Are trans diagnostic models of eating disorders fit for purpose? A consideration of the evidence for food addiction

Abstract

Explanatory models for eating disorders have changed over time to account for changing clinical presentations. The transdiagnostic model evolved from the maintenance model, which provided the framework for cognitive behavioural therapy for bulimia nervosa. However, for many individuals (especially those at the extreme ends of the weight spectrum), this account does not fully fit. New evidence generated from research framed within the food addiction hypothesis is synthesized here into a model that can explain recurrent binge eating behaviour. New interventions that target core maintenance elements identified within the model may be useful additions to a complex model of treatment for eating disorders.

Testing the addictive appetite model of binge eating: The importance of craving, coping, and reward enhancement

“…Our findings provide support for the addictive appetite model of BN and BED (Treasure et al, ) by providing evidence for heightened levels of craving for palatable foods and the tendency for these individuals to use eating as an emotion regulation strategy. These findings also contribute to the existing field of research testing the affect regulation model of binge eating (Haedt‐Matt & Keel, ; Leehr et al, ).…”

“…It was interesting to note that, after controlling for multiple comparisons, there were no significant differences between women with BN versus women with BED on measures of food craving, eating disorder psychopathology, or eating motivations. Within the framework of the addictive appetite model of binge eating, this finding can be explained by the fact that the same neural process is hypothesised to underpin binge eating behaviour in each population and therefore operates identically on a functional level in both BN and BED (Treasure et al, ). These findings therefore highlight commonalities in the psychological profile and maintenance factors of BN and BED, suggesting that similar treatment approaches may be useful in the treatment of both disorders.…”

“…An updated model of recurrent binge eating behaviour has therefore recently been proposed (Treasure, Leslie, Chami, & Fernández‐Aranda, ), which addresses the dysregulation of appetite in BN and BED not previously highlighted within the transdiagnostic model. One of the key factors proposed by this updated “addictive appetite” model of recurrent binge eating behaviour is the increased incentive salience of food cues and habitual response patterns to palatable food cues, which heighten desire and craving for these foods (Berridge, ).…”

“…There is thought to be down‐regulation of the response to other rewards in BN and BED, such that basal levels of low affect are common in this population (Volkow, Wise, & Baler, ). This low affect thus contributes to heightened likelihood of compensatory reward‐seeking, specifically in the form of palatable tastes (Treasure et al, ). This model of binge eating behaviour has previously received support from ecological momentary assessment studies, which found that participants reported greater levels of low affect immediately prior to binge eating episodes (Haedt‐Matt & Keel, ).…”

A Critical Examination of the Practical Implications Derived from the Food Addiction Concept

“…Therefore, dietary restraint does not necessarily have to be dysfunctional as long as flexible elements are added. This is in line with a food addiction model of binge eating behavior, which was recently developed by Treasure and colleagues [79•]. While this model recommends to avoid and abstain from certain foods (e.g., foods with a high glycemic index) rather than encouraging an absolute “no dieting approach”, it also suggests to discourage individuals from restricting healthy foods to prevent them from reaching a state of semi-starvation.…”