RDoC and the Future of Food Addiction and Eating Disorders

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It becomes more and more evident that all addictions are one. Apparently, whichever addictogenic behavior or substance gets to a person first will lay claim to an addiction-prone person, and if that addiction is ostensibly cured, another one will step up to take its place. (The illustration above is of the mythical Hydra. Cut off one head, and two more grow out.) The important message here is that any treatment must metaphorically rip out addiction by the roots, rather than clipping off the branches. If the underlying causes are not addressed, the whole effort is doomed to futility.

The Research Domain Criteria, the new framework in which research on mental disorders can be conducted, is the wave of the future. Hans W. Hoek says the RDoC project “aims to bridge neuroscience and genetics to inform diagnostic classification and clinical management” and describes how some researchers use its constructs “across biological units of analysis to describe the advances in the neurobiology of eating disorders.” He also says:

Interest in the addiction model of binge eating is increasing, leading to new approaches to treatment methods involving the use of opiate, dopamine and cannabinoid receptor blockers for Binge Eating Disorder.

Although Binge Eating Disorder (BED) is mostly associated with bulimia nervosa, the condition gets around, and gangs up with other symptoms in other eating disorders in what is called diagnostic crossover. But that’s not all–it also shows up as part of the pattern in various psychiatric conditions such as borderline personality disorder. Pamela Keel writes:

The Research Domain Criteria (RDoC) initiative encourages examination of basic dimensions of functioning across multiple units of analysis with the explicit goal of creating new systems for classifying mental disorders that will translate neurobiological and behavioral research into improved comprehension and treatment of psychiatric illnesses.

BED is one of the conditions that the Diagnostic and Statistical Manual is uncomfortable with, because of the way it is set up. Children are especially difficult to squeeze into DSM-5’s system, which does not cope well with their primary problem: having no “off” switch. They have “loss of control” (LOC) eating or disinhibited eating behaviors, labels which are not particularly helpful when science is clueless about finding that “off” switch. A number of researchers contributed to a symposium exploring how productive it might be to explore BED in the context of the RDoC framework. A study completed by several authors from diverse institutions had this to say:

RDoC, a proposal for classifying psychiatric disturbance based on dimensions of observable behavior and neurobiological measures, may be particularly useful for describing psychopathology in children with disordered eating.

Four authors from the University of Kentucky, who definitely consider BED an addictive behavior, reported on the “acquired preparedness model of risk for addictive behaviors.” But not all the critical opinion is favorable. Sanjay Srivastava discusses one of the early funding opportunity announcements based on RDoC, quoting the “overview:”

Clinical presentations of eating disorders are highly heterogeneous, involving broad and often overlapping symptomatology… dysregulated functions and associated neural circuits should be a critical focus of study, and, ultimately, the target of assessment and treatment for eating disorders.

This writer’s objection is that the RDoC paradigm makes no mention of family, social environment, media, culture, or numerous other factors commonly associated with eating disorders, and he calls these omissions “not a good sign of where things are headed.”

Your responses and feedback are welcome!


Source: “Classification, Epidemiology and Treatment of DSM-5 Feeding and Eating Disorders,” medscape.com, 2013
Source: “Application of the Research Domain Criteria (RDoC) Framework to Binge Eating: Insights into Component Processes that Cut Across Current Eating Disorder Diagnoses,” psychopathology.org, 10/05/12
Source: “Where is RDoC headed? A look at the eating disorders FOA,” hardsci.wordpress.com, 05/24/13
Image by Biodiversity Heritage Library

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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.
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Presentations

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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