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Compulsive Eating
Behavior and Food
Addiction
Emerging Pathological
Constructs
Edited by
Pietro Cottone
Boston University School of Medicine, Boston, MA, USA
Valentina Sabino
Catherine F. Moore
George F. Koob
National Institute on Alcohol Abuse and Alcoholism,
National Institutes of Health, Bethesda, MD, USA
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Contributors
Iris M. Balodis
Peter Boris Centre for Addictions Research, Department of Psychiatry and
Behavioural Neurosciences, McMaster University, St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
Revi Bonder
York University, Toronto, ON, Canada
Benjamin Boutrel
Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne
University Hospital, Switzerland; Division of Adolescent and Child Psychiatry,
Department of Psychiatry, Lausanne University Hospital, University of Lausanne,
Switzerland
Timothy D. Brewerton
Department of Psychiatry and Behavioral Sciences, Medical University of South
Carolina, Charleston, SC, United States
Jonathan E. Cheng
Laboratory of Addictive Disorders, Departments of Pharmacology and Psychiatry,
Boston University School of Medicine, Boston, MA, United States
Pietro Cottone
Caroline Davis
York University, Toronto, ON, Canada
Fernando Fernández-Aranda
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona,
Spain; Ciber Fisiopatologı́a Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine,
University of Barcelona, Barcelona, Spain
Ashley N. Gearhardt
Department of Psychology, University of Michigan, Ann Arbor, MI, United States
Kirstie M. Herb
Eastern Michigan University, Department of Psychology, Ypsilanti, MI, United States
Susana Jiménez-Murcia
Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine,
University of Barcelona, Barcelona, Spain
xiii
xiv Contributors
Paul J. Kenny
Nash Family Department of Neuroscience, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
George F. Koob
National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health,
Bethesda, MD, United States; Neurobiology of Addiction Section, Intramural
Research Program, National Institute on Drug Abuse, Baltimore, MD, United
States
James MacKillop
Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s
Healthcare Hamilton, Hamilton, ON, United States
Gemma Mestre-Bach
Carlos III, Madrid, Spain
Adrian Meule
Department of Psychology, University of Salzburg, Salzburg, Austria
Catherine F. Moore
Boston University School of Medicine, Boston, MA, United States; Graduate
Program for Neuroscience, Boston University School of Medicine, Boston, MA,
United States
Cara M. Murphy
Center for Alcohol and Addiction Studies, Brown University, Providence, RI,
United States
Katherine R. Naish
Peter Boris Centre for Addictions Research, Department of Psychiatry and
Behavioural Neurosciences, McMaster University, St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
Marc N. Potenza
Department of Psychiatry, Yale School of Medicine, New Haven, CT, United
States; Connecticut Council on Problem Gambling, Wethersfield, CT, United
States; Connecticut Mental Health Center, New Haven, CT, United States;
Department of Neuroscience and Child Study Center, Yale School of Medicine,
New Haven, CT, United States
Clara Rossetti
Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne
University Hospital, Switzerland; Division of Adolescent and Child Psychiatry,
Department of Psychiatry, Lausanne University Hospital, University of Lausanne,
Switzerland
Contributors xv
Valentina Sabino
Karen K. Saules
Eastern Michigan University, Department of Psychology, Ypsilanti, MI, United
States
Emma T. Schiestl
Erica M. Schulte
Eric Stice
Oregon Research Institute, Eugene, Oregon, United States
Sonja Yokum
Oregon Research Institute, Eugene, Oregon, United States
Eric P. Zorrilla
Department of Neuroscience, The Scripps Research Institute, La Jolla, CA,
United States
Preface
With the sharp increase in rates of obesity and eating disorders in Western countries,
a focus on the potential addicting properties of food has become a point of emphasis
for researchers attempting to explain behaviors and neurobiological processes that
may contribute to this growing epidemic. Drawing from analogous concepts in
the addiction literature, compulsive eating behavior has emerged as a transdiagnos-
tic construct, consisting of a pathological form of feeding that phenotypically, neuro-
biologically, and conceptually resembles compulsive-like behavior associated with
both substance/alcohol-use disorders and behavioral addictions.
Recently, the scientific community has begun to embrace and evaluate the
concept of addictive and compulsive eating behavior. A Web of Science search re-
veals a persistent, steady increase in compulsive eating research over time, coupled
with a recent explosion of “food addiction” studies following the creation and vali-
dation of new diagnostic tools in 2009 (Fig. 1). While the scientific discussion on
food addiction and compulsive eating behavior is in its nascent stage and the con-
cepts are still somewhat controversial, this research holds enormous potential for
improving treatment and prevention strategies for millions of people.
The book begins with “A History of Food Addiction” to place this concept and the
current state of research into a historical context. Furthermore, the term and diag-
nosis of “food addiction” is explained in great detail by the researchers key to its
development in “Food Addiction Prevalence, Development, and Validation of
FIGURE 1 Number of scientific publications on food addiction and compulsive eating in recent
decades.
Values were obtained by a Web of Science search for each 5-year span using the search
terms “food addiction” and “compulsive eating.”
xvii
xviii Preface
Diagnostic Tools.” Following this, we, the editors, wrote a chapter detailing on what
have been identified as the elements of compulsive eating behavior in “Dissecting
Compulsive Eating Behavior into Three Elements.” This chapter describes the ele-
ments of (1) habitual overeating, (2) overeating to relieve a negative emotional
state, and (3) overeating despite negative consequences and outlines their concep-
tion from the field of drug addiction after many behavioral and neurobiological over-
laps were observed. A more in-depth breakdown of each element follows in
Chapters 4e8. Chapter 4, “Habitual Overeating,” overviews the ways in which
eating behavior can become inflexible and rote in compulsive eating. “Reward
Deficits in Compulsive Eating” and “The Dark Side of Compulsive Eating and
Food Addiction” describe the dual processes that make up the element of overeating
to relieve a negative emotional state. In “Food Addiction and Self-Regulation,” the
inhibitory control processes that underlie overeating despite negative consequences
are discussed at length.
Other chapters serve to illustrate the overlaps among the elements of compulsive
eating behavior and between these elements and other biological mechanisms.
“Reward Processing in Food Addiction and Overeating” investigates the intersection
of striatal reward processes with prefronto-cortical control circuits. In “Interactions
of Hedonic and Homeostatic Systems in Compulsive Eating,” the elements of
compulsive eating are discussed in the context of highly relevant homeostatic
feeding mechanisms.
For updates into specific technical fields of research into compulsive eating
behavior, chapters on genetics (“Genetics and Epigenetics of Food Addiction”), neu-
roimaging (“Neuroimaging of Compulsive Disorders: Similarities of Food Addiction
with Drug Addiction”), and animal models (“Modeling and Testing Compulsive
Eating Behavior in Animals”) were included.
We have also included a chapter to address the highly relevant topic of “Sex and
Gender Differences in Compulsive Overeating.” This chapter not only does an excel-
lent and thorough job detailing the current evidence in this area but also highlights
an area of inquiry with much left to understand in terms of biological mechanistic
sex and gender differences in compulsive eating.
Furthermore, as the concept of food addiction and the consideration of forms of
pathological overeating as addictive behaviors have been fraught with debate, we
have a chapter devoted to “Addressing Controversies Surrounding Food Addiction.”
While we have a clear bias as editors of this book, this chapter serves to clarify some
of the most prominent arguments that continue to fuel discussion on this topic. We
hope to continue the discourse, while also using this book to highlight the undeni-
able breakthroughs in knowledge and mechanisms that have come about from the
food addiction concept.
In the final chapter, “Food Addiction and Its Associations to Trauma, Severity of
Illness, and Comorbidity,” the utility of, and implications for, studying food addic-
tion within the context of overall mental and physical health is discussed.
Each chapter stands on its own, and together all the chapters form a comprehen-
sive picture of what drives compulsive eating behavior, how the prevalence
Preface xix
compulsive eating, and how future therapeutic strategies may look. We have
intended that this book be a bridge between preclinical and clinical researchers
and drives further excitement in this rich and continually developing field.
Some common definitions of terms used throughout the book:
1. Binge eating: Eating within a 2-hour period of time an amount of food larger
than what most people would eat in a similar period of time under similar
circumstances and a sense of lack of control over eating during the episode.
2. Binge eating disorder: Recurrent (i.e., >1x weekly for 3 months, on average)
binge eating as defined above, coupled with marked distress regarding binge
eating and three or more cognitive symptoms (e.g., eating alone out of
embarrassment, feeling disgusted/guilty). Importantly, no compensatory be-
haviors (e.g., purging) are associated with binge eating.
3. Compulsivity: Repetitive behaviors in the face of adverse consequences as well
as repetitive behaviors that are inappropriate to a particular situation.
Compulsivity has historical roots in the symptoms related to obsessive
compulsive disorder, impulse control disorders, and substance-use disorders
and may involve engagement in compulsive behaviors to prevent or relieve
distress, anxiety, or stress.
4. Compulsive eating: Broadly defined as an irresistible, uncontrollable urge to
overeat despite efforts to control this behavior. Compulsive eating behavior
manifests as one or more of its constituent elements: habitual overeating,
overeating to alleviate a negative emotional state, or overeating despite
negative consequences.
5. Food addiction: Eating-related problems assessed by a recently created psy-
chometric measurement tool: the Yale Food Addiction Scale (YFAS). This
scale was originally modified in 2009 from the substance-dependence criteria
described by the Diagnostic and Statistical Manual (DSM, fourth ed.) and
subsequently updated to reflect changes to the substance-use disorder diag-
nosis in the DSM-5. A diagnosis of food addiction is given when a patient
displays clinically significant impairment or distress and meets criteria, such as
eating much more than intended and experiencing problems in ability to
function because of food. In the updated YFAS, a severity score is calculated
based on number of symptoms endorsed (2e3 ¼ mild, 4e5 ¼ moderate,
6þ ¼ severe). Importantly, this emerging but not fully established condition is
different from the already well-recognized feeding-related pathologies, and
further validation is necessary.
6. Overeating: Consuming an excessive amount of food relative to energy
expended.
7. Overweight/obesity: A body mass index 25 and 30 is considered overweight
and obese, respectively, as defined by guidelines set forth by the World Health
Organization. Overweight/obesity is neither necessary nor sufficient to char-
acterize compulsive eating.
xx Preface
8. Dopamine: A key neurotransmitter in the basal ganglia, long implicated not

only in Parkinson’s disease but also in incentive salience. In driving, incentive
salience dopamine conveys motivational properties to previously neutral
stimuli perpetuating cue and context reward seeking. Dopamine is not a reward
neurotransmitter per se. In fact, the midbrain dopamine system neurons
decrease firing to repeated presentation of predicted rewards, but it is reac-
tivated by unpredictable rewards. It is critical for the rewarding properties of
psychostimulant drugs and through its incentive motivational actions promotes
reward seeking in general.
9. Addiction: A chronically relapsing disorder characterized by compulsive drug
seeking, loss of control over drug intake, and emergence of a negative
emotional state when the drug is removed.
10. Brain reward system: The medial forebrain bundle and its connections histor-
ically forms the brain reward system. It supports brain stimulation reward with
the lowest currents of all structures in the brain. It is composed of not only
ascending monoamine pathways but also prominent descending pathways
from the basal forebrain to the midbrain and brainstem. The meso-
corticolimbic dopamine pathway projects from the ventral tegmental area and
parts of the substantia nigra to the ventral striatum and prefrontal cortex. It is
not the reward system per se but contributes to incentive salience (as described
above).
CHAPTER
A history of “food
addiction”
1
Adrian Meule
Department of Psychology, University of Salzburg, Salzburg, Austria
A chocolate inebriate has appeared. His addiction has been for three years, and his
general health is much impaired, principally the digestion. His only thought night and
day is how to get chocolate.
The Quarterly Journal of Inebriety, Volume 12, Issue 4, October 1890 (p. 392)
Introduction
Concepts of diseases and mental disorders are not set in stone. References to drink
madness can be found in ancient civilizations and terms such as drunkenness, intem-
perance, inebriety, dipsomania, or alcoholism were used in the 18th and 19th cen-
turies to describe substance-related addictive disorders (White, 2000). While the
fourth version of the Diagnostic and Statistical Manual of Mental Disorders
(DSM) distinguished between substance abuse and substance dependence
(American Psychiatric Association, 1994), this distinction has been repealed in its
fifth revision. The DSM-5 now lists several substance use disorders and, for the first
time, a nonesubstance-related addiction: gambling disorder (American Psychiatric
Association, 2013).
Similar dynamics can be found in the field of eating disorders. Anorexia nervosa
was the first eating disorder included in DSM-I in 1952 and appeared along pica and
rumination in DSM-II in 1968 (Dell’Osso et al., 2016). Bulimia nervosa was added
to the DSM-III in 1980. The DSM-IV yet again involved some slight changes in the
categorization of eating disorders and nowdin addition to changes made to the diag-
nostic criteria for anorexia and bulimia nervosadthe DSM-5 lists pica, rumination
disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nerv-
osa, binge eating disorder, and other specified eating disorders (e.g., night eating
syndrome).
In the light of high prevalence rates of obesity in the past decades, there is an
increased interest if certain foods may have an addiction potential and if obese
individualsdor at least a subgroup of themdcan be considered “food-addicted.”
In fact, it seems widely accepted that “food addiction” is a relatively new idea
that was conceived in the past 20 years to explain the rising obesity prevalence
(Davis, Edge, & Gold, 2014; Yau, Gottlieb, Krasna, & Potenza, 2014). Yet, is this
Compulsive Eating Behavior and Food Addiction. https://doi.org/10.1016/B978-0-12-816207-1.00001-9 1

2 CHAPTER 1 A history of “food addiction”
alleged “new disorder” really a new concept in an attempt to explain why nowadays
so many people are obese? This chapter will demonstrate that the concept of “food
addiction” actually has a long history and did not arise from the obesity pandemic.
References to addiction in relation to food in the 19th

century
In the scientific literature, references to addiction in relation to food have been made
as early as the late 19th century. In the first journal of addiction medicinedthe Jour-
nal of Inebriety (1876e1914)dfood was routinely mentioned (Davis & Carter,
2014; Weiner & White, 2007). When describing “diseased cravings,” for example,
Clouston (1890) referred to the stimulating effects of, craving for, and dependence
on both food and alcohol (Table 1.1). Similarly, Crothers (1890a) cautions against
some stimulating foods when describing how diseases in children with “alcoholic
ancestors” should be treated (Table 1.1). Finally, a case of a “chocolate inebriate”
is mentioned in the journal (Crothers, 1890b), describing his persistent craving for
and preoccupation with chocolate as an addiction (Table 1.1).
A description of eating disorders in 1932

Mosche Wulff was a Soviet-Israeli physician and psychoanalyst who lived from
1878 to 1971. In 1932, he published an article in German in the International Journal
of Psychoanalysis (Fig. 1.1), in which he describes case studies of five of his patients
(Wulff, 1932). I refer interested readers to an article by Stunkard (1990) that pro-
vides a short biographical note on Moshe Wulff along with an English translation
of some excerpts of his article. In a nutshell, Wulff’s case studies include the
description of binge eating, including precedent food craving and subsequent feel-
ings of guilt as well as aspects of emotional eating (eating more in response to nega-
tive affect, eating less when in a positive mood) and restrained eating (periods of
restriction between eating binges). Importantly, he calls the symptomatology of
all five cases “eating addiction” (German: Esssucht) throughout the article and pro-
vides an explanation for using this term at the end (Table 1.1).
“Food addiction” in the 1950s

Following up on Wulff’s observations, Hamburger (1951) noted the apparent paral-
lels between recurrent binge eating episodes and gambling or drinking: “it is this
eating pattern that most readily invites the label ‘addictive’” (Table 1.1). The Amer-
ican physician Theron Randolph (1906e95) first used the term “food addiction” in
the scientific literature in 1956 (Table 1.1). In contrast to modern views that associate
addiction with the consumption of highly processed foods (Ifland et al., 2015;
“Food addiction” in the 1950s 3
Table 1.1 Some references and quotes demonstrating the long history of the
“food addiction” idea.
References Quote
Clouston “It is a fact that some foods are more stimulating to the brain cortex than
(1890) others, e.g., strong beef-tea than milk, flesh than bread. [.] If from
childhood upwards the possessor of such a brain has depended on
stimulating diet and drink for its restoration when exhausted, there is an
intense and irresistible craving set up for such food and drink stimulants
whenever there is fatigue. Such a brain has developed an affinity for
them, and for such alone. Milk and farinaceous diet often become
repugnant, and when taken do not satisfy the brain craving. Its owner
becomes physiologically a flesh-eater and an alcohol-drinker.” (p. 207)
Crothers “There is a special affinity for all nerve stimulants by those higher brain
(1890a) centers. Their use constantly interferes with the natural development of
brain energy from food. Thus, alcohol, tea, coffee, and other substances
have a peculiar delusive effect. [.] The diet should not include meats of
any kind, because of their stimulating character; while meats contain
much food force, they act as stimulants to a brain already over stimulated
and exhausted, and increase the peril of nervous disease. The
pathological tendency of all these cases is to become alcohol-takers and
meat-eaters, hence the diet should always be non-stimulating and
farinaceous, and should be carried out with military regularity.” (p. 285)
Crothers “A chocolate inebriate has appeared. His addiction has been for three
(1890b)a years, and his general health is much impaired, principally the digestion.
His only thought night and day is how to get chocolate.” (p. 392)
Wulff (1932)b “I have used the term “eating addiction” above without justifying why I
deem it important to call it an “addiction” and not, for example, a
compulsion. I believe that the nature of this compulsive eating can be
best characterized by the term addiction. How do addiction and
compulsion differ from each other except regarding the different
manners through which they are experienced? [.] Another
characteristic of a compulsion is the fact that its suppression produces
anxiety while suppression of a compulsive, addiction-related urge
increases the tension of the addictive desire (if withdrawal symptoms do
not complicate the picture)djust as it was observed in the cases
described here with regard to eating.” (p. 299)
Hamburger “A number of authors have described people who show extreme
(1951) preoccupation with food and weight, who episodically consume
enormous amounts of food, in short periods of time in an ‘orgiastic’
manner (episodes varying in frequency from more than once a day to
once every few weeks), and who experience guilt, shame, depression
and self-condemnation following ‘binges.’ The parallel with apparently
‘compulsive’ patterns of gambling or drinking is immediately striking.
Indeed it is this eating pattern that most readily invites the label
‘addictive’.” (p. 487)
Randolph “Food addictionda specific adaptation to one or more regularly
(1956) consumed foods to which a person is highly sensitivedproduces a
Continued
Table 1.1 Some references and quotes demonstrating the long history of the “food
addiction” idea.dcont’d
References Quote
common pattern of symptoms descriptively similar to those of other
addictive processes.” (p. 221)
Hinkle et al. “One of the most common and difficult problems we face is that of food
(1959) addiction, both in the genesis of diabetes and in its treatment. Are there
physiological factors involved in this mechanism or is it all psychological?
What is its relation to alcohol addiction and addiction to narcotics? [.]
That is a good question, because these terms “food addiction” and
“compulsive eating” are widely used and widely misunderstood.” (p. 377)
Bell (1960) “Social custom and occupational contact, as well as medical treatment
and physiological need, can be responsible for the introduction of a
person to the chemicals involved in addiction. Food addiction is the only
one in which the chemicals and the person come together initially out of
physiological necessity.” (p. 1348)
Bell (1965) “It is important for the physician to explain that an uncontrollable need for
a drug or for alcohol is not planned; that initially these agents were used
to produce temporary improvement in wellbeing; and that addiction is a
very common type of human disability. It is helpful to compare tobacco
and food addiction to alcohol and drug addiction, and to remove as
much of the guilt and shame as possible at the first interview. The
physician has a good chance of initiating motivation if at the end of the
first interview the patient feels that he does not need to down-grade
himself in order to accept his illness.” (p. 230)
a
This quote is from an editorial for which authorship was not specified and, thus, the editor (T.D.
Crothers) is indicated as author here.
b
This article is in German and the quotes have been translated by the author of this chapter. An English
translation of some excerpts of this article can be found in Stunkard (1990).
Schulte, Avena, & Gearhardt, 2015), however, he noted that “most often involved are
corn, wheat, coffee, milk, eggs, potatoes, and other frequently eaten foods” (Ran-
dolph, 1956, p. 221). Although “food addiction” did not appear in other scientific
articles around this time, famous psychiatrist Albert J. Stunkard (1922e2014) noted
during a panel discussion in 1959 that the term “food addiction” was widely used
back then (Table 1.1; Hinkle, Knowles, Fischer, & Stunkard, 1959).
Varying themes in the second half of the 20th century

In 1960, Overeaters Anonymous was founded. This self-help organization is based
on the 12-step program of Alcoholics Anonymous and, accordingly, uses an addic-
tion framework for overeating. For example, in contrast to cognitive behavioral ther-
apy, which emphasizes flexible food choices with no forbidden foods (Wilson,
2010), Overeaters Anonymous advocates abstinence from certain foods
(Russell-Mayhew, von Ranson, & Masson, 2010). Yet, the term “food addiction”
Varying themes in the second half of the 20th century 5
FIGURE 1.1
Excerpt from the title page of an article by Mosche Wulff. It reads “International Journal of
Psychoanalysis; Edited by Sigmund Freud; Volume 18; 1932; Issue 3; On an interesting
oral symptom complex and its relationship to addiction; Lecture at the German
Psychoanalytical Society, April 12th, 1932; By Mosche Wulff; Berlin.”
was only occasionally mentioned in scientific articles in the 1960s and 1970s, pri-
marily in the context of obesity (Table 1.1; Bell, 1960, 1965; Clemis, Shambaugh,
& Derlacki, 1966; Swanson & Dinello, 1970; Thorner, 1970).
Notably, however, some cases of bulimia nervosa or binge/purge-subtype
anorexia nervosa were described as an addiction in these decades as well (Vander-
eycken, 1994). For example, Ziolko (1966) presents a case of “hyperorexia,” which
he denotesdsimilar to Wulff (1932)das “eating addiction” (i.e., Esssucht in
German). In a report about an expert group discussion about overeating and vomit-
ing, Garrow (1976) notes that “one group of subjects with chronic anorexia nervosa
exemplify many aspects of addiction; they habitually/constantly ingest and vomit
food in large quantities” (p. 407).
In the 1980s, the excessive food restriction displayed by individuals with
anorexia nervosa was mentioned for the first time in the context of addiction (Scott,
1983). Similarly, Szmukler and Tantam (1984) described anorexia nervosa as an
addictiondwhat they called starvation dependence. For example, they note that
“patients with anorexia nervosa are dependent on the psychological and possibly
physiological effects of starvation. Increased weight loss results from tolerance to
starvation necessitating greater restriction of food to obtain the desired effect, and
the later development of unpleasant ‘withdrawal’ symptoms on eating.” (p. 309).
Finally, Marrazzi et al. (Marrazzi et al., 1990; Marrazzi & Luby, 1986) compared
anorexic phenomenology with addictive states in their auto-addiction opioid model
of chronic anorexia nervosa.
Another approach stemming from an addiction perspective on eating was the ex-
amination of addictive personality in individuals with anorexia nervosa, bulimia
nervosa, or obesity (Davis & Claridge, 1998; Feldman & Eysenck, 1986; Kayloe,
1993; Leon, Eckert, Teed, & Buchwald, 1979). Several studies compared whether
individuals with anorexia nervosa, bulimia nervosa, or obesity scored higher than
healthy controls and similar to individuals with tobacco use, alcohol use, or
gambling disorder on certain addiction personality questionnaires (de Silva &
Eysenck, 1987; Hatsukami, Owen, Pyle, & Mitchell, 1982; Kagan & Albertson,
1986; Leon, Kolotkin, & Korgeski, 1979).
In the 1990s, a particular interest emerged on addiction-like consumption of choc-
olate. Characteristics of chocolate such as its macronutrient composition, sensory
properties, and ingredients such as caffeine and theobromine were discussed as con-
tributors to its addictive-like nature (Bruinsma & Taren, 1999; Patterson, 1993; Rozin,
Levine, & Stoess, 1991). Some studies investigated self-identified “chocolate addicts”
(Hetherington & Macdiarmid, 1993; Macdiarmid & Hetherington, 1995; Tuomisto
et al., 1999) or examined associations between “chocolate addiction” and other addic-
tive behaviors (Greenberg, Lewis, & Dodd, 1999; Rozin & Stoess, 1993).
Besides these themes, a variety of different topics were covered in one or few
single articles in the 1980s and 1990s. These include discussions of the role of en-
dorphins in terms of an addictive response in obesity (Gold & Sternbach, 1984;
Wise, 1981), substance abuse as a metaphor in the treatment of bulimia nervosa
(Slive & Young, 1986), a “foodaholics” group treatment program (Stoltz, 1984),
and some unusual case studies of addiction-like carrot consumption (Kaplan,

1996; Cerný;
Cerný, 1992). Finally, the first critical reviews were published, which
scrutinized adopting an addiction framework in the treatment of eating disorders
(Bemis, 1985) and questioned the overall “food addiction” approach based on con-
ceptual and physiological considerations (Rogers & Smit, 2000; Vandereycken,
1990; Wilson, 1991, 2000).
Increased popularity in the 21st century

Increased interest in “food addiction” in the early 2000s was largely driven by brain
imaging studies in humansdparticularly in individuals with obesity or binge eating
disorder (Volkow, Wang, Fowler, & Telang, 2008)dand by animal models of
addiction-like sugar intake (Avena, Rada, & Hoebel, 2008). Besides these lines of
research, numerous review articles were published that discussed behavioral, cogni-
tive, and neural parallels between obesity or binge eating disorder and substance
dependence and examined whether the diagnostic criteria for substance dependence
can be applied to food and eating (e.g., Barry, Clarke, & Petry, 2009; Corsica & Pel-
chat, 2010; Davis & Carter, 2009; Gearhardt, Corbin, & Brownell, 2009a; Ifland
et al., 2009; Pelchat, 2009; Thornley, McRobbie, Eyles, Walker, & Simmons, 2008).
Correspondingly, several approaches were developed to measure addiction-like
eating in humans based on translating substance dependence criteria to food and
Current developments 7
eating (Meule, 2011). For example, Cassin and von Ranson (2007) replaced refer-
ences to substance by binge eating in the substance dependence module of the struc-
tured clinical interview for DSM-IV axis I disorders to “diagnose” addiction-like
eating in individuals with binge eating disorder. Relatedly, Gearhardt, Corbin, and
Brownell (2009b) developed the Yale Food Addiction Scale by adapting DSM-IV
substance dependence criteria to food and eating. Scoring of this self-report ques-
tionnaire allows for a dichotomous classification of the presence or absence of
“food addiction.” It may be because of this uniqueness that the scale turned out to
be widely used in the years that followed (Meule & Gearhardt, 2014).
Current developments
In 2013, gambling disorder was the first behavioral addiction that was added as an
addictive disorder in addition to substance use disorders in DSM-5. Reflecting this
nosological change, researchers have proposed that framing addiction-like eating as
a behavioral addiction may be more appropriate than framing it as a substance-
related disorder (Hebebrand et al., 2014). This approach has intuitive appeal and,
at first glance, seems to resolve some controversies that are inherent in the
substance-based “food addiction” approach. Yet, the “eating addiction” approach
may create more problems than it solves. For example, efforts have been made to
develop self-report measures for capturing “eating addiction” (Ruddock, Christian-
sen, Halford, & Hardman, 2017). Yet, “eating addiction” may be in fact even harder
to distinguish than “food addiction” from existing concepts such as binge eatinge
related disorders (Schulte, Potenza, & Gearhardt, 2018; Vainik & Meule, 2018).
The current state of affairs can be broken down into three different views:
(1) certain foods are regarded as addictive substance(s), and, thus, so-called “food
addiction” represents a substance-related addictive disorder (Ifland et al., 2015;
Schulte, Potenza, & Gearhardt, 2017),
(2) it is not possible to identify a specific substance in foods that is addictive
(similar to nicotine in tobacco, ethanol in alcoholic beverages, tetrahydro-
cannabinol in cannabis, etc.), and, thus, so-called “eating addiction” represents
a behavioral addictive disorder (Hebebrand et al., 2014; Ruddock et al., 2017),
(3) neither “food addiction” nor “eating addiction” represent valid concepts ord
even if they aredthey are not necessary (Finlayson, 2017; Rogers, 2017;
Ziauddeen & Fletcher, 2013).
While most writings on this topic clearly take up one of these three positions, it
has also been argued that the addiction perspective on eating requires a more
nuanced view (Fletcher & Kenny, 2018). For example, Lacroix, Tavares, and von
Ranson (2018) emphasize that alternative conceptualizations of addictive-like eating
may be overlooked when the discussion is framed as a dichotomous debate between
food and eating addiction models. Such alternative views include, for example,
considering compulsivity as a transdiagnostic construct in both addiction and path-

ological overeating (Moore, Sabino, Koob, & Cottone, 2017).
Conclusions
“Food addiction” is not a new idea that emerged in the 21st century because of the
obesity pandemic. Instead, researchers have discussed for many decades whether
humans can be addicted to certain foods and whether certain eating behaviors repre-
sent an addictive behavior. The history of “food addiction” research involves different
perspectives, which range from mentioning food in the context of addiction in the late
19th century, describing binge eating as “eating addiction” in the 1930s, establishing
the term “food addiction” in the 1950s, acknowledging the addiction-like character of
binge eating in individuals with bulimia and binge/purge-subtype anorexia nervosa in
the 1960 and 1970s to characterizing the self-starvation of individuals with anorexia
nervosa as an addiction in the 1980s, and many more. Thus, research on “food addic-
tion” encompasses a long history with dynamically changing but recurring themes.
These include the types of food involved (e.g., chocolate and other foods), discussions
about the appropriateness of a “food addiction” versus “eating addiction” rationale,
and which type of individuals are involved (e.g., individuals with anorexia nervosa,
bulimia nervosa, binge eating disorder, and/or obesity).
In spite of its long history, the “food addiction” versus “eating addiction” versus
“not-an-addiction” discussion has developed to a lively debate in recent years. To
move the field forward, researchers need to generatedand agree upondtestable
predictions, which may include neural mechanisms (Fletcher & Kenny, 2018) or
whether the construct of addictive-like eating holds incremental clinical utility
over and above existing eating disorder diagnoses (Lacroix et al., 2018). Further-
more, providing an addiction framework in the prevention and treatment of eating
disorders and obesity will likely be helpful in some instances but may be unneces-
sary or even counterproductive in others (Meule, 2019). Therefore, future studies
need to systematically examine under which circumstances and for whom an addic-
tion perspective on eating is beneficial for normalizing food intake and reduce
eating-related distress.
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CHAPTER
Food addiction
prevalence: development
and validation of
diagnostic tools
2
Ashley N. Gearhardta, Erica M. Schulte, Emma T. Schiestl
There has been a steady increase in both public interest and scientific evalu-
ation of the food addiction concept in the last 20 years (Davis, 2013; Meule,
2015). This has been driven by a number of factors, particularly the global
pandemic of obesity that has accompanied the spread of highly rewarding, cheap,
and accessible processed foods (e.g., fast food, pastries). Obesity is now a leading
cause of preventable death, a major factor in reduced life expectancies, and a
contributor to increasing burden on the medical system (Kelly, Yang, Chen,
Reynolds, & He, 2008; Mokdad, Marks, Stroup, & Gerberding, 2004; Ng et al.,
2014). As the public health consequences of excess body weight have become
more apparent, basic science has identified striking parallels between the
biopsychosocial mechanisms underpinning addictive disorders and excess food
consumption (Ahmed, Guillem, & Vandaele, 2013; Avena, Rada, & Hoebel,
2008; Johnson & Kenny, 2010; Parylak, Koob, & Zorrilla, 2011), such as dysfunc-
tion in reward, motivation, stress, and inhibitory control systems. This has led to
the hypothesis that an addictive process may be contributing to overeating, for at
least a subset of individuals (Gold, Frost-Pineda, & Jacobs, 2003; Gold, Graham,
Cocores, & Nixon, 2009). Given that food consumption is necessary for survival
and eating past satiety is a relatively common occurrence, one of the challenges of
this emerging research is how best to assess and determine the prevalence of
clinically relevant food addiction. In the current chapter, we will (1) consider
initial approaches to identifying addictive-like eating, (2) discuss the development
of the most established measure of food addiction (i.e., Yale Food Addiction
Scale (YFAS)) and the prevalence of its “diagnostic” threshold score, (3) consider
an alternative framework for conceptualizing addictive-like eating, and (4) outline
future research directions that may advance understanding of the clinical
relevance of food addiction.
a
Ashley N. Gearhardt is the Senior author.
Compulsive Eating Behavior and Food Addiction. https://doi.org/10.1016/B978-0-12-816207-1.00002-0 15
16 CHAPTER 2 Food addiction prevalence
Early approaches to identifying food addiction

To survive in times of famine, humans have evolved to find certain tastes
(e.g., sweetness associated with sugar) or mouthfeel (e.g., creaminess associated
with fat content) that reflect high calorie content especially rewarding (Lieberman,
2006). For much of human history, these rewarding signals from food were confined
to naturally occurring foods, such as fruits or nuts. Over time, human ingenuity
allowed for the creation of new food products, such as chocolates and cakes, which
contained artificially high levels of rewarding ingredients such as sugar and fat. The
idea that these highly rewarding foods (e.g., chocolate) could be eaten in an addic-
tive way has been present since the 1800s (Meule, 2015), but access to large quan-
tities of highly rewarding foods was often restricted to affluent individuals, as
ingredients such as sugar were expensive (Mintz, 1986). Over time, with changes
in food science and economic policy, highly rewarding foods are no longer a rare
treat but now dominate the modern food environment. Highly processed foods
that have artificially high levels of refined carbohydrates (e.g., sugar, white flour)
and fat (e.g., pizza, chocolate, chips) are easily accessible, inexpensive, and heavily
marketed (Monteiro, Levy, Claro, de Castro, & Cannon, 2010). As these highly pro-
cessed foods have become more integrated into the food environment around the
globe, rates of obesity (particularly severe obesity), overeating, and diet-related dis-
ease have soon followed (Monteiro, Moubarac, Cannon, Ng, & Popkin, 2013).
Parallels between highly processed foods and drugs of abuse suggest that an
addictive process may be contributing to the widespread overconsumption of these
foods. The strongest evidence for this has been observed in basic science models,
where exposure to highly processed foods has been related to both biological and
behavioral indicators of addiction. Animals exposed to highly processed foods
(e.g., cheesecake, Oreo cookies) have exhibited neurobiological (e.g., dysfunction
in the mesolimbic dopamine system) and behavioral changes (e.g., binge behavior,
heightened motivational drive) that are consistent with addiction (Avena et al., 2008;
Johnson & Kenny, 2010; Oginsky, Goforth, Nobile, Lopez-Santiago, & Ferrario,
2016; Oswald, Murdaugh, King, & Boggiano, 2011; Parylak et al., 2011). Animal
models have also demonstrated that the consumption of highly processed foods leads
to changes indicative of the “dark” side of addiction by increasing the likelihood that
these animals will experience negative affective states (e.g., anhedonia, anxiety)
(Parylak et al., 2011). This enhances motivation to consume these foods in an effort
to both reduce negative emotional states and avoid withdrawal-like states when ac-
cess to these foods is limited (Parylak et al., 2011). Furthermore, a common ingre-
dient in highly processed foods, sugar, appears to be such a powerful reinforcer that
animals will overwhelmingly choose access to it over drugs of abuse (e.g., cocaine),
even if they are exhibiting signs of dependence to the drug (Ahmed et al., 2013).
Thus, in animals, these palatable, rewarding, and highly processed foods appear
to have a notable addictive potential.
In humans, obesity has been associated with neural responses implicated in
addiction. For example, obesity has been related to dysfunction in the mesolimbic
Yale Food Addiction Scale 17
dopamine systems, also observed in addiction (Volkow, Wang, Fowler, & Telang,
2008). Both obesity and addiction have also been associated with problems related
to cue reactivity, habit learning, self-control, stress reactivity, and interoceptive
awareness (Volkow, Wang, Tomasi, & Baler, 2013). However, there are concerns
with using obesity as a proxy for addiction. Obesity is a medical condition that
can result from a number of factors, including physical inactivity, medication side
effects, and genetic conditions (Grundy, 1998). Although obesity can reflect elevated
intake of highly caloric foods (Rosenheck, 2008), excess consumption is not neces-
sarily indicative of addiction. For example, 40% of college students binge drink
(O’Malley & Johnston, 2002), but only 6% meet criteria for alcohol dependence
(Knight et al., 2002). Additionally, individuals who have an addictive-like relation-
ship with food may be able to engage in behaviors (e.g., fasting, purging, excessive
exercising) that may lead to a body mass index (BMI) in the normal range (Meule,
2012). Thus, the use of obesity as a proxy for food addiction may both over- and
underidentify a phenotype consistent with an addictive response to highly processed
foods. Furthermore, there have been other conceptualizations of addictive-like
eating that have not relied on BMI but instead on self-identification as a “choco-
holic” or “carb craver” (Spring et al., 2008; Tuomisto et al., 1999). However, these
self-identified labels have not included an assessment of behavioral symptoms of
addiction and thus may represent a strong desire for a certain food type rather
than the construct of addiction as defined by the medical and scientific community.
Yale Food Addiction Scale

Given the lack of a standardized definition of food addiction, the original YFAS was
developed in 2009 (Gearhardt, Corbin, & Brownell, 2009). The YFAS applied the
Diagnostic and Statistical Manual of Mental Disorder (DSM) IV diagnostic criteria
for substance dependence (e.g., loss of control, continued use despite negative con-
sequences, withdrawal, tolerance) to the consumption of highly processed foods
(e.g., chocolate, pizza) (see Table 2.1 for DSM-IV and DSM-5 diagnostic criteria)
(American Psychiatric Association, 2000). The resulting 25-item measure has
been found to be psychometrically sound demonstrating internal consistency, teste
retest reliability, convergent, discriminant, incremental, and predictive utility
(Meule & Gearhardt, 2014). The YFAS provides two scoring options: (1) a contin-
uous symptom count that ranges from zero to seven symptoms met and (2) a “diag-
nostic” threshold of three of more symptoms plus clinically significant impairment
or distress paralleling the DSM-IV threshold for substance dependence (Gearhardt
et al., 2009). The YFAS has also been translated and validated in a number of other
languages, including German, Chinese, and Spanish (Chen, Tang, Guo, Liu, & Xiao,
2015; Granero et al., 2014; Meule, Heckel, & Kübler, 2012).
Prevalence estimates of YFAS food addiction seem to vary by the characteristics
of the sample. A metaanalysis places the weighted mean prevalence of YFAS food
addiction at 19.9% (Pursey, Stanwell, Gearhardt, Collins, & Burrows, 2014),
Table 2.1 Alterations from the DSM-IV substance-dependence criteria to the

DSM-5 substance-use disorder criteria.
DSM-IV substance-dependence
criteria DSM-5 substance-use disorder criteria
1. Substance taken in larger amount and 1. Substance taken in larger amounts or
for a longer period than intended over a longer period than was intended
2. Persistent desire or repeated attempt to 2. Persistent desire of unsuccessful
quit efforts to quit
3. Much time/activity to obtain, use, or 3. Much time/activity to obtain, use, or
recover recover
4. Important social, occupational, or 4. Craving or a strong desire/urge to use
recreational activities given up or 5. Recurrent use resulting in failure to
reduced fulfill major role obligations at work,
5. Use continues despite knowledge of school, or home.
adverse consequences (e.g., failure to 6. Continued used despite persistent
fulfill role obligation, use when physically social/interpersonal problems
hazardous) 7. Important social, occupational, or
6. Tolerance (marked increase in amount; recreational activities given up or
marked decrease in effect) reduced
7. Characteristic withdrawal symptoms; 8. Recurrent use in situations where it is
substance taken to relieve withdrawal physical hazardous
9. Substance use continued despite
persistent/recurrent physical or
psychological problems
10. Tolerance (marked increase in amount;
marked decrease in effect)
11. Characteristic withdrawal symptoms;
substance taken to relieve withdrawal
Note: The YFAS and the YFAS-C are based on the DSM-IV criteria for substance dependence. The
YFAS 2.0 and the YFAS-C 2.0 are based on the DSM-5 criteria for substance-use disorder.
although this number may be a high estimate because of the number of clinical sam-
ples (e.g., persons with eating disorders) included in the study. Many studies have
found that women relative to men endorse higher rates of YFAS food addiction,
although this gender difference has not always been found in all studies (Meule &
Gearhardt, 2014; Pursey et al., 2014). No consistent pattern of differences in food
addiction rate by race/ethnicity was identified with the original YFAS (Pursey
et al., 2014). However, food addiction has reliably differed by weight status and clin-
ical severity. For example, relatively healthy college students with low rates of
obesity exhibit food addiction rates around 5%e10% (Meule & Gearhardt, 2014),
whereas individuals with obesity who are undergoing bariatric surgery exhibit
significantly elevated rates around 14%e58% (Ivezaj, Wiedemann, & Grilo,
2017). Although rates of food addiction seem to be higher in individuals with
obesity, it is important to note that not all individuals with obesity meet the food
addiction criteria and not all individuals who meet the food addiction criteria are
obese (Pursey et al., 2014). Thus, as discussed previously, solely relying on BMI
as a proxy of addictive-like responses to food likely introduces measurement error.
Yale Food Addiction Scale 19
One of the main questions about the concept of food addiction is whether it is
sufficiently distinct from existent eating disorders (e.g., anorexia nervosa (AN),
bulimia nervosa (BN), binge eating disorder (BED)). Some overlap between food
addiction and binge-focused eating disorders (i.e., BN, BED) is to be expected, as
similar criteria are common across both constructs, including loss of control over
consumption and an inability to stop despite a desire to do so (Gearhardt, White,
& Potenza, 2011). Additionally, addiction and eating disorder perspectives implicate
dysfunction in many of the same mechanisms (e.g., impulsivity, reward dysfunction,
emotion dysregulation) (Schulte, Grilo, & Gearhardt, 2016). The similar phenotypic
presentations and mechanistic underpinnings of these disorders provide support for
the contribution of addictive processes in at least some presentations of binge-
focused eating disorders.
Food addiction rates have also differed by eating disorder status. Individuals with
BED seem to exhibit elevated rates of food addiction, with about half of individuals
meeting the original YFAS criteria (Gearhardt et al., 2012; Gearhardt, White,
Masheb, & Grilo, 2013). The presentation of BED and food addiction is associated
with a more severe clinical presentation than BED alone with more frequent epi-
sodes of binge eating, greater emotion dysregulation, and eating pathology (Gear-
hardt et al., 2012). Rates of food addiction are also elevated in BN. In patients
with BN, prevalence rates ranging from 81.5% (Granero et al., 2014) to 100%
(Meule, Rezori, & Blechert, 2014) have been noted. However, the rate of food addic-
tion is lower (30%) in individuals with remitted BN (Meule et al., 2014). Many of
the mechanisms implicated in addiction such as heightened impulsivity, emotion
dysregulation, and risky substance use are more strongly linked to BN than other
eating disorders (Dansky, Brewerton, & Kilpatrick, 2000; de Jonge, Van Furth,
Lacey, & Waller, 2003; Fischer, Smith, & Anderson, 2003), which may contribute
to the higher rates of YFAS food addiction. Longitudinal research has found that
higher rates of YFAS food addiction at baseline predict poorer treatment response
to a psychosocial intervention for individuals with BN (Hilker et al., 2016), which
suggests that assessing YFAS food addiction in patients with BN may be helpful
in identifying patients who may need additional clinical support.
One unexpected finding is that food addiction is also associated with AN,
particularly the binge/purge subtype (Granero et al., 2014). Given that the core
characteristic of AN is restricting food intake, it was not anticipated that food
addiction would be associated with this disorder. One possibility is that for individ-
uals with AN, the YFAS is assessing a different construct, such as subjective (but
not objective) loss of control over food consumption. A similar issue arose in the
context of binge eating, in which individuals with AN endorsed high levels of
binge eating episodes. However, in contrast to the binge episodes diagnostic of
BN and BED (i.e., loss of control and objectively large quantity of food
consumed), many of the binge eating episodes in AN reflected a subjective sense
of loss of control, but a small quantity of food consumed (Latner, Vallance, &
Buckett, 2008). To distinguish between these subtypes, binge eating episodes are
evaluated for whether they are subjective (i.e., feelings of loss of control, but small
amount of food consumed) or objective (i.e., feelings of loss of control, but with
objectively large amount of food consumed), and both have been found to be clin-
ically meaningful (Latner et al., 2008). Thus, in AN samples, the food addiction
construct may be similar to subjective binge episodes by assessing a subjective
sense of loss of control without objective addictive-like food consumption. How-
ever, more research is needed in AN samples to further evaluation the presentation
of addictive-like eating indicators in this group.
Based on the original YFAS, about half of individuals with food addiction meet
for an existing eating disorder, whereas the other half does not (Gearhardt, Boswell,
& White, 2014). Participants who meet for food addiction only exhibit similar levels
of clinically significant distress and eating pathology as those who meet for an eating
disorder only (Gearhardt et al., 2014). Thus, participants who meet for food addic-
tion (but not other eating disorders) appear to be a clinically relevant sample who
may not be receiving adequate clinical care. Importantly, there are distinct symp-
toms and mechanisms in addiction versus eating disorders that may be relevant
for individuals with food addiction but without an eating disorder. One distinction
between food addiction and binge-focused eating disorders is the pattern of con-
sumption. In binge-focused eating disorders, individuals must consume an objec-
tively large amount of food in a discrete period of time (e.g., 2 hours) and
experience a subjective sense of loss of control (American Psychiatric Association,
2013a). However, in addiction, no specific pattern of intake is required and individ-
uals can meet the diagnostic criteria if they exhibit discrete patterns of binge con-
sumption (e.g., binge drinking) or if they steadily and repeatedly administer over
long periods of time (e.g., chain smoking). They can also meet criteria despite a sub-
jective sense that they are in control of their substance use (American Psychiatric
Association, 2013b). These diagnostic differences may lead people who exhibit
compulsive eating behavior, but do not have discrete binges, to be captured by
food addiction where they may not receive a diagnosis of binge-focused eating
disorders.
There are also mechanistic and diagnostic differences between an addiction and
eating disorder perspectives that likely contribute to the nonshared variance between
these constructs. From an addiction perspective, withdrawal and tolerance are both
mechanistically important and are assessed as diagnostic criteria (American Psychi-
atric Association, 2013a). Withdrawal and tolerance are considered adaptations to
heavy, repeated use that may reflect the “dark” side of addiction (Koob, 2009). As
the body adapts to the use, more and more of the substance may be needed to achieve
previous levels of reward (i.e., tolerance) and when substance use is reduced or dis-
continued, these adaptations can result in physically and/or psychologically aversive
experience (i.e., withdrawal) that can increase the likelihood of relapse (Koob,
2015). The YFAS assesses both withdrawal and tolerance, whereas eating disorder
measures do not. In contrast, eating disorder perspectives focus on shape and weight
concerns as major driving factors in pathological eating (Fairburn, Cooper, Shafran,
& Wilson, 2008), where there is less focus on these as driving factors in the context
of addiction (Schulte, Grilo, et al., 2016).
Another random document with
no related content on Scribd:
otra alguna,
ueys vna perfeçion jamas
oyda,
ueys una discreçion, qual fue
ninguna,
de hermosura y graçia
guarnescida?
¿ueys la que está domando a
la fortuna
y a su pesar la tiene alli
rendida?
la gran doña Leonor Manuel
se llama,
de Lusitania luz que al orbe
inflama.
Doña Luisa Carrillo, que en
España
la sangre de Mendoça ha
esclareçido:
de cuya hermosura y graçia
extraña,
el mismo amor, de amor está
uençido,
es la que a nuestra Dea ansi
acompaña
que de la uista nunca la ha
perdido:
de honestas y hermosas claro
exemplo,
espejo y clara luz de nuestro
templo.
¿Ueys una perfeçion tan
acabada
de quien la misma fama está
embidiosa?
¿ueys una hermosura más
fundada
en graçia y discreçion que en
otra cosa,
que con razon obliga a ser
amada
porque es lo menos de ella el
ser hermosa?
es doña Eufrasia de Guzman
su nombre,
digna de inmortal fama y gran
renombre.
Aquella hermosura
peregrina
no uista en otra alguna sino en
ella,
que a qualquier seso apremia
y desatina,
y no hay poder de amor que
apremie el della,
de carmesí uestida y muy más
fina
de su rostro el color que no el
de aquella,
doña Maria de Aragon se
llama,
en quien se ocupará de oy
más la fama.
¿Sabeys quién es aquella
que señala
Diana, y nos la muestra con la
mano,
que en graçia y discreçion a
ella yguala,
y sobrepuja a todo ingenio
humano,
y aun ygualarla en arte, en ser
y en gala,
sería (segun es) trabajo en
uano?
doña Ysabel Manrique y de
Padilla,
que al fiero Marte uenze y
marauilla.
Doña Maria Manuel y doña
Ioana
Osorio, son las dos que estays
mirando
cuya hermosura y graçia sobre
humana,
al mismo Amor de amor está
matando:
y esta nuestra gran Dea muy
vfana,
de ueer a tales dos de nuestro
uando,
loallas, segun son es
escusado:
la fama y la razon ternan
cuydado.
Aquellas dos hermanas tan
nombradas
cada una es una sola y sin
segundo,
su hermosura y graçias
extremadas,
son oy en dia un sol que
alumbra el mundo,
al biuo me paresçen
trasladadas,
de la que a buscar fuy hasta el
profundo:
doña Beatriz Sarmiento y
Castro es una
con la hermosa hermana qual
ninguna.
El claro sol que ueys
resplandeçiendo
y acá, y allá sus rayos ya
mostrando,
la que del mal de amor se está
riendo,
del arco, aljaua y flechas no
curando,
cuyo diurno rostro está
diziendo,
muy más que yo sabré dezir
loando,
doña Ioana es de Çarate, en
quien vemos
de hermosura y graçia los
extremos.
Doña Anna Osorio y Castro
está cabe ella
de gran valor y graçia
acompañada,
ni dexa entre las bellas de ser
bella,
ni en toda perfeçion muy
señalada,
mas su infelize hado vsó con
ella
de una crueldad no vista ni
pensada,
porque al ualor, linaje y
hermosura
no fuesse ygual la suerte, y la
uentura.
Aquella hermosura
guarnecida
de honestidad, y graçia sobre
humana,
que con razon y causa fue
escogida
por honra y prez del templo de
Diana,
contino uençedora, y no
uençida
su nombre (o Nimphas) es
doña Iuliana,
de aquel gran Duque nieta y
Condestable,
de quien yo callaré, la fama
hable[1256].
Mirad de la otra parte la
hermosura
de las illustres damas de
Valençia,
a quien mi pluma ya de oy
mas procura
perpetuar su fama y su
excelençia:
aqui, fuente Helicona, el agua
pura
otorga, y tú, Minerua, enpresta
sçiençia,
para saber dezir quién son
aquellas
que no hay cosa que ver
despues de vellas.
Las cuatro estrellas ved
resplandesçientes
de quien la fama tal ualor
pregona
de tres insignes reynos
desçendientes,
y de la antigua casa de
Cardona,
de la vna parte Duques
exçelentes,
de otra el trono, el sçeptro, y la
corona,
del de Segorbe hijas, cuya
fama
del Borea al Austro, al Euro se
derrama.
La luz del orbe con la flor de
España,
el fin de la beldad y
hermosura,
el coraçon real que le
acompaña,
el ser, valor, bondad sobre
natura,
aquel mirar que en verlo
desengaña,
de no poder llegar alli criatura:
doña Anna de Aragon se
nombra y llama,
a do por el amor, cansó la
fama.
Doña Beatrix su hermana
junto della
vereys, si tanta luz podeys
miralla:
quien no podré alabar, es sola
ella,
pues no ay podello hazer, sin
agrauialla:
a aquel pintor que tanto hizo
en ella,
le queda el cargo de poder
loalla,
que a do no llega
entendimiento humano
llegar mi flaco ingenio, es muy
en vano.
Doña Françisca d'Aragon
quisiera
mostraros, pero siempre está
escondida:
su vista soberana es de
manera,
que a nadie que la vee dexa
con vida:
por esso no paresçe. ¡Oh
quién pudiera
mostraros esta luz, que al
mundo oluida,
porque el pintor que tanto hizo
en ella,
los passos le atajó de
meresçella.
A doña Madalena estays
mirando
hermana de las tres que os he
mostrado,
miralda bien, uereys que está
robando
a quien la mira, y biue
descuydado:
su grande hermosura
amenazando
está, y el fiero amor el arco
armado,
porque no pueda nadie, ni aun
miralla,
que no le rinda o mate sin
batalla.
Aquellos dos luzeros que a
porfia
acá, y allá sus rayos uan
mostrando,
y a la exçelente casa de
Gandia,
por tan insigne y alta
señalando,
su hermosura y suerte sube oy
dia
muy más que nadie sube
imaginando:
¿quién uee tal Margareta y
Madalena,
que tema del amor la horrible
pena?
Quereys, hermosas
Nimphas, uer la cosa,
que el seso más admira y
desatina?
mirá una Nimplia más que el
sol hermosa,
pues quién es ella, o él jamas
se atina:
el nombre desta fenix tán
famosa,
es en Valençia doña Cathalina
Milan, y en todo el mundo es
oy llamada
la más discreta, hermosa y
señalada.
Alçad los ojos, y vereis de
frente
del caudaloso rio y su ribera,
peynando sus cabellos, la
exçelente
doña Maria Pexon y
Çanoguera
cuya hermosura y gracia es
euidente,
y en discreçion la prima y la
primera:
mirad los ojos, rostro
cristallino,
y aquí puede hazer fin uuestro
camino.
Las dos mirad que están
sobrepujando,
a toda discreçion y
entendimiento,
y entre las más hermosas
señalando
se uan, por solo vn par, sin par
ni cuento,
los ojos que las miran
sojuzgando:
pues nadie las miró que biua
essento:
¡ued qué dira quien alabar
promete
las dos Beatrizes, Vique y
Fenollete!
Al tiempo que se puso alli
Diana,
con su diuino rostro y
excelente
salió un luzero, luego una
mañana
de Mayo muy serena y
refulgente:
sus ojos matan y su uista
sana,
despunta alli el amor su flecha
ardiente,
su hermosura hable, y
testifique
ser sola y sin ygual doña Anna
Vique.
Bolued, Nimphas, uereys
doña Teodora
Carroz, que del valor y
hermosura
la haze el tiempo reyna y gran
señora
de toda discreçion y graçia
pura:
qualquiera cosa suya os
enamora,
ninguna cosa nuestra os
assegura,
para tomar tan grande
atreuimiento,
como es poner en ella el
pensamiento.
Doña Angela de Borja
contemplando
uereys que está (pastores) en
Diana,
y en ella la gran dea está
mirando
la graçia y hermosura
soberana:
Cupido alli a sus pies está
llorando,
y la hermosa Nimpha muy
ufana,
en uer delante della estar
rendido
aquel tyrano fuerte y tan
temido.
De aquella illustre cepa
Çanoguera,
salio una flor tan extremada y
pura,
que siendo de su edad la
primauera,
ninguna se le yguala en
hermosura:
de su excelente madre es
heredera,
en todo quanto pudo dar
natura,
y assi doña Hieronyma ha
llegado
en graçia y disceçion al sumo
grado.
¿Quereys quedar (o
Nimphas) admiradas,
y uer lo que a ninguna dió
uentura:
quereys al puro extremo uer
llegados
ualor, saber, bondad y
hermosura?
mirad doña Veronica
Marradas,
pues solo uerla os dize y
assegura
que todo sobra, y nada falta
en ella,
sino es quien pueda (o piense)
meresçella.
Doña Luysa Penarroja
uemos
en hermosura y graçia más
que humana,
en toda cosa llega los
estremos,
y a toda hermosura uençe y
gana:
no quiere el crudo amor que la
miremos
y quien la uió, si no la uee, no
sana:
aunque despues de uista el
crudo fuego
en su vigor y fuerça buelue
luego.
Ya ueo, Nimphas, que
mirays aquella
en quien estoy continuo
contemplando,
los ojos se os yran por fuerça
a ella,
que aun los del mismo amor
está robando:
mirad la hermosura que ay en
ella,
mas ued que no çegueys
quiçá mirando
a doña Ioana de Cardona,
estrella
que el mismo amor está
rendido a ella.
Aquella hermosura no
pensada
que ueys, si uerla cabe en
nuestro uaso:
aquella cuya suerte fue
estremada
pues no teme fortuna, tiempo
o caso,
aquella discreçion tan
leuantada,
aquella que es mi musa y mi
parnaso:
Ioanna Anna, es Catalana, fin
y cabo
de lo que en todas por
estremo alabo.
Cabe ella está un estremo
no uicioso,
mas en uirtud muy alto y
estremado,
disposiçion gentil, rostro
hermoso,
cabellos de oro, y cuello
delicado,
mirar que alegra, mouimiento
ayroso,
juyzio claro y nombre
señalado,
doña Angela Fernando, aquien
natura
conforme al nombre dio la
hermosura.
Vereys cabe ella doña
Mariana,
que de ygualalle nadie está
segura;
miralda junto a la exçelente
hermana,
uereys en poca edad gran
hermosura,
uereys con ella nuestra edad
ufana,
uereys en pocos años gran
cordura,
uereys que son las dos el
cabo y summa
de quanto dezir puede lengua
y pluma.
Las dos hermanas Borjas
escogidas,
Hippolita, Ysabel, que estays
mirando,
de graçia y perfeçion tan
guarnesçidas,
que al sol su resplandor está
çegando,
miraldas y uereys de quantas
uidas
su hermosura siempre ua
triumphando:
mirá los ojos, rostro, y los
cabellos,
que el oro queda atras y
passan ellos.
Mirad doña Maria
Çanoguera,
la qual de Catarroja es oy
señora,
cuya hermosura y graçia es de
manera,
que a toda cosa uençe y la
enamora:
su fama resplandeçe por do
quiera
y su uirtud la ensalça cada
hora,
pues no ay qué dessear
despues de uella,
¿quién la podrá loar sin
offendella?
Doña Ysabel de Borja está
defrente
y al fin y perfeçion de toda
cosa,
mira la graçia, el ser, y la
exçelente
color más biua que purpurea
rosa,
mirad que es de uirtud y graçia
fuente,
y nuestro siglo illustre en toda
cosa:
al cabo está de todas su
figura,
por cabo y fin de graçia y
hermosura.
La que esparzidos tiene sus
cabellos
con hilo de oro fino atras
tomados,
y aquel diuino rostro, que él y
ellos
a tantos coraçones trae
domados,
el cuello de marfil, los ojos
bellos,
honestos, baxos, uerdes, y
rasgados,
doña Ioana Milan por nombre
tiene,
en quien la uista pára y se
mantiene,
Aquella que alli ueys, en
quien natura
mostró su sçiençia ser
marauillosa,
pues no ay pasar de alli en
hermosura,
no ay más que dessear a una
hermosa:
cuyo ualor, saber, y gran
cordura
leuantarán su fama en toda
cosa,
doña Mençia se nombra
Fenollete,
a quien se rinde amor y se
somete.
La cançion del çelebrado Orpheo,

fue tan agradable a los oydos de
Felismena, y de todos los que la
oyan, que assi los tenia
suspensos, como si por ninguno
de ellos uuiera passado más de lo
que presente tenian. Pues
auiendo muy particularmente
mirado el rico aposento, con
todas las cosas que en él auia
que uer, salieron las Nymphas por
una puerta de la gran sala, y por
otra de la sala a un hermoso
jardin, cuya uista no menos
admiraçion les causó que lo que
hasta alli auian uisto, entre cuyos
arboles y hermosas flores auia
muchos sepulchros de nimphas y
damas, las quales auian con gran
limpieça conseruado la castidad
deuida a la castissima diosa.
Estauan todos los sepulchros
coronados de enredosa yedra,
otros de olorosos arrayhanes,
otros de uerde laurel. De más
desto auia en el hermoso jardin
muchas fuentes de alabastro,
otras de marmol jaspeado, y de
metal, debaxo de parrales, que
por ençima de artifiçiosos arcos
estendian todas sus ramas, los
myrthos hazian cuatro paredes
almenadas, y por ençima de las
almenas, paresçian muchas flores
de jazmin, madreselua, y otras
muy apazibles a la uista. En
medio del jardin estaua una
piedra negra, sobre quatro pilares
de metal, y en medio de ella un
sepulchro de jaspe, que quatro
Nimphas de alabastro en las
manos sostenian, entorno dél
estauan muchos blandones, y
candeleros de fina plata, muy bien
labrados, y en ellos hachas
blancas ardiendo. En torno de la
capilla auia algunos bultos de
caualleros, otros de marmol
jaspeado, y de otras diferentes
materias. Mostrauan estas figuras
tan gran tristeza en el rostro, que
la pusieron en el coraçon de la
hermosa Felismena, y de todos
los que el sepulchro veyan. Pues
mirandolo muy particularmente,
vieron que a los pies dél, en una
tabla de metal que una muerte
tenía en las manos, estaua este
letrero:
Aqui reposa doña Catalina

de Aragon y Sarmiento cuya
fama,
al alto çielo llega, y se
auezina,
y desde el Borea al Austro se
derrama:
matéla, siendo muerte, tan
ayna,
por muchos que ella ha
muerto, siendo dama,
acá está el cuerpo, el alma
allá en el çielo,
que no la meresçio gozar el
suelo.
Despues de leydo el Epigramma,

vieron cómo en lo alto del
sepulchro estaua vna aguda de
marmol negro, con vna tabla de
oro en las vñas, y en ella estos
uersos.
Qual quedaria (o muerte) el

alto çielo
sin el dorado Apollo y su
Diana
sin hombre, ni animal el baxo
suelo,
sin norte el marinero en mar
insana,
sin flor, ni yerua el campo y sin
consuelo,
sin el roçio d'aljofar la
mañana,
assi quedó el ualor, la
hermosura,
sin la que yaze en esta
sepultura.
Quando estos dos letreros

vuieron leydo, y Belisa entendido
por ellos quién era la hermosa
Nimpha que alli estaua sepultada,
y lo mucho que nuestra España
auia perdido en perdella,
acordandosele de la temprana
muerte del su Arsileo, no pudo
dexar de dezir con muchas
lagrimas: Ay muerte, quán fuera
estoy de pensar, que me as de
consolar con males agenos!
Dueleme en estremo lo poco que
se gozó tan gran ualor y
hermosura como esta Nimpha me
dizien que tenía, porque ni estaua
presa de amor, ni nadie meresçio
que ella lo estuuiesse. Que si otra
cossa entendiera, por tan dichosa
la tuuiera yo en morirse, como a
mí por desdichada en uer, o cruda
muerte, quan poco caso hazes de
mi: pues lleuandome todo mi bien,
me dexas, no para más, que para
sentir esta falta. O mi Arsileo, o
disçreçion jamás oyda, o el más
claro ingenio que naturaleza pudo
dar. ¿Qué ojos pudieron uerte,
qué animo pudo suffrir tu
desastrado fin? O Arsenio,
Arsenio, Arsenio quan poco
pudiste suffrir la muerte del
desastrado hijo, teniendo más
ocasion de suffrirla que yo? ¿Por
qué (cruel Arsenio) no quesiste
que yo partiçipasse de dos
muertes, que por estoruar la que
menos me dolia, diera yo çien mil
vidas, si tantas tuuiera? A Dios,
bienauenturada Nimpha, lustre y
honrra de la real casa de Aragon,
Dios dé gloria a tu anima, y saque
la mia de entre tantas
desuenturas. Despues Belisa vuo
dicho estas palabras, y despues
de auer uisto otras muchas
sepulturas, muy riquissimamente
labradas, salieron por una puerta
falsa que en el jardin estaua, al
verde prado: adonde hallaron a la
sabia Feliçia, que sola se andaua
recreando: la qual los reçibio con
muy buen semblante. Y en quanto
se hazia hora de çenar, se fueron
a vna gran alameda, que çerca de
alli estaua, lugar donde las
Nimphas del sumptuoso templo,
algunos dias salian a recrearse. Y
sentados en un pradezillo,
çercado de uerdes salzes,
començaron a hablar vnos con
otros: cada vno en la cosa que
más contento le daua. La sábia
Feliçia llamó junto a si al pastor
Sireno, y a Felismena. La Nimpha
Dorida, se puso con Syluano
hazia vna parte del verde prado, y
las dos pastoras, Seluagia, y
Belisa, con las más[1257]
hermosas Nimphas, Cinthia y
Polydora, se apartaron haçia otra
parte: de manera que aunque no
estauan vnos muy lexos de los
otros, podian muy bien hablar, sin
que estoruasse vno lo que el otro
dezia. Pues queriendo Sireno,
que la platica, y conuersaçion se
conformasse con el tiempo y
lugar, y tambien con la persona a
quien hablaua, començo a hablar
desta manera: No me paresçe

Compulsive Eating Behavior Food Addiction Emerging Pathological Constructs 1St Edition Pietro Cottone Full Chapter

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Compulsive Eating Behavior Food Addiction Emerging Pathological Constructs 1St Edition Pietro Cottone Full Chapter

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Compulsive eating behavior & food

addiction: Emerging pathological

No part of this publication may be reproduced or transmitted in any form or by any

Library of Congress Cataloging-in-Publication Data

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Publisher: Nikki Levy

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8. Dopamine: A key neurotransmitter in the basal ganglia, long implicated not

Compulsive Eating Behavior and Food Addiction. https://doi.org/10.1016/B978-0-12-816207-1.00001-9 1

References to addiction in relation to food in the 19th

A description of eating disorders in 1932

“Food addiction” in the 1950s

Varying themes in the second half of the 20th century

Increased popularity in the 21st century

considering compulsivity as a transdiagnostic construct in both addiction and path-

Early approaches to identifying food addiction

Yale Food Addiction Scale

Table 2.1 Alterations from the DSM-IV substance-dependence criteria to the

La cançion del çelebrado Orpheo,

Aqui reposa doña Catalina

Despues de leydo el Epigramma,

Qual quedaria (o muerte) el

Quando estos dos letreros

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