Exploration of food addiction in people living with schizophrenia [accepted manuscript]

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The term “food addiction” denotes a concept among researchers and lay consumers as a behavioural phenotype related to excessive food consumption. The concept is in parallel to clinical criteria for substance dependence and may aid in our understanding the psychological factors on weight gain (Hebebrand, Albayrak et al. 2014). While there is a lack of consensus whether the entity of food addiction constitutes as a true and valid addiction (Pai, Vella et al. 2014), the literature on food addiction has grown rapidly due to operationalization of the DSM-IV diagnostic criteria for substance dependence to eating behaviours utilising the Yale Food Addiction Scale (YFAS) (Gearhardt, Corbin et al. 2009). Weight gain and morbidity in schizophrenia has a multifactorial origin. Antipsychotic medication, physical activity, socio-economic status, substance dependence including tobacco, alcohol and illicit substances as well as a poor diet, defined by a higher intake of saturated fat and low consumption of fibre and fruit are all known factors (Hjorth, Davidsen et al. 2014). Substance dependence and abuse has been identified as a common phenomenon in schizophrenia and the self-medication hypothesis has been postulated to explain the epidemiologic co-morbidity. Khantzian (Khantzian 1997) hypothesised that substances are taken for their psychotropic effects on the negative symptoms, thereby providing a clinical benefit such as reduced anhedonia or boredom. However, the long term substance abuse exacerbates acute episodes and complicates treatment in schizophrenia (Batel 2000). The knowledge of clinical factors predicting risk of obesity in schizophrenic populations that are more prone to weight gain, metabolic syndrome and related brain dysfunction is prudent. If food addiction is a true and valid addiction, the self-medication hypothesis may explain the burgeoning intake of hyper palatable food stuffs thus creating a poor nutrient intake profile and resultant obesity and metabolic disease. To our knowledge, no studies using the YFAS have been conducted among a sample of free-living people with schizophrenia attending an outpatient clinic. Such data is necessary to identify the phenotype for studying the relationship between obesity and neuropsychiatric diseases (Hjorth, Davidsen et al. 2014). Hence, the aim of the present study was to examine the prevalence of FA using the dichotomous version of YFAS as well as the dimensional symptom count. In addition, we explored associations between participant characteristics and FA diagnosis. Given the review of the literature and neurobiological overlaps in schizophrenia and addiction our hypothesis is that the prevalence of food addiction will be higher in schizophrenia than the general population.


School of Allied Health

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Open Access Journal Article

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Open Access

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