Table 3.

Exemplary quotes illustrating food addiction symptoms by consistency with DSM 5 criteria for substance use disorder.

	Consistent with DSM 5	Inconsistent with DSM 5	Can’t be Categorized
Loss of Control	“I transferred my alcohol addiction to ice cream and sugar. It got to be that I would buy a carton of ice cream and I’m like, “I’m only gonna have a half a bowl”, or whatever, and I would end up eating the entire carton. There’s just no stopping.”	“I started using that app, Noom. And tracking calories and I was able to lose 10 pounds which I felt helped and was really good for self-esteem, but tracking calories, I was like, “Oh, wow. I don’t need to eat nearly as much as I do normally.” And since then, I’ve noticed like, “Oh … “ I wouldn’t even identify this as a feeling before of where I feel sluggish, or just bloated.”	“I think a lot of the times, I’m just bored, so I’m eating even though I don’t actually feel the signs of hunger. It’s like if I’m in front of the computer for a really long time or especially if other people are eating, I just feel like I need to be eating too.”
Inability to Cut Down	“I can’t even count the number of times that I’ve been like, “This is the last time. I’m not gonna do this again.” And I’ve tried different methods. I’ve tried keeping a notebook and listing what I eat each day. I’ve tried keeping a white board on my wall […] I’ve tried making promises to myself, or making deals with myself … ‘If I don’t overeat this month, I can eat as much as I want on Thanksgiving.’ And, of course, I never keep to it.”		“I would go back to times where you’re trying to be more carb-restrictive, especially. But I think my body knew, whether I was trying to deny it or not, that I needed more of something like that if I wanted to have the same physical activities that I was trying to do. “
Time Spent	“I would literally go from Meijer to Kroger if they didn’t have the specific ice cream … It was coffee ice cream. If they didn’t have any, I would leave that store and go to another […] So yeah, I would definitely go out of my way. It was really pathetic, leaving a store to go to another and get ice cream. Why couldn’t I have vanilla?”	“I eat in short chunks of time and I kinda do it as I’m doing something else. If I’m heading out to go walk in the woods for pictures, I’ll grab an apple and eat that while I’m out, when I begin to walk […] Or snack in the car. So that I’m not spending a lot of time dedicated to it ‘cause I got so many other things going on.”	“I wasn’t sure about that particular question because a lot of that goes with being 300 months pregnant (i. e., being overweight/obese). Sluggish and tired is part of the deal that directly relates to food.”
Activities Given Up	“I didn’t wanna go to this event, because I kind of had it in my head that I was done eating for the day and if I go there, I’m going to order a drink, and get a snack and stuff, and I don’t want to do that even though I probably should be more social.”		“I think that I’m not as focused with people around me ‘cause I’m thinking of food, and I’m not able to do as much because I feel like the important things have been done when I eat. That’s the most important thing.”
Interpersonal Problems	“My husband. Sometimes, he’s just like, “Really? You know how much you can eat. How does this happen?” So, he gets frustrated.”
With-drawal	“Stopping sugar is … that’s definitely an irritating thing. Once you get past three or four days, it’s fine. But you can definitely tell it’s not a good thing. I get very short-tempered, kinda like quitting smoking. Just, “Don’t talk to me.” I wanna just pretend that nothing is going on and just get through this. And once you do that it’s fine. It’s like, “Wow, I feel so much better after this.”	“I definitely eat foods to feel better if I’m sad about life circumstances.”	“I’m so emotional that it’s physical … I think I do feel a tiredness … Even though I feel sluggish after eating, when I don’t eat certain foods, I feel tired. It’s probably psychosomatic.”
Tolerance	“The food doesn’t give me as much enjoyment as it did before, so I’m eating the same amount but it doesn’t seem to give me the endorphin high or whatever. I don’t know, I just … I’m just waiting for it to come back.”	“I suppose that that’s the problem with a lot of people who overeat. You’re stuffing things into places so you don’t have to feel, right? So, if I’m having a bad day, “I wanna have a cookie, I’m gonna have a cookie”“	“I was thinking about how when you were a kid and you got a slice of pizza or two, and you were just so happy with that one or two slices. And now I have one or two slices and I’m like, “This was nothing, I need something else.” And it’s either more pizza, or some type of vegetables or something.”
Role Obligation	“Not cleaning up. I let the kitchen just get out of control. I won’t even get dressed. So it’s like the kitchen and the rest of the house will really be out of control, and all I want to do is get some snacks and get back in the bed and watch TV.”		“When I get a hungry or if I want food, I’m gonna eat. So whatever, it’s gonna have to hold on for a minute.”
Consequences	“I shouldn’t say it has not in any way made me happy because the actual eating brings me instantaneous joy. But, far outweighing that is how bad I feel afterward … whether it’s shame, sadness, guilt, whatever.”		“I [had] just left the doctor’s office, and of course things were getting a little better, but I’m still not in the clear. So it’s just on my mind but I would still go out and get whatever I want to eat afterward and not think about it. Then it comes back later about the guilt, but yeah, it seems like sometimes it’s almost like even if I was just reminded 5 min ago, it won’t matter 5 min from now.”
Craving	“When I have certain cravings, like nothing is satisfying. So that’s … I would go to the store to get that certain food or that certain taste. If I … Like I have a taste for chocolate then I have to have chocolate. It doesn’t matter if I got other snacks or candy or anything, I want the chocolate ones.”
Hazardous Use	“Driving the car […] if I’m grabbing lunch somewhere or something, there’s always the possibility of killing someone or myself. I’ll reach in the back seat for something, and instead of just waiting until I got to where I was going, no, I’m gonna grab it, and then I’m like, “I could kill somebody.”		“I have high blood pressure and I know I should cut out all the salt and fat or whatever, but I still eat them.” [asked if doctor has said anything]” No, usually they just say, “Oh, eat lean chicken, or whatnot.”
Impair-ment or Distress	“I’ve gotten so big, I’ve gained so much weight, I mean, it’s bad. And it’s just from that, not controlling it, not have any sense of being able to say, “Oh, I can have one.” It’s really … It’s depressing to think about.”		“I would feel more distress ‘cause I’ve, in the past, used the tracking apps for breaking down calories, macronutrients for each meal. I was doing that probably to the point where it wasn’t healthy, then it was stressing me out ‘cause I had to be on there checking how much do I got left for the day.”