The Causes of Eating Disorders
A common explanation for the development of eating disorders is society’s preoccupation with thinness, and this certainly plays a part. However, most clinicians believe that there are many other contributing factors, including psychological, social, familial, spiritual, and at times biological.
Many useful books discuss the causes of anorexia, bulimia, and related eating problems. However, our goal is to help you understand your loved one’s experience and grasp why her behavior makes sense to her. Therefore, in this chapter we briefly discuss causes, and only in general terms.
In our culture, both men and women are pressured to look a certain way. Men are encouraged to be big and muscular with little or no body fat. Women are led to believe they should be thin. Although it has not always been the case, a person’s value is often associated with their size and/or shape. Consequently many of us base our own feelings of success or worth on the extent to which we conform to society’s idea of the “perfect” body.
Men and Being “Buff”
A few decades ago, a popular magazine advertisement depicted a cartoon showing a thin, pale young man who was desperate to become “buff” so he’d be admired by his girlfriend and respected by the muscled men he saw on the beach. The product promised to make him big and powerful, clearly delineating a connection between body size and being a worthy, vital man.
Our society’s current version of the ideal male body is “cut,” “lean,” and “ripped.” This “perfection” has a very narrow definition, one that few men are physically able to achieve through a healthy diet and exercise. In response, some develop anorexia nervosa in an attempt to lose all body fat. Others develop a relatively new phenomenon termed “reverse anorexia,” a condition in which the individual sees himself as physically underweight and weak, no matter what his true body size. As a result, he goes to great, if not extreme, lengths to become more muscular, often putting his health and life at risk.
Women and Being Thin
For women, a thinner, less curvy “ideal” shape has replaced the once-admired hourglass figure that was popular for centuries. This trend toward thinness was exacerbated in the 1960s when 17-year-old British model Leslie Hornby, nicknamed Twiggy, met with unprecedented popularity in the UK and America. At that time she stood 5′ 7″, had measurements of 31-22-32 inches, and weighed only 97 pounds.
It wasn’t long before girls and women alike began patterning their makeup, hair, clothing, and body shape after hers. Thinness became associated with success, wealth, beauty, and power. The myth that being thin is a requirement for a happy life found a new and eager audience.
Conversely, as our culture has come to overvalue thinness, it has also come to devalue any body shape considered too big. Women with larger bodies are often viewed as weaker or less intelligent than their svelte counterparts. They are disregarded for certain types of jobs, thought to have poor social skills or fulfilling relationships, and “billed” as lonely, deprived of affection, and overly dependent on others. These false beliefs persist despite the fact that there’s no evidence that such things have anything whatsoever to do with body shape or size.
Our personal attitudes and stereotypes about body size and what it implies don’t just suddenly appear one day. They tend to form and develop when we are young, and typically become more established as we mature, sewing the seeds of body dissatisfaction that eventually grow into eating disorders.
I was very overweight and I got teased. I was so lonely and always felt left out. No one wanted to be my friend. I decided early on that I’d better not stay fat.
My family made fun of fat people. All of us did. It was like a sport for us. Now I’m ashamed of how we acted. But it did drive home to us kids that being large was not something good to be, not something to be proud of.
My mom was big, and she hated it. She talked about it all the time. I decided early on that I’d never let that happen to me.
My whole childhood I heard, “You’ll never make anything of yourself if you grow up fat.”
No matter what they do, most women aren’t physically capable of reaching the degree of thinness portrayed as ideal in our culture. Nonetheless, many will spend their lives attempting to alter their bodies and feeling inadequate and dissatisfied with themselves as a result.
Physical Changes Due to Puberty
Both girls and boys experience normal, dramatic, physical changes related to puberty, and females specifically must increase body fat in order for menstruation to begin. Many young women do not know this fact, and begin dieting or resort to an eating disorder in response to this normal biological change.
I suddenly started growing taller really fast. My body didn’t feel like my own. After a while I got used to the new me, sort of like I grew into my new size.
Nobody told me what was supposed to happen in your teenage years, about what my body needed to be doing. So I fought it. My friends all did too. We thought we had things wrong with us. I wish someone would have told us what to expect.
I gained weight in places I had never had weight before. My mom explained that that was because my period was coming. I was nervous about it, but she turned out to be right.
Just as people in general are unique and varied, individuals who develop eating disorders encompass a diverse range of personality types. They can be shy or gregarious, introverted or extroverted. They may enjoy many hobbies or only a few. They can love to go to parties and be social, or prefer to stay at home alone or with just a close friend.
This being said, individuals who are prone to developing eating disorders often share specific personality characteristics. They tend to be perfectionists, highly-driven, and ambitious. They can also be anxious or “high-strung” by nature, as well as sensitive, inclined to “people pleasing,” and self-doubting about their thoughts, opinions, and beliefs.
I care too much about what everyone thinks about me. I want to make everyone happy all the time. I don’t care how that makes me feel.
People always say how compulsive I am. How driven I am all the time. But I can’t sit still. I have to be moving and doing things all the time.
I’ve always been fear-based. I’m afraid of everything. Especially change. Even good kinds of changes terrify me. I hate being so insecure.
Everything has to be in its place. If it’s not, I get so nervous I can’t stand it.
Insecurity is a constant theme for someone with an eating disorder. She may worry a great deal about whether she’s good enough, whether she’s loved, whether she’s making the “right” choices. She may feel she isn’t as smart, competent, or powerful as other people.
I don’t know what I’m doing. I never know. Why is it that everyone always seems to know what to do? How do they know?
I second-guess myself like crazy. I’ll think I think one thing, then the next minute change my mind. Again and again, over and over. Whatever anyone’s opinion is, that’s what my opinion becomes.
I’m afraid people won’t like me if I do the wrong thing. I’m terrified about not making the correct choice or decision.
This low self-esteem and lack of confidence are often perplexing to friends and family. Their perception is that she’s a capable individual and they expect her to have a strong sense of who she is, high self-esteem, and great self-confidence.
Many individuals who suffer from eating disorders also suffer from depression or anxiety. Some research has suggested that particular types of brain chemicals, called neurotransmitters, may be involved.
For instance, disturbances in amounts of the neurotransmitter serotonin might be responsible for some of the bingeing and purging behaviors of bulimia. Serotonin may also be involved in the regulation of hunger and fullness. Individuals with anorexia often have lower-than-normal levels of another neurotransmitter, norepinephrine, which is believed to be partly responsible for regulating mood, alertness, and response to stress.
One of the difficulties in deciphering a biological component in eating disorders is determining whether an imbalance in neurotransmitters precipitates the development of the illness or whether the imbalance occurs as a result of the disorder. This depends on the individual and is best discussed with a medical professional.
Genetics may also be a factor. Research in this area has been initiated in part by the observation that anorexia can run in families, and that bulimia repeatedly occurs in families where members suffer from depression or alcoholism. Many questions about the relationship between genetics and eating disorders remain to be answered and deserve additional study.
Significant attention has been paid to the family dynamics of people with eating disorders. Unfortunately, trying to understand the influence of close family relationships sometimes leads to blaming others, particularly parents, for their perceived failures or shortcomings. To do so is neither helpful nor particularly accurate. Our experience has been that, in general, families have good intentions and try to do the very best they can.
That said, some shared characteristics exist in families where an eating disorder is present, and becoming aware of them is useful. One commonality is that they tend to have difficulty expressing and managing emotions, something that can be due to a number of factors. For this reason, helping families learn how to handle their feelings in an effective and healthy way is a critical aspect of recovery.
My family doesn’t know what to do with feelings. We just pretend they don’t exist. I don’t know what to do with them either, so I throw them up.
In my family you always had to act pretty. You could never be mad or loud. You could never make noise. I learned to not show what I was really feeling. Sometimes I’m still not even sure what I’m feeling.
My father was really volatile. He could get really mad and yell. I hated it. It felt so unsafe and out of control. I hate that I could have feelings in me that might be scary and out of control.
Also, in some cases the quality of the bonds between family members is lacking. Instead of being flexible, respectful and balanced, where each person involved feels freedom to be him or herself, the relationships tend to fall into three general categories: too close (enmeshed), too distant (disconnected), or an erratic combination of the two.
My mom always wanted me with her. It felt like she wanted me to be her best friend. It felt creepy to me. I wasn’t her friend, I was her daughter.
My family’s relationships are inconsistent. They change from minute to minute. It feels crazy. You never know what to expect.
I love my sister, but she acts like she hates me. Most of the time she gives me the silent treatment, she won’t say a word. We live in the same house, but we may as well be a million miles away.
I missed my dad a lot. He traveled a lot for work and even when he was there I didn’t see him. I guess since he was gone so much, even when he was home, my mom managed everything. She didn’t let him really parent us. He got more and more distant over time. I wondered if he felt left out. I sure felt left out from him.
Changing Parental Roles
As children mature, assume more independence, and take on added responsibilities, the role of the parents continually shifts. In general, the younger their ages, the more parents are involved in decisions regarding their children’s lives. But an important aspect of growing up is learning to make one’s own choices. Stepping back and allowing children to assess their options and make their own choices may be difficult, but doing so is essential to their healthy development.
In families where an eating disorder is present, however, parents commonly have difficulty with this issue. One family, for example, may worry that their child isn’t ready or able to make the “right” choices for herself, so instead of encouraging her to take on this challenge, they continue to make decisions for her. Another might expect their child to be capable of making decisions that are far beyond what’s appropriate for her age or abilities, and therefore choose to remain distant and comparatively uninvolved. Yet another family may show signs of both of these attitudes, if, for instance, the parents have conflicting ideas about child rearing. Regardless of the situation, the end result is invariably the same: confusion on the part of the loved one, and trouble or failure when she tries to consider options and then choose what she believes to be best for her.
It was hard for my mom to trust me. She worried and worried. But after a while she could see that I didn’t always make “perfect” choices, but I mostly did okay.
My folks acted like they thought I as 25 when I was 11. They had me set my own curfew, buy my own groceries, choose most things for myself. Then they wondered why I didn’t make the “right” choices. Hello, I was 11— I didn’t know what I was doing.
An eating disorder can also be precipitated by a situation or occurrence that feels overwhelming or traumatic. Although the exact nature of the event isn’t as important as how it is experienced by your loved one, triggers include: leaving home for the first time (summer camp, college); the death of a parent; verbal, emotional, or sexual abuse; or teasing and bullying.
A group of girls at middle-school started harassing me—about everything. They were just plain mean. I was terrified of them. And I wanted to disappear.
I thought I was really independent and grown up. I couldn’t wait to go to college. But once I got there, I really didn’t know how to take care of myself at all.
My brother got mugged in the city. He was okay, but the whole thing freaked me out. It made everything seem so random, so out of control.
Determining a Cause
The cause of an eating disorder is quite a bit more complicated than, say, that of a bacterial infection, which can be directly traced to the presence of a particular organism. With an eating disorder, though, several factors are usually involved, and no two cases are exactly alike.
Sometimes it is more useful to think in terms of risk factors that might predispose someone to the development of the illness. One person can have every possible risk factor for an eating disorder and remain perfectly healthy. Someone else may have only one, but because of the particular constellation of events that make up her life and how they affect her, she may go on to develop full-blown anorexia or bulimia.
Although the idea of discovering what underlies your loved one’s illness may be tempting, try not to place too much value on the emergence of a simple, single cause. Exactly what happened to precipitate the eating disorder may never become clear, and dwelling on this issue too long or too much can become burdensome and frustrating for everyone. Remind yourself that what is important is how to treat the disorder once it’s been recognized.
Reprinted with permission from Why She Feels Fat
by Johanna Marie McShane and Tony Paulson
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