In a recent study, researchers from the University of Minnesota found a possible link between severe Post Traumatic Stress Disorder (PTSD) in women and addiction to food. The results of this study may help explain why previous research has also connected a diagnosis of PTSD with increased risk of weight gain and obesity. There is an additional concern that these individuals may be at increased risk for other health problems associated with obesity, including diabetes and heart disease. We know that approximately 7.7 million adults in the United States experience PTSD and this anxiety disorder can significantly impact a person’s ability to function (Whiteman, 2014). For some, the symptoms of PTSD interfere with their ability to work or participate in other important daily activities. Those who suffer from PTSD may turn to drugs or alcohol, seeking relief from their symptoms. Recent research suggests that those with PTSD, especially women, may also turn to food to escape and soothe painful psychological symptoms. In fact, certain foods may hijack the brain in ways that are very similar to the effects of drugs or alcohol.
Addiction and PTSD
Symptoms of Post Traumatic Stress Disorder can develop after a person experiences a very stressful, frightening, traumatic, or life-threatening event. This disorder can be diagnosed by a behavioral health professional, using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Traumatic events affect different people in different ways, and people are often surprised and confused by the symptoms they may experience after a traumatic event. PTSD symptoms are not a sign of weakness, but are a result of the brain having difficulty processing an overwhelming event or situation. Anyone can potentially develop symptoms of PTSD after events like: serious accidents or injuries, physical or sexual abuse, combat experiences, or other events that threaten personal safety. Symptoms of PTSD may include:
- Continuous or reoccurring thoughts, images, or memories of the upsetting event that intrude on daily life
- Problems with sleeping, including insomnia and nightmares
- Feelings of nervousness, irritability, and anxiety
- Feeling jumpy, and being easily startled
- Problems with concentration
- Feelings of detachment from people and events
- Feelings of numbness, or being cut-off and from emotions
- Desire to avoid situations, people, places, or thoughts that are reminders of the even
Those who do develop PTSD symptoms after a traumatic event may also develop depression, especially if the PTSD is not treated. But, what about the possible link between PTSD and addiction? According to Jacobsen, Southwick, and Kosten (2001), substance use disorders are very common in people who have PTSD. In their review of addiction and PTSD literature, Volpicelli, Barlaman, Hahn, Wallace and Bux (1999) also found that addiction, specifically alcohol addiction, is strongly associated with PTSD. For example, women who were sexually assaulted as children reported turning to alcohol to cope with and reduce symptoms of PTSD. Additionally, they found that in one study, 40% of people attending inpatient substance abuse treatment also had symptoms meeting criteria for a diagnosis of PTSD. They also found evidence that co-occurring PTSD and substance use disorders were more common for women than for men. Studies show that 30-57% of women who abuse substances also have symptoms that meet the criteria for PTSD. This evidence suggests that addiction and PTSD can go hand-in-hand, especially for women (Volpicelli, et al., 1999).
Often, substance abuse begins after the development of PTSD symptoms, and substances may be used in an effort to cope with and decrease the painful symptoms of PTSD. It’s estimated that one in three people with a substance use disorder also has symptoms of PTSD (Latest Research on Treating PTSD and Addiction, 2014). Unfortunately, this type of self-medicating can lead to physiological dependence on one or more substance, which includes withdrawal symptoms and the need for increasing amounts of the substance to obtain relief. Understanding the link between PTSD and addiction can help behavioral health professionals develop more comprehensive and effective treatments to address both the mental health and the substance use disorder. But what about the link between PTSD and behavioral addictions, like food addiction? Is there the same connection?
Understanding Food Addiction
We know that people with PTSD are at risk of developing addictions to substances like drugs or alcohol, but can they also become addicted to food and eating? Is it really possible for a person to become addicted to something they need for their very survival? While food addiction is not a diagnosis included in the current edition of the Diagnostic and Statistical Manual of Mental Disorders, there have been numerous research studies evaluating the possibility that people can become addicted to eating certain types of food. The concept of food addiction may explain why some people turn to food to relieve painful feelings, like those associated with PTSD. To better understand this connection, it’s helpful to start by defining and describing food addiction. What does it mean to be addicted to food? In the recent University of Minnesota study, researchers defined food addiction symptoms using the Yale Food Addiction Scale (Whiteman, 2014). Some signs and symptoms of food addiction include:
1. Eating when no longer hungry four or more time each week
2. Feeling the need to eat more and more food to effectively reduce stress (at any time)
3. Worrying about the need to reduce food intake four or more time per week
Other signs of food addiction may include experiencing strong cravings for certain types of foods, excessive dieting, eating in secret, or using laxatives or inducing vomiting after overeating (Addiction.com, 2014) Defining the signs and symptoms of food addiction helps us understand what people experience, and how they might be using food to feel better. There is evidence that the same pleasure and reward centers in the brain that are triggered by drugs or alcohol can also be triggered by certain types of food. Food with high sugar, salt, or fat content may be particularly addictive (Addiction, 2014). Cravings for certain foods can be strong, and controlling eating behaviors can become more and more difficult.
Just like addiction to drugs or alcohol, food addiction can lead to adverse health effects and impaired functioning in relationships, school, or work. However, when painful emotions occur, as can happen with PTSD, it’s natural to want them to stop. It can be tempting, and very easy, to turn to tasty foods to feel better. According to Yale University Researcher, Ashley Gearhardt, food can act just like a drug to activate pleasure centers in the brain, potentially triggering cravings, withdrawal, and tolerance symptoms for some (McMillen, 2011).
In this study, fMRI brain scans were used to evaluate brain activity in 48 women with high scores on a survey of food addiction symptoms. Gearhardt found that the women seemed to anticipate and crave food just as a person addicted to drugs craves their drug of choice. The women had activity in the same regions of the brain as those with drug or alcohol dependence. Those who scored high on measures of food addiction also had much less activity in the reward centers of the brain, as compared with those endorsing fewer food addiction symptoms. This may indicate the development of tolerance to certain foods, which could then lead to the need to eat more of the food to create the same pleasant feelings. Additionally, the women with more food addiction symptoms showed less activity in the areas of the brain responsible for self-control, which may help explain overeating behaviors (McMillen, 2011). The potential for addiction to certain types of foods seems plausible, but how does PTSD increase the likelihood of developing this particular type of addiction?
The Connection between PTSD and Food Addiction
The recent research conducted at the University of Minnesota indicates that women with PTSD may be more susceptible to developing an addiction to food (Rettner, 2014). The study included over 49,000 women between the ages of 29 and 42. The participants were initially recruited to take part in the study in 1989. In 2008, the participants completed a questionnaire that assessed their exposure to any type of traumatic event and symptoms of PTSD. In 2009, they responded to a questionnaire that assessed for symptoms of food addiction (Whiteman, 2014). It’s important to note that not everyone who experiences a traumatic event goes on to develop symptoms of PTSD, and this was also the case in this study. Of the 81% of women who reported experiencing at least one traumatic event, 17% reported 4-5 symptoms of PTSD and 10% reported 6-7 symptoms of PTSD. These women generally reported that they first experienced PTSD at about age 30.
In this study, the researchers found that the women with more symptoms of PTSD also experienced a higher rate of food addiction. The women who reported no PTSD symptoms at all reported a 6% rate of food addiction, while women who endorsed 6-7 symptoms of PTSD reported an 18% incidence of food addiction—over twice the prevalence as compared to those without PTSD symptoms. Additionally, the most significant food addiction issues were associated with the earliest onset of PTSD symptoms (Whiteman, 2014).
While the concept of food addiction is relatively new, and still somewhat controversial, these studies help us understand how people with PTSD symptoms may use food as a way to self-medicate the painful symptoms of this disorder. Certain types of food seem to have the ability to act on the brain like a drug, creating the need for more and more, and undermining self-control. As with any addiction, addiction to food can create additional health challenges. Understanding the connections between addiction, including food addiction, and PTSD will help behavioral health professionals develop more effective treatment interventions, and supports for those living with this disorder.
Addictions.com. (2014). Retrieved September 23, 2014, from http://www.addictions.com/food/
Jacobsen, L. K., M.D., Southwick, S. M., M.D., & Kosten, T. R., M.D. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158, 1184-1190. Retrieved September 23, 2014, from http://journals.psychiatryonline.org/article.aspx?articleid=174935
Latest research on treating PTSD and addiction: Behavioral health evolution. (2014). Retrieved September 23, 2014, from http://www.bhevolution.org/public/perspectices_201203.page
McMillen, M. (2011, April 04). Addiction to food, drugs similar in the brain. Retrieved September 24, 2014, from http://www.cnn.com/2011/HEALTH/04/04/food.drug.addiction.same.to.brain/index.html
Rettner, R. (2014, September 19). Why posttraumatic stress could make women more susceptible to food addiction. Retrieved September 24, 2014, from http://www.huffingtonpost.com/2014/09/19/women-food-addiction-ptsd_n_5850454.html
Volpicelli, J., M.D., Balarman, B., Hahn, J., Wallace, H., & Bux, D. (1999). The role of uncontrollable trauma in the development of PTSD and alcohol addiction. Alcohol Research and Health, 256-262. Retrieved September 24, 2014, from http://pubs.niaaa.nih.gov/publications/arh23-4/256-262.pdf
Whiteman, H. (2014, September 18). Post-traumatic stress disorder in women linked to food addiction. Retrieved September 22, 2014, from http://www.medicalnewstoday.com/articles/282629.php