Eating disorders are complex conditions that involve genes, psychology, and the environment.
Some feel strongly that eating disorders are distinct from addictions, but I believe it is helpful to at least look at the similarities and consider their overlap. Additionally, many people who have eating disorders also suffer from other addictions, including substance abuse, compulsive shopping, gambling, and sex addiction, so I think it’s helpful to explore the similarities.
It is becoming apparent that eating and drug disorders share a common neuroanatomic and neurochemical basis.Gold & Star, Eating Disorders chapter 27
Eating disorder “addictions”
Addictions are characterized by how a person feels and responds to their addictive behavior or substance. This includes:
- Feeling compelled to do something
- A preoccupation with doing something
- Persistently doing something despite negative consequences
- Relapse despite a deep desire to stop
- Craving the action not doing it
Here’s how you can line up eating disorder behaviors with the list of addictive behaviors:
- Feel compelled to restrict, binge, and/or purge food
- Are preoccupied with body weight, the next meal, or a desire to feel complete emptiness
- Persist in eating disorder behaviors even when families beg them to stop and they are shown evidence of negative consequences
- Commit to ending the behavior, only to repeatedly relapse
- When abstaining from behavior, crave the “high” that the behavior created
The “addictive” neurobiology
“The constellation of behaviors we call addiction is provoked by a complex set of neurological and emotional mechanisms that develop inside a person.”  Addiction research has found biological, chemical, neurological, psychological, medical, emotional, social, political, economic, and spiritual contributing factors.
From a neurobiological standpoint, addictions engage the brain’s attachment, reward, and incentive-motivation systems. The engagement of these systems reduces the rational thinking and impulse control areas in the cortex.
There are four dominant brain systems involved in addiction, all of which exhibit signs of being out of balance compared to non-addicted brains:
- The opioid attachment-reward system
- The dopamine-based incentive-motivation apparatus
- The self-regulation areas of the prefrontal cortex
- The stress-response mechanism
The purpose of an addiction
Many people who struggle with addictions also suffer from co-existing mental disorders including depression, anxiety, post-traumatic stress disorder, attention deficit hyperactivity disorder, autism spectrum disorder, and obsessive-compulsive disorder. Additionally, these conditions, as well as addiction, often coexist with eating disorders.
Eating disorders and addictions may appear like “bad habits,” but they are much deeper than a habit. They are firmly entrenched behaviors that we use to moderate our inner state of being. They can literally rewire the brain and nervous system, bringing a sense of calm and peace that is otherwise unattainable.
Dismissing addictions as “bad habits” or “self-destructive behavior” comfortably hides their functionality in the life of the addict.Vincent Felitti, MD
Addictions serve an important purpose in the life of the person who is addicted. Most importantly, the addiction gives the person a temporary sense of relief. Unfortunately, the relief is short-lived. The long-term impact of continuing to use the addictive behavior or substance is continued, often increasing dependence on the addiction.
Several personality traits are found among people who become addicted to substances or behaviors. These traits stem from genetic and neurobiological conditions that create psychological impacts including:
- Poor self-regulation
- Lack of basic differentiation
- Lack of a healthy sense of self
- A sense of deficient emptiness
- Impaired impulse control
These traits may pre-date the addiction, and they often become more entrenched and obvious as the addiction continues.
Eating disorders and addictions don’t exist in a vacuum. They arise in a society in which the addictions begin as something that is socially acceptable, even honored and praised. But there is a critical tipping point. At that point, a person who was doing something socially acceptable like shopping, having a drink after work, or going on a diet, slips into disordered behavior. People who are addicted exhibit the following social behaviors:
- Loss of integration into family and culture
- A sense of exclusion, isolation, and powerlessness
- A sense of shame and the belief of being inherently “bad”
- Utilizing deception and manipulation, regardless of the consequences, to pursue the addiction
People who have addictions are seeking something outside to soothe their inner state of mind. But this is not obvious to most people. The paradox of addiction is that a person is seeking something to curb their insatiable emptiness, yet they will never feel sated as long as they are stuck in the addiction. It’s never enough because the emptiness is inside.
What characterizes an addiction? Quite simply this: you no longer feel that you have the power to stop. It seems stronger than you. It also gives you a false sense of pleasure, pleasure that invariably turns into pain.Ekhart Tolle
A person craves eating disorder behaviors because they believe it soothes their deep sense of lack and emptiness. And yet eating disorder behaviors never actually soothe because it is not what they really need.
“The addict is never satisfied. His spiritual and emotional condition is one of impoverishment, no matter how much he achieves, acquires, or possesses. In the hungry-ghost mode, we can never be satiated.” 
What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood.Alice Miller, Breaking Down the Wall of Silence
The fear within
Many people who have an eating disorder believe the eating disorder is a harmless, even healthy, friend. But in order to recover from an eating disorder, a person must decode the language the eating disorder used to communicate.
An eating disorder can mask a deep pain in the psyche. At some point, the person learned that they must not speak of this deep pain, and thus they adopt an eating disorder or other addiction in order to manage their deep discontent. The pain must emerge in some way and, for some, it is through eating disorder behaviors.
Addictions displace a person’s ability to truly feel emotions and express them in a natural, healthy way. The longer a person remains in an eating disorder, the further underground their vulnerability burrows. Recovery requires a person to bring their vulnerability into the light and see that the eating disorder was a maladaptive coping mechanism.
Not a choice
When a person is addicted to a behavior or a substance, they are not in charge. They are not making a choice. Even though the behavior hurts them, they are compelled in unseen and unobserved ways to keep doing them. They firmly believe it is the only way they can survive. To imagine a life without an eating disorder is incomprehensible. Their sense of self, their sense of worth, is innately connected to the disorder.
Finally, eating disorders share addiction’s central dilemma: “if recovery is to occur, the brain, the impaired organ of decision making, needs to initiate its own healing process. An altered and dysfunctional brain must decide that it wants to overcome its own dysfunction: to revert to normal—or, perhaps, become normal for the very first time.” 
Luckily, this does happen. Full recovery is 100% possible. Many people have made a full recovery from eating disorders. They have gone beyond abstaining from eating disorder behaviors and achieved full sobriety. Don’t ever lose hope!
 The book In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Mate provides comprehensive and deeply compassionate insight into addictions and the people who live with them. Although the main focus of the book is people who are addicted to substances, behavioral addictions are also explored, including Dr. Maté’s own behavioral addictions.