Eating Disorders as Addictions

We have heard it all before – our culture is ripe with concerns and worries about weight. Despite the illusion that here in the United Kingdom the problem is not too serious – an illusion spawned from our being convinced that obesity and other weight problems are only fatal in the U.S.A. - data gathered in 2007 showed that 65% of men and 56% of women in England are obese or overweight, and that in Scotland children are consuming a dangerous amount of sugar – approximately 17% of each days calorie consumption is made up of base sugars such as glucose1. These figures are certainly shocking, but there is another side to the coin of weight problems, where people become obsessed with losing weight and being slimmer. Being underweight is as severe a problem as being severely overweight and carries with it psychological issues which can stay with the individual for a lifetime. This essay is concerned with both the biological and psychological aspects of eating disorders, with a special focus on anorexia nervosa, and will attempt to identify some of the reasons behind their aetiology. This essay hypothesises that eating disorders are a form of addiction and will begin by describing some of the symptoms of anorexia nervosa and bulimia nervosa, after which the physiological nature of addiction will be explored. Succeeding this will be an explanation of why it is plausible that eating disorders are a form of addiction, based on the information and data described previously.

Anorexia nervosa is a serious eating disorder, which exerts intense psychological power over the individual and causes extreme bodily changes. The symptoms include a devout belief that one is overweight no matter how thing one becomes (this can lead to chronic body dysformia, even if the individual recovers), obsession and control around food including ritualistic behaviour, avoiding food completely, vigorous exercise and use of laxatives2. All this leads to an extremely unhealthy body and mind, and it is an underlying fear of becoming overweight that governs the behaviour3. It is estimated that 1 in 100 women aged 15-30 suffer from anorexia in the UK4 . Bulimia nervosa is another common eating disorder and is characterised by a similar obsession with thinness and unhealthy eating patterns as anorexia, but there are differences. Bulimia is associated with episodes of binging and purging food, either by purposefully making oneself vomit or through extreme amounts of exercise. Binging periods see the individual consume a vast amount of food in a very short period of time and during these periods one feels as though one has completely lost all control which can lead to extreme guilt and this perpetuates the period of purging which follows. Another difference between anorexia and bulimia is that it is possible for someone suffering from bulimia to be a normal weight or even overweight5 since it is the control element and the interchanging periods of binging and purging which characterise it – this also means it carries it’s own dangers beyond malnutrition and being chronically underweight. Bulimia can lead to numerous gastric problems due to the pressure placed on the stomach, enamel of the teeth can become eroded due to frequent vomiting and over-exercise can lead to exhaustion and damage the muscular-skeletal system in the body, particularly the joints. Another difference between the two disorders is that those suffering from anorexia tend to demonstrate an unhealthy obsession with food itself – it’s preparation, it’s calorie content, what other people are eating etc. - whereas those with bulimia are more focussed on their own personal body shape. Clearly there is a strong psychological element to these disorders since, despite all the physical and bodily issues they can cause, hundreds of people continue these lifestyles.

Furthermore, among those suffering from these disorders are those who view it as a desirable and empowering state to be in. The increasing number of “pro-anorexia” or “pro-ana” websites found on the internet, where those already suffering can share tips on how to conceal their illness from others and even offer advice to others who seek to become anorexic. Eating disorders are among the very few disorders which are viewed in a positive light by the sufferers (can we still call them sufferers in light of this information?) and are used by them to define their personality and construct an identity. There are few papers in publication which have studied this phenomenon in depth, but social neuroscientist Daniel Goleman describes how the internet has changed our social behaviour - “we stay in touch at arms length” and tells us that over the internet more explicit and sexual desires are expressed – it does not take too much thought to realise that we are more open and honest online, and these pro-ana websites provide a piece of cyberspace where sufferers can express and show the truth behind their relationship with the illness.

So what exactly is going on here? These disorders are clearly life-threatening at their worst and even mild anorexia or bulimia can be dangerous – these are not simply people being conscious of their bodies, they are chronic mental illnesses characterised by very clear behaviour patterns and physiological changes in the body. To what extent are they caused by biological factors - such as changes in the hormones during puberty – or by sociological and cultural factors – such as the media and the self-objectification theory6.
“The focus…is on the increase or decrease in weight, rather than understanding
the social and emotional dimensions of what it is like to be a young
woman suffering from an eating disorder” (Rich, 2006)
The above is taken from a paper published to attempt to highlight the sociology of anorexia more to provide a richer analysis of the disorder and to move away slightly from the dominant biomedical model, which fails to recognise the psychological and mental difficulties associated with the disorder. The message is a simple one – there is more than just weight gain/loss when it comes to anorexia and bulimia. No one can deny the importance of understanding the biology of the disorders, and indeed physiology is important in regulating mood and emotion and so is imperative to aetiology and recovery, but this essay will incorporate both a medical and a socio-psychological approach to the disorders.

One theory of the aetiology of eating disorders is called the self-objectification theory and states that women alter their bodies in order to keep with the demands of a patriarchal society in which women are seen as objects. However, it seems an odd concept that women change their body image purely to please men since if this were the case surely the situation would have improved since the feminist movement? When in fact, if there is any case to be made for the argument of the media influence the self-objectification argument must be false as it has only been in the last forty years or so – since the sex revolution of the 1960’s and 70’s – and this has done nothing to rectify the prevelence of eating disorders, therefore it cannot be a simple case that women are used to being subordinate and thus alter their bodies simply because they live in a society where the self-perpetuating idea that women are somehow below men has been embedded in them. The two theories could work together however, in that it may not be to please men that women objectify their own bodies – it could be simply to compete with other women. This goes back to our evolutionary roots and reminds us that we are subject to Darwinian laws as any mammals are.

A more biologically based idea behind the development of eating disorders, could explain part of the aetiology of disorders in women. As puberty begins in women, the body undergoes a huge hormonal transformation and it is believed by some psychologists that the change in sex hormones coupled with the bodily changes undergone by the individual could lead to more self-consciousness which in turn could trigger a fear and eventually develop into an eating disorder. But once again, it seems a stretch that being slightly self-conscious of ones new body would be so closely linked to dangerous eating disorders – this seems like an evolutionary failure, if women so easily become afraid of their own bodies! There is little evidence to support the claims made here, and also it does not explain the rising number of boys and men developing eating disorders.

Going back to a more sociocultural perspective, dissatisfaction with ones body appears to be an obvious answer – why else would one want to change it? But this then begs the question why people are dissatisfied with what they have, and it is at this point where the finger gets pointed at the media. We are bombarded with images of the “ideal” figure every day from magazines, television and models in the windows of high street shops. Clearly, if this is the case then the justification for it’s continuation is economic – where would designers and cosmetics companies be without the women who become convinced that a little more foundation or one more bottle of miracle cream will make them happy. However, it is improbable that mere dissatisfaction with ones body leads directly to dangerous eating disorders of the magnitude discussed above as these are much stronger than a simple desire to lose a few pounds. It could provide a starting point, from which the individuals desire to lose some weight develops into something more serious and this will be discussed further below as the idea that eating disorders are forms of addiction is explored.

Addiction is characterised by both physiological and psychological changes in the individual. The most common form of addiction in the UK is substance abuse, usually involving alcohol or tobacco, although illegal drugs such as narcotics and opiates are certainly not unheard of. Addiction can be described as a dangerous love-hate relationship between the individual and the object/event whereby the individual is willing to go to extremes in order to obtain the object or relive the event. It is characterised by compulsive and obsessive behaviour, manipulative behaviour, a loss of interest in anything unrelated to the object/event and the individual suffers psychologically (withdrawal symptoms) when they do not have the object. The quicker a drug gets into the brain circuitry, the more addictive it is said to be, since it alters the balance of neurotransmitters in the brain while bypassing the senses – and it is the “highs” produced by these changes in the brain that addicts crave. Dopamine and serotonin are two neurotransmitters whose levels in the brain are effected hugely by the presence of drugs, but are also responsible for mood levels and anxieties. Different drugs alter the brain circuits in different ways – some encourage the brain to produce more dopamine and some mimic the neurotransmitters already present – but the central point is that addiction occurs due to a change in brain chemistry by flooding the circuitry with dopamine and serotonin. This then leads to psychological addiction as areas in the brain affected include the limbic system which is responsible for mood regulation and is the brain’s reward centre.

We can already see how it might be possible to liken eating disorders to addiction, given the similarities in terms of behaviour – obsession and compulsion in order to obtain whatever goal (whether it be to be unnaturally thin or one more line of cocaine) with little or no regard for the consequence to oneself or to others. Another similarity is the manner in which these problems gradually take over the individuals life – the issue slowly becomes a defining part of the individuals identity (as we saw above, sometimes this is seen as a positive thing by those suffering from anorexia) and the involvement of the limbic system. Albeit a more psychological desire in the case of eating disorders, there is certainly an element of achieving a “high” from refraining from eating or from limiting calorie intake drastically. One could certainly draw parallels from the behaviourist concept of operant conditioning, where positive reinforcement (in this case, the good feeling the individual gets when he/she refuses to eat) will lead to repetition of the behaviour in future. And as with substance abuse, as the brain chemistry adapts to accommodate the excess dopamine or serotonin which means the addict requires the drug in greater quantities – so the degree to which the individual suffering from an eating disorder starves their body of food increases.

Of course, in some ways it seems a strange analogy to make. Addictions such as substance abuse are focussed around the addict getting something – it involves an intake of something in order to induce a state of dis-sobriety. The opposite is true of eating disorders. At the foundations of anorexia is the strict control of and in some cases total abstention from food intake – an active avoidance of taking in anything at all. In the case of bulimia where there is a period of binging, sometimes to the point the individual feels ill and nauseous, there is also the period of purging – where the individual actively removes anything they have consumed from their body by a number of methods. However, this could be simply an extension of the addiction. Afterall, addiction represents a relationship between an individual and an object/event – in case of those suffering from an eating disorder, the relationship is that between the individual and food.
To briefly return to an issue mentioned earlier concerning obesity, there is indeed a body of psychologists who argue that addiction to food is more than plausible and in cases such as chronic overeating, thyroid problems and compulsive overeating disorder, the psychology underlying the relationship between the individual and food is indeed representative of addiction. I am arguing that the same is true of eating disorders – simply negate the proposition. Those suffering from an eating disorder are addicted to the self-perpetuating “high” they experience by being able to decline and control food.

Ultimately, at the centre of all eating disorders there is a control issue, and the same is true of addiction. The addiction feels out of control and suffers terrible withdrawal symptoms if the need they feel for the object of their addiction is not satisfied and this can lead them to take terrible action. Those suffering eating disorders also suffer if they are not in a position to control what goes into their bodies and this can lead to emotional and psychological anxiety and distress. Sometimes these effects can last a lifetime – only about 40% of those suffering from anorexia fully recover. It is possible to live without having made a full recovery, but the potential for relapse is high unless monitored carefully, and it is estimated that around about 5% of cases are fatal. This essay has addressed the aetiology of eating disorders – from both a sociocultural and psychological perspective and from a more biological perspective – and has explored the various symptoms of the two most common disorders, anorexia nervosa and bulimia nervosa. The proposed idea that eating disorders are a form of addiction was then introduced, and the arguments clearly explained. In conclusion, eating disorders can be portrayed as types of addiction, and this could lead to new ways of helping to treat the disorders rather than with mere medication and a focus on physical statistics such as weight and jeans size. A person can be bulimic without necessarily being underweight and no one has perfected deception or will-power as well as an anorexic.

Hi Luntifeathers, I enjoyed your analysis of this matter. I agree with you on the fact that in this sort of situation there usually are two factors involved: a physical and a mental factor. You have focused on the physical factor because often times the mental factor gets highlighted. I would like to point out that this kind of thing can only occur when both factors are present. I have personally seen people kick cocaine addictions without any help for instance (apart from some ganja, something to do and a lot of cold sweat). On the other hand no addiction can come into being without a certain physical effect. So, how can this be?

If we examine Freud’s architecture of the workings in the mind we see that there are three ‘domains’ (so to speak): ‘Es’ (the drives), ‘Über-Ich’ (Super-Ego) and ‘Ich’ (Ego). ‘Es’ represents the domain of the bodily functions in the mind. The ‘Über-Ich’ represents the domain of the cultural values and the ‘Ich’ represents the domain of the compromise between the two. Looking at this we see that The ‘Es’ is the correlates to Kant’s noumenon and the ‘Über-Ich’ correlates to Kant’s phenomenon. Because there is a difference between the two the human mind needs to find a compromise between the two, which creates the ‘Ich’.

So, a physical need leads to a chance in the behavior of the ‘Ich’. However, a change in the ‘Über-Ich’ also leads to a change in the ‘Ich’. Here we see the two factors that you describe emerge clearly: a mental and a physical factor dominating behavior. One might wonder why behavior is not changed when a certain behavior is understood as harmful (or strange, wrong, etc). The reason for this is desire. Desire is the physical drive (of the ‘Es’) in combination with the mental ‘forbidden’ (of the cultural ‘Über-Ich’): One desires what one has a drive for, but forbids oneself to have (hence the necessity of both the physical and the mental aspect you described). So, the physical reaction to a certain compound (be it drugs or be it food) is desired when one forbids oneself to actually use the compound. This is the very core of addiction. In the case of eating very little or throwing up the subject has a small drive to eat and feels restrained to choose for oneself, or realizes one has eaten too much and therefore throws up out of guilt of the ‘violent release’ of the desire).

This leaves the question how such conditions can be treated or dissolved. There is only one way to do so: that individual has to let go of the (private) cultural values contained in the ‘Über-Ich’. That way the drives contained in the ‘Es’ can find its own balance. In that sense the drives structure the human behavior automatically, only limited by the feeling of restraint (by means of the cultural values in the ‘Über-Ich’).

Wie ‘Es’ war, so soll ‘Ich’ werden.
~Sigmund Freud.

I am placing this second bit here because I feel I was a bit short in my explanation of how to get past this desire. The thing of it is that when desire comes into existence the ‘Über-Ich’ is being used in an unnatural way. Normally a bodily function is expressed in a way that a subject knows from what that subject understands of the culture the subject belongs to. In (all) situations where troubles arise the ‘Über-Ich’ is being used as a rule-base. That means that it is no longer the expression of something, but the desired end-result: one size fit all. Factually the reasoning becomes a comparison between the rule-base and the act; the act only being ‘good’ when the act is equal to the rule-base. In logic the faulty reasoning would be represented by a syllogism with two minor premisses and the natural reasoning would be represented by a syllogism with a major premisse. A major premisse always is about the working in the mind.: a certain thing we can think and a minor premisse always is an ‘image’ or ‘expression’ thereof.

I hope I have sufficiently elaborated with this. If not, feel free to ask.

I apologise if it appeared I was being unbalanced in my focus - I was trying to be as fair to both the mental and the physical factors. I agree that desire is a major contributor to the perpetuation of behaviour, but it comes as a consequence of the addiction - it is the fuel that keeps the fire burning so to speak. It is interesting what you are saying about the suger-ego and the id. Another way of looking at this is to use Higgin’s concept of the three selves - the Actual Self (how we actually behave in the real world), the Ideal Self (how we would like to behave and think) and the Ought Self (how we feel we should act and think). Anxiety builds up when there is friction between the ought self and the actual self (this leads to guilt, shame and depression) or between the ideal self and the actual self (this leads to a feeling of being useless, unfulfilled and also depression). These feelings naturally lead to a change in behaviour - addiction being one of numerous ways in which the conflict manifests itself. Self-discrepancy becomes the base upon which addictions grow, and desire - with all it’s positive connotations, alongside the good feeling the “high” gives one - is the catalyst for this development.

I have to ask though - what do you think desire actually is?

It is very interesting that with addiction, the psychological and the biological factors function alongside eachother. It is almost as if the substances are governed by rules similar to Darwinian natural selection - they consciously want to survive and do so by causing an organism to become addiction to consuming it. Of course, this is highly unlikely, but a fun idea none the less.

Hi Luntifeathers, I can understand that you do not read my response for what I am trying to say since your focus is on the addiction. My entire response was an attempt to show that it has got nothing to do with an addiction what so ever. I guess my cocaine example was not such a good choice. Let me start anew:

  1. We speak of an addiction when a great response of the body is noticed and a great dependency of the body follows. This is, however, a very ambiguous claim. The same might be said for oxygen for instance. Personally when the subject of addiction comes up I usually joke about still not having been able to kick the oxygen habit. My body depends on it and if I do not get any real soon I feel as if I will die. So, an addiction is simply an extreme within the set of normal bodily reactions.

  2. Desire is not the fuel that keeps addiction burning; desire ís the addiction. One of the characteristics of an addiction is the enormous desire to get that feeling again, right after the effects wear off. It reminds me of a guns and roses song (Mr. Brownstone): “I used to do a little, but a little wouldn’t do it so a little got more and more”.

  3. My proof that desire is the culprit here is as follows. We all know the story of the healthy man getting a heart attack while jogging. The reason this happens is because an unbalance in oxygen (no, this is not a joke…but a hilarious comeback after people make fun of my oxygen joke…) in the body. The thing of it is that when the heart starts pumping it demands more and more oxygen that will be delivered across the body. This can be solved by taking deep breathes. The drive is to inhale oxygen, mind. But when one stops running the body will need a moment to calm down. From that moment on we should stop gasping, but we are taught to inhale lots of oxygen when we are tired. The fact that the body is no longer distributing the oxygen across the body, combined with the ‘goal’ of inhaling oxygen leads to a a panting: a moment of not inhaling oxygen leads to a convulsive big gasp of oxygen. If this progresses for some time we call it a hyperventilation. When too much oxygen gets stuck in the heart a heart attack occurs and the healthy jogger dies from an oxygen overdose. Here we see desire coming around the corner as the actor leading to an overdose. I could have made a similar example out of sex, watching television or having philosophical discussions. All it takes is a bodily function that is not equal to the cultural ‘goals’. All compounds that have effects on the body can be said no to. Trust me, I have seen it happen. All that needs to be done is beating the desire. From that moment on the sky is the limit.

  4. With this I am not saying that there are no addictive substances in our food. I know there are. Perhaps the worst of them is sugar. Ask any diabetic: can’t live with it and can’t live without it.

  5. I Would like you to point me to a clarification of this Higgins’ theory. I do not know his work and I cannot find a good clarification. Your (very short) summary seems not to be able to explain certain working. So, I think I am misunderstanding you, you are misunderstanding (or merely misquoting) him or he is simply misunderstanding it (<–the real).

  6. Are you studying psychology or a derivation thereof? I am asking this because it is common in psychology nowadays to rule out the leading position of the mind on the body; as if the body is always in the lead. If you are of such a conviction I would like to stipulate the psychosomatic effect that occurs when somebody believes to be afflicted with an illness, or, for that matter, all pygmalion effects. To be historically correct I would like to stipulate that all psychology is derived from Freuds work, who came to psycho-analysis because certain physical behaviors could not be clinically explained. He thus discovered neuroses. These are the stimuli coming from the mind, directing the body to certain behavior. We might go even further back to Descartes ‘Pineal Gland’, but I am afraid to be burnt at the stake (:P). Anyway, The question remains: are you studying psychology or a derivation thereof?

===addendum===
I probably overstated my case for the mental side of the matter. My point is that there are two ingredients and not one. When you mention addiction as a physical reaction you are ignoring the second ingredient. The reason I am trying to show the importance of the second ingredient is because desire can only emerge with these two ingredients. Even more important: the expressions in the ego know both ingredients. I will go to such lengths as to say that every though (syllogism) has both ingredients. I hope this comes across.

Dear Luntifeathers, I must suggest that you link articles instead of writing huge essays, at the links you give specific comments, which are easily identifyable when most of us should know about these notoriously illnesses, but can’t distinct comments from article.

Besides it takes an extreme manic obsessiveness to keep interest in SUCH long article. Learn the laconic ways for your own good.

Yes anorectic nervosa are usually caused by the victim being happy to remove all the “overwhelming” fat from their body, and in that dopamin are released, thus they are enslaved by this behaviour.

Hex - just a note - this is the Essays & Theses board. It was created to accommodate long posts. Extreme manic obsessiveness is not a prerequisite, however.

Can this be restated? I have trouble following this particular sentence.

In natural functioning what is “the something” of which the “Uber-Ich” is the expression? The collective sublimation of the Id? Cultural values in and of themselves?

Is it incorrect to say “the act only being “good” when the act is proscribed (not forbidden) by the rule base?” But I agree with the notion that the addict is seeking to unify with or liquidate the Super-Ego with addictive behavior - a complete equivalence. But I am unclear I think to your precise viewpoint.

So working of the mind is equal to another working of the mind. This is natural reasoning.

Whereas chasing equivalence of an image/expression of a working of the mind to another image/expression of a working of the mind is fallacious/addictive logic.

I see some sense to it I think. By that logic most philosophical/religious/ideological endeavors are narcotic!

I like Freud because he is so unfashionable but perhaps very relevant!

I would like to share some thoughts inspired by the OP’s well written essay.

Anorexia is experienced in adolescence - and when earlier or later could be expressed as early adolescence or protracted adolescence.

Isolating socio-psychological factors is difficult because adolescence is a time in itself of finding mature roles - thus when cultural standards for those good roles seem more arbitrary or selective - the propensity towards an illness around the particular private devastations of the individual goes up in toto in a way unable to be pegged to a discrete variable form.

Some Anorexia seems a kind of famine-protest against aribtrary unjustness of social norms. Some Ana’s are quite wonderful loving souls - others are appallingly vain and selfish - so it seems the truth of the aetiology lies in the sense of reality which can be brought to bear on the intersubjective life-world of types of sufferers.

Do I have faith that the addiction sociobiological paradigm hinted at in the essay will catalyze better help? No - it is phenomenologically moribund.

Moved from Essays & Theses