In the last post, I announced that I've written a book about the fact that I now understand restrictive eating disorders to be a very powerful, brain based addiction to the state of energy deficit. If you haven't read that post then hop back to do so and then return to this one.
This post introduces you to the concept of an addiction to energy deficit in more detail. What is energy deficit, what is an addiction to it and how does it present? These questions are all answered below.
Energy Deficit
For most people, being in a state of energy deficit is unpleasant. They will get hungry, irritable, shaky and depressed. People with restrictive eating disorders on the other hand, appear to get a calming and anxiolytic effect from it. To people with restrictive eating disorders, energy deficit has a similar effect as those experienced by people addicted to other forms of drugs.
Energy deficit is a physiological state in which your body has insufficient energy in terms of energy coming in and/or stored energy supplies to meet its requirements. It's important to understand that energy deficit doesn't just relate to insufficient calories being consumed relative to those being used. It also relates to whether your body has sufficient fat and lean tissue stores to meet the minimally necessary level that your brain recognises it needs. If your body is below this minimum level, you will remain in a state of energy deficit until your body mass is restored and until you are consistently consuming enough to meet your body's ongoing demands. This necessary level for your body composition is also known as your set point. It is largely genetically determined and cannot be predicted by a doctor or a BMI chart.
When the drug you are addicted to is a physiological state, such as energy deficit, it's harder to pinpoint which aspects of your life and behaviours relate to it. This is especially true when comparing eating disorders as a form of addiction to someone who has an addiction to drugs, gambling or pornography, where there is a specific drug or behaviour. This is very likely why eating disorders have yet to be widely recognised as a form of addiction.
How Does an Addiction to Energy Deficit Develop?
When you developed an eating disorder, you initially engaged in behaviours that put your body into a state of energy deficit. Your brain received a high reward response from this physiological state, very possibly reinforced by praise from those around you for the weight you had lost. This reward response will have generated high feelings of pleasure and a drive to repeat the behaviours that created this feeling. Any behaviours that you engaged in to create a deeper energy deficit were rewarded by your brain, using a chemical called dopamine, which reinforced them and gave them a highly addictive quality. Over a short space of time, these behaviours will have become compulsive and hard to stop, even as your reward response from them decreased.
There are two categories of behaviours that can become addictive or compulsive when you have a restrictive eating disorder,
The first category includes behaviours that directly lead to energy deficit and maintain or deepen it. These are instantly rewarding because they are related to the instant pursuit of the energy deficit state, which is ultimately the drug fix that your brain is seeking.
The second category includes behaviours that arise as a result of your being in a semi-starved or energy deficit state. These starvation behaviours can also become deeply ingrained, hard-to-break habits and entwine in the same brain networks driving the first category of behaviours.
Listed below are some of the most common addictive and compulsive behaviours seen in someone with a restrictive eating disorder. Everyone experiences a different cocktail of these. This cocktail can also change over time as the eating disorder evolves, because the overarching addiction is to energy deficit, and so the reward comes from any behaviours that create this internal state.
Addictive & Compulsive Behaviours Common to Restrictive Eating Disorders
Behaviours That Directly Create Energy Deficit:
Food restriction in any form, which might be restricting amounts, macros, micros, avoiding certain food types or only making healthy choices.
Exercise and movement, including lower-level movement, such as constantly standing, fidgeting, doing housework or keeping busy.
Purging through vomiting.
Using laxatives or diet pills.
Weighing and measuring foods (to restrict).
Calorie or other macro counting.
Using apps or Fitbit-type devices to track food intake, movement, heart rate, weight or anything else.
Chewing and spitting.
Feeling addicted to the sensation of an empty stomach.
Weighing yourself or body checking.
Behaviours That Arise from Starvation Syndrome:
Visiting supermarkets or other food stores (even though nothing is bought).
Looking at recipes or obsessing over food in other ways, such as scrolling through food porn images on social media.
A strong compulsion to restrict on money spending.
Hoarding or collecting items, food related or otherwise.
I deliberately left binge-eating off these lists. Although binge-eating in someone with a restrictive eating disorder can have addictive properties, I wouldn't consider it within the same category of addictive behaviours underlying the restrictive eating disorder. I will talk more about this in a future post.
If you like to listen, as well as (or instead of read!) then this blog post is the transcript of a podcast episode which you will find on my podcast series,
available on this website, on all mainstream podcast platforms and on YouTube!