By Dr. Lauren Muhlheim
When someone we love is struggling with an eating disorder, it’s natural to want to understand what led to this challenge. Just as with any illness—be it diabetes, cancer, or even the flu—we seek answers.
However, when it comes to eating disorders, the question of “what caused this?” is particularly complex. The reality is, we still don’t fully understand what causes eating disorders.
It’s important to clarify that families do not cause eating disorders.
Many people often presume simplistic explanations, such as the influence of unrealistic beauty standards in the media or issues with parenting. And while certain factors, like trauma, can heighten the risk of developing any mental health issue, among them eating disorders, they don’t guarantee that someone will develop one. Recent research has shown that the truth is far more nuanced. Eating disorders appear to be complex illnesses influenced by a variety of factors, rather than a single cause. They seem to arise from a mix of biological, psychological, and environmental factors and their interplay. Additionally, there are many different paths that can lead to similar outcomes, such as anorexia nervosa or bulimia nervosa or ARFID.
It’s vital that family members approach this topic with compassion and an open mind. Understanding that these disorders are multifaceted can help us support our loved ones more effectively, fostering an environment of empathy rather than blame.
When we identify factors that contribute to the development of eating disorders, they tend to fall in 2 main categories: biological/genetic and environmental factors.
The primary reason that eating disorders run in families appears to be genetic. In terms of genetic factors, various studies estimate the genetic contribution to eating disorders such as anorexia, bulimia, and binge eating to be 40-60%. Heritability for ARFID appears to be even higher, 70-85% (Dinkler et al, 2023).
It’s important to clarify that research doesn’t point to a single “eating disorder
gene,” nor does it suggest that genes directly “cause” eating disorders. Instead, for some individuals, variations in multiple genes may play a role in shaping certain traits that can influence their risk for these disorders. For example, some people may inherit traits such as anxiety, perfectionism, or moodiness, which have been associated with a higher likelihood of developing an eating disorder. It’s also crucial to recognize that these traits can also be linked to other mental health disorders.
It’s essential to recognize that not everyone with an eating disorder has a family member who also struggles with one. In fact, most cases are sporadic and do not have any clear family history. While some families do have a higher risk for eating disorders, they are the exception rather than the rule. Additionally, the smaller family sizes today may not provide enough information to determine if someone has a genetic predisposition to an eating disorder. Just because a family history indicates some level of risk, it doesn’t mean that an individual is destined to develop an eating disorder. There are potentially protective factors too. Creating a family environment where body diversity is celebrated and all foods fit may provide some protection against eating disorders.
The greater weight that early research on eating disorders put on environmental risk factors has resulted in these factors shouldering more of the blame historically. Environmental factors include events and influences in an individual’s life, such as diet culture, the media, trauma, and weight teasing. Environmental factors may be shared (experienced by many people, such as diet culture) or nonshared (experienced by an individual, such as weight teasing).
One environmental factor often linked to eating disorders is media exposure. Dr. Ann Becker’s groundbreaking research in Fiji provides compelling insights. She studied two groups of schoolchildren in 1995 and 1998, comparing their behaviors before and after Western television was introduced to the island. Her findings revealed a significant increase in disordered eating behaviors, particularly the practice of purging to lose weight, after Western TV became available.
The following are environmental factors that have been implicated in the
development or maintenance of eating disorders:
While it’s clear that societal and cultural influences shape our perceptions of
eating and body image, these factors alone cannot fully explain the occurrence of eating disorders. If they could, we would see 100 percent of those exposed to these environmental influences developing an eating disorder, which simply isn’t the case.
The relationship between sociocultural influences and eating disorders is
complex. One useful framework for understanding this is the tripartite model,
which suggests that messages from media, peers, and parents all play a role in shaping an individual’s acceptance of the thin ideal and their tendency to engage in social comparison. These two factors can lead to body dissatisfaction, which is often a precursor to various forms of disordered eating.
Additionally, sociocultural models highlight that other elements—such as gender, ethnicity, and certain athletic environments—can either amplify or mitigate these influences. This helps explain why some groups may be at a higher risk of developing eating disorders.
When it comes to eating disorders, it’s clear that neither genes nor environment alone is the sole cause. Instead, these disorders usually arise from complex interactions between genetic predispositions and environmental influences. Even when individuals or their families can identify a triggering event, it’s usually just one piece of a larger puzzle. This event often serves as a catalyst, setting off a chain reaction of factors.
For instance, someone with a genetic predisposition to eating disorders may
consciously choose environments that emphasize negative body image. This
might include engaging with thin influencers in the media or taking part in
activities like ballet, which can contribute to increased exercise and weight loss.
Likewise, someone with a genetic predisposition may be especially vulnerable to weight-related teasing, which can amplify the harmful impact of such
experiences. Even a single instance of teasing could lead them to begin dieting, potentially worsening the problem.
Teenagers who are genetically predisposed may find themselves dieting much longer than their peers, who might only dabble in it for a short time and then move on. This prolonged dieting can be risky, especially for those with personality traits linked to anorexia nervosa, like high anxiety and perfectionism. These traits can make them more likely to seek out social circles that reinforce dieting and body-conscious behaviors, perpetuating the cycle.
While it may feel disheartening not to pinpoint exactly what triggers an eating disorder, there’s a hopeful side: just as environmental factors can heighten vulnerability to these disorders, changing the environment can foster conditions that support recovery. Positive shifts—like empowering women, reducing the objectification of all genders, and promoting respect for diverse body shapes and sizes—can help everyone. These changes benefit not only those at risk for eating disorders but also those facing related challenges like depression, creating a healthier, more inclusive society for all.
Editor’s Note: If you are a parent, I recommend learning about the impact of
“negative energy balance.”
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