Eating disorders have much in common with addiction to substances and to behavioural addictions. But there are also significant differences. These will be taken into account within the context of an addiction treatment centre. However, this will not be a suitable setting for every person with an eating disorder.
The characteristics eating disorders have in common with addiction are:
As with addiction, it helps to see eating disorders as the manifestation of an unhealthy relationship – in this case with eating or with food. What makes it problematic is the nature and quality of the relationship. At its root lies the more or less conscious urge to regulate feelings in order to better cope with the experience of life. This relationship paradoxically ends up threatening mental health, physical wellbeing and sometimes even life itself.
The obvious difference with other behavioural addictions such as gambling and addiction to substances like alcohol, heroin, cocaine etc., is that food is essential to sustain life. This critical factor has particular implications for the care of patients in an addiction treatment and recovery programme that has abstinence as its starting point.
The question of abstinence in the treatment of eating disorders is inevitably more nuanced. The patient is helped to abstain from the behaviours which are symptomatic of the problematic relationship such as purging, weight loss, bingeing, orthorexia or restriction. This gives patients the chance to become aware of the feelings which threaten them when they do not resort to the behaviour. Some patients will need to understand that an obsession with self-image rather than enhancing self-esteem is likely to undermine it.
They can be helped to recognise the self-defeating nature of their coping response and with close support acquire and practice new, positive behaviours to deal with these feelings. This will open the path to resolving them in time.
The characteristic tendency to isolation and secrecy can be addressed by the treatment centre’s capacity to monitor the patient around the clock. A person with an eating disorder can benefit greatly in a community of people aiming at recovery, such as in an addiction treatment centre. The support of the members of the group will be particularly encouraging, especially if the others undergoing treatment understand the necessary difference in the application of abstinence.
That food is served in a residential treatment centre provides the scope to observe eating, as well as weight and self-image related behaviours. Staff can work closely with the patient to establish a healthier relationship with food; one that focusses on balanced nutrition and sustenance rather than as a means of controlling mood. The range of complementary therapies and other activities available offers other opportunities to loosen the restrictions of the obsession.