Moral Factors in Addiction

How does DSM-5, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, define addiction? In the simplified addiction criteria, there are four subheadings, one of which encompasses social problems. This includes such matters as the neglect of relationships and their ensuing responsibilities, like keeping the rent paid and taking care of the necessary life tasks at home, or in educational or employment settings. Maintaining an addiction will cause a person to give up the activities they used to care about unless purposes can be combined. A parent who can score dope at their child’s sports event has exceptional life-management skills.

Another whole category of “tells” concerns ignoring risk in the pursuit or use of the addictive substance. Getting a supply from another parent at a park is not quite the same as driving to a bad neighborhood at night to meet a stranger. This escalating behavior includes not only dicey environments but stubborn persistence in the destructive habit even though it causes obvious problems.


It is easy to picture a heroin addict doing any of those things. But with just a bit more imagination, it is also possible to conceptualize a food addict making the same mistakes — perhaps not on such a large scale, and not with large consequences like prison — but still, life-damaging bad decisions.

Indeed the consequences may seem, to an outsider, trivial and even ridiculous. Friends make fun of each other’s eating habits, often as a caring gesture, because it is one of the few acceptable ways to address another adult’s potentially destructive habits. But to the person burdened by those habits, it is no joke. Here are some excerpts from a piece by Anita Badejo, in a series of confessional articles by people with eating disorders:

Eventually, my mom realized I was sneaking food and she started hiding sweets in the kitchen in hopes of curbing my steady weight gain. Instead, I became an expert at climbing on countertops, calculating how much I could eat of something before she would notice, and burying wrappers in the trash. Often, I’d throw away the balanced, nutritious lunches she’d pack me […] in favor of pizza and curly fries.

This was obviously someone who did not suffer from insatiable hunger, but selective hunger. Otherwise, she would have consumed both the healthful lunches and the fat-filled and fried meals. By climbing on kitchen counters, Badejo risked a fracture or a concussion. That her mother would be disappointed or angered by the lies (and the wasted good food) did not faze her. But what really caused her to focus on the idea that her behavior was not normal was the realization that “I thought more about what I’d eat when I got to my friends’ houses than the time I’d spend with them.” Then,

I hoped going to my dream college would somehow absolve me of my lack of self-worth and, with that, my eating habits. Instead, I spent much of my freshman and sophomore years […] feeling like a fraud and making full use of my unlimited meal plan by stuffing to-go containers and eating alone in my dorm room.

This was both a social problem and, in terms of health, a calculated risk. Very close to the end of her essay, the author admits,

I’ve come to realize I eat the same way I hit my snooze button every morning: just a little bit more. Tired when I should feel energized, so empty despite being so full. Food is still the first thing I think about when I wake up and the last thing I think about before I go to bed. I still spend much of my time trying to hide just how much I eat it.

Your responses and feedback are welcome!

Source: “DSM-5 Criteria for Addiction Simplified,”, 08/20/20
Source: “I’m Mending My Broken Relationship With Food,”, 02/26/15
Image by airpix/CC BY 2.0

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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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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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