Does compulsive behavior in Anorexia Nervosa resemble an addiction? A qualitative investigation.

Lauren R. Godier,Rebecca J. Park

doi:10.3389/fpsyg.2015.01608

Abstract

The characteristic relentless self-starvation behavior seen in Anorexia Nervosa (AN) has been described as evidence of compulsivity, with increasing suggestion of parallels with addictive behavior. This study used a thematic qualitative analysis to investigate the parallels between compulsive behavior in AN and Substance Use Disorders (SUD). Forty individuals currently suffering from AN completed an online questionnaire reflecting on their experience of compulsive behavior in AN. Eight main themes emerged from thematic qualitative analysis; compulsivity as central to AN, impaired control, escalating compulsions, emotional triggers, negative reactions, detrimental continuation of behavior, functional impairment, and role in recovery. These results suggested that individuals with AN view the compulsive nature of their behavior as central to the maintenance of their disorder, and as a significant barrier to recovery. The themes that emerged also showed parallels with the DSM-V criteria for SUDs, mapping onto the four groups of criteria (impaired control, social impairment, risky use of substance, pharmacological criteria). These results emphasize the need for further research to explore the possible parallels in behavioral and neural underpinnings of compulsivity in AN and SUDs, which may inform novel treatment avenues for AN.

Highlights

Anorexia nervosa (AN) is a severely debilitating psychiatric disorder characterized by an intense fear of weight gain or becoming fat, despite significantly low body weight (American Psychiatric Association, 2013)
This study aimed to examine the validity of the suggested parallels between AN and substance addiction with a qualitative investigation of the subjective experience of compulsive weight loss behavior in AN
Theme One: Compulsivity is Central to AN As the prompt questions in this study lead participants to base their answers around the compulsive nature of behavior in AN, and due to the deductive nature of the analysis, compulsivity was placed as the main and central theme emerging from the data

Summary

Introduction

Anorexia nervosa (AN) is a severely debilitating psychiatric disorder characterized by an intense fear of weight gain or becoming fat, despite significantly low body weight (American Psychiatric Association, 2013). Individuals with AN place extreme over-importance on the control of weight and shape, and often have disturbed body image perception (Fairburn et al, 2003). These distorted beliefs and perceptions are accompanied by a perpetual drive for thinness, and continuous lowering of weight goals (Barbarich-Marsteller et al, 2011). Compulsivity is defined as a trait in which actions are persistently repeated despite adverse consequences (Robbins et al, 2012) This can be seen in the drug-seeking behavior characteristic of substance dependence, in which a lack of control is felt over behavior, despite the adverse consequences of drug taking (Kalivas and Volkow, 2005).

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