A Combination of Factors
Cause Eating Disorders
Eating disorders are complex illnesses caused by a combination of factors, including environmental, cultural, social, psychological, emotional, behavioral, individual, familial, and biological factors.
“Risk factors” is a term used to describe those characteristics that predispose people to a specific disease, such as an eating disorder. These risk factors are determined by the frequency of their appearance in people with the disease relative to their occurrence in the general population. By lowering the risk factors of an illness, one lowers the chances of contracting the disease. It is important to understand these risk factors, in order to design effective prevention programs.
One risk factor for having an eating disorder is being female, but beware, males are just as susceptible to eating disorders as women. No one is immune from eating disorders. People of different ages, races, and economic classes are affected by eating disorders. Not every risk factor will apply to every person with an eating disorder.
Just as it is a mistake to think only females get eating disorders, so too, it is a mistake to assume all males with eating disorders possess the same traits and experiences. Males with eating disorders are all different. They have different experiences, different issues, and different personalities. One common misconception is that all males with eating disorders are athletes, obsessed with working out to become more muscular. Another misconception is that most males with eating disorders are gay and vainly in pursuit of the perfect body.
Some factors that predispose individuals to eating disorders are listed below.
The media is a major source of reflecting and reinforcing our cultural ideals of physical attractiveness as well as portraying masculine and feminine characteristics and roles. While women tend to be presented in the media as thin, weak, and vulnerable, men are portrayed as muscular, strong, powerful, and energetic. Both men and women are seen as sex objects with men being dominant.
In a 1999 report entitled, “Boys to Men: Media Messages About Masculinity,” Children Now, an organization that examines the impact of the media on children, concluded that the media’s portrayal of men reinforces social attitudes that link masculinity to power, control, and dominance.
The media portrays the ideal man as strong, muscular, thin, youthful, well groomed, energetic, and intelligent. The implication is that if you emulate these celebrities or buy an advertiser’s product, you will become successful, admired, and sexually attractive.
Especially alarming is that the media portrays aggression and violence as a normal expression of masculinity as a way to deal with conflict.
These media images are reinforced in children’s male cartoons and toy action figures. A study done by Harrison G. Pope, Jr., Roberto Olivardia, Amanda Gruber, and John Borowiecki in the 1990’s found that male action figures have grown much more muscular as time has progressed, with many contemporary male action figures far exceeding the muscularity of the largest human bodybuilders.
Men are finding they are being objectified in the same way they have objectified women. A 2002 study at the University of Wisconsin suggested that the increasing focus on a fit and muscled male body are causing the same anxiety and insecurity in boys and men that have been experienced by women for decades.
Perhaps teenagers and young adults are particularly susceptible to eating disorders, because they are trying to discover their identity as they move from childhood into adulthood. They compare themselves to others and are sensitive to how others perceive them. They want to fit in and be admired by their friends, not teased. They highly value their peers opinions. Consequently, teenagers are eager to conform to the external qualities their peers value, in order to be “cool.”
There is the pervasive feeling that one must be thin and attractive to be successful, make friends, and win a sexual partner. The notion of being fat and growing older is looked upon with repugnance. Consequently, many people pursue thinness and a youthful appearance with a vengeance.
Preoccupation with Weight
Concerns over issues of weight and shape seem to increase the risk of one being affected by an eating disorder, including those with a higher body mass index, those who worry about their weight, those who have a history of dieting, and those who are teased for being overweight.
Certain situations can become triggering events that put into motion the starting of an eating disorder as a means of coping with the trauma. Such events could include a sexual identity crisis; physical, emotional, or sexual abuse; a death of a family member or friend; or an accident. Studies have found a history of sexual abuse is common in women with eating disorders, especially bulimia; and if studies were done on males, there would likely be found males whose eating disorder has been triggered by the emotional pain of sexual, emotional, or physical abuse.
Sometimes families inadvertently create an environment that predisposes one to an eating disorder, such as when parents put pressure on children to be thin, tease a child about being overweight, don’t allow open expression of feelings, place too high expectations on a child, are critical, rigid, overprotective, detached, or ineffective in dealing with conflict. A child’s risk for an eating disorder seems to increase when a parent suffers from a psychiatric disorder, eating disorder, or addiction. There are probably both genetic and environmental reasons for this.
Certain personalities seem to be more vulnerable to eating disorders. Males with eating disorders tend to have dependent, avoidant, passive-aggressive personality-styles (Kearney-Cooke & Steichen-Asch, 1990). Such a person, for example, craves social approval, fears rejection and criticism, and feels ambivalent. Bulimics often are impulsive. People with eating disorders commonly are perfectionists. They tend to have low self-esteem, feelings of inadequacy, and a sense of loneliness. Those with eating disorders commonly have difficulty coping with stress and change. They often have a “black and white” thinking pattern, where things are all good or all bad, all success or all failure, with no in-between possibilities.
While an eating disorder is the primary diagnosis, secondary psychological conditions typically co-exist in people with eating disorders. Depression, anxiety disorders, and obsessive-compulsive disorder (OCD) are common in people with eating disorders. High rates of borderline personality disorder, avoidant personality disorder, obsessive-compulsive personality disorder, and narcissism exist among people with eating disorders. People who have problems with substance abuse and other addictions seem to be at an increased risk for eating disorders.
People in certain careers tend to be more predisposed to eating disorders. Being thin, groomed, and well dressed is the mark of a professional appearance. Jobs requiring public appearances and sports-related careers seem to be at high risk for eating disorders.
Athletes are at high risk for eating disorders, because many athletes have high expectations put upon them by coaches to do whatever it takes to win. Often athletes will try to slim down and build muscle through rigorous work outs and restricting their food intake, thinking this will improve their performance at their sport. Runners, swimmers, skaters, gymnasts, and wrestlers are the athletes that seem most at risk for eating disorders.
Homosexual men seem to be at higher risk for eating disorders than their heterosexual counterparts. There may be two reasons for this. First, the gay culture highly values a thin, muscular physique (Schneider & Agras, 1987). Secondly, a gay man’s sexual identity crisis might be so traumatic that it becomes a triggering event for the eating disorder, in order to help him cope with his conflict.
Research is revealing that genetics may play a more significant role in who is affected by an eating disorder than we ever imagined. Studies have found that identical twins, who are more genetically similar than fraternal twins, are more likely to share a specific eating disorder than fraternal twins. This research seems to support a link to a genetic component to having an eating disorder.
Researchers have linked two chromosomes (1 and 10) to anorexia and bulimia, and several other genes have been identified as potentially predisposing people to eating disorders.
Brain chemicals known as neurotransmitters may be responsible for predisposing people to eating disorders. Neurotransmitters communicate messages to the brain and throughout the body to generate the body’s functioning, such as for breathing and to keep the heart beating. These neurotransmitters can affect such areas as mood, concentration, sleep, appetite, and weight. For example, people with eating disorders tend to have abnormal levels of the neurotransmitter serotonin.
With a deficiency of serotonin people are likely to feel depressed or act aggressively. In theory, a person who has a low level of serotonin who binges on sweets, starches, or carbohydrates would increase his serotonin levels, and hence, his sense of well-being and fullness. Someone with high levels of serotonin is apt to feel constantly anxious, agitated, and overwhelmed. A person who drastically restricts calories, theoretically would reduce the amount of serotonin produced, and hence, would feel calmer and more in control.
These examples show how the body may instinctively respond in certain ways, in order to soothe itself. Deficiencies and excessive amounts of serotonin and other brain chemicals can affect mood and behavior. Dr. Ken Weiner, medical director of the Eating Recovery Center in Denver in an interview in May 2009 made this analogy to the connection of biology and the environment, "Genes load the gun, life pulls the trigger.”
Kearney-Cooke, Ann & Steichen-Asch, Paule. Chapter 5: "Men, Body Image, and
Eating Disorders" in Males with Eating Disorders, ed. A. E. Andersen.
New York: Brunner/Mazel, 1990, p. 64.
Pope, Harrison G. Jr.; Olivardia, Roberto; Gruber, Amanda; and Borowiecki, John.
International Journal of Eating Disorders, Vol. 26, no. 1, pp. 65 – 72.
Published Online on 5-11-99 at:
Schneider, J. A. & Agras, W.S. (1987). “Bulimia in Males: A Matched Comparison with
Females” in International Journal of Eating Disorders, Vol. 6, pp. 235 – 242.