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

Compulsive eating behavior & food
addiction: Emerging pathological

constructs 1st Edition Pietro Cottone
Visit to download the full and correct content document:
https://textbookfull.com/product/compulsive-eating-behavior-food-addiction-emerging-
pathological-constructs-1st-edition-pietro-cottone/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Eating Disorder Tools Overcome compulsive eating 1st

Edition Thomas King Monica Carriello
https://textbookfull.com/product/eating-disorder-tools-overcome-
compulsive-eating-1st-edition-thomas-king-monica-carriello/
Neuroscience for addiction medicine : from prevention

to rehabilitation : constructs and drugs First Edition
Ekhtiari
https://textbookfull.com/product/neuroscience-for-addiction-
medicine-from-prevention-to-rehabilitation-constructs-and-drugs-
first-edition-ekhtiari/
Compulsive Sexual Behavior Disorder Understanding

Assessment and Treatment 1st Edition Ed Balon Richard
https://textbookfull.com/product/compulsive-sexual-behavior-
disorder-understanding-assessment-and-treatment-1st-edition-ed-
balon-richard/
Brain Lock Twentieth Anniversary Edition Free Yourself

from Obsessive Compulsive Behavior Jeffrey M. Schwartz
https://textbookfull.com/product/brain-lock-twentieth-
anniversary-edition-free-yourself-from-obsessive-compulsive-
behavior-jeffrey-m-schwartz/
Emerging nanotechnologies in food science 1st Edition
Busquets
https://textbookfull.com/product/emerging-nanotechnologies-in-
food-science-1st-edition-busquets/
Food and eating in America : a documentary reader 1

edition Edition Giesen
https://textbookfull.com/product/food-and-eating-in-america-a-
documentary-reader-1-edition-edition-giesen/
Eating in Us National Parks : Cosmopolitan Taste and

Food Tourism 1st Edition Kathleen Lebesco
https://textbookfull.com/product/eating-in-us-national-parks-
cosmopolitan-taste-and-food-tourism-1st-edition-kathleen-lebesco/
Organizing Eating : Communicating for Equity Across

U.S. Food Systems 1st Edition Sarah E. Dempsey
https://textbookfull.com/product/organizing-eating-communicating-
for-equity-across-u-s-food-systems-1st-edition-sarah-e-dempsey/
Emerging Technologies For Promoting Food Security

Overcoming The World Food Crisis 1st Edition Chandra
Madramootoo
https://textbookfull.com/product/emerging-technologies-for-
promoting-food-security-overcoming-the-world-food-crisis-1st-
edition-chandra-madramootoo/
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
Academic Press is an imprint of Elsevier
125 London Wall, London EC2Y 5AS, United Kingdom
525 B Street, Suite 1650, San Diego, CA 92101, United States
50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States
The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom
Copyright © 2019 Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any

means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies
and our arrangements with organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright
by the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this ﬁeld are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional
responsibility.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
ISBN: 978-0-12-816207-1
For information on all Academic Press publications visit our website at

https://www.elsevier.com/books-and-journals
Publisher: Nikki Levy

Acquisition Editor: Joslyn Chaiprasert-Paguio
Editorial Project Manager: Sandra Harron
Production Project Manager: Paul Prasad Chandramohan
Cover Designer: Christian Bilbow
Typeset by TNQ Technologies

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.
References
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental
Disorders (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders (5th ed.). Washington, DC: American Psychiatric Association.
Avena, N. M., Rada, P., & Hoebel, B. G. (2008). Evidence for sugar addiction: Behavioral and
neurochemical effects of intermittent, excessive sugar intake. Neuroscience & Biobehav-
ioral Reviews, 32, 20e39. https://doi.org/10.1016/j.neubiorev.2007.04.019.
References 9
Barry, D., Clarke, M., & Petry, N. M. (2009). Obesity and its relationship to addictions: Is
overeating a form of addictive behavior? American Journal on Addictions, 18,
439e451. https://doi.org/10.3109/10550490903205579.
Bell, R. G. (1960). A method of clinical orientation to alcohol addiction. Canadian Medical
Association Journal, 83, 1346e1352.
Bell, R. G. (1965). Defensive thinking in alcohol addicts. Canadian Medical Association
Journal, 92, 228e231.
Bemis, K. M. (1985). "Abstinence" and "nonabstinence" models for the treatment of bulimia.
International Journal of Eating Disorders, 4, 407e437. https://doi.org/10.1002/1098-
108X(198511)4:4<407.
Bruinsma, K., & Taren, D. L. (1999). Chocolate: Food or drug? Journal of the American Di-
etetic Association, 99, 1249e1256. https://doi.org/10.1016/S0002-8223(99)00307-7.
Cassin, S. E., & von Ranson, K. M. (2007). Is binge eating experienced as an addiction?
Appetite, 49, 687e690. https://doi.org/10.1016/j.appet.2007.06.012.

Cerný,
L., & Cerný, K. (1992). Can carrots be addictive? An extraordinary form of drug
dependence. British Journal of Addiction, 87, 1195e1197. https://doi.org/10.1111/
j.1360-0443.1992.tb02007.x.
Clemis, J. D., Shambaugh, G. E., Jr., & Derlacki, E. L. (1966). Withdrawal reactions in
chronic food addiction as related to chronic secretory otitis media. Annals of Otology, Rhi-
nology & Laryngology, 75, 793e797. https://doi.org/10.1177/000348946607500319.
Clouston, T. S. (1890). Diseased cravings and paralyzed control: Dipsomania; morphinoma-
nia; chloralism; cocainism. Journal of Inebriety, 12, 203e245.
Corsica, J. A., & Pelchat, M. L. (2010). Food addiction: True or false? Current Opinion in
Gastroenterology, 26, 165e169. https://doi.org/10.1097/MOG.0b013e328336528d.
Crothers, T. D. (1890a). Alcoholic heredity in diseases of children. Journal of Inebriety, 12,
281e286.
Crothers, T. D. (1890b). Editorial: Legal treatment of inebriates. Journal of Inebriety, 12,
386e392.
Davis, C., & Carter, J. C. (2009). Compulsive overeating as an addiction disorder. A review of
theory and evidence. Appetite, 53, 1e8. https://doi.org/10.1016/j.appet.2009.05.018.
Davis, C., & Carter, J. C. (2014). If certain foods are addictive, how might this change the
treatment of compulsive overeating and obesity? Current Addiction Reports, 1, 89e95.
https://doi.org/10.1007/s40429-014-0013-z.
Davis, C., & Claridge, G. (1998). The eating disorders as addiction: A psychobiological
perspective. Addictive Behaviors, 23, 463e475. https://doi.org/10.1016/S0306-4603(98)
00009-4.
Davis, A. A., Edge, P. J., & Gold, M. S. (2014). New directions in the pharmacological treat-
ment of food addiction, overeating, and obesity. In K. P. Rosenberg, & L. C. Feder (Eds.),
Behavioral Addictions (pp. 185e213). London, UK: Academic Press.
de Silva, P., & Eysenck, S. (1987). Personality and addictiveness in anorexic and bulimic
patients. Personality and Individual Differences, 8, 749e751. https://doi.org/10.1016/
0191-8869(87)90077-8.
Dell’Osso, L., Abelli, M., Carpita, B., Pini, S., Castellini, G., Carmassi, C., & Ricca, V.
(2016). Historical evolution of the concept of anorexia nervosa and relationships with
orthorexia nervosa, autism, and obsessiveecompulsive spectrum. Neuropsychiatric Dis-
ease and Treatment, 12, 1651e1660. https://doi.org/10.2147/NDT.S108912.
Feldman, J., & Eysenck, S. (1986). Addictive personality traits in bulimic patients. Person-
ality and Individual Differences, 7, 923e926. https://doi.org/10.1016/0191-8869(86)
90097-8.
Finlayson, G. (2017). Food addiction and obesity: Unnecessary medicalization of hedonic
overeating. Nature Reviews Endocrinology, 13, 493e498. https://doi.org/10.1038/
nrendo.2017.61.
Fletcher, P. C., & Kenny, P. J. (2018). Food addiction: A valid concept?
Neuropsychopharmacology, 43, 2506e2513. https://doi.org/10.1038/s41386-018-0203-9.
Garrow, J. S. (1976). Pathology of eating group report. In T. Silverstone (Ed.), Appetite and
Food Intake (pp. 405e416). Berlin: Abakon.
Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009a). Food addiction: An examination
of the diagnostic criteria for dependence. Journal of Addiction Medicine, 3, 1e7. https://
doi.org/10.1097/ADM.0b013e318193c993.
Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009b). Preliminary validation of the Yale
Food Addiction Scale. Appetite, 52, 430e436. https://doi.org/10.1016/j.appet.2008.12.003.
Gold, M. S., & Sternbach, H. A. (1984). Endorphins in obesity and in the regulation of appe-
tite and weight. Integrative Psychiatry, 2, 203e207.
Greenberg, J. L., Lewis, S. E., & Dodd, D. K. (1999). Overlapping addictions and self-esteem
among college men and women. Addictive Behaviors, 24, 565e571. https://doi.org/
10.1016/S0306-4603(98)00080-X.
Hamburger, W. W. (1951). Emotional aspects of obesity. Medical Clinics of North America,
35, 483e499.
Hatsukami, D., Owen, P., Pyle, R., & Mitchell, J. (1982). Similarities and differences on the
MMPI between women with bulimia and women with alcohol or drug abuse problems.
Addictive Behaviors, 7, 435e439. https://doi.org/10.1016/0306-4603(82)90015-6.
Hebebrand, J., Albayrak, Ö., Adan, R., Antel, J., Dieguez, C., de Jong, J., … Murphy, M.
(2014). “Eating addiction”, rather than “food addiction”, better captures addictive-like
eating behavior. Neuroscience & Biobehavioral Reviews, 47, 295e306. https://doi.org/
10.1016/j.neubiorev.2014.08.016.
Hetherington, M. M., & Macdiarmid, J. I. (1993). "Chocolate addiction": A preliminary study
of its description and its relationship to problem eating. Appetite, 21, 233e246. https://
doi.org/10.1006/appe.1993.1042.
Hinkle, L. E., Knowles, H. C., Fischer, A., & Stunkard, A. J. (1959). Role of environment and
personality in management of the difficult patient with diabetes mellitus: Panel discussion.
Diabetes, 8, 371e378. https://doi.org/10.2337/diab.8.5.371.
Ifland, J., Preuss, H. G., Marcus, M. T., Rourk, K. M., Taylor, W. C., Burau, K., … Manso, G.
(2009). Refined food addiction: A classic substance use disorder. Medical Hypotheses, 72,
518e526. https://doi.org/10.1016/j.mehy.2008.11.035.
Ifland, J., Preuss, H. G., Marcus, M. T., Rourke, K. M., Taylor, W., & Wright, H. T. (2015).
Clearing the confusion around processed food addiction. Journal of the American College
of Nutrition, 34, 240e243. https://doi.org/10.1080/07315724.2015.1022466.
Kagan, D. M., & Albertson, L. M. (1986). Scores on MacAndrew Factors - bulimics and other
addictive populations. International Journal of Eating Disorders, 5, 1095e1101. https://
doi.org/10.1002/1098-108X(198609)5:6.
Kaplan, R. (1996). Carrot addiction. Australian and New Zealand Journal of Psychiatry, 30,
698e700. https://doi.org/10.3109/00048679609062670.
Kayloe, J. C. (1993). Food addiction. Psychotherapy, 30, 269e275. https://doi.org/10.1037/
0033-3204.30.2.269.
References 11
Lacroix, E., Tavares, H., & von Ranson, K. M. (2018). Moving beyond the “eating addiction”
versus “food addiction” debate: Comment on Schulte et al. (2017). Appetite, 130,
286e292. https://doi.org/10.1016/j.appet.2018.06.025.
Leon, G. R., Eckert, E. D., Teed, D., & Buchwald, H. (1979a). Changes in body image and
other psychological factors after intestinal bypass surgery for massive obesity. Journal
of Behavioral Medicine, 2, 39e55. https://doi.org/10.1007/BF00846562.
Leon, G. R., Kolotkin, R., & Korgeski, G. (1979b). MacAndrew Addiction Scale and other
MMPI characteristics associated with obesity, anorexia and smoking behavior. Addictive
Behaviors, 4, 401e407. https://doi.org/10.1016/0306-4603(79)90011-X.
Macdiarmid, J. I., & Hetherington, M. M. (1995). Mood modulation by food: An exploration
of affect and cravings in ’chocolate addicts’. British Journal of Clinical Psychology, 34,
129e138. https://doi.org/10.1111/j.2044-8260.1995.tb01445.x.
Marrazzi, M. A., & Luby, E. D. (1986). An auto-addiction opioid model of chronic anorexia
nervosa. lnternational Journal of Eating Disorders, 5, 191e208. https://doi.org/10.1002/
1098-108X(198602)5:2<191.
Marrazzi, M. A., Mullingsbritton, J., Stack, L., Powers, R. J., Lawhorn, J., Graham, V., …
Gunter, S. (1990). Atypical endogenous opioid systems in mice in relation to an auto-
addiction opioid model of anorexia nervosa. Life Sciences, 47, 1427e1435. https://
doi.org/10.1016/0024-3205(90)90521-R.
Meule, A., & Gearhardt, A. N. (2014). Five years of the Yale Food Addiction Scale: Taking
stock and moving forward. Current Addiction Reports, 1, 193e205. https://doi.org/
10.1007/s40429-014-0021-z.
Meule, A. (2011). How prevalent is "food addiction"? Frontiers in Psychiatry, 2(61), 1e4.
https://doi.org/10.3389/fpsyt.2011.00061.
Meule, A. (2019). A critical examination of the practical implications derived from the food
addiction concept. Current Obesity Reports, 8, 11e17. https://doi.org/10.1007/s13679-
019-0326-2.
Moore, C. F., Sabino, V., Koob, G. F., & Cottone, P. (2017). Pathological overeating:
Emerging evidence for a compulsivity construct. Neuropsychopharmacology, 42,
1375e1389. https://doi.org/10.1038/npp.2016.269.
Patterson, R. (1993). Recovery from this addiction was sweet indeed. Canadian Medical As-
sociation Journal, 148, 1028e1032.
Pelchat, M. L. (2009). Food addiction in humans. Journal of Nutrition, 139, 620e622. https://
doi.org/10.3945/jn.108.097816.
Randolph, T. G. (1956). The descriptive features of food addiction: Addictive eating and
drinking. Quarterly Journal of Studies on Alcohol, 17, 198e224.
Rogers, P. J., & Smit, H. J. (2000). Food craving and food "addiction": A critical review of the
evidence from a biopsychosocial perspective. Pharmacology, Biochemistry and Behavior,
66, 3e14. https://doi.org/10.1016/S0091-3057(00)00197-0.
Rogers, P. J. (2017). Food and drug addictions: Similarities and differences. Pharmacology,
Biochemistry and Behavior, 153, 182e190. https://doi.org/10.1016/j.pbb.2017.01.001.
Rozin, P., & Stoess, C. (1993). Is there a general tendency to become addicted? Addictive
Behaviors, 18, 81e87. https://doi.org/10.1016/0306-4603(93)90011-W.
Rozin, P., Levine, E., & Stoess, C. (1991). Chocolate craving and liking. Appetite, 17,
199e212. https://doi.org/10.1016/0195-6663(91)90022-K.
Ruddock, H., Christiansen, P., Halford, J., & Hardman, C. (2017). The development and vali-
dation of the Addiction-Like Eating Behaviour Scale. International Journal of Obesity,
41, 1710e1717. https://doi.org/10.1038/ijo.2017.158.
Russell-Mayhew, S., von Ranson, K. M., & Masson, P. C. (2010). How does Overeaters Anon-
ymous help its members? A qualitative analysis. European Eating Disorders Review, 18,
33e42. https://doi.org/10.1002/erv.966.
Schulte, E. M., Avena, N., & Gearhardt, A. (2015). Which foods may be addictive? The roles
of processing, fat content, and glycemic load. PLoS One, 10(2), e0117959. https://doi.org/
10.1371/journal.pone.0117959.
Schulte, E. M., Potenza, M. N., & Gearhardt, A. N. (2017). A commentary on the “eating
addiction” versus “food addiction” perspectives on addictive-like food consumption.
Appetite, 115, 9e15. https://doi.org/10.1016/j.appet.2016.10.033.
Schulte, E. M., Potenza, M., & Gearhardt, A. (2018). How much does the Addiction-Like
Eating Behavior Scale add to the debate regarding food versus eating addictions? Interna-
tional Journal of Obesity, 42, 946. https://doi.org/10.1038/ijo.2017.265.
Scott, D. W. (1983). Alcohol and food abuse: Some comparisons. British Journal of Addiction,
78, 339e349. https://doi.org/10.1111/j.1360-0443.1983.tb02521.x.
Slive, A., & Young, F. (1986). Bulimia as substance abuse: A metaphor for strategic treatment.
Journal of Strategic & Systemic Therapies, 5, 71e84. https://doi.org/10.1521/
jsst.1986.5.3.71.
Stoltz, S. G. (1984). Recovering from foodaholism. Journal for Specialists in Group Work, 9,
51e61. https://doi.org/10.1080/01933928408412515.
Stunkard, A. (1990). A description of eating disorders in 1932. American Journal of
Psychiatry, 147, 263e268. https://doi.org/10.1176/ajp.147.3.263.
Swanson, D. W., & Dinello, F. A. (1970). Follow-up of patients starved for obesity. Psycho-
somatic Medicine, 32, 209e214. https://doi.org/10.1097/00006842-197003000-00007.
Szmukler, G. I., & Tantam, D. (1984). Anorexia nervosa: Starvation dependence. British Jour-
nal of Medical Psychology, 57, 303e310. https://doi.org/10.1111/j.2044-
8341.1984.tb02595.x.
Thorner, H. A. (1970). On compulsive eating. Journal of Psychsomatic Research, 14,
321e325. https://doi.org/10.1016/0022-3999(70)90060-7.
Thornley, S., McRobbie, H., Eyles, H., Walker, N., & Simmons, G. (2008). The obesity
epidemic: Is glycemic index the key to unlocking a hidden addiction? Medical
Hypotheses, 71, 709e714. https://doi.org/10.1016/j.mehy.2008.07.006.
Tuomisto, T., Hetherington, M. M., Morris, M.-F., Tuomisto, M. T., Turjanmaa, V., &
Lappalainen, R. (1999). Psychological and physiological characteristics of sweet food
"addiction". International Journal of Eating Disorders, 25, 169e175. https://doi.org/
10.1002/(SICI)1098-108X(199903)25:2<169.
Vainik, U., & Meule, A. (2018). Jangle fallacy epidemic in obesity research: A comment on
Ruddock et al. (2017). International Journal of Obesity, 42, 585e586. https://doi.org/
10.1038/ijo.2017.264.
Vandereycken, W. (1990). The addiction model in eating disorders: Some critical remarks and
a selected bibliography. International Journal of Eating Disorders, 9, 95e101. https://
doi.org/10.1002/1098-108X(199001)9:1<95.
Vandereycken, W. (1994). Emergence of bulimia nervosa as a separate diagnostic entity: Re-
view of the literature from 1960 to 1979. International Journal of Eating Disorders, 16,
105e116. https://doi.org/10.1002/1098-108X(199409)16:2<105.
Volkow, N. D., Wang, G.-J., Fowler, J. S., & Telang, F. (2008). Overlapping neuronal circuits
in addiction and obesity: Evidence of systems pathology. Philosophical Transactions of
the Royal Society B, 363, 3191e3200. https://doi.org/10.1098/rstb.2008.0107.
References 13
Weiner, B., & White, W. (2007). The Journal of Inebriety (1876e1914): History, topical anal-
ysis, and photographic images. Addiction, 102, 15e23. https://doi.org/10.1111/j.1360-
0443.2006.01680.x.
White, W. (2000). Addiction as a disease: Birth of a concept. Counselor, 1(1), 46e51.
Wilson, G. T. (1991). The addiction model of eating disorders: A critical analysis. Advances in
Behaviour Research and Therapy, 13, 27e72. https://doi.org/10.1016/0146-6402(91)
90013-Z.
Wilson, G. T. (2000). Eating disorders and addiction. Drugs & Society, 15, 87e101. https://
doi.org/10.1300/J023v15n01_05.
Wilson, G. T. (2010). Eating disorders, obesity and addiction. European Eating Disorders
Review, 18, 341e351. https://doi.org/10.1002/erv.1048.
Wise, J. (1981). Endorphins and metabolic control in the obese: A mechanism for food
addiction. Journal of Obesity & Weight Regulation, 1, 165e181.
Wulff, M. (1932). Über einen interessanten oralen Symptomenkomplex und seine Beziehun-
gen zur Sucht. Internationale Zeitschrift für Psychoanalyse, 18, 281e302.
Yau, Y. H. C., Gottlieb, C. D., Krasna, L. C., & Potenza, M. N. (2014). Food addiction: Ev-
idence, evaluation, and treatment. In K. P. Rosenberg, & L. C. Feder (Eds.), Behavioral
Addictions (pp. 143e184). London, UK: Academic Press.
Ziauddeen, H., & Fletcher, P. C. (2013). Is food addiction a valid and useful concept? Obesity
Reviews, 14, 19e28. https://doi.org/10.1111/j.1467-789X.2012.01046.x.
Ziolko, H. U. (1966). Zur Psychodynamik der Ess- und Stehlsucht (Hyperorexie und
Kleptomanie). Psychotherapy and Psychosomatics, 14, 226e236. https://doi.org/
10.1159/000285827.
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:
"Forgive him," she said. "You always make it up with us when we are
naughty. Perhaps you was naughty, or said something he didn't understand."
"It's him says things we don't understand," declared Peter, "and mother's
never naughty, and you ought to be ashamed to say it, Auna."
"We're often naughty without knowing it, Peter," explained Auna.
"Well, and if we are, how can we know we're naughty when nobody
tells us?" asked Avis. "Father won't speak to mother, and how can you make
it up if a person won't speak to you?"
"You can speak to them," said Auna.
Her mother was in the broken-spirited state when an adult will talk with
children as equals.
"I did speak to him, Auna," she said. "I prayed him to listen and tell me
what I'd done. But I'm never to hear him speak again."
"Then more won't I," declared Peter. "God's my judge, mother, if father
don't say he's sorry for being such a beast, I'll run away from him."
"And so will I," added Avis. "And if I was you, I'd run away too,
mother. Then where would he be?"
Auna, terrified at these words, crept out of the room and ran away to
hide her own tears. Then Margery dried her eyes and controlled herself.
"Don't you pay no heed to the silly things I've said—either of you. It'll
come right. And I won't have no hard words against father. A better father
and a kinder and more generous, no children ever had. So never let me hear
you say one word against him, for that I couldn't bear. He'll come home all
right I expect; and don't let him see nothing but smiles when he does. And
both forget I was such a silly mother as to cry about nothing. Where's
Auna? I've frightened the child. Now you be off to the kennels, both of you,
and sweep the snow away, and let's all be ashamed of ourselves."
Thus she sought to undo the mischief of her weakness, and partially
succeeded; but her own moods swept her like a cross-sea, and when the
interminable hours of the morning had passed, when noon came, and dinner
time, and still Jacob did not return, she began to lose her nerve again.
She yearned for her mother, and the longing grew until at last, unable to
endure more, she dressed for walking and slipped out of Red House
unknown to the children. At every turn of the way to Brent she expected to
meet Jacob; but he did not appear. He was coming back by Lydia Bridge
and reached his home an hour after Margery had left it. He guessed that she
had gone not to return, and was glad. He had spent the morning with his
lawyer, a man older than himself, who expressed deep concern at hearing
his opinions and prayed for patience and delay. Mr. Dawes had worked for
Jacob's father before him and felt staggered by this most unexpected
disaster. He read the record while Jacob sat and waited; then he argued for
time, for reconsideration and explanations—at worst a separation for the
family's sake. But he spoke to deaf ears and Jacob presently explained that
he was there to direct and not receive advice. The lawyer's talk appeared
worse than vain from his standpoint, for all was already accomplished and
only the details remained. His evidence assured the sequel. The incredulity
of Mr. Dawes made Bullstone impatient and the lawyer's lamentations he
nipped in the bud. He left explicit directions to institute proceedings for
divorce against his wife and cited Adam Winter as co-respondent. Once
more Mr. Dawes protested at the absurdity of the situation. Against Adam
no whisper had ever been heard. He enjoyed a reputation for plain-dealing
and stood well among the Chosen Few.
But Jacob declined argument.
"I'm here to issue orders," he said, "and you're here to carry them out. If
you won't, I can put my business into other hands."
Thus it was left and the solicitor, deeply concerned for both parties, read
and re-read Jacob's statement, yet felt the issue to be in the highest degree
doubtful. He could barely believe the truth of Bullstone's claims and he
suspected that the other parties might well deny them and fight him. He
perceived the horror of such a situation, and determined at any cost to
change his client's mind, if it were possible to do so. He decided for the
moment to brave Bullstone's anger and do nothing at all. He would at least
give the man time to grow calm and consider the gravity of his intentions.
As yet Jacob was far from calm; he stood too near the evidence of his own
senses, and Mr. Dawes perceived that he was beyond reason for the
moment. He left it and only hoped that Bullstone would not throw down his
challenge, and so drive his wife from him for ever.
But this climax was reached before the end of that day.
At dusk Mr. and Mrs. Huxam drove up to Red House in a cab, asked to
see Jacob and were shown into the parlour. They did not bring Margery, but
came for an explanation of her husband's conduct.
Jacob was in the kennels when they arrived and quickly joined them. He
brought in a lamp with him and set it on the table.
Barlow Huxam spoke as soon as the door was shut.
"Our daughter came to us this afternoon in a very poor way," he said. "It
seems that last night you swore before her face never to let her hear your
voice again. You kept your word to-day and went to Brent this morning and
didn't return. She waited until far beyond forenoon and then came to us. If
you can explain this in a manner to satisfy me and my wife, I'll be glad,
because on the face of it, it looks as if you'd took leave of your senses,
Jacob."
"I've taken leave of my honour, that's all," answered Bullstone. "Or it

would be truer to say that my honour has been stolen from me by my wife.
You understand what I mean no doubt. I've got proof positive and shall act
accordingly. I'm sorry for you too."
"Good God! You stand there and dare to say and think that Margery's
not faithful to you?"
"Saying and thinking matter nothing now. I've said too little, Barlow
Huxam, and I've thought too much. Now I know—I know. It's in my
lawyer's hands—Mr. Dawes—and you'll hear from him, if you're going to
stand for your daughter."
"Let's be clear," answered Huxam, who was now very angry. "Let's get
to the bottom of this, before we see you for the last time I hope. What shall
we hear from Mr. Dawes?"
"You'll hear that I'm going to divorce my wife for her adulteries—that's
what you'll hear."
"You dare to stand there before me and tell that damnable lie. Margery!
Margery! And you've lived with her for near twenty years and can think it!
What filth are you made of? What poisonous, beastly stuff has got into you?
Her—the clean, pure thing—with nought but honest blood in her veins and
honest thoughts in her mind! Her—adultery—you're a madman!"
"You'd better go," answered Bullstone quietly. "If she doesn't own it, so
much the worse. There's no defence for either of them. I'm not mad, though
my Maker knows I've endured enough to make me. I want to hear nothing
about her—or him. I want to be free, and I mean to be free."
Then Judith Huxam spoke. She had been sitting motionless while her
husband walked up and down the room. She had turned very pale, when
Jacob stated his determination, and she had put her hand up to her breast
and kept it there. She was quite collected and showed no emotion.
"And who is the man, Jacob Bullstone?" she asked.
"Adam Winter is her paramour."
"That godly, steadfast creature!"
Barlow spoke and bade his wife rise and accompany him.
"We'll be gone. This must be answered by others than us," he said.
But Mrs. Huxam did not move. A strange expression was in her face.
She looked coldly and curiously at Jacob. Then a faint flush lightened her
pallor.
"The mills of God grind slow but exceeding sure," she said. "I
understand; I know what's happened now, and you'll know presently.
Eighteen and more years ago I came into this room for the first time, and I
saw a sight that shook me to the roots of my being. I saw that you'd flung
another book to lie on the Bible. Looking back, I've often wondered why I
didn't stop your marriage with our daughter on that. But the Lord chose that
things should go on; and they went on. And He was looking ahead to this;
and, in His mercy, He showed me yesterday that nothing better than this
could have happened. He showed me yesterday, when you spoke
blasphemies in my ears, that it was time Margery left you if she was to save
her soul. So I'm not surprised at what you've told me to-night. This is all
God's plan. He chooses strange tools to do His work, as you said yesterday,
and He's chose you yourself and no other, to part you from your wife. You
understand that, don't you? It ain't Adam Winter, or any other man, that's
come between you and the mother of your children. It's yourself—led to it
by an outraged God. You are one of the doomed and always was, as I've
known too well these many days, though, Christian like, I hoped and prayed
for you. But the Lord knew, and He's took our child from the evil to come
and—hear this—He'll take your children from the evil to come also. There
must be offences, Jacob Bullstone, but woe—woe to them that bring them!
Our child shall hear your voice no more as you have sworn; and neither
shall you hear her voice, nor see her again, nor yet her shadow. If you'd
been a saint till now, this piece of work would have damned you, and
henceforth you'll go the scorn of every self-respecting woman and the hate
of every man. And you'll call on the hills to cover you, but they won't."
She got up and looked at her husband.
"Now we can go," she said.
"And understand this," added Barlow, whose voice, even in passion,

sounded genial and mellow contrasted with his wife's—"Mind this, you
dirty dog, if I spend every farthing I have on earth, and have got to borrow
more on my knees from my neighbours, I'll fight you to the end, till my
daughter's righted in the face of the nation. And when that's done, may God
help you, for there won't be any other party to do it. And Winter will say the
same."
Jacob was unshaken.

"The spoken word remains," he answered, "and the long story remains
—every item—stamped in my brain for eternity. They may lie; but justice is
justice. No power on earth can undo what's done, or leave it doubtful."
"You speak true," said Mrs. Huxam. "God Almighty will see to that.
There'll be no shadow of doubt on earth, or in hell, or heaven, when this is
blazed to the light."
They went out to drive away. Snow had begun to fall again and the full
force of a blizzard was reserved for this night.
"Best tell your driver to go by the lower road," said Jacob calmly, as he
stood and saw them depart. "There'll be drifts already on the other way."
BOOK II
CHAPTER I
CHORUS
Within a month of his wife's departure, Jacob Bullstone began to

perceive the full significance of the thing that he had done.
He learned that his petition would be opposed and he received from

Barlow Huxam a cheque, being the present market value of the land on
which the postmaster's house was in course of erection. And time had
opened his eyes to other issues, for he found that the sympathy he
anticipated was not forthcoming. Acquaintances evaded him, and when he
expected his few friends to express regret at his misfortunes, they did not.
Indeed all were anxious to avoid the subject on such occasions as they were
unable to avoid him. From a brief, unnatural quest of fellow-creatures,
therefore, and an inner impulse, to seek a spirit of support, Jacob soon
turned back into himself, since no such spirit appeared. Time dragged and
he grew more and more restless on discovering the body of public opinion
ranged against him.
One thing he had done, two days after the outrage that demanded it. He
had first written to Adam Winter expressing his regret for his violence; and
he had then torn up the letter and gone to see the master of Shipley in
person.
He learned that Samuel Winter was ill and Adam on the land. Their aunt
spoke to him, and if looks could have done him evil, Jacob must have
suffered. She answered his questions with the fewest words possible, then
shut the door in his face.
Jacob sought Winter, found him presently, walked up to him and spoke.
"I only want to say this: that I'm sorry I struck you. I was three parts
mad at the time. But I did a wrong thing to assault you and I'm prepared to
suffer my penalty in that matter."
Adam was not at work. He walked on the sheltered side of a hedge, with
his hands in his pockets, and now he looked curiously at the other.
"Do such a trifle as that trouble you?" he asked. "Well, I've heard you.
Now you'd better go. There's nothing to be said between us till I answer you
afore the law."
"Are you wise to deny it and bring me to the proofs?"
The other cut him short.
"Go," he said, and Jacob turned away.

He puzzled not a little to understand why his wife's family were
prepared to defend the case, and supposed that they must honestly believe
their daughter to be wronged. He explained this on the assumption that
appearances set against the likelihood of such an offence, and they knew
not that the final evidence was in his own possession. He had conversations
with his lawyer and found Mr. Dawes not in the least helpful. The old man
had obeyed him with extreme reluctance; but he did not pretend to be in
sympathy with his client, and the fact that both Jacob's wife and Adam
Winter were prepared to oppose the appeal and deny the offence went far to
make Mr. Dawes still less sanguine. He tried again and again to change
Bullstone's mind and failed; but his attitude served to create increased
bewilderment in the other. Indeed Jacob puzzled to see how isolated he had
become. The fact made him still more determined and still more distrustful
of everybody but himself. He resented such lack of understanding and was
impelled by it to trumpery emotions, ridiculous in the light of his present
huge affliction. They persisted, however, and his wounded pride drove him
forward with increasing obstinacy to fight to the end, that his wrongs might
be proved and his justification appear. There awoke a desire to confound
those who now set flowing the tides of criticism against him. They came as
a new thing, contrary to experience, for he had always understood that the
betrayed husband might count upon the support of most serious-minded
people. At home there was no pity for him save in one quarter. The children
came and went from their grandparents, and he had expected that they
might bring messages; but they never did. Not a syllable ever reached him
from his wife, or from the Huxams. Indeed his own boy and elder girl were
restive and taciturn under this terrible situation. Once Avis reported that
Margery was ill, and Peter openly corrected her for mentioning her mother
at Red House. Only Auna continued trustful, but she missed her mother and
was very downcast and silent. She, too, went to see Margery; but even she
had nothing to say on returning home.
Once Jacob asked Auna if her mother were at the post-office; but the
girl only looked frightened and shook her head. Whereupon he soothed her.
"Don't take on, Auna. Trust me. The others can't, but you understand me
best. You must trust me as much as you love me. Mother and I have got to
part, because she has done what I can't forgive. Indeed she wouldn't come
back any more if she could. She won't want to do that. But I hope you'll
stop with me, because I don't see how we could ever live without each
other. But you must all decide that for yourselves when I've been to
London."
It was a strange speech to Auna's ear, yet she felt no doubt. To live away
from her mother seemed a terrible thought, but life away from her father
must be impossible. She told herself that she would sooner be dead than
live without him, and she assured him of the fact; whereupon he warned
her.
"Always think that whatever may happen," he said. "There will be

people who will tell you that I am the wicked one; but everybody will know
differently before very long. For God forbid that I should tell anything but
the truth, Auna; and the truth is enough. And many hate me and speak evil
against me, and I know Avis and Peter believe it, and John Henry believes
it, else he'd have been over to see me before now. But you mustn't believe
it. You mustn't let anything come between us, Auna."
Already with proleptic instinct he sought to tighten the bonds between

the child and himself; already he felt that a time might quickly come when,
of all his family, she alone would be left. But only a passing mood
prompted him to this scene with the girl. Again and again, while time
dragged intolerably and he smarted under consciousness of the people's
aversion, he calmed himself with assurance that time would soon vindicate
and justify. Then those who now lacked pity for his plight, or anger against
his wrongs, would be the first to come forward and acknowledge their
errors.
One supporter he had—of a sort who rather embarrassed him than not.
Yet the new kennel-man, George Middleweek, was staunch enough, and
having gleaned particulars of the situation, though not from Bullstone,
resolutely upheld Jacob.
Middleweek succeeded Barton Gill, who had now finally withdrawn

from Red House to live in a cottage half a mile distant, and since the new-
comer's character was clouded by past intemperance, he entertained a lively
regard for Jacob, when he took him on trial against so grave a fault. But Mr.
Middleweek understood dogs and promised to be valuable. He swore by his
new master from the first and also won Peter's regard.
He was a widower of fifty, and he had the wit to take something of

Jacob's measure after a month at Red House. Then he ventured on a friendly
word or two and feared that he had been unwise, since Jacob took no notice
at the time; but, later on, George perceived that his goodwill had been
acceptable.
A week before all interested parties would be called to London,

Bullstone visited William Marydrew, though a shadow now existed between
them. For even William proved no whole-hearted friend in Jacob's opinion,
and he had been astonished to find that the old man terribly doubted.
William declared the tragedy a personal one; he felt for both parties and
was aged by a misfortune so unexpected.
"I thought nobody would question that I was right," said Jacob, "and yet
such is the regard in most people for the woman over the man that even you
——"
"But you can't well understand, from your own-self point, how this
looks to the world at large, including me," explained William. "It's come on
all the nation like a bolt from the blue, because no thought of such a fatal
thing ever fouled the air. The dirtiest tongue would not have dared to
whisper it. 'Tis beyond belief and experience of the parties; and what seems
the gathered knowledge of many days to you, falls on our ears like a clap of
thunder. And so you can't expect folk to side with you as a matter of course,
Jacob. On the contrary, 'tis the last thing you might have expected with such
a record for fine living and clean behaviour as your wife has. And the last
straw was when we heard that she and Adam Winter deny and defy you and
he going to stand up for their good names. The common people don't know
much, but where human nature's the matter, they be quite as clever as the
scholars, and often a damn sight cleverer; because the poor are up against
human nature all the time and life teaches them the truth about it; whereas
the other kind miss it, owing to book larning being so mighty different. And
hearing that Adam and Mrs. Bullstone are going to fight you, the people
take their side; because well they know they wouldn't stand up before a
judge and jury if their cause weren't good. No—they'd cut and run, as you
expected to see 'em."
"The people argue without knowledge of the facts," answered Jacob;

"but you, who have heard the facts from me in secret and know whereon
my case stands—how you can still hold the balance against me, for all our
long friendship—that puzzles me, William."
"I'm a truthful man where my memory will let me be," answered Mr.
Marydrew, "and so I won't pretend anything. Words have as many meanings
as a songbird have notes, Jacob, and the ear be often bluffed into believing
things by the mind that is hungry to believe 'em. Against the words, which
sounded to your ear as if them two was in each other's arms, you've got to
balance what's mightier than words. That's deeds and the conduct of a
lifetime, and principles that have never been doubted. Winter's life all men
know. He's religious in a true sense, and though I've got no use for the
Chosen Few, no more than you have, yet you can't deny that there's never
been one of 'em catched out in a crooked deed."
"It's that canting, stiff-necked sort who always are caught soon or late,"
answered Jacob, "and I'll say this, William: I believe that if my late wife had
had her way, she'd have been much too clever to take this line. She knows
the damnable truth in her heart, and she's been driven into denying it by her
parents—not for her own sake, but their credit. She never told them the
truth of course. And if she had, seeing there are no witnesses that I can call,
they'd deny it."
But Billy shook his head.
"Mrs. Huxam wouldn't have made her husband fight for a lie. She
believes that her daughter is a wronged woman, and she'll be true to her
rooted faith, that this has happened for good by the will of God. Of course I
don't believe that everything that happens is to the good myself, but Judith
Huxam holds to that opinion, and she's saying that what you've done puts
you down and out for eternity, while it opens the door to your wife's
salvation, which you were making doubtful. You'll find that this dreadful
job won't shake her in her opinion, that God's behind all; and the upshot
won't shake you in your opinion, that God have nothing to do with our
disasters—beyond building us in a pattern that's bound to breed 'em.
"You and me agree that the evil that matters to us comes from within—
so there you are. And the pity is that the evil we breed can't stop with us,
but must pour over for other people; and that again shows it isn't only the
evil we breed from within matters, because we be all called upon to suffer,
more or less, from the evil that others breed. In fact 'tis a very pitiful come-
along-of-it every way and I wish to God I'd gone to my rest afore it
happened."
Thus William discoursed; but he did not depress his hearer. Jacob
Bullstone could only wonder at the blindness of his neighbours. He wasted
no more time in resenting it. He only pressed forward to the hour when all
would justify him and grant that he was not deceived.
Billy changed the subject, though that was difficult to do. During these
tumultuous days he dreaded the appearance of Bullstone and sometimes
even made shift to avoid him. For, like many others, he was deeply sensible
of his friend's approaching downfall and, unlike many others, who now
hated Jacob, he—a lifelong friend—mourned for the future and feared the
shape that it must take with such a man.
"How's your new hand, George Middleweek?" he asked. "He's a chap as

knows his own mind—faulty though it is."
"A success. I like him, because he is sane and understanding. After

Barton Gill he's a comfort. He has character and a pretty good knowledge of
life. And he won't fall over the drink again. I've let him into my feelings a
bit—not about my troubles, but my opinions in general. He's a widower and
doesn't trust religious people, nor yet women."
William laughed at this description.
"So much the more time to give to the dogs. I've often known them as
was devoted to dogs didn't like women. Yet, though they be oftener
compared to cats, I've known a good few dog-like women also. Not so
much dog-like towards men, but dog-like to duty and religion and children
and so on. My daughter, Mercy, was such a woman. Duty and religion were
one with her. In fact duty was her religion and she made it a very good
working faith. For what more can you ask of religion than to keep you out
of mischief and to make you live in honesty and charity with your
neighbours? That's reality; but a lot of religion is not. I knew a saint of God
once, and she was on all accounts the most objectionable woman I ever did
know—made the very thought of Heaven chilly. A bleak, holy woman, as
never did a wrong thing, or thought a wrong thought, and yet left the bulk
of her neighbours in a beastly temper after she'd been along with them five
minutes. How she did it nobody could understand. The very parson she sat
under gave her a miss when he could."
"Women have wronged men far oftener than men have wronged them,"
said Bullstone and William sighed doubtfully.
"There's less understanding between the men and women than there
was," he answered. "Education drives 'em apart instead of draws 'em
together. The women be getting so famous clever that they see a lot about
us that used to be hidden from 'em, and we don't bulk so grand in their eyes
as we did. They have a deal hidden in 'em that's been waiting to come out;
and now it's beginning to do so. It was always there, mind you, but hid
under ignorance, and I say us men haven't half known our luck all these
years."
Jacob listened.
"They're changing for the worse," he said.
"They are trying out the stuff hid in 'em," repeated William. "Woman be
God A'mighty's last creation, Jacob, and no doubt He worked into 'em
pretty near everything He'd got left over. Us never will understand all there
is to 'em, and only a fool thinks he can."
"I was such a fool."
"Don't drag yourself in. Keep your mind open. That's what I pray you to
do. You've appealed to the Law and you must abide by the Law. And if it
holds that you are mistook; then——" He broke off and took the younger
man's hand.
"I'm your friend, be it as it may," he said.
Jacob nodded, shook the ancient hand and went his way without words.
For a moment he considered William's broken sentence, but could not

see what might have finished it.
Indeed Mr. Marydrew himself felt the fatuity of any ultimate thought or
hope at this crisis.
With very genuine grief in his eyes he watched Bullstone depart.
"Broke on the wheel of the world, because he weren't turned true," he

said to himself. "But which of us be? Which of us be? Not one."
CHAPTER II
VERDICT
Spring had conquered the river valleys and was climbing to hilltop
again. Those old pack-horse tracks, where bygone generations of beast and
man have gradually beaten the ways down and down, until they run lower
than the fields and the woods about them—those deep, heat-holding
Devonshire lanes were dowered with green once more and lush with young
leaves and fronds. At their feet opened wood sanicle and dewy moschatel;
crowning them the bluebells wove their purple and scattered their
fragrance; beside rill and water-trough golden saxifrages shone, and the
wood strawberry was in blossom with the violet.
Amelia, after noon on the day that followed Adam Winter's return from
London, put on her sunbonnet and taking a man's walking-stick, which she
had always used since her illness, crossed Shipley Bridge, passed over the
green space beyond and presently reached the home of Mr. Marydrew. She
knocked and he came to the door.
"Morning, Billy," she said. "I thought you'd like to know how it went.
Adam got back last night and just catched a train after the verdict was
given. T 'others come home to-day—so he believes."
"I needn't ax you for the verdict. I see it in your face," he answered.
"But come in and tell me, what you've heard."
She sat by his kitchen fire presently and tapped the ground with her
stick to drive home the points. He listened without comment.
"'Tis a triumph for the Chosen Few against the ways of darkness,"
declared Amelia, "and it went very much indeed as you said it would; and
we won't talk about him, nor yet the proper wreck and ruin he's made of
himself, because we shan't agree about that. But this is what happened. He
said what his beastly thoughts made him believe was the truth; and his wife
and my nephew told what was the real truth; and then his great weapon
against them broke his own head. He gave out certain words, that he swore
he'd heard Margery and Adam use in Adam's own bedroom by night. He'd
heard Margery say, 'Quick, quick—there's a dear'; and he'd heard Adam say,
'Come, then—come.' And Margery had laughed."
Mr. Marydrew nodded.
"That was his tower of strength; but I always warned him he might have
heard wrong, and that if they denied it there was only his word against
theirs."
"They didn't deny it," answered Miss Winter. "Like the truthful
creatures that they are, they admitted every syllable—and why not? For
how were them words said do you suppose? The truth was this. Poor
Samuel had been struck down by the illness just after Adam recovered.
Margery had brought some nice food for me, and Adam had axed her to
come upstairs and coax Samuel to take his medicine, which he refused to
do. It was in Samuel's room and to Sammy himself, while she offered him
his physic in a wine-glass, that Margery said, 'Quick, quick—there's a dear';
and it was to Samuel that Adam said, 'Come, then—come.' And then
Samuel had bolted his physic and Margery had laughed at the face he
pulled. And when they heard that explanation, the jurymen believed it. They
had long got restive and weary of the whole piece of nonsense, and now
they said they were satisfied, and Adam says that anybody could have seen,
even before the jury spoke, that the judge was also terrible tired of it. The
great judge summed up on the evidence that Bullstone brought forward, and
that his wife and Adam explained, and he talked mighty straight to the
petitioner—that's Jacob Bullstone—and told him that he'd let vain
imaginings get hold on his mind and allowed his jealousy to poison his
vision and his sense of justice and honour to his wife and to the co-
respondent—that's my nephew. He said that in his opinion it was a dreadful
thing that good money and good time should have been wasted over an
obstinate and mistaken man's error. Then he talked to the jury, and presently
the jury went out. But in three minutes by the clock they was back in court
and dismissed the petition with costs, and all his fabric of lies and flimsy
fancies was down in the dust. And that means Bullstone can't get no
divorce, and Margery and Adam come out of it without a shadow upon 'em,
and her hateful husband have got to pay the lawyers every penny and all the
expenses. Because the judge agreed with the verdict, and went so far as to
say that there were no grounds whatever for the suit, and that it should
never have been brought. In a word right has triumphed, and I shall always
think a lot more respectful of the Law than I have in the past."
"Costs follow the verdict, of course," answered Billy, after considering

this matter in silence. "And what else follows it? We shall see as to that.
Time must pass. A good flight of time be the only thing for all parties,
Amelia."
"Time can do a lot," she said, "but it can't undo what's done; and if you
think——"
"Let time pass," he repeated. "Only time will heal the sores."
"You needn't talk like that," said the old woman. "Adam haven't got no
sores, except natural sorrow for an ill-used woman. For himself, nought can
gall one like him. He's above the people's blame or praise, for when a man
goes into a law court, and gets mauled by a paid lawyer, whose business be
to show him in the wrong; and when he comes out of it with only the
respect of his fellow-creatures, and never a stain on his life and history—
then you may reckon he's a bit out of the common. And she was white as
death in court and fainted once. And my nephew's terrible sorry for the
woman, and sorry for himself, too, because he says he can never have any
more to do with her. It's a natural instinct in him that they must be nought to
each other after this; and I doubt not Margery will feel the same. Their lives
can never touch in friendship no more, William."
"Very like they would both feel so," admitted Billy. "And what does
Adam say about Jacob Bullstone?"
"He won't name him, and when Samuel cursed him and threatened great
blows against him, Adam bade his brother be careful to do no evil. All he
said was that Bullstone would suffer last and suffer longest."
"A very true saying, and your nephew be the wisest of all concerned,"
declared the old man. "For Adam this came as the greatest shock, because it
burst upon him more unexpected and terrible than on the woman even. She
knew her husband's weakness and, for brave pride, hid it from all eyes,
including Adam's. And he will agree with me that 'time' is the only word."
"In your opinion it may be," answered Amelia; "but in the opinion of
the Chosen Few, I reckon 'eternity' will be the only word. And don't you
think, or dream, or tell Adam, or this fool, Bullstone, or anybody else, that
time be going to soften it, because there's plenty of righteous people about
as will take very good care that time does no such thing."
"That's what I'm afraid of," admitted Billy; "but don't you be one of
them, my dear. If us would only let time, like patience, do her perfect work,
wounds might often heal that never do; but no doubt a lot of godly folk
won't be content to stand by and leave this pair in the hands of God."
"What God wills must happen," answered Amelia, "but you may bet
your life, William, He won't will to bring them two together again; and
nobody but a vain thinker and a man weak in faith would hope such a
horror. However, you can very well leave Margery to her Maker and her
mother; and as to her husband, if he was a man, he'd hang himself."
"Don't you be angry," urged Mr. Marydrew. "Your nephew have come
out as he went in, without a shadow upon him. For the rest, don't you cast a
stone. That ain't like you. Let charity conquer."
"You're his side we all know," answered Miss Winter; "and I'll give you
a warning for yours. Don't let your sense of justice go down afore the
wicked man. He'll gnash his teeth no doubt and wring his hands; but don't
you try to come between him and his punishment, Billy, because you can't."
"True. I can't," he replied. "If you knew Bullstone like what I do, you'd
have no fear he was going to escape anything."
Then Amelia astonished him by a penetration for which he had not

given her credit. Her intuition may have sprung from anger—a fruitful
source of bitter truth—but it threw a light upon what might presently
happen, and William was not prepared, though much inclined, to contradict.
"You say that. But a woman always knows one side of men better than
any man can, and old maid though I may be, I'll tell you this. Bullstone ain't
the sort to lie in the dirt for his sins and scrape himself with potsherds.
Don't you think that. He'll snatch at hope, like the drowning at a straw. He'll
look at it all from his own point of view, as usual, and fifty to one he'll fool
himself there's a way out. Yes—he won't see himself as all clean and honest
men see him, William. He'll only see that his wife's a pure woman and that
he was mistook to think her a whore. And what then? Have he got the
decency to pour ashes on his head for shame, and slink away from the sight
and sound of men? Not him! He'll say Margery's worthy of him, after all,
and that he must have her home again. He'll expect presently to find her
forgive him like the Christian she is, and it will be his fixed dream and hope
to win her back at any cost—till he wakes from the dream and the hope
dies. And not till then will his true punishment begin. That's Jacob
Bullstone, and that's the man his wife knows, and we know, and you'll live
to know. Far ways off what you pictured—eh?"
The ancient doubted.
"What you say about a woman knowing a side of man's mind that other
men do not, be very likely true," he answered. "But I trust you will live to
see yourself mistook in this matter. It's a great thought and you may be
right; but if that happened, along with it would go a lot more that's in the
man, which I know and no woman does. I can only say again, let time take
charge, and I wish nobody else but time was going to have a hand in it."
While they talked, Adam Winter wandered, unseeing, among his sheep
on the hill with his hands in his pockets and a sense of anticlimax in his
soul. The excitement was ended. He had seen himself justified and cleared;
he had seen an innocent woman pitied; and he had seen Bullstone
confounded. Now he was in the midst of sweet things and breathing fresh
air with the heights rolling before his eyes and the larks aloft. But no
exhilaration, only a sense of sickness and misery hung over him. He, too,
longed for the time to pass, that the sordid memories of the trial might grow
fainter.
Elsewhere Jacob Bullstone travelled from London and sat wrapped in
his thoughts. But they were no covering for him. They fled past in wild rags
and tatters, as the steam across the train window; and he could not frame a
consistent argument, or follow any line of reasoning. All was chaotic,
confused, hurtling, and every thought lashed like a whip. He struggled
against the rush of ideas as a man against a blinding storm. He could clutch
at nothing for support; or perceive any steadfast glimpse through this welter
of what the future held in store. He was too astonished to suffer much as
yet, save unconsciously, as an animal suffers. The reality, as it had
developed in a law court, took a form so utterly unlike that which he had
accepted as reality, that simple amazement reigned in him for a long time. It
supported him in a sense through the trial and, now, as he came home, it
gradually gave place to bewilderment, which, in its turn, quieted down until
the stormy waters of his mind grew sufficiently smooth to offer a reflection
of the situation newly created, and he began to trace the picture of the
future.
He was trying to appreciate this evasive vision and find some firm,
mental rock for his own feet when he got home again. But as yet nothing
clearly emerged, and as often as he clutched at a steadfast-seeming point
from which to start thinking, the image broke up under the storm swell
which still swept through his mind. He felt as one in the presence of death.
He desired to know, now that this earthquake had fallen upon him and his,
who were left alive. He felt himself to be first among the dead, and
believed, until much later, that existence could only be a living death
henceforward.
Then he tramped after noon through the lanes, carrying his bag and
sweating under the black clothes he wore. He pursued the familiar way,
walked, ridden, driven a thousand times from boyhood to manhood, and he
found an empty, peaceful spot in his brain that could see the bluebells and
mark the breaking riot of the green. This consciousness of spring served to
revive an element which had persisted with him during the past destruction
and denunciation of the Divorce Court. He had listened humbly to the
appalling errors the Law declared him to have committed, and he had
viewed without passion the naked picture of his mistaken suspicions—each
displayed and each destroyed by truth in turn. He felt no rage at this

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

Uploaded by

Copyright:

Available Formats

You might also like

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

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

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

Uploaded by

Copyright:

Available Formats

Compulsive eating behavior & food

addiction: Emerging pathological

Eating Disorder Tools Overcome compulsive eating 1st

Neuroscience for addiction medicine : from prevention

Compulsive Sexual Behavior Disorder Understanding

Brain Lock Twentieth Anniversary Edition Free Yourself

Food and eating in America : a documentary reader 1

Eating in Us National Parks : Cosmopolitan Taste and

Organizing Eating : Communicating for Equity Across

Emerging Technologies For Promoting Food Security

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

Library of Congress Cataloging-in-Publication Data

For information on all Academic Press publications visit our website at

Publisher: Nikki Levy

Typeset by TNQ Technologies

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

"We're often naughty without knowing it, Peter," explained Auna.

"You can speak to them," said Auna.

But Jacob declined argument.

Barlow Huxam spoke as soon as the door was shut.

"I've taken leave of my honour, that's all," answered Bullstone. "Or it

"And who is the man, Jacob Bullstone?" she asked.

"Adam Winter is her paramour."

"That godly, steadfast creature!"

"We'll be gone. This must be answered by others than us," he said.

She got up and looked at her husband.

"Now we can go," she said.

"And understand this," added Barlow, whose voice, even in passion,

Jacob was unshaken.

Within a month of his wife's departure, Jacob Bullstone began to

He learned that his petition would be opposed and he received from

"Are you wise to deny it and bring me to the proofs?"

The other cut him short.

"Go," he said, and Jacob turned away.

"Always think that whatever may happen," he said. "There will be

Already with proleptic instinct he sought to tighten the bonds between

Middleweek succeeded Barton Gill, who had now finally withdrawn

He was a widower of fifty, and he had the wit to take something of

A week before all interested parties would be called to London,

"The people argue without knowledge of the facts," answered Jacob;

But Billy shook his head.

"How's your new hand, George Middleweek?" he asked. "He's a chap as

"A success. I like him, because he is sane and understanding. After

William laughed at this description.

"They're changing for the worse," he said.

"I was such a fool."

"I'm your friend, be it as it may," he said.

For a moment he considered William's broken sentence, but could not