A comment on Starcevic (2016) the case of food addiction

To the Editor

We read with interest the commentary by Starcevic (2016), highlighting the proliferation of behavioural addictions and the associated implications. He notes that the surge in behavioural addictions is historically in line with the rise in obsessive compulsive spectrum disorders evident 10–15 years ago. Thus, the fundamental issue maybe that these disorders do exist and they have failed to find their niche in psychiatric nosology and, thus, have morphed from the obsessive compulsive spectrum and are now emerging as addictions. Although there are issues pertaining to understanding normal activities as deviant due to their frequency, for example, a need appears to be indicated by the reoccurrence of these phenomena through differing designations over time.

Moreover, Starcevic (2016) emphasises that conceptualising problematic behaviours as an addiction has several consequences; the most pertinent being trying to address the behaviour devoid of the function that it is serving for the individual. Thus, perhaps the crux of the issue is the underlying psychopathology that is impelling the atypical behaviour. Therefore, collectively the impetus lies in understanding the underlying psychopathology in order to understand how the atypical behaviour is best conceptualised and designated.

A behavioural addiction that has received a great deal of attention in the last decade is food addiction (FA). Our research in relation to FA has indicated that the concept appears to be intertwined with other forms of psychopathology (Pai et al., 2016). In a sample of the general population (n = 118), 9.32% (n = 11) were found to meet the Yale Food Addiction Scale (YFAS) criteria for FA; of those who met the FA criteria, 81.82% reported living with a long-term mental health condition. In a sample of individuals with severe mental illness (schizophrenia, schizoaffective disorder; n = 94), 26.59% (n = 25) met the YFAS criteria for FA, a prevalence rate much higher than in the general population. Thus, it appears that FA is associated with the co-occurrence of other mental illnesses.

A central problem pertaining to the FA construct relates to its measurement. FA is measured by the YFAS (Gearhardt et al., 2009); however, FA has become synonymous with this measure as such rendering the existence of the construct as circular. Therefore, a need exists to move beyond purely conceptualising the FA construct through the YFAS in order to gain a better understanding of the phenomenon, the associated psychopathology and the most appropriate designation. In relation to behavioural addictions generally, this is an enormous challenge due to the diversity of behaviours that could be conceived as addictions; nonetheless this challenge needs to be tackled in the coming years while also acting with caution to ensure we do not pathologize ‘normal’ behaviour.