Food Addiction: Alternate Diagnoses

One Month Old Today

Here is the confluence of two trains of thought. The first concerns the omission of food addiction from the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The other is the quality of life experienced by an obese child – not as a result of the obesity, but beforehand. Not just the inconveniences and humiliations of being overweight, but the challenges of life in the home of origin, the ambient psychological atmosphere of the nest in which the person is raised.

Between the covers of DSM-5 are many categories, but one diagnosis that might explain a portion of child obesity cases seems, like food addiction, to be missing. Regardless, we are assured that this aberration does exist by Dr. Patricia Love, who wrote The Emotional Incest Syndrome: What to Do When a Parent`s Love Rules Your Life. Emotional incest is described as a “surprisingly common but rarely identified” condition, in which the afflicted parent will overly bond with a “chosen child.” Physical acting out may not take place, but the child becomes, in all other ways, the needy parent’s surrogate spouse. Dr. Love says of a typical patient with father issues:

She now understands that their overly close relationship was the source of many of her problems – including her most vexing one, obesity. “I think I’m avoiding relationships by stuffing myself with food,” she told me. “A part of me is still connected to my father. It feels wrong to be with anyone else. So I eat and eat.”

Folie à Deux (Madness for Two)

Folie à deux is the discarded terminology for a type of mutual mental illness that also used to be called Shared Paranoid Disorder. (A clinician seeking its DSM-5 identity would have to choose between Delusional Disorder or Other Psychotic Disorder.) The primary patient is typically older, more intelligent, and possessed of a stronger personality – qualities that describe most parents – and indeed more than half the known cases involve same-sex relatives, usually mother and daughter. The delusions fostered by the psychiatrically ill primary patient are unquestioningly accepted by, and become reality for, the impressionable secondary patient. The literature says:

The acceptance of these beliefs results from a lack of critical evaluation by both members of the dyad and in the secondary patient it may be aggravated by the social isolation recurrent in these patients.

Like a cult leader, the delusional primary patient has a vested interest in cutting the weaker person off from other influences. Although Folie à deux was responsible for some widely publicized historical homicides, it can also appear in humbler guises. A mother, for instance, might take advantage of living with a daughter “for a long time in a close relationship, sharing their lifestyle, feelings, beliefs and hopes without any outside influence.” Such a mother might indoctrinate a daughter with the belief that being overweight is not only okay, but desirable. It is, after all, a big cruel world out there, and staying home Saturday night to bake cookies with Mom is a safe choice.

Other Suspect Family Dynamics

Dr. Sigmund Freud blew lid off the institution of the family and identified it as the root of quite a few problems that will not go away any time soon, no matter how many case studies we read. Behind closed doors, between people whose main interest should be caring for each other, things get crazy. A reader sent this in:

Years ago, I met a guy who was just released from his 26th stay in the mental ward of the local hospital. Every time he got admitted to the looney bin, he felt like he was scoring a point against his rich and powerful father, who had to pay all the bills. I wonder if any teenagers stay fat as a way of getting revenge?

What a chilling thought. Could there be such tormented young people, so angry that, consciously or unconsciously, they want to stay obese forever to punish their parents? Is there a kid somewhere whose mission is to be a living, breathing reproach to paternal neglect, a constant reminder of maternal narcissism, a 500-pound monument to parental failure? In the face of such egregious dysfunction, what can a school nurse or a social worker do?

Your responses and feedback are welcome!

Source: “The Emotional Incest Syndrome: What to Do When a Parent`s Love Rules Your Life,”, undated
Source: “Folie à deux: how it fits in DSM-5,”, 2014
Image by Tom Page


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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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