Addictions can be difficult to address......I am an addict, with a range of co-morbidities, and if honest, find it difficult to constantly, mindfully, attend to my addictions.
Binge Eating i.e. the consumption of atypically large amounts of food while experiencing loss of control occurs across a range of eating disorders. Criteria for binge eating disorder (BED) include recurrent bingeing (> 1week for 3 months). eating rapidly and eating until uncomfortably full. BED is the most common eating disorder (ED) symptom occurring 4.5 to 6.9 percent of people and is associated with medical complications such as infertility, obesity and metabolic syndrome.
Both ED's and addictive disorders show a similar development trajectory, with onset often occurring during adolescence, following a chronic course, and frequently involving periods of remission and recurrence. Moreover, there is significant comorbidity, with nearly 40 percent of individuals with ED's meeting criteria for addiction. These behavioural similarities are largely associated with neurological impairments in dopamine and serotonin systems.
Reward dysfunction is implicated in ED's and addiction. Reward deficiency theory holds that individuals resort to using perceived, highly rewarding behaviours, to compensate for an innate hyposensitive response to reward, caused by a genetic determinant attributed to reduced dopamine receptors. Whereas reward sensitivity theory suggests that hypersensitivity to rewarding properties e.g. food increases the addictive potential of those stimuli. Either variant of reward dysfunction manifests as difficulty tolerating delayed reward and increased desire for the rewarding stimuli.
Another impairment in addiction and ED's is poor after regulation. Affect regulation encompasses awareness, understanding and acceptance of emotions, as well as the ability to modulate responses to emotion. According to self-medicating hypothesis, individuals engage in continued substance abuse (e.g. drugs, food, internet, gambling, sex, gaming) to avoid or escape negative emotion and affect. Interestingly, self-medication initially reduces negative affect but ultimately results in increased negative affect. Similarly, individuals who binge eat often report engaging in bingeing to escape from negative emotions. While bingeing can temporarily provide emotional relief, distress is often ultimately exacerbated due to feelings of shame and guilt from losing control over eating.
Impulsivity is multi-faceted encompassing behaviour that occurs without careful consideration, exhibiting a component of rashness. Across a variety of domains, individuals with ED's or addictions demonstrate increased levels of trait and behavioural impulsivity. However, negative and positive urgency (acting rashly in response to negative and positive mood) have emerged as the strongest impulsivity domains related to ED's and addiction.
Addicts often act rashly. The rash action defined by urgency is a behavioural response to emotions. Additionally it is difficult to inhibit behaviour in the presence of something extremely rewarding, particularly when longing for a hit of dopamine. When you are tired, and lack sleep, urgency often exacerbates ten-fold. Research has suggested that the above constructs, after regulation, impulsivity and reward processing likely have overlapping neurocircuitry. Together, these three deficits can contribute to an "addiction vulnerability".