Do ED Behaviours Resemble an Addiction? - Looking at ED'S Through a Different Lens
Anorexia Nervosa has the highest mortality rate of any psychiatric disorder (1,2), more people die each year due to eating disorders than the annual national road toll (3), yet its origins remain complex and deeply personal.
When I was first introduced to the symptoms, characteristics, and behaviours that define anorexia nervosa, something didn’t quite fit. While many of the descriptions resonated—the relentless pursuit of thinness, the fear of gaining weight, and the compulsion to restrict food—I felt there was something deeper beneath my eating disorder. These definitions captured parts of my experience but not the whole picture. It was as though my disorder had roots that extended far beyond what was visible on the surface.
For me, anorexia wasn’t solely about achieving thinness or avoiding weight gain. It felt more like an addictive coping mechanism—a way to assert control in a world that felt unpredictable and overwhelming. The behaviours, though harmful, brought a sense of relief and stability. Over time, I began to wonder if my eating disorder was less about appearance and more about deeper patterns of addiction, shaped by past trauma and family influences.
This realization sparked a question: Could anorexia, for some, function as a form of addiction? Could it be driven not just by societal pressures or perfectionism but also by inherited predispositions and the lingering effects of unresolved trauma?
I want to be clear: I don’t believe this is the only explanation for why anorexia nervosa develops. Eating disorders are deeply complex, and no single theory can encompass every experience. However, I do think this perspective may resonate with others who feel they don’t quite fit into the conventional narrative of anorexia nervosa. For those who—like me—sense that their disorder stems from something deeper, this theory might offer a new lens through which to understand their struggles.
In this post, I will explore the possibility that anorexia nervosa, for some individuals, functions as a form of addiction. I’ll examine how trauma, family history, and neurobiological factors may contribute to the development of an eating disorder and how these elements intertwine to create a complex and deeply personal experience. By sharing this theory, I hope to broaden the conversation around eating disorders and create space for the diverse and varied ways they manifest.
Section 1: Understanding Anorexia Nervosa
Anorexia nervosa is a serious mental health condition that affects both the body and mind. At its core, it is characterized by restrictive eating, an intense fear of gaining weight, and a distorted body image. However, anorexia is more than just a focus on food or appearance; for many, it becomes a way to cope with underlying emotional or psychological pain. It often serves as a means of exerting control in an otherwise chaotic or overwhelming world.
- Rapid weight loss or frequent weight fluctuations
- Loss or disturbance of menstruation (if applicable)
- Decreased libido
- Fainting or dizziness
- Poor circulation
- Bloating, constipation, and food intolerances
- Lethargy
- Facial changes (e.g., sunken eyes, pale skin)
- Fine body hair (e.g., lanugo)
- Anxiety or irritability around meal times
- Intense fear of weight gain
- Difficulty concentrating or thinking
- Low self-esteem or perfectionism
- Increased sensitivity to comments about food, weight, body shape, or exercise
- Dieting behaviours (e.g., fasting, counting kilojoules, avoiding certain food groups)
- Repetitive behaviours related to body shape and weight (e.g., body checking, constantly weighing themselves)
- Eating in private or avoiding meals with others
- Secrecy about eating (e.g., claiming to have eaten when they haven’t)
- Compulsive or excessive exercising
- Radical changes in food preferences (all of a sudden saying they dislike a food they have always loved)
- Preoccupation with preparing food for others, recipes, or nutrition
For some, restricting food and controlling weight may be a way to manage aspects of life that feel out of their control. Over time, their body image may become central to their sense of self-worth. Anorexia nervosa can also be a way to express emotions that may feel too overwhelming, such as pain, stress, or anxiety (5).
Restrictive behaviours often serve as coping mechanisms for unresolved trauma, which is commonly a root cause of the disorder. Similarly, tendencies toward perfectionism and self-criticism may reflect dysfunctional family dynamics or past adverse experiences. These factors suggest that anorexia is not only a response to societal pressures, but also a manifestation of deeply ingrained emotional regulation patterns and survival strategies.
Women and girls are more likely to be affected by eating disorders than men and boys. While research on transgender and gender non-conforming people is limited, existing studies suggest they are more likely than cisgender individuals to experience eating disorders or engage in disordered behaviours (6). In Australia, 63% of people with eating disorders are women and girls (7), while 37% are male (8). Additionally, between 15-20% of people with anorexia nervosa and bulimia nervosa are male (9).
These gender disparities may be influenced by societal pressures, such as rigid beauty standards that disproportionately target women and gender non-conforming individuals. For transgender individuals, body dissatisfaction can be compounded by gender dysphoria and societal stigma, increasing vulnerability to eating disorders. Meanwhile, eating disorders in men are often under-recognized, leading to delayed diagnoses and limited access to care (10). Understanding these gendered patterns is crucial for developing more inclusive and effective support systems.
Section 2: Eating Disorders and Addiction: A Shared Pathway?
The similarities between anorexia nervosa (AN) and addiction extend beyond behaviour to the neurobiological processes that drive these compulsions. Both AN and substance use disorders (SUDs) involve dysregulation in the brain's reward system, primarily mediated by dopamine. In addiction, substance use hijacks the brain’s reward system, reinforcing behaviours that stimulate dopamine release. Similarly, in AN, self-control over food and weight may be rewarded in ways that mirror the rewarding effects of substance use. This overlap in neurochemical pathways suggests that the compulsive behaviours observed in AN may follow similar mechanisms to those seen in addiction, making recovery challenging without targeted interventions.
The compulsive nature of behaviour in AN and addiction also manifests in similar developmental patterns. Both disorders often begin with an initial phase of reward-seeking. For individuals with AN, weight loss may initially provide feelings of euphoria or accomplishment, much like the early stages of drug use in addiction. Over time, however, the compulsive behaviour becomes more entrenched, and individuals find it increasingly difficult to stop despite the negative consequences. This overlap in both behavioural and neurobiological mechanisms suggests that AN and addiction may share common pathways in the brain, contributing to the persistence of compulsive behaviours.
A 2015 study titled Does Compulsive Behaviour in AN Resemble an Addiction? (11) explored the role of compulsivity in anorexia nervosa through participant interviews and surveys. Eight key themes were identified, which reveal the central role of compulsive behaviours in the onset, persistence, and recovery of AN. These themes underscore the striking similarities between AN and addiction.
Compulsive behaviours were described as central to the onset of AN and integral to an individual’s identity. Participants often said they would not feel “anorexic” without these behaviours. The compulsions related to food and weight loss became so entrenched that they were viewed as core aspects of their self-image.
Participants described their compulsions as being outside their conscious control, similar to cravings and compulsive substance use in addiction. Even when they recognized the harm of their actions, they felt powerless to stop. Many participants reported repeated failed attempts to stop, highlighting the difficulty of overcoming AN, much like the struggles of those with SUDs.
The compulsive behaviours associated with AN led to significant impairments in daily life, such as isolation, strained relationships, and difficulty maintaining work or school commitments. This mirrors the life disruptions caused by addiction.
Despite the harm caused, participants continued engaging in their compulsive behaviours. This reflects the continuation of substance use in addiction, where individuals keep using substances despite knowing the risks and consequences.
As participants lost more weight, their compulsions became more severe, with stricter rules around eating and exercise. This escalation mirrors the increased tolerance seen in addiction, where larger quantities of a substance are needed to achieve the same effect.
When participants were prevented from engaging in their compulsive behaviours, they experienced intense withdrawal-like symptoms, such as anxiety, fear, and agitation. Some substituted one compulsive behaviour for another, similar to the substitution seen in addiction.
Negative emotions, such as anxiety and low self-esteem, were significant triggers for compulsive behaviours. Participants used these behaviours to manage or suppress their emotions, much like individuals with SUDs use substances to cope with emotional distress.
Compulsivity was identified as the greatest barrier to recovery. Despite their desire to recover, participants found it extremely difficult to break free from their compulsive behaviours, which is similar to the challenges faced by those in addiction recovery.
The study’s findings reveal strong similarities between AN and SUDs, particularly in areas like compulsivity, impaired control, and emotional regulation.
Impaired Control: Both AN and SUDs involve a lack of control over behaviours despite the desire to stop. Participants in the study reported feeling compelled to engage in their compulsive behaviours, even when they recognized the harm caused. This mirrors the diagnostic criterion for SUDs, which includes an inability to control substance use despite the desire to cut down or stop.
Social Impairment: Both disorders lead to significant impairments in relationships and functioning. Participants with AN reported social isolation and strained family dynamics, much like individuals with SUDs face breakdowns in relationships and struggles with maintaining work or social obligations.
Risky Use: In both AN and SUDs, individuals continue harmful behaviours despite the risks involved. Participants described continuing their compulsive behaviours, even when they caused psychological and physical harm, similar to substance use in SUDs despite known risks.
Pharmacological Criteria: The escalation of compulsive behaviours in AN, such as stricter rules around eating and exercise, mirrors the tolerance seen in addiction, where greater amounts or frequencies of substance use are required to achieve the same effect. Withdrawal-like symptoms, such as anxiety and agitation when preventing compulsive behaviours, also resemble the withdrawal symptoms observed in SUDs.
Given the compelling parallels between AN and SUDs, therapeutic strategies designed for addiction treatment may be beneficial for individuals with anorexia nervosa. For example:
- Exposure Response Therapy (ERT), commonly used to treat addiction-related compulsive behaviours, could be adapted for AN to help individuals resist compulsions related to food and weight loss.
- Neuromodulatory techniques, such as repetitive Transcranial Magnetic Stimulation (rTMS), have shown promise in addiction therapy and may also reduce compulsive behaviours in AN.
While the study provides valuable insights into the compulsive nature of anorexia nervosa, it has several limitations:
- Self-Report Bias: Reliance on self-reported data may affect the accuracy of participants’ reflections on their behaviours, especially since many individuals with AN struggle to recognize or describe their behaviours.
- Sampling Bias: The study's sample may not fully capture the diversity of experiences within the AN population, as it was part of a larger research project with specific inclusion criteria.
- Conceptual Bias: The study assumed that participants would agree that their behaviours were compulsive, which may have influenced their responses.
- Qualitative Analysis Limitations: Deductive analysis could introduce selection bias, as themes may have emerged based on pre-existing hypotheses. Additionally, the use of online surveys limited the depth of engagement with participants compared to face-to-face interviews.
Section 3: Genetic Connection Between Addiction and Anorexia
Genetic research has revealed significant overlap between anorexia nervosa (AN) and substance use disorders (SUDs), particularly in shared genetic vulnerabilities. Studies suggest that individuals with family histories of addiction may share genetic predispositions that increase their susceptibility to both conditions. This genetic overlap, especially in areas related to the brain's reward systems, is key in understanding addictive behaviours, whether linked to substances or restrictive eating (12).
Genetic Vulnerabilities and Reward Systems
Both AN and SUDs tend to run in families, suggesting that genetic markers could predispose individuals to develop addictive behaviours. These markers are thought to be associated with the brain's reward systems, which regulate impulsivity, reward-seeking, and self-control. When these neurobiological pathways become dysregulated, individuals with these genetic predispositions may be more vulnerable to developing anorexia nervosa. In such cases, food restriction becomes a maladaptive coping mechanism, similar to how substance abuse functions in addiction (12).
Environmental Influences and Family Dynamics
Family dynamics, especially in homes affected by addiction, play a significant role in the development of eating disorders like anorexia nervosa. Children raised in these environments often experience emotional unavailability, secrecy, or overcontrol. In such chaotic or unpredictable settings, restricting food intake may provide a temporary sense of control and stability—acting as an emotional coping mechanism, much like the compulsive behaviours seen in addiction (13).
For example, children in households affected by addiction may develop perfectionism or a need to exert control over certain aspects of their lives, including eating habits. These traits can manifest early and persist even after recovery from an eating disorder. The need to control food intake can serve as a coping strategy, helping individuals manage stress or difficult family dynamics, much like how individuals with addiction use substances to relieve emotional pain (13).
The Role of Dysfunctional Family Environments
Genetic vulnerabilities combined with dysfunctional family dynamics form a powerful foundation for the development of eating disorders like anorexia nervosa. Families with histories of substance abuse often exhibit patterns such as emotional detachment, inconsistent boundaries, and enabling behaviours. These dysfunctional dynamics can exacerbate the development of maladaptive coping strategies, such as food restriction, which individuals use to regain a sense of control.
Studies on family dynamics and eating disorders show that individuals from homes affected by addiction are more likely to develop eating disorders as a means of asserting autonomy and managing emotional distress (14). In families with emotional instability or addiction, food restriction offers a temporary sense of control in an otherwise unpredictable environment. This need for control mirrors the compulsive behaviours seen in substance addiction, where individuals fixate on a particular behaviour—whether it’s food intake or substance use—as a way to cope with underlying stress and trauma.
Toxic family dynamics, such as neglect or enabling behaviours, can create an emotional void, driving individuals to adopt control-oriented behaviours like anorexia. In these environments, food restriction may become a symbolic attempt to regain control over one's body, acting as a response to the lack of control within the family (15).
Genetic predispositions and environmental factors, particularly dysfunctional family dynamics, play a significant role in the development of anorexia nervosa. While genetic vulnerabilities provide a foundation for susceptibility, family environments marked by addiction and emotional instability can exacerbate this risk. By understanding how genetic and environmental factors intersect, we gain insight into how anorexia nervosa can develop as a coping mechanism for individuals in chaotic family settings.
Section 4: Trauma and its Role in Anorexia Nervosa
Trauma, especially during key developmental stages, can act as a catalyst, turning a predisposition to addictive behaviours into the manifestation of anorexia nervosa. For trauma survivors, particularly those with genetic or familial vulnerabilities, restrictive eating behaviours often emerge as a coping mechanism. This is an attempt to regain a sense of safety, control, or mastery over their lives (16).
The Link Between Trauma and Eating Disorders
Research indicates that individuals who have experienced trauma are at a higher risk of developing eating disorders, such as anorexia nervosa. For many, restrictive eating becomes a way to manage overwhelming emotions or escape from painful memories (16). The trauma may be emotional, physical, or sexual in nature, often leading to a disconnection from one’s body or a desire to control it. In these cases, food restriction offers temporary emotional relief, much like how substance use can numb pain for those struggling with addiction.
Restrictive Eating as a Coping Mechanism
Restrictive eating can be viewed as a form of emotional numbing. It provides individuals with a false sense of control over their lives in the face of traumatic experiences. Just as addiction to substances offers a way to escape or manage emotional distress, anorexia nervosa offers an alternative form of relief through control over one's body and food intake (17).
The temporary sense of mastery provided by restrictive eating can be incredibly powerful, as it creates an illusion of control. For trauma survivors, this control over food and body image can serve as a shield from emotional turmoil, offering brief respite from the pain of past experiences.
Trauma plays a pivotal role in the development of anorexia nervosa, particularly for individuals who have genetic or familial vulnerabilities. Restrictive eating, in this context, is not just about food or weight—it is a coping mechanism that provides temporary relief and a sense of control in the face of overwhelming emotional pain (16).
Section 5: The Addiction-Like Nature of Anorexia Nervosa
When we consider the combined influence of genetic predisposition, environmental factors, and trauma, it becomes evident that anorexia nervosa shares significant similarities with substance use disorders. Genetic vulnerabilities lay the foundation for addictive behaviours, while family dynamics, particularly those shaped by addiction, foster an environment in which control-oriented behaviours, like food restriction, can thrive. Trauma then acts as a catalyst, triggering an addiction-like relationship with food restriction.
Compulsive Behaviours and the Need for Control
Anorexia nervosa, much like addiction, is driven by compulsive behaviours linked to a need for control and emotional regulation. Both disorders alter the brain’s reward and inhibition systems, reinforcing the cycle of compulsive behaviours. The addictive nature of anorexia lies in how it hijacks the brain's reward system, leading to an obsessive focus on food, weight, and body image. This is similar to how substance use disorders fixate on a substance as a means of coping with emotional distress (18).
Neurobiological Similarities
Studies comparing the neurobiology of food restriction and addiction suggest that anorexia nervosa and substance use disorders share common brain pathways related to reward processing and compulsivity (19). This overlap in brain activity further supports the idea that anorexia functions as an addiction-like disorder. Just as individuals with substance use disorders fixate on their drug of choice, those with anorexia become similarly fixated on controlling food intake and body image.
Section 6: Shifting the Focus to Compassionate Recovery
Understanding the complex relationships between anorexia nervosa, genetic predispositions, environmental influences, and trauma not only deepens our understanding of the disorder but also holds profound implications for the recovery process. By viewing anorexia nervosa as an addiction-like disorder, both individuals in recovery and those who support them can shift the focus from guilt and self-blame to a compassionate, healing approach. This shift emphasizes that anorexia is not simply about food or weight but reflects deeply ingrained coping mechanisms related to trauma and emotional dysregulation (20).
Shifting the Focus from Blame to Healing
Viewing anorexia nervosa through the lens of addiction reveals that restrictive eating behaviours often stem from deeper emotional struggles rather than simple control issues or vanity. This perspective helps those in recovery avoid the self-blame commonly associated with eating disorders (20). By understanding anorexia as driven by complex neurobiological, emotional, and environmental factors—similar to addiction—recovery can focus more on healing underlying wounds than just addressing surface behaviours (21).
Recognizing anorexia as an addiction-like disorder shifts the recovery narrative. It highlights that recovery is not just about “fixing” eating behaviours but addressing the root causes of those behaviours. Just as substance use disorders often stem from the need to manage overwhelming emotions, past trauma, or unaddressed psychological pain, anorexia nervosa frequently has similar underlying triggers (22). Acknowledging these connections validates the experience of those with anorexia and helps them recognize that their obsession with food and weight is, at its core, a coping mechanism for deeper emotional distress.
Therapeutic Approaches: Tailored and Compassionate Treatment
Given the understanding of anorexia as an addiction-like disorder, therapeutic approaches need to be multifaceted, addressing the individual's unique needs. Traditional treatment models, which focus primarily on weight restoration or food-related behaviours, may fall short in promoting long-term recovery. Instead, recovery should be framed within the context of addressing trauma, addiction-like behaviours, and emotional regulation. Several therapeutic approaches, backed by research, are particularly relevant for this type of recovery.
Trauma-Focused Therapy
Research highlights the critical role of trauma in the development of anorexia nervosa, making trauma-informed therapy an essential component of recovery. Trauma-focused therapies, such as Eye Movement Desensitization and Reprocessing (EMDR) or Cognitive Behavioural Therapy for Trauma (CBT-T), help individuals process and integrate traumatic memories that may fuel restrictive behaviours. EMDR, for example, has been shown to effectively treat trauma by helping individuals reframe traumatic experiences, reducing the emotional charge tied to these memories and interrupting the cycle of trauma-driven behaviours (23).
By addressing the trauma at the core of their struggles, individuals can work through the emotional pain that often leads to restrictive eating and compulsive behaviours. A trauma-informed approach offers a safe, supportive environment where individuals can explore how past experiences may have contributed to their eating disorder, allowing for healing that goes beyond food and weight issues.
Addiction-Informed Care
Since anorexia nervosa shares significant neurobiological and behavioural similarities with addiction, addiction-informed care becomes another valuable approach. Treatment programs that incorporate principles from substance use recovery, such as those found in 12-step models or behavioural addiction therapy, can help individuals understand the compulsive nature of their eating disorder. These models reframe restrictive eating as a form of addiction that requires strategies similar to those used in substance use recovery (21).
Cognitive Behavioural Therapy (CBT) for eating disorders is another key evidence-based approach that can be adapted to treat the addiction-like components of anorexia. CBT targets distorted thought patterns and behaviours related to food, weight, and self-image, helping individuals replace unhealthy coping strategies with healthier alternatives (24). Dialectical Behaviour Therapy (DBT), originally developed for Borderline Personality Disorder, is increasingly used in the treatment of eating disorders. DBT focuses on building emotional regulation skills, distress tolerance, and mindfulness—tools that are critical for managing the emotional pain often associated with anorexia and addiction (25).
Integrated Approaches: Dual Diagnosis Treatment
For individuals struggling with both anorexia nervosa and substance use disorders, an integrated dual diagnosis treatment approach is essential. These programs simultaneously address both disorders, recognizing that the behaviours associated with anorexia are often intertwined with addictive tendencies. Integrating therapeutic interventions from both eating disorder treatment and addiction recovery provides a comprehensive approach, offering holistic support for individuals coping with both conditions. Research suggests that integrated care leads to better outcomes by treating the full scope of an individual's struggles (20).
Family Therapy
Family dynamics often play a significant role in the development of anorexia nervosa, making family-based therapy (FBT) an integral part of the recovery process, particularly for adolescents. FBT involves the family in the therapeutic journey, helping them understand the disorder from a clinical perspective (26). Educating families about the biological and psychological components of anorexia helps them adopt more supportive, non-judgmental attitudes toward the recovery process, minimizing enabling behaviours and unhealthy interactions. Family therapy also addresses dysfunctional dynamics, such as control issues, which may have contributed to the development of restrictive eating behaviours.
Conclusion
Anorexia nervosa is a multifaceted disorder with complex origins, shaped by an intricate interplay of genetic, environmental, and psychological factors. Traditionally, the disorder has been viewed as a problem centered around food or body image. However, by exploring anorexia through the lens of addiction-like behaviours, we gain a broader perspective that recognizes the neurobiological pathways, compulsive behaviours, and emotional struggles shared with substance use disorders. This understanding, informed by genetic predispositions, environmental influences, and trauma, helps us appreciate the disorder's complexity and the diverse ways in which it manifests.
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