Eating disorders describe diseases characterized by irregular eating habits and severe body weight or shape distress or concern.
Eating disorders may include inadequate or excessive intake of food that may ultimately harm the well-being of an individual.
Eating disorders are complex, factor-influenced disorders.
While the exact cause of eating disorder is unknown, a combination of biological, psychological and/or environmental abnormalities is generally believed to contribute to the development of these diseases.
Psychological Factors for Eating disorder
- Emotion Repression
Studies pointed out that eating disorders patients are, for most of the times, always under a high stress level.
As they are not good at expressing their emotions overtly, they may suppress their own, or even other’s, negative mood internally.
When emotions are suppressed for long or overloaded, it may result in physical and psychological disorders.
For example, studies found that when we are stressful, hormonal level will change and simultaneously, there will be an increase in our immunity against diseases to enable us to cope with our stresses.
However, this effect may not last long, when our stresses continue to increase to an unbearable level, our immunities against diseases will drop drastically and thus we would be more vulnerable to catch minor illnesses.
Studies showed that negative mood is very often one of the risk factors couses of eating disorders.
According to Hawkins and Clement’s (1987) people rely on eating as a mean to comfort themselves or divert their negative emotions.
This emotional-focused coping strategy may help comfort our emotions shortly.
However, many eating disorders patients mistakenly regard it as a long-term problem-solving strategy, which eventually turns into a mean to avoid the problems and would easily lead to vicious cycles.
They usually rely on self-destructing means, like starving or fasting, to alleviate their negative mood.
However, it may eventually create even more negative feelings because of their fear of fat and severe dissatisfactions on their body image.
- Distorted Self-image
Many patients believe body figures and appearances stand for everything, and thus they have spent a lot of time in these aspects.
They may strive for socially acceptable outlook and body figure in order to get the recognition from others and boost one’s self-esteem.
Some patients seem to be very tough in front of the others, but actually they have a low self-evaluation and self-esteem.
That is why they need to use their appearance and body figure to enhance their self-esteem and to get recognition from others.
However, for most of the times, their self-image and self-evaluation are always disturbed.
Patients who are obsessive in thinking about weight and food may strictly force themselves to meet their self-defined standard, which is usually hard to achieve.
Also read: Types of Eating Disorder And Its Medication
- Personality Traits
People with some particular personality traits are at high risk of getting eating disorders. The most common trait is perfectionism.
Patients are very strict to themselves and stubborn on certain things.
They usually adopt dichotomous thinking mode, believe that if they cannot achieve their standard, they are total failures and are for most of the times denying their abilities.
As a result, it is particularly difficult for them to get a sense of satisfaction when compared to others.
When their lives are out of their control and expectations or they fail to meet with their standards, they will shift to an area which is easier to control, such as weight.
That is why they become self-critical on their body and is particularly sensitive to numbers such in relation to pounds and inches.
According to Bruch (1973), they will soon get into the vicious cycles which lead to body dissatisfaction and no matter how many pounds they have already lost, they are still not satisfied .
This kind of personality trait may lengthen the treatment period.
Besides, people with high level of mood swings and neauthesis, low self esteem and negative self-evaluation are also at high risk of getting eating disorders.
Those people are highly sensitive to the changes surrounding them.
Some of them are extremely attached to somebody or familiar environment; when changes occur, they become stressful and cannot afford losing the dependent object.
As a result, they will use weight control or binging as a mean of ventilating the feelings of loss and emptiness.
These kinds of behaviors are to shift attention, make oneself numb and relieve emotions.
- Other Mental Health Problems
Eating disorders have high co-morbidity with certain mental illnesses, especially mood disorders (depression and anxiety.
It is difficult to say whether eating disorders are caused by mood disorders or that eating disorders cause mood disorders.
However, it explains why SSRIs (common drugs prescribed for patients with mood disorders) can sometimes be effective in controlling binging problem under the guidance and supervision of a qualified doctor.
As a matter of fact, the occurrence of eating problems may be caused by many stressors and confusions in life.
Whether to eat or not is only the presenting problem on surface, however, it is the underlying frustration and distress which makes people depressed and having eating problems.
Eating then unconsciously turns into a bad habit or a vicious cycle to express these sufferings in life.
Patients may not easily recognize the relationship between their problem and eating pattern.
Counseling, one of the main tasks, is to help patients recognize their underlying problems, which may be the cause of their behavioral problem.
Another common co-morbidity is obsessive-compulsive disorders.
Patients usually force themselves into certain repetitive behaviors, common ones are those which are related to weight control, in order to have a sense of security.
Patients who are comorbid with obsessive-compulsive disorders may repeat something related to eating and weight control, such as compulsive eating, washing hands, brushing teeth and counting calories.
These kinds of behaviors are usually driven by the extremely anxious mood.
To eliminate this kind of obsessive thought, they may use repeated behaviors to relieve their stresses and anxieties.
Also read: How to Recover From Eating Disorder
Familial Factors for Eating Disorder
The modes of communications, ways to express emotions and education standards of a family may affect the development of children.
According to Johnson et al. (2002) , understanding patients’ family background is essential for treatment because, for most of the times, they are inter-related.
Another explanation are that eating disorders are a psychological problem about control and power struggle.
This explanation can apply to many types of family relationship.
The followings are some of the common problematic family relationships.
- Authoritarian Parenting Style
Children who grow up under an authoritarian parenting style may feel that they lack autonomy.
Many living arrangements are decided and arranged by their parents, especially their eating habits.
As a result, many of their things are manipulated by others and that they are unable to exert control over them.
When they entered puberty and become rebellious, they have stronger and stronger desire to get back the autonomy and try to struggle for their own identity in their everyday lives.
To establish their own identity, they need to first identify one thing that is easy to control in order to prove that they have the ability to control over their lives.
However, when they soon recognize that everything around them is already under tight restraints, they then choose weight control, a seemingly easier and personal way, as a first step to demonstrate their autonomy towards their parents and themselves.
Refusal to eat is very often a behavior to express their strong discontent over their parents’ control.
Gradually, eating disorders become a strong weapon for the children in power struggle between them and their parents within the family.
By using eating disorders as their weapon, the children regain control over everything around them, and even their parents.
Over-protective Parenting Style
Nowadays, people generally have strong desire for high living standards.
Many couples tend to choose to have one child only and as a result of this, they devote all the resources to their only child.
The overly concerned parents would try to give the best of all things and take good care of every single detail in their child’s daily lives.
However, from the children’s personal growth, overprotective parenting style may make their children not able to handle things independently, they could either turn rebellious and egoistic or that they might rely on their parents too much.
After a certain period of time, they may not want to grow up and would rather live under the protection of their parents.
Some patients would choose to use “eating problems” to obtain eternal care from their parents, trying to regress to the baby stage again so that they could be cared by their parents again.
- Power Struggle within the Family
Besides, some children may use eating as a mean of grasping the attention from the significant others.
According to Ma et al. (2002) , the ultimate goal of their behavior is to get back love and care from their parents.
However, there are some special cases that children use eating disorders as a mean to restore their parents’ marital relationship.
Because of their eating problems, parents need to put away their personal conflicts with one another and align to confront their children’s problem.
Sometimes, it can be the case of attention seeking among the siblings. Children are always afraid of losing mother’s love and care when there is a new member in the family.
When they are sick, they may draw attention from the significant others which is what they are longing for.
This may explain why eating disorders may sustain many years if the family do not recognize this vicious cycle.
In conclusion, although family relationship can be the cause of the illness, what we know is many patients do respect and love their parents very much.
They often would not want to see their parents fighting one another or that they would like to bear the entire burden (to resolve problems within their family) all by themselves.
This explains why they choose using their own body in a wrong way (refusal to eat or binge eating) to ventilate their emotions so as to avoid the outbreak of family conflicts and to restore the integrity of the family.
Socio-Cultural Factors for Eating Disorder
- Misleading Message
Nowadays, slimming has become a trend in every country.
Many people follow a unique standard of the body figure and believe that “thin” means beautiful and successful; “fat” means failure, ugliness and low self esteem, which may induce dissatisfaction to one’s body figure.
Slimming TV series always present the so-called “standard” body figure in front of the audience and use the “successful case” to symbolize high self-esteem and being successful in work, social life and relationship.
However, it provides a paradoxical dream to the audience that once you get “slim”, you can resolve everything in your life.
On the other hand, they also exaggerate the problem of being fat which induce a sense of fear.
However, when people think analytically, all the messages they said are only an advertisement for promoting their products or services.
- Body Dissatisfaction and Drive for Thinness
People of different social background may have different concepts as to what is “beautiful”.
However, for most of the times, it is easily affected by the media.
One study indicated that ever since TV was introduced to Fiji Island in 1995, 69% of the girls started to diet and 15% started to develop the habit of vomiting 3 years later.
The girls hoped very much that their body figures were as slim as the TV models’ which increased the risk of developing eating disorders.
The result showed that media actually affects our value and behavior. Besides, the frequency of watching TV series and movies might predict body dissatisfaction; and the frequency of watching music video might predict drive for thinness.
Audience may internalize the image showed on TV as a standard for themselves, and start dieting to strive for this “ideal” size even though they are physically in normal size.
- Extreme Dieting Methods and Wrong Beliefs
Research showed that extreme dieting practice was highly correlated with bulimia.
It might be a factor to sustain the binging problem too (Fairburn, 1997). We can find the above results in our hotline data.
Almost 95% of patients practice extreme dieting in an irrational speed before the development of bulimia.
Slimming and beauty companies choose some artists to be their spokesperson; and claim that participants can loss many pounds and inches in a short period of time.
The most fascinating point is that the process is very easy, that people can eat whatever they want, that they need not to do exercise and take medicine but still the effect can last for long without any side effects.
Many people are attracted by these claims and are very eager to try but do not realize that the methods used in the slimming process could actually be risk-taking.
Originally, it is normal and healthy for someone who is overweight to be on diet.
However, the advertisements do not mention about what is medically defined as “fat” and “obesity”, but only focus on weight reduction and speed.
They also ignore individual difference, such as height, bone mass and heredity.
People in general may not know if they use unhealthy dieting method, such as extremely low calories-intake, it is easier to rebound to original weight, or even heavier; they will be more easily prone to catching bulimia nervosa psychologically speaking.
Biological Factors for Eating Disorder
- Set Point Theory
Biologically, every individual will maintain their body weight within a certain range after they grow up.
Therefore, when we use irrational means (such as extremely low calories intake) and extremely high speed to lose weight which our body cannot adapt to, his/her metabolic rate will slow down in order to regulate the body weight to retrieve the set point.
If we cannot gradually teach our body that the reduced pounds or fat are not necessary for our body, our body will try its best to store fat in order to maintain the set point (the pounds).
These can explain why people who reduce weight in a short period of time will usually rebound when they eat normally.
This theory explains why people who adopt extreme dieting methods usually have a very strong desire to eat both psychologically and physically, and thus explain why losing weight too speedily would precipitate weight rebound sooner or later.
- Dysfunction of Serotonin
Many studies showed that the abnormalities (such as inactive) of serotonin were associated with the development of eating disorders .
In addition, many patients have comorbidity with illnesses related to the problem of serotonin, such as Anxiety Disorders, Obsessive Compulsive Disorders, and Mood Disorders.
Drugs, like Selective Serotonin Re-uptake Inhibitors (
Genetic Factors for Eating Disorder
In family studies, higher incident rates of eating disorders among relatives of eating disorders patients were revealed.
Besides, in twins studies, monozygotic twins had a higher concordance rate of eating disorders than dizygotic twins, which showed that genetic effects had been in association with the development of eating disorders.
However, such a high concordance rate might be attributed by both the shared genes and the shared environment.
According to some studies, the ratio of female to male in the prevalence of eating disorders was approximately 10:1, of which adolescents and early adults were regarded as the high-risk population.
The greater possibility of developing eating disorders in these periods most probably was related to the hormonal and physical changes (being taller, the development of secondary sexuality) of adolescents during puberty.