BINGE-TYPE EATING DISORDERS AND ULTRA-PROCESSED FOOD ADDICTION: PHENOMENOLOGY, PATHOPHYSIOLOGY AND TREATMENT IMPLICATIONS

Joan Ifland^1*Timothy D Brewerton²

• ¹Food Addiction Reset, LLC, Seattle, United States
• ²University of South Carolina, Columbia, Missouri, United States

BACKGROUND AND OBJECTIVE: Despite their clinical differences, loss of control binge eating (LCBE) is a core feature of all binge-type eating disorders (EDs), including binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa binge purge type. The emerging concept of food addiction (FA), or ultra-processed food addiction (UPFA), is also characterized by LCBE, which is associated with obesity regardless of diagnosis.HYPOTHESIS AND THEORY: The phenomenology and clinical features of binge-type EDs and UPFA overlap considerably, yet they also have distinct clinical features and treatment approaches. These conditions share pathophysiological mechanisms, which are reviewed in this paper. Specifically, evidence demonstrates that LCBE, regardless of diagnosis, is characterized by alterations in neurobiological systems mediating reward sensitivity, stress reactivity, and cognitive function that are similar to the disturbances found in alcohol and other substance use disorders (SUDs). Ultra-processed foods (UPFs) used by patients with LCBE have addictive psychoactive properties. However, the key substance use disorder (SUD) recovery protocols of harm reduction or abstinence from addictive substances are not currently treatment approaches commonly employed in the treatment of binge-type EDs. The objectives of this paper are to organize evidence that the LCBE characteristics of binge-type EDs and UPFA overlap and to consider the impact of these findings on treatment protocols, specifically the application of harm reduction and/or abstinence from psychoactive UPFs.RESULTS: Neurobiological studies of individuals with LCBE consistently show signs of addictive alterations, especially hyperactive reward centers, stress reactivity, and cognitive impairment, as well as maladaptive use of UPFs. DISCUSSION: Findings suggest that treatment outcomes for binge-type EDs might improve if harm reduction and/or abstinence protocols for recovery from UPFA were applied. A level of support comensurate with a severe addiction could improve treatment outcomes for these often recurrent and treatment refractory disorders. Possible rationales for current treatment exclusion or marked reduction of UPF abstinence protocols are offered.CONCLUSION: Application of SUD recovery protocols could improve outcomes of binge-type EDs and UPFA. Approaches used in recovery from a severe substance addiction such as harm reduction and/or abstinence with a high level of support could be beneficial. Barriers to use of abstinence protocols are offered.