The addiction model of eating disorders: A critical analysis

Addiction is a poorly understood and widely misused concept. Far from providing an explanation of eating disorders, the concept is itself in need of explanation. Addiction is most commonly viewed as a disease, and it is this notion that has been applied uncritically to eating disorders in general and binge-eating in particular. The associations between eating disorders and psychoactive substance abuse are reviewed. The evidence indicates a greater than expected rate of psychoactive substance abuse in patients with eating disorders, and vice versa. Interpretation of these findings is obscured by a number of methodological problems, including inconsistent diagnostic criteria and assessment methods of questionable validity. Family studies show a similar co-occurrence, but suffer from comparable shortcomings. Moreover, comorbidity rates between eating disorders and other psychiatric disorders are higher. Studies of clinical samples might simply reflect the well-known tendency for patients with multiple problems to seek treatment. Consistent with this view, the results of two community studies of eating disorder patients show no significant co-occurrence with substance abuse. Theoretical and therapeutic implications of the addiction model are measured against available evidence on the nature and treatment of eating disorders.