Causes and Risk Factors of Eating Disorders

Eating disorders can transform lives in profound and challenging ways, affecting both physical and mental well-being. While these complex conditions can impact anyone, certain risk factors for eating disorders make some individuals more vulnerable than others. Recognizing these risk factors, along with the causes and available treatment options, is crucial for prevention, early intervention, and recovery.

Types and Symptoms of Eating Disorders

Eating disorders can fundamentally alter a person’s relationship with food and eating behaviors. These disorders affect approximately 5% of the population, with symptoms typically emerging during adolescence or young adulthood ^[1]. 

The American Psychiatric Association identifies the following types of eating disorders ^[1]:

• Anorexia Nervosa: People with anorexia nervosa maintain a weight that’s significantly below what’s considered healthy through severe food restriction while experiencing an intense fear of gaining weight and a distorted perception of their body image.
• Bulimia Nervosa: Individuals with bulimia nervosa experience recurring episodes where they consume unusually large amounts of food and feel unable to stop eating, followed by compensatory behaviors such as self-induced vomiting, excessive exercise, or laxative misuse to prevent weight gain.
• Binge Eating Disorder: Binge eating disorder involves recurring episodes of eating significantly more food than needed, experiencing a lack of control during the binge, and feeling distressed about the eating behavior.
• Other Specified Feeding and Eating Disorder (OSFED): This disorder includes individuals who experience significant distress around eating and food but don’t meet all the criteria for other disorders.
• Avoidant/Restrictive Food Intake Disorder (ARFID): Individuals with ARFID display extremely picky eating habits or limited food intake without concerns about body weight or shape. They often avoid certain foods due to their texture or taste or having fears about eating.
• Pica: Individuals with pica persistently eat non-food substances that have no nutritional value, such as paper, soap, or clay.
• Rumination Disorder: People with rumination disorder repeatedly regurgitate food that may be re-chewed, re-swallowed, or spit out.

Biological Risk Factors for Eating Disorders

The precise cause of eating disorders remains unclear. However, similar to other mental health issues, various factors may contribute to their development.

The National Eating Disorders Association has identified the following biological risk factors for eating disorders ^[2]:

• Genetics: Some people’s genes may heighten their likelihood of developing eating disorders. Thus, an individual’s risk for developing an eating disorder is higher if a first-degree relative, such as a parent or sibling, has been diagnosed with one. 
• Familial Mental Health Issues: The presence of other mental health conditions like anxiety, depression, or addiction within the close family network can also increase susceptibility to an eating disorder.
• Previous Dieting Behaviors: A background involving deliberate dieting or restricting food intake (by type or amount) is frequently reported as a starting point for an eating disorder. For instance, prior dieting and weight-management strategies are linked to the onset of binge eating patterns.
• Inadequate Energy Intake: Low energy availability (LEA) occurs when the body doesn’t receive enough energy through nutrition to meet the demands of its physiological processes. This state can arise from a poor understanding of nutritional needs, demanding athletic training, or combining food restriction with excessive exercise. LEA might be a symptom of an eating disorder or a factor that increases the risk of developing one. 
• Type 1 Diabetes: Individuals with Type 1 diabetes face a distinct risk. Research suggests that up to 39% of women and 15% of men with this condition will develop an eating disorder. 

Additionally, recent research published in the Journal of Eating Disorders suggests a connection between gastrointestinal microbiota and autoimmune reactions. These biological components can influence how the body processes nutrients and regulates appetite, potentially contributing to the development of eating disorders ^[3]. 

Psychological and Environmental Risk Factors in Eating Disorders

The psychological risks for developing an eating disorder often stem from complex emotional and mental health challenges. Many individuals who develop eating disorders experience perfectionism, low self-esteem, and difficulty managing emotions. These psychological factors can create a foundation of vulnerability that, when combined with environmental stressors, may trigger disordered eating patterns ^[4]. 

Along these same lines, an individual’s environment, societal expectations, and cultural influences can play a role in eating disorders, as they can shape how individuals view themselves and their bodies. Peer pressure, especially during adolescence, can significantly impact body image and eating behaviors. Additionally, participation in activities that emphasize body size and shape, such as ballet, modeling, or certain sports, can increase the risk of developing an eating disorder. Furthermore, idealized body images and diet culture can exacerbate risk factors in vulnerable individuals ^[2]. 

Perhaps not surprisingly, family dynamics may also be involved in eating disorder development. Research has shown that family discord, parental indifference, and overprotective parenting styles can contribute to increased risk ^[5]. What’s more, certain personality traits and coping-skill deficits can make individuals more susceptible to developing these conditions.

Mental Health and Eating Disorders

The relationship between eating disorders and mental health conditions is complex, with each potentially influencing and exacerbating the other. Research has shown that individuals with eating disorders frequently experience co-occurring mental health conditions, which can complicate both diagnosis and treatment ^[3]. 

The mental health challenges associated with eating disorders can create a cycle that perpetuates both conditions. For example, depression may lead to changes in eating patterns, which can then worsen depressive symptoms. Similarly, anxiety disorders may manifest in rigid eating behaviors or food-related rituals that can evolve into more severe eating disorder symptoms. 

Mental health conditions that can co-occur alongside eating disorders include:

• Depression and mood disorders
• Anxiety disorders
• Obsessive-compulsive disorder (OCD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)
• Personality disorders

When it comes to treatment, addressing both the eating disorder and any co-occurring mental health conditions typically leads to better outcomes than addressing a single condition independently. This comprehensive approach helps break the cycle of interconnected symptoms and supports long-term recovery ^[6]. 

Addiction and Eating Disorders

The relationship between eating disorders and substance use disorders is particularly complex and concerning. Research shows that up to 50% of individuals with eating disorders also have a substance use disorder ^[7]. 

Co-occurring disorders exist when someone experiences both a mental health condition and a substance use disorder concurrently. In the case of eating disorders and addiction, these conditions often share similar psychological and behavioral patterns, including compulsive behaviors that are difficult to control despite negative consequences ^[7]. 

Several factors contribute to this high rate of co-occurrence. Both conditions often stem from similar risk factors, including trauma, anxiety, depression, and low self-esteem. Additionally, some individuals may use substances to suppress appetite, cope with emotional pain, or manage eating disorder symptoms. Others might develop disordered eating patterns while struggling with substance use.

The overlapping nature of these conditions presents unique challenges for treatment. However, integrated treatment approaches that address both conditions simultaneously are preferred, as treating one condition while ignoring the other often leads to poor outcomes ^[7]. 

Prevention Strategies for Eating Disorders

Early intervention and prevention strategies play a crucial role in reducing the risk of eating disorder development. Prevention efforts focus on two key areas: reducing known risk factors, (body dissatisfaction, basing self-worth on weight and shape) and simultaneously strengthening protective factors (self-compassion and appreciation for body functionality). 

Creating a supportive environment is essential for prevention. Parents and caregivers can help by modeling healthy attitudes toward food, weight, and exercise. This includes avoiding negative comments about body size or shape, refraining from restrictive dieting, and promoting balanced, nutritious eating habits without labeling foods as “good” or “bad.” 

Educational institutions are also important components of prevention, as they can implement programs that promote body positivity and healthy relationships with food. These programs often focus on media literacy, helping young people critically evaluate unrealistic body images and beauty standards in the media. Schools can also provide resources for stress management and emotional regulation, as these skills help protect against disordered eating patterns ^[4]. 

Treatment for Eating Disorders

Treatment for eating disorders typically involves a comprehensive, multidisciplinary approach that addresses both the physical and psychological aspects of the condition. The most effective treatment plans are typically tailored to each individual’s specific needs, considering their particular eating disorder, severity of symptoms, and any co-occurring conditions.

• Psychotherapy plays a central role in eating disorder treatment, with Cognitive Behavioral Therapy (CBT) being the most extensively studied and validated approach ^[8]. This form of therapy helps individuals identify and change destructive thought patterns and behaviors related to food, eating, and body image. Group therapy and family-based treatment can also provide valuable support and tools for recovery.
• Nutrition counseling represents another crucial component of treatment. Registered dietitians with specialized training in eating disorders help patients develop healthy eating patterns and meal planning strategies. They work closely with individuals to challenge food-related fears and establish a balanced relationship with eating ^[6]. 
• Medical monitoring is essential throughout the treatment process, as eating disorders can cause serious physical complications. Healthcare providers regularly assess vital signs, weight, and other health indicators to ensure safe recovery. In some cases, medications such as antidepressants or anti-anxiety medications may be prescribed to address co-occurring mental health conditions ^[8]. 

The level of care required varies depending on the severity of the eating disorder. While some individuals can recover through outpatient treatment, others may need more intensive options such as partial hospitalization programs, residential treatment, or inpatient hospitalization. The earlier treatment begins, the better the chances for a full recovery. 

Recovery is Possible

Eating disorders are complex conditions influenced by a variety of biological, psychological, and environmental factors. While these disorders can have serious impacts on physical and mental health, simply acknowledging their risk factors and causes represents a crucial step toward prevention and treatment. The path to recovery looks different for everyone, but healing is possible. Through personalized treatment approaches, compassionate support, and increased understanding of these conditions, individuals with eating disorders can and do recover.