Is binge eating a type of addiction? What about food restriction or calorie counting or obsessive exercise?
I have always been intrigued about the neurobiology, that is the brain and nervous system’s involvement in eating disorders; the individuals I have worked with over the last 15 years have spoken about their disordered eating and exercise behaviors feeling like “an addiction” and as time has gone on, this area has drawn more and more attention in the research space too.
When we talk about addiction, we have to talk about dopamine; dopamine is a neurotransmitter that is responsible for pleasure, satisfaction and motivation. We understand that drugs are addictive because they stimulate a pathway called the mesolimbic pathway in the brain; limbic stands for the structures that are involved with emotions. There is of course, natural variation of how much dopamine is stimulated. In this pathway, dopamine does not work by signalling pleasure, but rather the anticipation, the build up, the urge or the desire; knowing something is possible.
Dopamine is a neurotransmitter that is responsible for pleasure, satisfaction and motivation. Food, like sex and drugs triggers dopamine which is why we crave it and why it makes us feel good.
Dopamine is also stimulated through another pathway, the nigrostriatal pathway, this supports us engage in a behaviour. So dopamine in the mesolimbic pathway motivates us to start thinking about having breakfast and in the nigrostriatal pathway enables us to move and cook it for pleasure and satisfaction. Food, just like drugs stimulate both of these pathways which is how food makes us feel good and why we crave it.
Other things that release dopamine can be something perceived as pleasurable such as chocolate, something surprising such as watching a TV series or something valuable such as oxygen after a breath hold. Exercise can also stimulate dopamine release through the endorphins that it releases.
The pathway that addiction works through is the central nervous system, the CNS; and one of it’s roles is to assess what is going on within our body, as well as the environment around us and then adapt to gain safety and balance, what we refer to as homeostasis. The brain and body wants to be in a stable, balanced baseline; and that includes its levels of dopamine. Too much and things start to feel fuzzy and manic and too little and things feel low and depressed; things such as food, drugs and sex don’t only just impact the brain, but the brain also makes changes in response to the way it is impacted to strive to create that stable baseline.
The brain and body wants to be in a stable, balanced baseline and that includes it's levels of dopamine. Too much and things start to feel fuzzy and manic and too little and things feel low and depressed.
This stable baseline is shown in how we regulate our temperature, if our nervous system picks up it is too cold, it sends a message to our brain, which we refer to as process A; and then the brain responds by sending a message to our muscles to shiver, we refer to this as process B.
Opponent process theory also suggests that feelings are maintained around this stable baseline or set point; any stimulus that alters the brain's function to impact how we feel, will trigger a response by the brain that is the opposite of the stimulus, for example we may be really excited over holiday (process A) but often feel “holiday blues’ afterwards (process B).
This is the same with drugs, as an example we can use a very popular drug, caffeine; if we have never or rarely have coffee and consume it, we really notice the side effects; we often feel wired, energised and hyperaroused; this moves us away from the stable baseline. If we get into the habit of having a coffee every morning, the brain starts to anticipate this move away from baseline stability and adapts to the caffeine by suppressing it’s natural arousal and we start to need the coffee to achieve a baseline awake state to feel “normal”. If we forget our coffee we often feel exhausted and grumpy. This starts to explain tolerance, if we want to feel like the first time we had a coffee we will have to have two coffees or a stronger one to feel the same effect; without coffee we now experience withdrawal symptoms, this is called dependence.
This video explores the concept of dependence in a relatable way.
We don’t drink coffee because we are tired, we are tired because we drink coffee.
Similarly, we could hypothesise that with a binge eating episode, it means consuming food that contains nutrients and energy that alters blood glucose as well as sensation, taste and textures that drive up dopamine and feel immensely pleasurable because of the effect on the brain and nervous system (process A); overtime the brain adapts to these effects by counteracting the binge’s effect (process B).
The relationship between food / the act of eating and the brain is bidirectional; the brain is not just a passive recipient of endorphins, nutrients and energy, but it also responds to the effect of this food and eating; this can feel like a “comedown” after a binge until dopamine levels gradually return to normal. The brain likes stability, it responds to a binge by creating the opposite state; if a binge initially creates pleasure and is repeated, the brain's response is to decrease everyday pleasure, therefore the only way for a regular binge eater to feel normal is to binge eat. After a while binges don’t feel good, they are used to starve off withdrawal.
We don’t binge eat because we are feeling low, we are feeling low because we binge eat.
The brain likes stability, it responds to a binge by creating the opposite state; if a binge initially creates pleasure and is repeated, the brain's response is to decrease everyday pleasure, therefore the only way for a regular binge eater to feel normal is to binge eat.
We could also relate this to dietary restriction or using a calorie counting app, often the motivation for these start through a diet and dopamine is released when a certain number of calories is kept below; because it makes us feel good, satisfied. In order to get that hit of dopamine again we need to keep below that number and see it regularly on the app; the app becomes soothing and therefore the brain anticipates this down regulation when the phone app is out (process A); it learns over time that in order to maintain homeostasis it needs to increase arousal which can feel like anxiety without the app.
We don’t compulsively count calories because we are obsessive, we are obsessive because we count calories.
This can also be related to exercise; exercise releases endorphins which stimulates dopamine release. If we repeat this behaviour, the brain responds to this release by decreasing dopamine levels to maintain homeostasis, and developing a “need” to exercise in order to maintain a feeling of “okayness”; overtime and with the right genetics this can become a dependence.
We don’t obsessively exercise because we feel anxious, we feel anxious because we obsessively exercise.
We can explore if a behaviour feels addictive; although sometimes ‘addiction” doesn’t fit right, even if we are using it outside the DSM medicalised criteria, sometimes “dependence” or “compulsion” feels a better fit; by looking at the following
Tolerance = this means that you feel you need to increase the intensity of time spent binge eating / exercising / restricting to achieve the desired effect. This may mean that before you were binge eating once a week but you have noticed it increasing over the previous weeks or months.
Withdrawal = this refers to the feeling if for whatever reason you cannot binge eat or use a calorie continue app or stick to the exercise routine that you have or had planned, meaning you feel a sense of anxiety and perhaps anger and frustration too. You might feel an even greater desire to binge / calculate calories / exercise to try and manage these feelings.
Intention = this refers to the intent to stop or reduce a behaviour but being unable to do so.
Loss of control - over time and reliance on binge eating or calorie counting or exercise, the less able you feel to be able to cope with your thoughts and your feelings. All thoughts and focus eventually circle back to eating, body image, food or exercise, even though you may have an awareness that something is wrong you cannot stop yourself from planning a binge, going to the shop, counting meals or planning more gym sessions or doing more reps. The behaviour becomes in control.
Time - a large chunk of your time is dedicated to binge eating, trying not to binge, recovering from a binge, planning meals, training. Even when not cooking or training you may find your mind wandering to binge eating or exercise.
Conflict - family and hobbies slowly fall away, you start to spend less time with friends and family and turn down invites to get to the gym or binge or plan meals. Work or school may suffer creating anxiety between working harder and binge eating, calorie counting or training, which ultimately is often relieved by binge eating or training.
Continuance - if you continue to train through illness and injury or if you binge or resitrct despite there being health consequences, this is a big indicator that exercise is being used for something other than wellbeing or binge eating is an issue.
Eating disorders are "biopsychosocial conditions" because they are not caused or maintained by one thing alone.
Ultimately, eating disorders are classified as “biopsychosocial conditions” because not one thing causes or maintains them, but rather a complex blend of biology, including the brain, nervous system and genetics, our psychology and the environment around us and that we grew up within. They move along a very similar pathway to addictions and thinking of them in this way, for some people, can take away the self blame and allow themselves to replace this with compassion, which offers up space for healing.
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