Incorporating food addiction into disordered eating: the disordered eating food addiction nutrition guide (DEFANG)

Abstract

Although not formally recognized by the DSM-5, food addiction (FA) has been well described in the scientific literature. FA has emerged as a clinical entity that is recognized within the spectrum of disordered eating, particularly in patients with bulimia nervosa, binge-eating disorder and/or co-occurring addictive disorders and obesity. Integrating the concept of FA into the scope of disordered eating has been challenging for ED treatment professionals, since there is no well-accepted treatment model. The confusion surrounding the implications of FA, as well as the impact of the contemporary Westernized diet, may contribute to poor treatment outcomes. The purpose of this review is twofold. The first is to briefly explore the relationships between EDs and addictions, and the second is to propose a new model of conceptualizing and treating EDs that incorporates recent data on FA. Since treatment for EDs should vary based on individual assessment and diagnosis, the Disordered Eating Food Addiction Nutrition Guide (DEFANG) is presented as a tool for framing treatment goals and helping patients achieve sustainable recovery.

Body uneasiness is associated with food addiction symptoms: A cross‐sectional study

“…This is in accordance with previous findings showing that FA is frequently diagnosed (between 65% and 100%) in patients with a current diagnosis of BN and (between 41.5% and 72.2%) in patients with BED and clinical levels of binge eating (Burrows et al, ; Imperatori, Fabbricatore, et al, ). Therefore, as already hypothesized (Imperatori, Fabbricatore, et al, ; Treasure et al, ; Wiss & Brewerton, ), FA may be conceptualized as a trans‐nosographic construct in obese and overweight patients and in all patients with EDs, especially in those with BED and BN. Although, this interpretation remains speculative, given that we did not assess the possible presence of EDs, it might be useful in future research to directly investigate differences in body uneasiness in patients with “singular” forms of dysfunctional eating patterns (i.e., FA, BED, BN, and AN) using well validated tools such as the Eating Disorder Examination Questionnaire.…”

“…Previous studies have reported that body uneasiness could be a relevant feature in AN, BN (Cuzzolaro et al, ; Franzoni et al, ), and BED (Cuzzolaro, Bellini, Donini, & Santomassimo, ). Previous research has also shown that FA has significant psychopathological overlap (e.g., reduced control over eating, depressive symptoms, and emotion dysregulation) with BED and BN (Wiss & Brewerton, ). However, compared to EDs, FA is not characterized by body image related symptoms.…”

“…It has been observed (Wiss & Brewerton, ) that FA seems to also have significant psychopathological overlap (e.g., reduced control over eating, continued use despite negative consequences, emotion dysregulation, and depressive symptoms) with other EDs, particularly with BN and BED, even if there are also some crucial differences (Imperatori et al, ). For example, FA, but not BED or BN, is characterized by biopsychological symptoms such as withdrawal and tolerance.…”

Are trans diagnostic models of eating disorders fit for purpose? A consideration of the evidence for food addiction

“…New findings from genetic studies suggest that both psychological and somatic aspects may need to feature in our models of eating disorders . One example of this is the disordered eating food addiction nutrition guide, which uses 2 dimensions, weight and predisposition, as a means of categorizing the different forms of eating disorders.…”

The association of serum leptin levels with food addiction is moderated by weight status in adolescent psychiatric inpatients

“…However, the items of the YFAS questionnaire were tailored alongside the DSM‐IV criteria for “substance related and addictive disorders,” which causes ongoing debates (Finlayson, ; Hebebrand et al, ; Long et al, ; Schulte et al, ; Ziauddeen et al, ). New conceptual constructs like “food use disorder” (Nolan, ) or a Disordered Eating Food Addiction Nutrition Guide came up recently (Wiss & Brewerton, ). Most notably, Ruddock et al reported on the development and initial validation of the Addiction‐like Eating Behaviour Scale (Ruddock, Christiansen, Halford, & Hardman, ), which embarks for the first time on the concept of “eating addiction.” Further research also with these new instruments is warranted to explore how well the concept of “eating addiction” will match with clinical experience on the one side and biomarkers like leptin on the other side.…”