Dr. Angela Hanford
Most people either know someone or know of someone who has struggled with an eating disorder. According to the National Eating Disorders Association (NEDA), national surveys have estimated that in the United States about 20 million women and 10 million men will develop an eating disorder at some point during their lifetime.
In addition, eating disorders can have devastating effects on a person’s life and the lives of their family and friends. Therefore, prevention, recognition, and treatment of eating disorders are crucial.As you are likely aware, there are three types of eating disorders that are often discussed in popular media: anorexia nervosa, bulimia nervosa, and binge-eating disorder. For the sake of simplicity, we will be focusing on factors that contribute to these three diagnoses.
Before we discuss risk factors, it is important to know that eating disorders are complex and multifaceted. We do not see one single cause creating an eating disorder, but rather that there are many factors that contribute to someone developing an eating disorder.
Furthermore, not everyone who displays risk factors will go on to experience an eating disorder. Throughout this article we are going to examine several of the risk factors that have been associated with eating disorders.
If you have any questions about these or other risk factors, please do not hesitate to reach out and ask questions. We are here to help!
Common Risk Factors Associated with Eating Disorders
1. Cultural and Societal Factors
You only need to turn on the television, open your social media account, or peruse a magazine stand to see that we live in a society that is obsessed with the perfect body. Whether is the stick thin body for women or the buff look for men, the emphasis of one particular body type as desirable and all others as undesirable can wreak havoc one’s body image and self-esteem.According to NEDA, research has demonstrated that exposure to a thin ideal body type (e.g, thinness) is associated with an increase in body dissatisfaction. Body dissatisfaction, in turn, is a risk factor of eating disorders. The effect of society on eating disorder occurrence may be especially significant for someone who is predisposed to developing an eating disorder.
In addition, experiencing bullying about weight and/or other size and weight prejudices can also be a contributing risk factor to someone developing an eating disorder. We see this negative influence occurring not only during the teenage years, but also throughout adulthood in the work and social environments.
2. Psychological Characteristics and Temperament Factors
People who struggle with eating disorders also display a vast array of psychological characteristics and temperaments. There are also psychological traits, including one’s temperament, that have been associated with increased risk for eating disorders. However, these traits do not necessarily cause an eating disorder, as many people with similar characteristics do not develop eating disorders.
Common psychological and/or temperament factors that have been associated with eating disorders include:
- Perfectionism: According to NEDA, perfectionism is a large risk factor for the development of eating disorders. Those who struggle with perfectionism tend to set unrealistic standards for themselves.
- Feeling a lack of control in life: Eating disorder behavior can be a way for the individual to feel like they are taking back control when life feels chaotic.
- Tendency toward being highly self-critical: With self-criticism, which is often accompanied by perfectionistic traits, one can develop an overall negative view of oneself, low self-esteem, depression, or other types of emotional struggles.
- Body Image Dissatisfaction: This is another high predictor for an individual developing an eating disorder.
- Emotional Disorders: This includes depression, anxiety, substance abuse, and an array of other diagnoses.
- Obsessive and Compulsive Traits
- Low Self-Esteem
- Difficulty expressing emotions: Sometimes this is due to a family dynamic where emotional expression is avoided or it can simply be an aspect of one’s own psychological makeup. Regardless, many people who have eating disorders feel as though they are wearing a mask, needing to act happy and “together” in order to be accepted by others.
- Difficulty coping with emotions: Eating disorder behaviors, such as purging, food restriction, excessive exercise, or binge-eating become a way for an individual to cope with emotions that he or she does not feel able to handle in a healthier manner. Dialectical Behavioral Therapy is one treatment modality that can be helpful for an individual who needs to develop emotion regulation skills.
3. Traumatic Events
Experiencing trauma or any life event that feels overwhelming may also precede the onset of an eating disorder. For example, researchers have found an association between physical and sexual abuse and eating disorders.
Not only do many abuse victims suffer from shame and body image concerns, but when life becomes overwhelming, eating disorder behavior can provide the individual with perceived control over one’s life and/or a way to cope with overwhelming feelings.
4. Biological/Genetic Factors
According to NEDA, research has demonstrated that there is an increased risk for developing an eating disorder when an individual has a first degree relative (e.g., parent or sister) who has been diagnosed with an eating disorder or other significant mental illness.
It is unclear exactly how the genetic piece factors into the equation. It has been hypothesized that genes may provide an individual with a genetic predisposition to a specific disorder that is then expressed when triggered by other risk factors.Additionally, some researchers have suggested that hormonal and other neurological factors may play a role in eating disorder onset and maintenance. However, much research is needed in order to clarify the genetic and biological connection to eating disorders.
Finally, there is a higher incidence of eating disorders in women compared to men. There may be many explanations for this difference, nonetheless, it appears as though females report more eating disorders than males.
Dieting is a very common factor that precipitates the development of an eating disorder. There are likely several explanations for this association. For example, it may be that someone who has a genetic predisposition to eating disorders may go on to develop an eating disorder due to dieting. In addition, dieting often increases obsession with and shame surrounding weight and food, which may also contribute to eating disorder behavior.
6. Sports and Career Factors
Although athletics can lead to increased self-esteem and the ability to work with others in a team setting, there can be a connection to eating disorders. Certain athletic activities, such as dance, gymnastics, running, swimming, and wrestling, which focus on an individual maintaining a certain size and/or weight have been associated with the development of an eating disorder. Similarly, professions that require a specific size, such as modeling, have also been associated with eating disorders.
7. Family Factors
First of all, it is important to note that family members are not to blame for someone developing an eating disorder. According to the Academy For Eating Disorders (2010), research has not supported the notion that family factors are a primary cause for someone developing an eating disorder (Grange, D.L., Lock, J., Loeb, K, & Nicholls, D., 2010).
In addition, family dynamics may be a function of having someone in the family unit who is struggling with the eating disorder. That being said, there may be dynamics in a family that contribute to or help to maintain eating disorder behavior.
Several family dynamics that have been associated with eating disorders include:
- Lack of emotional expression: An atmosphere that discourages emotional expression can be associated with eating disorder behavior. Therefore, it is important for family members to learn how to express and cope with emotions in a healthy manner.
- Disconnected family
- A chaotic family environment
- Rigid or unclear emotional and physical boundaries: Boundaries are important in families. They help us to develop identity apart from another and also give safety as children and teens begin to explore the world. Having too few boundaries or boundaries that are too rigid can become problematic to emotional and social development.
- An over-emphasis on the importance of physical appearance
- An overly critical family environment where perfection is the goal
- Emotional disorders, such as substance abuse
Red Flags For Eating Disorders
You may be wondering, “Are there behaviors that may indicate that my loved one is struggling with an eating disorder?” The answer is, “yes.” There are red flags to be aware of that could point to an eating disorder. However, it is important to remember that these are merely red flags and should not be used to diagnose an eating disorder.
Behaviors that could indicate the presence of an eating disorder include:
- Refusing to eat in front of others
- Frequently skipping meals
- Often cooking for others, but failing to eat what he or she prepared
- Excessive focus on “clean” or “healthy” eating
- Obsessing about weight and body size (e.g., Continuously saying, “Do you think I am fat?” or “I am fat.”)
- Frequently using the toilet during and right after meals
- Secretive behavior with food, including developing large stashes of food
- Scars on knuckles that could indicate purging behavior
- Tooth decay, which could be a function of purging behavior
- Wearing baggy clothes to cover up significant weight loss
- Obsession with weighing oneself or the number on the scale
- Isolating oneself from others
Overview of Eating Disorder Treatment
If you or a loved one suspects an eating disorder, it is important to seek help since eating disorders can be life-threatening. For example, anorexia is associated with heart problems, organ problems, low blood pressure, osteoporosis, along with other serious medical complications.
Some health problems associated with bulimia include esophageal or stomal ruptures, tooth decay, severe dehydration, and heart problems. Binge-eating disorder is also linked with such conditions as heart disease and high blood pressure. In addition, eating disorders can have a detrimental effect on every aspect of life, including school and work, emotional, physical, spiritual, financial, and relational.
Treatment is usually structured as a team approach, the team consisting of the patient, a counselor, a physician, and a dietitian. Eating disorders are often accompanied by other emotional difficulties such as depression, anxiety, and/or addictions. Therefore, a comprehensive psychological and physical evaluation is needed.
There are several treatment options to consider: outpatient (once or twice a week), intensive outpatient (a few times a week), partial hospitalization, or inpatient/residential. The level of care you need depends on the severity of symptoms and your medical condition.
Your physician, dietitian, and counselor will work together to determine which treatment option is best for you. When looking for a counselor, you will want to find someone who has experience with and training in the treatment of eating disorders. The same criteria applies when finding a physician and dietitian.
So, what is the bottom line? It is important to remember that eating disorders are very serious and debilitating medical conditions. Eating disorders also have many possible risk factors, rather than a single cause. However, with the right treatment, there is hope of healing!
If you or a loved one is struggling with an eating disorder or eating disorder behavior, we are here to help you on your path to recovery. Counseling is a vital component of the recovery process, along with medical and nutritional support. Reach out … you are not alone! In fact, you are just a phone call or email away to beginning your journey toward heath and healing.
Academy For Eating Disorders – www.aedweb.org
International Association of Eating Disorders Professionals – iadep.com
National Eating Disorders Association (NEDA) – nationaleatingdisorders.org
Grange, D.L., Lock, J., Loeb, K, & Nicholls, D. (2010). Academy for eating disorders position paper: The role of the family in eating disorders. International Journal of eating disorders. January; 43: 1-5. doi: 10.1002/eat.20751.https://www.edcatalogue.com/the-causes-of-eating-disorders, Retrieved 1/11/18.https://www.nationaleatingdisorders.org/learn/general-information/what-are-eating-disorders, Retrieved 1/11/18.https://www.nationaleatingdisorders.org/media-body-image-and-eating-disorders, Retrieved 1/11/18.https://www.nationaleatingdisorders.org/learn/general-information/risk-factors, Retrieved 1/11/18.https://www.nationaleatingdisorders.org/factors-may-contribute-eating-disorders, Retrieved 1/11/18.
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