What are the causes of eating disorders?

Eating disorders are serious mental illnesses, but what are the causes? Considering that millions of individuals worldwide have eating disorders, this is an important question. And despite the natural assumption, eating disorders affect people of all races, ages and gender. They’re also not limited to people who “look sick.” The majority of people who have eating disorders are not medically considered “underweight.”

It’s estimated that the lifetime risk of developing a eating disorder by age 80 is about 4.6%. However, eating disorders are chronically under diagnosed. Some estimate that up to 10% of the population will have an eating disorder in their lifetime.

Despite the high prevalence of eating disorders, they are poorly understood and suffer from stigma. Many misconceptions about their causes and exactly what it means to have an eating disorder lead to low rates of diagnosis and poor treatment success.

Here are the three main factors that are currently considered causes of eating disorders.

1. Genetics & biology

• Genetic factors contribute to the chance of someone developing an eating disorder.
• Often eating disorders run in families, and it’s not uncommon to find other cases of disordered eating in the family tree.
• Twin studies have revealed a 40% to 60% of liability to anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).
• People who have eating disorders are more likely to have serotonin abnormalities and other biological factors that may contribute.

2. Psychology & mental health

• Highly correlated with other mental health conditions like anxiety, depression, Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD) etc.
• People who have eating disorders tend to be Highly Sensitive Personalities (HSPs) and struggle with perfectionism and low self-worth.
• Stress is a trigger for eating disorder behaviors, and eating disorder behaviors can reduce symptoms of stress in the short-term.
• Eating disorders are often considered “maladaptive coping mechanisms” designed to help people cope with stress.

3. Environment & society

• Eating disorders appear to be more common in societies that value certain body types over others.
• Dieting and weight control practices, which are commonly encouraged in our society, increases the risk of developing an eating disorder.
• Over-exercising and pursuing a highly-controlled diet, which are commonly presented as positive in our society, increase the risk of developing an eating disorder.
• Social media, particularly Instagram, has been associated with a rise in poor body image and eating disorder behaviors.
• Poor body image, which is pervasive in our society, is highly correlated with eating disorder development.
• Certain family dynamics are linked to eating disorder development.

Signs of an eating disorder

Eating disorders are commonly missed, primarily because most people assume the main symptom is weight. However, the majority of eating disorders are in people who are not medically “underweight.” The only eating disorder that includes a minimum weight is anorexia, which is the least common eating disorder by far.

Here are some symptoms that may indicate an eating disorder:

• Preoccupation with food
• Sudden elimination of or obsession with certain foods
• Cutting out food groups
• Skipping meals
• Increased exercise
• Rigid approach to eating and exercising
• Weighing self every day
• Engaging in diet behaviors
• Counting calories, steps, macros, carbs, etc.
• Talking about food more than seems normal
• Following “inspirational” accounts on social media related to food and exercise
• Sneaking food
• Having food rules
• Avoiding family meals and social eating
• Worrying about weight, talking about gaining/losing weight, etc.

If you have any of these symptoms, or if your loved one does, consider getting an eating disorder evaluation.

Josh’s story – looking beyond weight as a symptom

Josh had always felt different from his peers. While other boys seemed to be interested in playing outdoors all the time, Josh was more interested in staying inside, reading and working on models.

Josh’s dad had been a high school athlete, and he was always trying to convince Josh to join a sports team or at least go outside and throw the baseball or shoot baskets. The more his dad pressured him, the more Josh retreated into himself.

Meanwhile his sister was popular, outgoing, and athletic. She seemed to shine in every area, and Josh felt as if his dad wished he could be more like her.

Josh began lifting weights in his room. He found some friends online who were into weight lifting and counting their macros. They drank protein shakes and took supplements to increase their muscle size.

Since he could do these things indoors, Josh enjoyed weight lifting. He started spending a few hours per day lifting weights with his friends online. They would share tips and tricks about getting bigger and leaner.

Josh’s parents were initially happy that he was making friends and doing a sport. Even though it wasn’t what they had in mind, it still seemed like a good idea. But after six months, Josh was increasingly nervous. He was visibly stressed during meals, and asked to prepare his own food.

His doctor noticed that he was anxious and asked for a psychological evaluation. While Josh was not underweight, his obsessive attention to food, exercise, and his body, meant he had an eating disorder. He entered treatment and is now in recovery.

Events that can trigger eating disorders

Some eating disorders seem to come out of the blue. But when we take a look at the causative factors and combine them with life events, sometimes we can see why the eating disorder developed.

Here are some life events that may trigger an eating disorder in someone who is susceptible:

• Changing schools
• Going to college
• Graduating
• Death in the family
• Divorce
• Breaking up with a romantic partner
• Breaking up with a friend
• Sexual assault/rape
• Witnessing violence
• Being in an accident
• Natural disasters

All of these events can create stress. And for someone who is susceptible to an eating disorder, that stress can lead to eating disorder behaviors.

Mandy’s story – stressful events as a trigger

Mandy had always been a highly sensitive child. She was fairly shy in elementary school, but found a good group of friends in middle school and seemed to be coming out of her shell.

Then her parents divorced and she moved with her mom to another school district. Mandy did her best, but she felt lost and isolated at her new school. And her mom loved her very much, but was struggling with becoming a single parent, getting a new job, and recovering from her divorce.

The stress of this situation is nobody’s fault. But Mandy started believing that if she lost some weight she would fit in and feel better at school. She started to diet a little bit, cutting out sugar and meat. Soon she was going for daily runs. Her mom at first thought it was healthy, and that Mandy was adjusting well.

But soon it became clear that Mandy was obsessed with her weight, food and exercise. Rather than finding ways to connect with her new school, she was investing her energy in her body.

Her mom got her into therapy as soon as she noticed, and Mandy started working on her stress in more adaptive ways. While she wasn’t diagnosed with a full eating disorder, her behavior was definitely heading in that direction.