Why Eating Disorders in Teen Girls Are Being Treated as Addictions
A paradigm shift in understanding and treating adolescent eating disorders through the lens of addiction neuroscience
Imagine a teenage girl, let's call her Emily, who spends hours each day trapped in a cycle of obsessive calorie counting, restrictive eating, and secret binge episodes.
She knows her behaviors are harming her, but she feels an overwhelming, compulsive urge to continue. This loss of control, this powerful drive despite negative consequences, is a hallmark of both eating disorders (EDs) and addiction.
Recent research is revealing that for some teens, an eating disorder may be less about vanity and more about a neurological addiction to the behaviors or even the foods themselves 1 9 .
For decades, these fields were treated as separate. However, a paradigm shift is underway, especially in treating adolescent females, who are disproportionately affected. This article explores this compelling connection, detailing the groundbreaking science that is paving the way for innovative and more effective treatment strategies.
Brain imaging studies suggest that the same reward pathways (involving dopamine) that are hijacked by drugs like cocaine are also activated by highly palatable foods and by binge-eating behaviors 9 .
This shared neurobiology suggests that certain foods and eating behaviors can have an addictive potential for vulnerable individuals.
A dangerous manifestation where individuals restrict food intake to "save" calories for alcohol consumption or to get intoxicated faster 5 .
A recent Polish study found that among young adults with probable alcohol addiction, a staggering 80.95% of women also showed signs of a potential eating disorder 5 .
| Feature | Drunkorexia | Anorexia Nervosa |
|---|---|---|
| Primary Aim | To drink larger amounts of alcohol without weight gain | To achieve weight loss due to a distorted body image |
| Behavior Pattern | Situational, often around social drinking events | Persistent and constant restrictive behavior |
| Focus | Caloric control specifically to enable alcohol use | Overall caloric control and fear of weight gain |
Source: Adapted from 5
A 2025 meta-analysis confirmed a medium positive correlation (r = 0.418) between difficulties in emotion regulation and disordered eating 4 .
Why are adolescent females particularly vulnerable? Adolescence is a period of intense emotional and physical change. Teen girls who struggle to manage difficult emotions like anxiety, sadness, or anger may turn to disordered eating behaviors as a maladaptive coping mechanism.
Creates a numbing sense of control or emptiness
Serves as a temporary distraction or comfort
Provides a violent release of pent-up emotional tension
A crucial study that explored substance use in adolescents actively seeking treatment for eating disorders (2001-2012)
To examine the prevalence and risk factors associated with substance use in a clinical population of adolescents with eating disorders 3 .
Participants: 290 adolescents (ages 12-18) evaluated at an Eating Disorders Program over 11 years.
Diagnostic Precision: Used the Eating Disorder Examination (EDE) interview for DSM-5 criteria diagnosis.
Assessing Substance Use: Employed the K-SADS interview to assess substance use patterns.
Psychological Measures: Collected data using Beck Depression Inventory (BDI) and demographic information.
Substance use was common among these adolescents before they typically met formal criteria for a Substance Use Disorder 3 .
This study was pivotal because it showed that addictive behaviors linked to eating pathologies begin manifesting in adolescence. It highlighted that the binge-purge subtype is particularly associated with higher risk of substance use, reinforcing the idea of shared mechanisms 3 .
Understanding this field requires familiarity with the tools scientists use to measure these complex behaviors.
| Tool Name | Function | Description & Relevance |
|---|---|---|
| Eating Disorder Examination (EDE) | Diagnostic Interview | The "gold standard" clinical interview for assessing eating disorder diagnoses and psychopathology. It provides precise data on behavioral frequency and cognitive concerns 3 . |
| Yale Food Addiction Scale (YFAS) | Assessing Addictive-Like Eating | A psychometric tool that applies DSM criteria for substance use disorders to the consumption of highly palatable foods. The children's version (YFAS-C) is used for adolescents 9 . |
| Difficulties in Emotion Regulation Scale (DERS) | Measuring Emotion Dysregulation | A validated self-report scale that assesses multiple aspects of emotion regulation difficulties. High scores are strongly correlated with both eating disorder severity and addictive behaviors 4 . |
| Alcohol Use Disorders Identification Test (AUDIT) | Screening for Alcohol Misuse | A widely used World Health Organization screening tool to identify risky drinking patterns and alcohol use disorders. Crucial for detecting co-occurring issues like drunkorexia 5 . |
| Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) | Comprehensive Psychiatric Interview | A semi-structured interview used to assess a wide range of psychiatric diagnoses, including substance use disorders, in children and adolescents. Provides reliable data on frequency and patterns of use 3 . |
The evidence is compelling: for a significant subset of adolescent females, eating disorders and addictive behaviors are intertwined conditions fueled by shared vulnerabilities like emotional dysregulation, impulsivity, and altered reward processing in the brain.
Viewing these disorders through an addictive lens reduces stigma—framing them not as failures of willpower but as complex neurobiologically-based illnesses.
Clinics are now routinely screening teens with EDs for substance use and vice versa.
Treatment programs are increasingly adopting strategies effective for both conditions, such as Dialectical Behavior Therapy (DBT).
Therapy focuses on the underlying inability to manage emotions, providing healthier coping tools.
While the journey is difficult, this evolving understanding brings hope. By recognizing the addictive nature of these behaviors, we can develop more effective, compassionate, and neurologically-informed interventions to help teens break the cycle and reclaim their lives.