What Causes An Eating Disorder?

By Tracy Narins Welchoff, Ph.D.
Undoubtedly the most commonly asked question of friends and family members, it is understandable that loved ones want to know why their loved one is suffering from this scary, confusing, complicated illness.  Is it the parents’ fault? (Nope.)  Is it vanity or a desperate attempt at getting attention? (nope and nope.)  Is it a choice?  Is it a behavior problem?  (Still nope.)  In fact, there is no simple answer to this important question.  Eating disorders are complex and affect people of all ages, ethnicities, socioeconomic groups, genders, and education levels.  They impact loving, supportive well-functioning families as well as families with significant dysfunction. Eating disorders also occur in people of all shapes and sizes.  External appearance should never be used as an indication of someone’s potential to develop an eating disorder, nor is it an indicator of its seriousness.
 
Risk factors involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, so two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Although not an exclusive list, the following can be considered in trying to understand the myriad of contributory factors to the development and maintenance of an eating disorder.
 
BIOLOGICAL FACTORS

• Having a close relative with an eating disorder.
• Having a close relative with a mental health condition. Anxiety, depression, and addiction can run in families and may increase the chances of developing an eating disorder.
• Negative energy balance- burning off more calories than you take in leads to a state of negative energy balance. This may be due to dieting, growth spurts, illness, and intense athletic training.
• Type 1 Diabetes
• Malnutrition- this can lead to severe physical and psychological problems, put the brain in an altered state, and lead to an inability to make rational food decisions.
• Genetic factors may account for 40-60% of the risk for eating disorders.
• Disruption in elements of the appetite system such as chemical/ hormonal reactions
• Neuroimaging studies have revealed an ability to ignore hunger signals as well as changes in the role of dopamine in the reward signals that usually occur with eating.

 
PSYCHOLOGICAL

• Perfectionism.
• Body image dissatisfaction and an internalization of the appearance ideal.
• Issues of  depression, isolation, low self-esteem, and obsession with weight loss.
• Anxiety disorders: generalized anxiety, social phobia, and obsessive-compulsive disorder often precede the eating disorder.
• Behavioral inflexibility: Tendency to always follow the rules and feel there was one “right way” to do things.
• Adolescent Onset: many eating disorders appear during adolescence, but there are plenty of cases of onset being in early childhood before puberty or in later life.

 
SOCIAL

• Weight stigma. The message that thinner is better is everywhere, and exposure to this can increase body dissatisfaction and lead to eating disorders.
• Teasing or bullying, especially about weight.  This includes seeing others being targeted and worrying that one will also become a target.
• The socially-defined “ideal body” concept increases the risk of an eating disorder by increasing the likelihood of dieting and food restriction.
• Acculturation: People from racial and ethnic minority groups may be at increased risk due to complex interactions between stress, acculturation, and body image.
• Limited social networks, loneliness, and isolation.  This may be a cause, effect, or both.
• Gender: Significantly more females than males suffer from eating disorders, although the difference is likely exaggerated due to the under-diagnosis and under-reporting of males with eating disorders.  Additionally, those on the LGBTQ spectrum are at higher risk for eating disorders due to a combination of factors already mentioned such as body dissatisfaction, teasing or bullying, family or peer rejection, or other identity issues.
• Athletic involvement: Athletes experience additional pressure to perform at a high level and are often led to believe that “thinner equals better/ faster/ stronger”. 

In Conclusion…
Genetic factors work in combination with environmental, psychological, and other biological effects to increase risk.  An individual’s genetic predisposition might influence how one responds to the environment as well as what environments an individual might seek out.  Eating disorders are not a choice.  They are serious psychiatric illnesses accompanied by a high medical risk.  It is important to know, however, that eating disorders are treatable and do not automatically last a lifetime.  Early, aggressive treatment is widely considered the best approach as this minimizes lasting physical problems as well as psychosocial and developmental disruption.  Recovery is possible and always worth fighting for.  Please reach out to the staff at Narins EDC if you have questions or concerns.