Processed Food Addiction

Foundations, Assessment, and Recovery

Joan Ifland PhD, Marianne T. Marcus, Harry G. Preuss, Joan Ifland, Marianne T. Marcus, Harry G. Preuss

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781351646239
• Edition: 1
• Topic: Medicina
• Subtopic: Endocrinologia e metabolismo

Obesity and eating disorders have stubbornly refused to respond to treatment since the 1990's. This book organizes the evidence for a possible answer, i.e., that the problem could be one of addiction to processed foods. In a Processed Food Addiction (PFA) model, concepts of abstinence, cue-avoidance, acceptance of lapses, and consequences all play a role in long-term recovery. Application of these concepts could provide new tools to health professionals and significantly improve outcomes.

This book describes PFA recovery concepts in detail. The material bridges the research into practical steps that health professionals can employ in their practices. It contains an evidence-based chapter on concepts of abstinence from processed foods. It rigorously describes PFA pathology according to the DSM 5 Addiction Diagnostic Criteria. It applies the Addiction Severity Index to PFA so that health practitioners can orient themselves to diagnosing and assessing PFA. It contains ground-breaking insight into how to approach PFA in children.

Because the book is evidence-based, practitioners can gain the confidence to put the controversy about food addiction to rest. Practitioners can begin to identify and effectively help their clients who are addicted to processed foods. This is a breakthrough volume in a field that could benefit from new approaches.

Section II

Diagnosis and Assessment

8 Diagnosing and Assessing Processed Food Addiction

Dennis M. Donovan, and Joan Ifland

Food Addiction Training, LLC Cincinnati, OH

CONTENTS

8.1 Introduction

8.1.1 Challenges in Diagnosing PFA

8.1.2 Prevention Strategies

8.1.3 The PFA Diagnosis vs. Other Diagnoses

8.1.4 Probing for Subtleties and Severity

8.1.5 Using the ASI

8.1.6 Strengths and Limitations

8.2 Why Diagnose and Assess: Purposes of Diagnosis and Assessment

8.2.1 Distinguishing Weight Loss from PFA

8.2.2 Motivating the Client

8.2.3 Defining the Scope of the Problem

8.2.4 Determining a Diagnosis

8.2.5 Developing Outcome Expectancies

8.2.6 Personal Assessment: Domains of Assessment

8.2.7 Determining Readiness to Change and Readiness for Treatment

8.3 How and When to Assess: Practical Aspects of the Assessment Process

8.3.1 How Much Is Enough? Balancing Scope of Assessment with Cost and Utility

8.3.2 Timing and Sequence of Assessments

8.3.3 Methods to Enhance Validity and Reliability of Assessments

8.3.4 Interviewing Techniques and Styles

8.4 Putting It All Together

8.4.1 Treatment Planning and Matching Clients to Treatment

8.4.2 Avoid Overwhelm with a Menu of Options of Small Steps

8.5 Summary

References

8.1 INTRODUCTION

It almost goes without saying that diagnosis and assessment are the keys to recovery from addictions. Without an adequate diagnosis and assessment, a health professional cannot develop a recovery treatment plan. Without an assessment, a client cannot perceive the need for and value of taking action. Accurate assessment is the key to getting appropriate help for the epidemic of overeating manifesting as processed food addiction (PFA).

For the purposes of diagnosing and assessing PFA, this textbook uses two gold standard instruments, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5), Substance-Related Addiction Diagnostic Criteria (SUD) and the Addiction Severity Index (ASI). These are summarized as follows.

The DSM SUD for alcohol use disorder have been adapted for PFA as shown below ( American Psychiatric Association, 2013, 490–491).

1. Processed foods are consumed in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control processed food consumption.
3. A great deal of time is spent in activities necessary to obtain processed foods, consume processed foods, or recover from their effects.
4. Craving, or a strong desire or urge to consume processed foods.
5. Recurrent processed food consumption resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued processed food consumption despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of processed foods.
7. Important social, occupational, or recreational activities are given up or reduced because of processed food consumption.
8. Recurrent processed food consumption in situations in which it is physically hazardous.
9. Processed food consumption is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by processed foods.
10. Tolerance, as defined by either of the following:
    1. A need for markedly increased amounts of processed foods to achieve intoxication or desired effect.
    2. A markedly diminished effect with continued consumption of the same amount of processed foods.
11. Withdrawal, as manifested by either of the following:
    1. The characteristic withdrawal syndrome for processed foods.
    2. Processed foods are consumed to relieve or avoid withdrawal symptoms.

The thresholds specified in the DSM for a use disorder are two to three symptoms for mild, four to five symptoms for moderate, and six or more for severe (American Psychiatric Association, 2013, 484).

The ASI is a semi-structured interview designed to address seven potential problem areas in substance-abusing clients: medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status. The severity ratings are the interviewer’s estimates of the client’s need for additional treatment in each area. The severity scale ranges from 0 (no treatment necessary) to 9 (treatment needed to intervene in life-threatening situation). Each rating is based upon the patient’s history of problem symptoms, present condition, and subjective assessment of their treatment needs in a given area (Treatment Research Institute, 2017).

Information collected through the ASI informs the treatment plan. This information also helps the practitioner develop options for first steps. Allowing the client to choose from options can facilitate getting started. The ASI also yields information that can structure tracking progress toward goals. A copy of the ASI can be downloaded from http://www.tresearch.org/wp-content/uploads/2012/09/ASI_5th_Ed.pdf.

8.1.1 Challenges in Diagnosing PFA

In the field of PFA, the tasks of developing a diagnosis and assessment face numerous challenges. First, PFA assessment is in its infancy. Although various assessment tools have been proposed, they do not necessarily address PFA as a substance use disorder with many manifestations. They may underestimate use. As seen in Part I, “Fundamentals,” there is evidence for the application of the SUD model to overeating. This is as opposed to a behavioral or process model that would apply to gambling, shopping, Internet, or sex addiction. Addictive foods and cues have been shown to be at the heart of PFA. So, Part II, “Assessment,” depends on established SUD diagnostic and assessment tools, i.e., the DSM 5 SUD criteria for diagnosing and the ASI for assessment as adapted for overeating of processed food.

Secondly, diagnosis and assessment for PFA need to cover a wide range of dysfunction across a range of functional areas. Dysfunction can extend from cognitive impairment and mood disorders, to extensive physical, relationship, financial, career, and family problems. In severe cases, the client may be experiencing cravings continuously and spending most days seeking, eating, and recovering from processed food use. The following chapters describing dysfunction under each of the DSM 5 SUD criteria demonstrate the breadth of the disorder. Although the extent and areas of impairment can be overwhelming, developing a complete picture is crucial to developing a sufficiently comprehensive treatment plan and motivating a client to see a need for treatment and to follow the plan.

Overlooking any comorbid impairment can lead to assignments that are beyond the abilities of the client. For example, failing to find memory loss may lead to the false assumption that a client can remember instructions. This in turn could lead to frustration over a lack of progress because the client cannot remember what to do. Patiently reviewing the extensive SUD diagnostic criteria as well as the results of the ASI will yield rewards in a well-matched treatment plan and good progress.

Another factor in the challenge of assessing PFA is that the addiction may have been diagnosed repeatedly as a weight-loss problem as opposed to a serious mental disorder. The client may have experienced multiple failures at “weight loss” as a result of the misdiagnoses. Thus the client may be fearful of failure in yet another “weight loss” program. Reframing the problem as an SUD may take some practice for the health care provider but could be the key to persuading the client to try again and to use different methods for putting the disorder into remission. The assessment can play an important role in diverting attention from weight loss to more serious impairments such as mobility, fatigue, symptoms of the metabolic syndrome, and loss of executive function. By describing the potential to recover from ailments well beyond the scope of weight loss, the practitioner may be able to motivate the client to begin and stay with recovery.

And finally, practitioners may find it hard to accept that PFA, as diagnosed by the DSM 5 SUD criteria, is quite common but does not necessarily correspond to weight status. Practitioners may benefit from the discipline of systematically developing a profile of behaviors that conform to the DSM 5 SUD criteria. With the detailed information provided in the following chapters, practitioners will be able to probe for instances of addictive behaviors that could otherwise escape notice and avoid being distracted by weight status.

Practitioners can self-monitor for the temptation to dismiss or downplay results at the minimal and mild end of the scale. Addictions are progressive and in the case of PFA, there are intense pressures in obesogenic environments that can accelerate the development of PFA. Aggressive treatment even in minimal or mild cases of preaddiction can be warranted.

8.1.2 Prevention Strategies

Selective prevention strategies can be applied to groups that are at risk for the development of PFA even if clients from these populations have not yet ma...