Lecture 10.2

Question 1

What is the difference between a wanted substance and a required substance in the context of Substance Use Disorders (SUDs)?

Answer 1

SUDs form in response to a wanted substance, not a required substance.

Question 2

How is Food Addiction defined?

Answer 2

Food Addiction is defined as addiction-like behaviours that develop in association with the consistent intake of highly palatable foods.

Question 3

What is the homeostatic balance between in normal eating?

Answer 3

Normal eating involves a homeostatic balance between hunger and satiety.

Question 4

What are the features of normal eating in terms of control, consequences, and preoccupation?

Answer 4

In normal eating, control is flexible, responsive to hunger and satiety cues, and conscious. The consequences of normal eating typically involve no negative consequences. Preoccupation in normal eating means that food does not dominate thoughts or activities.

Question 5

What is overeating?

Answer 5

Overeating is consuming food past the point of satiety.

Question 6

What are the features of overeating in terms of control, consequences, and preoccupation?

Answer 6

In overeating, control is situational, involving a temporary lapse but is rectified. The consequences of overeating involve temporary discomfort and mild regret. Preoccupation in overeating means that thinking about food might increase, but does not become pervasive.

Question 7

What are the features of Food Addiction in terms of control, consequences, and preoccupation?

Answer 7

In Food Addiction, control involves a significant loss of control and a compulsion to eat. The consequences of Food Addiction include health problems, social isolation, psychological symptoms, and financial burden. Preoccupation in Food Addiction involves cravings, thinking about and obtaining food, and neglecting other activities in favor of foods.

Question 8

What are the prevalence rates of Food Addiction in general community samples, obesity, clinical Major Depressive Disorder (MDD), subclinical MDD, and Binge Eating Disorder?

Answer 8

The prevalence rate of Food Addiction is 5-20% in general community samples (Pursey et al., 2014), 15-25% in obesity (Meule & Gearhardt, 2014), 25-29% in clinical Major Depressive Disorder (Mills et al., 2019, 2020), 22% in subclinical MDD (Bartschi & Greenwood, 2023), and 57% in Binge Eating Disorder (Gearhardt et al., 2012).

Question 9

Is Food Addiction currently recognized as a formally diagnosable disorder in the DSM-5, DSM-5-TR or ICD-11, and if not, what DSM-5 category is it considered under?

Answer 9

Food Addiction is not currently recognized as a formally diagnosable disorder in the DSM-5, DSM-5-TR or ICD-11. It falls under the DSM-5 category of ‘Non-Substance Related Disorders’.

Question 10

What other disorders were considered for inclusion in the DSM-5 category ‘Non-Substance Related Disorders’?

Answer 10

Other disorders considered for inclusion in the DSM-5 category ‘Non-Substance Related Disorders’ include compulsive overeating, sex addiction, and internet addiction.

Question 11

What is the most widely used measure for Food Addiction, and by whom was it developed?

Answer 11

The most widely used measure for Food Addiction is the Yale Food Addiction Scale (YFAS; Gearhardt et al., 2009, 2016).

Question 12

What are the features of the Yale Food Addiction Scale (YFAS) 2.0, including the number of items, rating scale, timeframe reference, and subscales?

Answer 12

The YFAS 2.0 features 35 items rated on a scale of 0 (Never) to 7 (Every Day), with a timeframe reference of the past 12 months. It also has 11 subscales corresponding with each of the 11 diagnostic criteria for Substance Use Disorder in the DSM-5, and 1 subscale to determine clinically significant impairment.

Question 13

How is meeting the YFAS criteria for food addiction defined?

Answer 13

Meeting the YFAS criteria for food addiction is defined as having a symptom count score of 2 or more out of 11, and also endorsing clinically significant impairment.

Question 14

What are the 11 subscales of the YFAS 2.0 and what does each subscale measure?

Answer 14

The 11 subscales of the YFAS 2.0 are:
Increased Intake: eating highly palatable foods in larger amounts or for longer than intended.
Inability to Quit: wanting to cut down or stop eating highly palatable foods but not managing to.
Increased Time to Obtain: spending a lot of time getting, using, or recovering from eating large amounts of highly palatable foods.
Cravings: cravings and urges to eat highly palatable foods.
Failed Role Obligations: not managing work, home, or school related obligations because of highly palatable food intake.
Use Despite Problems: continuing to eat highly palatable foods, even when it causes problems in relationships.
Activities Given Up: giving up social, occupational, or recreational activities because of highly palatable food intake.
Physically Hazardous Use: repeatedly eating highly palatable foods in dangerous situations, such as while driving.
Adverse Consequences: continuing to eat highly palatable foods, despite awareness of physical or psychological problems that could have been caused by or made worse by the food in question.
Tolerance: habituating to the amount of highly palatable foods consumed, and therefore needing more to obtain the desired effect, such as stress relief.
Withdrawal: development of withdrawal symptoms, which can be relieved by eating more of the highly palatable food.

Question 15

What are the key structures and functions of the Mesolimbic Dopamine Pathway, including the VTA, NAc, SN, DS, Insula, OFC, Amygdala, and LH?

Answer 15

The key structures and functions of the Mesolimbic Dopamine Pathway are:
VTA: origin of pathway, production of DA.
NAc: association of reward, motivation, reinforcement.
SN: encodes motivational salience and valence of stimuli.
DS: habit formation, decision making about reward.
Insula: processing internal and external signals related to addiction and emotions.
OFC: processing value of stimuli and acting accordingly.
Amygdala: association of reward with positive emotions.
LH: incentive to eat.

Question 16

According to Kalon et al. (2017), what are the aetiological factors contributing to Food Addiction?

Answer 16

According to Kalon et al. (2017), the aetiological factors contributing to Food Addiction are highly palatable foods activating reward pathways and circuitry, operant conditioning where food is seen as a reward resulting in corresponding changes in dopamine signaling, the use of foods to cope with negative emotional states or acute/chronic stress, low mood resulting in an attentional bias towards highly palatable foods to relieve stress, craving involving reward, salience, executive control, and memory, and impulsivity which is reward seeking behavior and the inability to delay gratification.

Question 17

According to Kalon et al. (2017), what are the aetiological factors maintaining Food Addiction?

Answer 17

According to Kalon et al. (2017), the aetiological factors maintaining Food Addiction are altered dopamine reward pathways to maintain positive reinforcement associations between food and eating behavior, the disruption or override of energy homeostasis mechanisms by highly palatable foods over time, where leptin, ghrelin, and insulin are involved in signaling in the hypothalamus to maintain homeostatic eating, prolonged stress causing increased intake of highly palatable foods to cope, and impaired cognitive control regulating decision making, rewards, and initiation or inhibition of food intake.

Question 18

How do highly palatable foods affect reward pathways and circuitry?

Answer 18

Highly palatable foods activate reward pathways and circuitry.

Question 19

How does operant conditioning contribute to Food Addiction?

Answer 19

Operant conditioning contributes to Food Addiction by food being seen as a reward, which results in corresponding changes in dopamine signaling.

Question 20

What role do mood, stress, and food cues play in Food Addiction?

Answer 20

Foods are used to cope with negative emotional states, or acute/chronic stress. Low mood may result in an attentional bias towards highly palatable foods to relieve stress.

Question 21

What role do craving and impulsivity play in Food Addiction?

Answer 21

Craving involves reward, salience, executive control, and memory. Impulsivity is reward seeking behavior and the inability to delay gratification.

Question 22

How do leptin, ghrelin, and insulin influence energy homeostasis, and how might highly palatable foods disrupt these mechanisms?

Answer 22

Leptin, ghrelin, and insulin are involved in signaling in the hypothalamus to maintain homeostatic eating. Over time, highly palatable foods may disrupt or override these mechanisms.

Question 23

How does chronic stress relate to the intake of highly palatable foods?

Answer 23

Prolonged stress causes increased intake of highly palatable foods to cope.

Question 24

What role does cognitive control play in food intake?

Answer 24

Cognitive control regulates decision making, rewards, and the initiation or inhibition of food intake.

Question 25

According to Gearhardt et al. (2011), what brain regions are activated in adults meeting YFAS criteria in anticipation of receiving food, and what is the relationship between YFAS scores and dPFC and caudate activation?

Answer 25

According to Gearhardt et al. (2011), in adults meeting YFAS criteria, the anticipated receipt of food activated the anterior cingulate, medial orbitofrontal PFC, and amygdala. Higher YFAS scores were associated with greater dPFC and caudate activation in response to food reward.

Question 26

According to Imperatori et al. (2015), what is the association between the number of YFAS symptoms and functional connectivity in fronto-parietal areas?

Answer 26

According to Imperatori et al. (2015), 3 or more YFAS symptoms were associated with increased functional connectivity in fronto-parietal areas.

Question 27

According to Lerma-Cabrera et al. (2016), how do high sugar foods affect the release of endogenous opioids and the dopamine system in the NAc?

Answer 27

According to Lerma-Cabrera et al. (2016), high sugar foods trigger the release of endogenous opioids in the NAc and activate the dopamine system.

Question 28

According to Feldstein Ewing et al. (2017), how does the consumption of high calorie drinks affect brain activation?

Answer 28

According to Feldstein Ewing et al. (2017), the consumption of high calorie drinks increased activation in the NAc, cerebellum, and bilateral OFC, which is the same pattern of activation as 'traditional' SUDs.

Question 29

According to Davis et al. (2011), what did obese adults meeting YFAS criteria experience?

Answer 29

According to Davis et al. (2011), obese adults meeting YFAS criteria had greater cravings and snacking on sweets.

Question 30

According to Spring et al. (2008), how did a sweetened drink affect women who craved carbohydrates, and what happened with repeated exposure?

Answer 30

According to Spring et al. (2008), for women who craved carbohydrates, a sweetened drink alleviated negative mood. However, this effect decreased after repeated exposure, indicating tolerance.

Question 31

According to Markus et al. (2017), which foods does tolerance develop fastest to, and what percentage of the sample reported physiological withdrawal effects?

Answer 31

According to Markus et al. (2017), tolerance develops fastest to high fat sweet or savory foods. 5% of the sample reported physiological withdrawal effects to high fat savory and high fat sweet foods.

Question 32

According to Lent & Swencionis (2012), what was associated with increased anxiety in bariatric surgery candidates when not near food?

Answer 32

According to Lent & Swencionis (2012), in bariatric surgery candidates, addictive personality traits were associated with increased anxiety when not near food, indicating withdrawal.

Question 33

According to Bartschi & Greenwood (2023), what did YFAS symptoms significantly mediate the relationship between?

Answer 33

According to Bartschi & Greenwood (2023), YFAS symptoms significantly mediated the relationship between MDD severity and BMI.

Question 34

According to Mills et al. (2019), which YFAS symptoms were positively associated with leptin levels, and what was the relationship between YFAS symptoms and ghrelin?

Answer 34

According to Mills et al. (2019), leptin levels were positively associated with Inability to Quit, Use Despite Problems, and Adverse Consequences. YFAS symptoms were unrelated to ghrelin.

Question 35

According to Mills et al. (2020), what sex-specific effects were found for dopamine and which YFAS symptoms were positively associated with dopamine in females?

Answer 35

According to Mills et al. (2020), there were sex-specific effects for dopamine. In females, dopamine was positively associated with Inability to Quit, Adverse Consequences, Withdrawal, Use Despite Problems, and Failed Role Obligations. There were no associations found in males.

Question 36

According to Mills et al. (2021), what was the relationship between YFAS symptoms and plasma cortisol?

Answer 36

According to Mills et al. (2021), YFAS symptoms were unrelated to plasma cortisol.

Question 37

What are the arguments against the validity of Food Addiction?

Answer 37

Arguments against the validity of Food Addiction include that food is necessary for survival, whereas substances that form the basis of 'traditional' SUDs are not. It is also argued that Food Addiction may be better defined as 'compulsive overeating' due to the overlap with other eating disorders, such as Binge Eating Disorder, although there is no preoccupation with weight in Food Addiction, so it is still different. Additionally, it is argued that Food Addiction may be better defined as 'additive addiction', because it is the sugar or fat content of the food that forms the basis of the behaviour and not the food as a whole.

Question 38

What are the arguments in favor of the validity of Food Addiction, particularly in comparison to 'traditional' SUDs?

Answer 38

Arguments in favor of the validity of Food Addiction include that it is becoming increasingly recognized in transdiagnostic and substance dependence literature. When compared to 'traditional' SUDs, Food Addiction shows increased susceptibility to stress in onset and maintenance, similar activation of reward-mediated brain circuits, similar links to dopamine in the CNS and PNS, similar behaviors such as cravings, disinhibition, and tolerance, a similar likelihood of poorer treatment outcomes including functional impairment and physical health problems, and similar subjective reports of experiences with substances.

Question 39

Are there diagnosis-specific treatment options currently available for Food Addiction, and if not, how is it suggested to treat it?

Answer 39

There are no diagnosis-specific treatment options currently available for Food Addiction. However, because of the overlap with other SUDs, it is suggested to treat it similarly.

Question 40

What are the treatment options for Food Addiction, including Cognitive Behavioral Therapy and Mutual Aid strategies?

Answer 40

Treatment options for Food Addiction include Cognitive Behavioral Therapy, which addresses negative emotions or stress underlying eating behaviors, and Mutual Aid strategies, where individuals or groups voluntarily collaborate with one another in a 12-step model to address and improve social, behavioral and cognitive factors related to food use.

Question 41

What is an example of a Mutual Aid strategy for Food Addiction?

Answer 41

An example of a Mutual Aid strategy for Food Addiction is Food Addicts in Recovery Anonymous (FA).