Eating Disorders and Cross-Addiction

don't eat

Some addicts specialize in substances, some in behaviors, and some engage in both. Addiction can involve a substance like cocaine or a behavior like gambling. An eating disorder can result from a certain type of food acting as an addictor for a particular person, or it can be behavioral, like binge eating and purging. Ex-smokers and recovering alcoholics are notorious for gaining weight. People weaned from unhealthy food dependency might turn around and become hooked on the technology that tracks their daily calorie-burning activity. Dr. Vera Tarman says of her patients:

Another pattern that I discovered were the people who had once suffered from anorexic disorders coming into treatment for cocaine or crack addiction.

Statistically, the overlap between all kinds of addictions is huge. offers an interesting perspective on the similarities between people with substance abuse disorders and eating disorders, and the traits they share:

Examples include feeling anxious in social situations and being more prone to depression…

It has also been suggested that both groups suffer from an addictive personality, which makes it logical that an addiction to habits related to eating could lead to alcohol or drug addiction, or vice versa.

Cross-addiction could logically be called omni-addiction or any-addiction. To take a very pertinent current example, advocates of marijuana decriminalization scoff at the charge of addictiveness, while detractors swear they can point to numerous marijuana addicts. But the contradiction is only an apparent one. It is summarized succinctly by Joe Rogan, who maintains that if someone is addicted to marijuana, it’s only because “marijuana got there first.” As Dr. Tarman emphasizes, it is all “the same disease of compulsion and obsession, with different manifestations.”

The StepstoRecovery website notes that among girls between the ages of 11 and 17, the number one desire is to be thin. Eating disorders happen, and when they happen in conjunction with alcohol addiction or drug addiction, things can get serious really fast.

There is indeed evidence of an increased prevalence of substance misuse among eating disorder sufferers, particularly those with binge eating disorder and bulimia. For example, once diagnosed with binge eating disorder the lifetime risk of alcohol or drug abuse is 25%, while as many as 40% of people with bulimia also suffer from substance abuse.

This page mentions one of the many iterations of Mattel’s popular female role model, Slumber Party Barbie, released in the 1960s. This doll…

…came complete with scales displaying the permanent value of 110 lbs. and a book entitled “How to lose weight,” which only contained the phrase “Don’t eat.”

Other Implications of Cross-Addiction

The notion of cross-addiction is also related to the problem of diagnostic crossover, which is particularly noticeable in patients with eating disorders, who tend to shift between diagnoses, at least as the various diagnoses are defined by the Diagnostic and Statistical Manual of Mental Disorders. An article about cognitive behavioral therapy (CBT) notes that it takes a trans-diagnostic approach “with the goal of treating eating disorder psychopathology across diagnoses, rather than a specific diagnosis.”

The treatment addresses the shared, underlying core beliefs (i.e., over-evaluating and controlling one’s weight and shape) in order to break the maladaptive cognitive and behavior patterns that have maintained the eating disorder.

This intriguing thought comes from Dr. Tarman:

Anorexics resist food the same way as the drug addict resists withdrawal from their drug.

It is strangely echoed by a bulimic patient on a website where people write in anonymously to share their struggles:

Even just eating a leaf of lettuce will be followed by an almost animalistic panic to get the “poison” out of me. I feel this panic in every cell of my body like some deep-rooted survival instinct.

Dr. Tarman adds:

While an eating disorder may be a dual diagnosis alongside an addiction for some, it is just as likely a possibility that it IS part of the addictive disorder itself… If the person is a food addict, rather than suffering from a true eating disorder, then the typical treatment used for eating disorders is not only not helpful (hence the high rate of recidivism and relapse in eating disorders), but actually dangerous.

Your responses and feedback are welcome!

Source: “Finally Sober, Suddenly Fat: Food Addiction is Another Drug Addiction,”, 05/02/13
Source: “Starving Yourself to Achieve the Impossible Figure of Barbie,”, undated
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,”, 04/01/12
Source: “Arianna-C-Podcast,”, 01/30/15
Image by The Fat Diaries


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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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