The notion that binge eating is a form of addiction comes up frequently in experts' discussions of the diagnosis.
Many binge eaters themselves talk about "cravings," "benders" and "hangovers," often describing a dynamic in binge eating that is eerily familiar to an alcoholic's descent into oblivion, as the first drink -- or the first after-dinner cookie -- leads uncontrollably to another and another. Rina Silverman says a binge "numbs me."
Like many who struggle with the problem, she attended Overeaters Anonymous meetings for a while. Modeled on the 12-step program of achieving abstinence, Overeaters Anonymous urges its members to -- among other steps -- identify and abstain completely from foods that seem to trigger powerful cravings to overeat.
Refined sugars and processed foods are a common ingredient.
But this approach, Silverman says, left her more depressed and discouraged. Many researchers and others who identify themselves as binge eaters are similarly critical of such advice.
Chavese Turner, who last year founded a national advocacy organization called the Binge Eating Disorder Assn., found that Overeaters Anonymous simply felt wrong. Identifying certain foods as "bad" and therefore off-limits, said Turner, seemed too simple and off the mark. There were always other, allowable foods to eat in excess. And racking her brain for what she could eat, rather than dealing with an anxiety or noticing that her stomach already felt full, seemed to miss the point.
Having grown up with an alcoholic mother -- now sober for 23 years -- Turner was open to the idea that her eating benders might be an inherited form of addiction. But alcohol, Turner knew, was something you could live without. Food was not; the temptation to binge was unavoidable at least three times a day.
The notion that binge eating and addiction are linked is supported by brain imaging studies that show significant overlap between the brain circuits activated by a drug addict's "craving" and those of a binge eater pondering an eating jag. Researchers also find that the brains of overeaters and those with substance addictions share a common shortage of receptors for the neurotransmitter dopamine, a key chemical in the activation of reward-seeking brain circuits.
"Those are fascinating studies that might yet establish that binge eating and substance abuse and addiction share common origins," says Steven Wonderlich, a University of North Dakota eating specialist who also serves on the American Psychiatric Assn.'s work group on eating disorders.
But Wonderlich cautions that such evidence so far falls far short of doing so. The brain's far-reaching reward circuitry is involved in lots of behaviors that involve motivation, learning and emotion -- not just pathological cravings. And dopamine imbalances are implicated in many neurological disorders, including Parkinson's disease.
"I think the case for the addiction model is extremely weak," says Rutgers University psychologist Terry Wilson. In addiction, the abused substance is the focus of urges, cravings and a high. Those who binge eat are not so focused on their substance of abuse, Wilson noted.
In time, however, the brain studies that have spurred interest in an addiction link may help refine the diagnosis of binge eating. So too will work that has found a role for genetic inheritance in the development of binge eating.
Says Turner's mother, Donna Underhill, who has struggled with eating disorders herself: "Getting sober was probably one of the hardest things I've ever done."
But, Underhill says, she looks at Chavese and thinks "alcoholism was a piece of cake compared to this. She can't not eat."