I haven’t sat down and written anything for this blog since April ha. Life has been busy and it’s much easier for me to write a few quick paragraphs for the insta (follow me @foodfreedomdietitain) vs a more lengthy piece on here. I have a tad bit more time on my hands during this season of life, so I’m back, returning to my love of writing, story telling, + education others on disordered eating / eating disorders.
Many of you have reached out and asked me the same question related to your eating disorder:
“How did I get here?”
How did my relationship with food and my body get this bad? How did this happen? Why did this happen? So today, I want to dive deep into some of the factors that contribute to the development of eating disorders. After reading this post, you may be able to better identify some of the things that have contributed to your eating disorder, but you may not fully understand “why it had to happen to you”. That’s okay. My hope is that despite your experience with your eating disorder, you will rise up with a greater sense of resilience, compassion, empathy, and courage. Individuals with eating disorders are some of the most kind, compassionate, intelligent, diligent, creative, and awesome people that I know. There is no doubt in my mind that you can overcome this.
So…. how does it happen? How does someone develop an eating disorder?
Eating disorders are complex psychological disorders that are caused by a number of biological, psychological, and sociocultural risk factors. So even if you intentionally chose to go on a diet or engage in eating disorder behaviors, you can’t just choose to develop an eating disorder.
Lay that shame down… it’s not your fault.
You have to have multiple risk factors for the grey sky and dark clouds to develop into a full-blown thunderstorm. This is why not everyone who diets automatically gets an eating disorder. In order for a person to have an eating disorder, biological, psychological, and social risk factors have to all come together at just the right time to create what is often referred to as “the perfect storm”. Below I’ve outlined a list of factors that have the potential to contribute to the development of an eating disorder. This piece is not comprehensive, but I’ve tried my best to make it as detailed as possible w/as many risk factors as I’ve been able to find via research and my own clinical experience.
I. Biological Risk Factors:
- Genetics– Insights from genetic research reveal that eating disorders are highly heritable, meaning that there are certain genes that make a person more susceptible to developing an eating disorder. This is why eating disorders tend to run in families.¹ Some researchers have even started to identify specific genes related to specific eating disorders / eating disorder behaviors, which I believe has the potential to do a whole lot in terms of reducing shame / prevention / better treatment options. Individuals who have family members who suffer from anxiety, obsessive-compulsive disorder, depression, and/or addiction are also at a higher risk for developing an eating disorder, as these mental illnesses commonly coincide with eating disorders.¹
- Gastrointestinal Disorders– Individuals who suffer from gastrointestinal disorders (celiac disease, irritable bowel syndrome, crohn’s disease, diverticulitis, etc.) are more likely to engage in disordered eating patterns. This is because individuals with GI disorders worry that the food they eat could potentially cause stomach pain or nausea/vomiting, which can consequently lead to food restriction.²
- Type 1 Diabetes– Individuals who suffer from T1DM (type one diabetes mellitus) are at a higher risk for developing an eating disorder because they are required to focus on food, labels, and blood glucose control, all the while experiencing metabolic disturbances.1Insulin omission, which can be deadly, is the most common eating disorder behavior seen in this population.1
- Puberty / Pregnancy + Postpartum / Menopause- This one could also fall under “sociocultural” because of the way our culture treats body changes (particularly biological body changes that all women experience). Any time a woman experiences one of these biological body changes, they are at a higher risk for disordered eating / eating disorders than general population because of the way that our culture negatively views weight / body changes.
- Chronic Illness- Research shows that chronic illness, specifically “diet treated chronic illnesses”, such as type 1 and type 2 diabetes, cystic fibrosis, celiac disease, and other gastrointestinal disorders may increase the risk of developing an eating disorder in children.³ This is likely due to the intense focus on diet, in combination with the stress of living with a chronic illness, plus underlying psychological and genetic factors.
- Semi-Starvation– Using more calories than you consume WILL result in semi-starvation, which can seriously mess with brain chemistry. Individuals who burn more calories than they take in often become preoccupied with food, lack the ability to concentrate, and are more susceptible to binge-eating. Dieters, individuals who live in food deserts, and athletes are at the highest risk for expending more calories than they are taking in.
- Female Gender / Transgender Folks: Eating disorders are more common in females + transgender folks (not to say that cis-gendered males cannot get eating disorders… they 100% can and do, and often are overlooked + under-reported due to shame and stigma).¹
- Temperament: It’s not uncommon for individuals with eating disorders to have harm-avoidant temperaments, which can include excessive worrying, pessimism, and shyness.4 Individuals with bulimia nervosa or anorexia nervosa binge/purge type are also harm-avoidant, but they also exhibit higher levels of impulsivity and novelty seeking.4 It’s also common for individuals with eating to exhibit cognitive distortions such as all-or-nothing thinking and mental rigidity.
II. Psychological Risk Factors:
- Anxiety / Obsessive Compulsive Tendencies:As previously mentioned above, anxiety disorders frequently precede / co-occur with eating disorders. According to the National Eating Disorder Association, “Research has shown that a significant subset of people with eating disorders, including two-thirds of those with anorexia, showed signs of an anxiety disorder (including generalized anxiety, social phobia, and obsessive-compulsive disorder) beforethe onset of their eating disorder.”¹
- Low Self-Esteem / Body Dissatisfaction: People who develop eating disorders are more likely to be dissatisfied w/their bodies.¹ Body image issues / low self-esteem are a component of MANY eating disorders, but not all.
- Perfectionism: Perfectionism is also a hallmark of eating disorders, particularly those that are more restrictive in nature.¹ This can manifest in perfectionism in eating, body image, or both.
- Life Stressors: Life transitions such as death of a loved one, the end of a relationship / divorce, job loss / change, increase in financial obligations, starting college, getting married, having children, moving into a new home / city, diagnosis of chronic illness, injury, work stress, being a caregiver for a sick family member, friendship conflict, or anything else that you perceive as a life stressor (and an inability to properly cope with said stressor) can also contribute to eating disorders.
- Substance Abuse: Research estimates that up to half of all individuals with eating disorders abuse alcohol or illicit drugs.5 Per NEDA, the substances most frequently abused by individuals with eating disorders or with sub-clinical symptoms of these disorders include caffeine, tobacco, alcohol, laxatives, emetics, diuretics, appetite suppressants, heroin, and cocaine.5
- Weight Stigma / Emphasis on Thin Ideal: US culture constantly bombards the public with the message that thin-bodied people are healthy, more successful, happier, and overall more worthy than individuals who live in larger bodies. Research shows that exposure to this type of thinking can increase body dissatisfaction, which consequently can lead to eating disorders.¹ Furthermore, weight stigma in the health care setting can often either encourage eating disorder behaviors i.e. “you need to diet to lose weight” OR cause eating disorders to be overlooked i.e. “she doesn’t have an eating disorder because she isn’t underweight”.
- Acculturation: Per NEDA, “…people from racial and ethnic minority groups, especially those who are undergoing rapid Westernization, may be at increased risk for developing an eating disorder due to complex interactions between stress, acculturation, and body image. Within three years after western television was introduced to Fiji, women who previously comfortable with their bodies and eating began to develop serious eating related problems: 74% felt “too fat;” 69% dieted to lose weight; 11% used self-induced vomiting; 29% were at risk for clinical eating disorders.”¹ Despite similar rates of eating disorders among ethnic and racial minority groups in the United States, people of color are significantly less likely to receive help for their eating issues.5
- Dieting Family Members / Peers: This one is pretty much common sense, but the more an individual is immersed with friends and family members who are dieting, the higher their chances are of developing an eating disorder.
- Family Addiction: Children of parents who are addicted to a chemical substance are more susceptible to developing anxiety, depression, perfectionistic tendencies, and lack of appropriate emotional regulation skills, which can increase their risk for developing an eating disorder.6
- Trauma: Research shows that there are many types of trauma that can be associated with eating disorders including neglect, sexual assault, sexual harassment, physical abuse and assault, emotional abuse, emotional and physical neglect, sexual abuse, teasing, and bullying.7 Other forms of trauma that may contribute to eating disorders include community violence, complex trauma, refugee trauma, terrorism and violence, and historical trauma. It’s important to note that trauma is defined by “a deeply disturbing event that infringes upon an individual’s sense of control and may reduce their capacity to integrate the situation or circumstances into their current reality.”7 Trauma is any event(s) that exceed our capacity to cope and cause a disruption in emotional functioning. Some traumatic events are not inherently life or bodily-integrity threatening (as the ones listed above), but are indeed traumatic because the individual is left experiencing notable helplessness. Many of the life stressors listed above can be traumatic for some people and not for others; no trauma is more valid or worthy of attention than another. Unresolved trauma and/or PTSD can be an important perpetuating factor in the maintenance of symptoms.5
IV. Other High Risk Populations:
- LGBTQ+: Transgender individuals experience eating disorders at rates significantly higher than cisgender individuals (as mentioned above). While research indicates that lesbian women experience less body dissatisfaction overall, research shows that gay, lesbian, and bisexual teens may be at higher risk of binge-eating and purging when compared to heterosexual peers.5 Compared with heterosexual men, gay and bisexual men had a significantly higher prevalence of lifetime full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder.5 Prevalence rates between heterosexual women, and lesbian and bisexual women are not significantly different.5
- Athletes: Athletes are at a higher risk of developing eating disorders than the general population for a few reasons. Many sports emphasize diet + weight in order to gain a “competitive edge over opponents” while some just flat out encourage dieting for sake of appearance. Those external pressures, coupled with high energy expenditure from practices, games/competitions, etc. create a high risk environment. 41.5% of female HS athletes in aesthetic sports (i.e. gymnastics, dance, volleyball, swimming, etc.) reported disordered eating.5 In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa.5 Though most athletes with eating disorders are female, male athletes are also at risk—especially those competing in sports that tend to emphasize diet, appearance, size and weight, such as rowing, wrestling, and cross country.5