Have you ever wondered if it’s a good idea for someone with an eating disorder, such as bulimia or anorexia nervosa, to follow an abstinence-based food plan like Bright Line Eating?
Recently, my colleagues Dr. Joy Jacobs and Dr. David Wiss, and I published a peer-reviewed article in the prestigious journal Frontiers in Psychiatry.
The article was a perspectives piece called “Abstinence-Based Treatment of Comorbid Eating Disorders and Ultra-Processed Food Addiction.” I’d like to highlight some of the topics we covered by sharing my own story.
A Case Study: My Food Addiction and Eating Disorder
In my case, food addiction preceded my eating disorder. I stole food as a child, binged, and showed signs of food addiction. My drug addiction began at 14. I got clean at 20, but the food addiction came back. I worked the 12 Steps, but after meetings binged on massive quantities of food.
I was formally diagnosed after I moved to Rochester, NY, and started my Ph.D. program. I binged so hard I gained 16 pounds in one week and ruptured my stomach lining. At some point, I started throwing up my food. It was exhausting and unmanageable.
Eventually, I became abstinent—what we would call Bright—and had six beautiful months. Then I broke abstinence, and the bingeing was the worst I’d ever had. I relapsed into bulimia.
I got abstinent again and had 11 years of peace with my food. At the end of those 11 years, I founded Bright Line Eating. Some time later, with the stress of travel, having young kids, and still being a full-time college professor, I again relapsed and then I binged intermittently for many years. I decided early on that I was going to be honest in my vlogs, so I shared that with all of you.
Finally, I got squeaky clean, with all four Bright Lines, even in restaurants. I surrendered at a deeper level.
Published Research: How to Treat Someone With an Eating Disorder and Food Addiction
I bring this up because many of the themes of my life were part of this most recent article, which discusses how to treat people who have both an eating disorder and food addiction.
Generally, it’s a rough estimate to say that half the people with eating disorders also have food addiction, and vice versa, but each of these conditions is totally distinct.
Someone who steals and eats butter or sugar, for example, again and again, has an addiction, not an eating disorder. The pull to get that fix is intense. People who have a clinical level of distress or impairment about their food have an addiction.
Throw bingeing into the mix, or purging, or extreme restricting, and you have both. But some people have an eating disorder without food addiction. Someone who’s experiencing sexual assault, for example, may stop eating to give herself control. She notices a rush from not eating. That’s an eating disorder
Treatment Methods Cause Tension in the Field
The tension in the field right now is that the standard of care for eating disorders is to work toward “normal eating,” to disabuse people of their food rules and get them away from thinking of food as shame.
The challenge is that moderate quantities of substances aren’t always good for addicts. So those on the food addiction side are saying that this is harmful, and even moderate levels of certain foods may not work for them. And those on the eating disorder side say that food is food, and you can’t label a food as bad or good.
In our paper, we argue for a nuanced perspective and that there’s no one-size-fits-all approach. And I need to say this to my beloved Bright Lifers: An abstinence-based approach is not going to be right for everyone. Some people may be triggered by it, and it may kick up symptoms of an eating disorder. They may need a moderate-eating model.
A Need for Clinicians Who Take a Measured Approach
We need clinicians who understand nuance, who see that someone might need to start or stop an abstinence-based program, or maybe try something in the middle like abstinence from just specific foods or behaviors for a while. We need people who are not attached to one dogmatic perspective, and can truly listen to the patient and their whole life history. We need clinicians who are not wedded to any one approach.
If you have symptoms of an eating disorder and food addiction, first, I want you to know that I love you, and I AM you. You may get a sense, when trying different techniques, of what will work for you. I loved abstinence. That worked for me. But it may not work for you, and harm reduction might be better for you.
Everyone is different. If you’re listening to this vlog and are a staunch Bright Lifer, I want to ask you to keep an open mind. Not everyone may be supported by a Bright Line perspective. And if you have any interest in working with people in a clinical fashion, that’s wonderful because we need that! We need clinicians who understand both the food addiction side and the eating disorder side. When you work with people, be open-minded and serve the whole person, understanding that there’s lots of gray area, as well as ways to blend and mix a food addiction model and an eating disorder model.
We have some amazing citations in our new article, which argues for that balanced perspective. I’ll put a link to the paper below. I encourage you to read it.
Read the research paper here: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1586490/full
