debate on the topic.
We know, for example, that in a dimension of pathological appeal to food, the satisfactory and rewarding experience of consumption would have happened in the absence of real metabolic needs.
Some studies have shown that the neurological circuits involved in the search for food And in the research of drugs they would be the same (eg Volkow and O’Brien, 2007).
However the concept of Patological dependence on food remains controversialespecially for the overlaps that come to be created, on a diagnostic level, with other much more known paintings in literature, let’s see which ones.
A controversial diagnosis
Other authors argue that food dependence occurs only in specific subgroups of obese patients, or those with uncontrolled eating disorder (Binge Eating Disorder – Bed) (Wang, Potenza et al., 2012).
Many Bed criteria actually resemble those of the use of substances (DUS) and many clinicians report the use of psychotherapeutic techniques of the Dus treatment in the management of the Bed (von Ranon and Robinson, 2006).
A study by Gearhardt et al. (2012) showed that 57% of patients with Bed also met the criteria for the Patological dependence on food And that higher dependence scores preded more uncontrolled feeding episodes.
Bed and dependence on food are therefore distinct but superimposed conditions?
The Binge Eating Disorder (Bed)
In order to diagnose a bed, they must occur recurring episodes of binge.
A tan is defined by both the following characteristics:
(a) Eating in a period defined as time (e.g. over two hours) an unquestionably greater amount of food than what most people would eat at the same time interval and in similar circumstances
(b) sensation of loss of control over the power supply during the episode. Furthermore, the binges must be associated with at least three of the following symptoms:
- eat much faster than normal,
- Eat until you feel unpleasantly full;
- Eat large quantities of food even if you don’t feel physically hungry;
- Eating in solitude because it is ashamed of how much food is taking place;
- Try disgust towards itself, depression and guilt after each episode.
Finally, we know that a marked discomfort must be present against bulimic behavior and that the binges take place, on average, at least two days a week for a period of six months.
Food addiction
Using the Yale Food Addiction Scale (YFAS) a group of researchers from Yale – led by Gearhardt – found that the most frequent features of food addiction are:
- repeated and useless attempts to reduce excessive nutrition;
- continuing the behavior despite the evidence of deriving problems;
- A lot of time spent to hide food, to eat and recover from excesses.
The same author emphasizes how, however, the same characteristics are also the most observed in obese subjects suffering from Bes (Gearhardt, 2012).
The greatest evidence in support of the existence of the Diagnosis of food addiction They derive from Neurobiology (Volkow, 2012): it is certain that dopamine has a role in the induction of pathological addictions and many foods have dopaminergic properties.
The administration of dopamine antagonists or the injury of the dopaminergic system, in the rats, attenuates the response to food and reduces the compensatory effect of food with high sugar content (oat et al., 2003).
The reduced availability of D2-Like receptors for striatal dopamine is related to the onset of compulsive intake of food in obese rodents (Johnson and Kenny, 2010).
What conclusions Gearhardt arrives?
At the end of his studies, the author concludes that 43% of subjects with Bed did not satisfy the criteria for food addiction with YFAS.
30% of subjects with dependence on food diagnosed with YFAS did not satisfy the criteria for Bed.
Finally, the subgroup of Bed subjects that satisfied the YFAS criteria for dependence presented greater levels of: negative affectivity, emotional discomfort, less self -esteem and eating disorder (DCA).
Bed and food addiction are therefore distinct conditions that can also occur in superimposed mode!
Which treatment?
Cognitive behavioral therapy for addictions is applied to pathological dependence on food, with a due clarification: it is not working on abstinence, but on the progress of foods that have high properties.
It then integrates with some elements taken from the Bed treatment protocols, such as the Fairburn protocol (1981), with a cycle of 20 sessions about distributed between:
- Establish therapeutic alliance/psychoeduCare to the disorder/inform about the TCC;
- Introduce regular and healthy food plan (involvement of the nutritionist);
- I work on dysmorphophobia, cognitive distortions, clinical perfectionism …
- Employment maintenance and management plan.
The standard TCC can be integrated with elements of the dialectical Behavior Therapy (DBT), such as:
- implementation of emotional regulation skills;
- stress tolerance;
- Mindfulness and awareness
- interpersonal skills.
In conclusion: it is premature to refuse the concept of food dependence and available data indicate the need for further epidemiological and clinical investigations.
It is important that future research focuses on food dependence in its peculiarity (distinguishing it from other forms of food behavior pathology).
Bibliography
- Gearhardt, An, Corbin, WR (2009). Food Addiction: An Examination of the Diagnostic Criteria for Dependence. Journal of Addiction Medicine, 3 (1), 1-7.
- Gearhardt, An, Corbin, WR (2009). Preliminary validation of the Yale Food Addiction Scale. Appetite, 52 (2), 430-436.
- Gearhardt, An, Grilo, Cm, Dileone, RJ, Brownell, KD & Potenza, MN (2011). Can food be adapted? Public Health and Policy Implication. Addiction, 106 (7), 1208-1212.
