In a world of over-diagnosis, virtually anything can be considered a mental disorder if you are willing to pay someone to give you therapy for it. Afraid of attractive women? You have Venustraphobia. Afraid of GMO foods? The name is in the works. Body piercings. plastic surgery, eating couch cushions, every odd compulsion has someone saying clinically it's real.
Even in the fuzzy world of behavior, being an actual clinical diagnosis requires an evidence basis and most pop diagnosis addictions don't have that; it's just individual weirdness manifesting a compulsion.
What about food? DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) made the issue fuzzier, itemizing three issues as clinical addiction; 'binge eating disorder' (BED), Anorexia nervosa and Bulimia nervosa, while combining categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe and then making the term addiction separate as well.
If there are three disorders related to a product that people abuse or are irrationally dependent on, why couldn't the product be addictive? But can a food addiction be treated? Can it be prevented? The only real evidence for food addiction comes from animal models but there are important caveats to be borne in mind when looking at the animal evidence. There are claims for differences in brain responses to images of food in lean and obese individuals but is very inconsistent and does not currently support the idea of food addiction.
According to some studies, up to 10-15% of obese individuals suffer from BED - but BED is also claimed in people that are normal weight. The term 'food addiction' has been coined by the popular press and by many sufferers as a reasonable explanation for their predicament. Imaging studies of the brains of obese patients that score highly for food addiction on the Yale Food Addiction Scale show that certain areas implicated in reward and addiction have an altered response to both images of appetizing foods and even to the taste of food.
Speaking at the 26th European Congress of NeuroPsychopharmacology, Professor Suzanne Dickson, neuroscientist at the University of Gothenburg, Sweden, said, "the introduction of 'addictive disorders' allows classification of behavioral addiction for the first time, for example with pathological gambling, but this does not apply to food addiction. Although there might be neurobiological and clinical overlaps between 'addictive-like' overeating and substance related and addictive disorders, a major difference is that is that food consumption, unlike alcohol, cocaine, or gambling or internet gaming behaviors, is necessary for survival.
"A subgroup of obese patients indeed show 'addictive-like' properties with regard to overeating, such as loss of control, but this does not automatically mean they are addicted."
However, more evidence is needed to support inclusion of food addiction as a diagnostic category. Professor Dickson said: "This evidence itself is insufficient to support the idea that food addiction is a mental disorder. We do not have a clinical syndrome of food addiction so far, and it is very important to establish the validity of a condition before putting it forward for inclusion in the DSM."
She pointed out that the trend to recognize behaviors as addictions is a major step forward and will help avoid stigmatizing people that exhibit these behaviors. "This development is critical because behavioral obsessions that are not pathological can potentially be medicalized, and thus receive a formal diagnosis, in which they reflect an excessive, but non-pathologic, engagement. However, it will be important to avoid over-diagnosing disorders, reflecting the inflationary trend in the lay public to label various behaviors as 'addiction'."
"While the idea of food addiction is intuitively very appealing, there is actually little evidence so far to suggest that it actually exists in humans," said panelist and psychiatrist Dr. Hisham Ziauddeen, from the Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge . "It is a very important idea to explore, but it is essential that we have sufficient research to conclusively support it before we hurry to recognise it as a genuine condition and start thinking of ways to tackle and treat it."