Overeating And Other Excessive Behaviors (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
Overeating, a behavior not always limited to persons with BULIMIA, is grouped together with substance abuse and dependence in a superfamily of disorders designated as behavioral (non-substance-related) addictions. The term impulse control disorders has been used by some clinicians to describe these behaviors. In this context the notion of ADDICTION centers on the repetitiveness of the behavior and would include such behaviors as compulsive spending, compulsive gambling, pathological overeating (bulimia), hypersexuality, kleptomania (repetitive, compulsive stealing when there is no need), as well as miscellaneous obsessive-compulsive behaviors such as tics and hair-pulling (trichotillomania). Some researchers have pointed out similarities among these disorders and believe that there may be similar brain mechanisms involved in some of them. For example, it has been shown that DOPAMINE levels in certain areas of the brain (such as NUCLEUS ACCUMBENS) are elevated by the ingestion of reinforcing drugs including COCAINE, AMPHETAMINES, OPIOIDS, and, to some degree, NICOTINE. However, increased dopamine levels in these same brain circuits have been shown to occur when animals anticipate food or sexual activity. Also, learning, conditioning, and reinforcement play important roles in these repetitive behavior disorders as well as in the more traditional chemical or substance-abuse and-dependence disorders. It has also been pointed out that treatments for nonchemical "addictive" disorders often follow principles used in substance-abuse disorders; for example, identifying trigger and high-risk situations, teaching alternative coping behaviors, and emphasizing relapse prevention. Self-help groups using AA principles have also been organized, such as Overeaters Anonymous or Gamblers Anonymous. Some pharmacologic agents appear to alter both drug ingestion and obsessive-compulsive behaviors that are not drug related. For example, SEROTONIN UPTAKE INHIBITORS, now used as ANTIDEPRESSANT medications, seem to help alcoholics decrease alcohol consumption and compulsive hair-pullers reduce that behavior.
Such broad definitions of addictive behaviors have disadvantages when they focus too much attention on the commonalities among the diverse behaviors while minimizing the differences and particularities. At a time when rapid progress is occurring in the understanding of the biological processes associated with substance dependence, focusing only on commonalities may obscure the value of therapeutic interventions aimed at specific disorders. For example, nicotine transdermal patches seem to have considerable value in treating tobacco dependence but are probably of no value for cocaine dependence or compulsive gambling.
The way society (or science) chooses to categorize behaviorsesirable or undesirable, repetitive or episodics determined in large measure by the objectives of developing the categorization. There are probably some circumstances where it is helpful to think about a broad category of problematic excessive behaviors encompassing everything from substance abuse to television watching. There is also the risk that in doing so we convey the notion that excessive drug use is no more serious or refractory to intervention than watching television or jogging. Certainly at the present time the social costs and medical consequences of the substance-use disorders are so great that we should be cautious about embracing any conceptual scheme that tends to trivialize or make these problems seem less serious than they are.
(SEE ALSO: Addiction: Concepts and Definitions; Adjunctive Drug Taking; ; Obesity; )
AMERICAN PSYCHIATRIC ASSOCIATION. (1994). Diagnostic and statistical manual of mental disorders-4th edition. Washington, DC: Author.
BALL, G. G., & GRINKER, J. A. (1981). Overeating and obesity. In S. J. Mulé (Ed.), Behavior in excess. New York: Free Press.
JAFFE, J. H. (1990). Trivializing dependence. British Journal of Addiction, 85, 1425-1427.
LEVISON, P. K., GERSTEIN, D. R., & MALOFF, D. R. (EDS.). (1983). Commonalities in substance abuse and habitual behavior. Lexington, MA: Lexington Books.
MARKS, I. (1990). Behavioural (non-chemical) addictions. British Journal of Addiction, 85, 1389-1394.
JEROME H. JAFFE