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From Disordered Eating to Addiction: The “Food Drug” in Bulimia Nervosa

Umberg, Erin N. MA, MS*; Shader, Richard I. MD*; Hsu, L. K. George MD; Greenblatt, David J. MD*

Journal of Clinical Psychopharmacology: June 2012 - Volume 32 - Issue 3 - p 376–389
doi: 10.1097/JCP.0b013e318252464f
Review Articles

The high prevalence of substance abuse in individuals with bulimia nervosa (BN) and the pervasive symptom substitution in many types of drug addiction suggest that a number of substances—including food—can impair an individual’s self-control, even in the presence of negative consequences. Nonetheless, the neurobiological similarities between BN and drug addiction are not clearly established. This review explores how the specific eating patterns seen in BN (binge eating and purging, with intermittent dietary restriction) are particularly addictive and differentiate BN from other eating disorders and obesity. A number of peripheral and central biological aberrations seen in BN may result in altered reward sensitivity in these individuals, particularly through effects on the dopaminergic system. Neurobiological findings support the notion that BN is an addictive disorder, which has treatment implications for therapy and pharmacological manipulations.

From the *Department of Molecular Physiology and Pharmacology, Tufts University School of Medicine; and †Department of Psychiatry, Tufts Medical Center, Boston, MA.

Received March 13, 2011; accepted after revision December 19, 2011.

Reprints: David J. Greenblatt, MD, Tufts University School of Medicine, 136 Harrison Ave, Boston MA 02111 (e-mail:

Funding was provided through the Shader Family Fellowship awarded from the Shader Family Research and Education Fund at Tufts University.

© 2012 Lippincott Williams & Wilkins, Inc.