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Essay on Eating Disorder

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Eating disorders represent a complex intersection of psychological, physical, and social issues. They are not just about food but are serious mental health conditions. This essay aims to delve into the various aspects of eating disorders, exploring their types, causes, effects, and treatments, providing a comprehensive understanding for students and individuals keen on understanding this intricate topic.

Eating Disorders

Eating disorders are serious mental health conditions characterized by an unhealthy preoccupation with eating, exercise, and body weight or shape. They can have devastating physical and psychological consequences. The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia Nervosa: Anorexia is characterized by an intense fear of gaining weight and a distorted body image, leading individuals to restrict their food intake drastically. This can result in severe malnutrition, physical health issues, and even life-threatening conditions.
Bulimia Nervosa: Bulimia involves recurrent episodes of binge eating, followed by behaviors aimed at compensating for the excessive calorie intake, such as purging through vomiting, excessive exercise, or laxative use. This cycle of overeating and purging can have serious health consequences.
Binge-Eating Disorder: Binge-eating disorder is marked by recurrent episodes of consuming large quantities of food in a short period, often without control. Unlike bulimia, individuals with this disorder do not engage in purging behaviors, which can lead to obesity and related health issues.
Avoidant/Restrictive Food Intake Disorder (ARFID): ARFID is characterized by highly selective eating patterns, avoiding certain foods or food groups based on sensory issues, aversions, or limited interest in food. This disorder can result in nutritional deficiencies and impaired growth in children.
Other Specified Feeding or Eating Disorders (OSFED): OSFED, previously known as EDNOS (Eating Disorder Not Otherwise Specified), includes a range of eating disorders that do not fit the strict criteria for anorexia, bulimia, or binge-eating disorder. It encompasses various disordered eating patterns.
Night Eating Syndrome: Individuals with night eating syndrome consume a significant portion of their daily caloric intake during the nighttime. They may wake up to eat, often experiencing insomnia and emotional distress.
Muscle Dysmorphia (Bigorexia): Muscle dysmorphia primarily affects men and is characterized by an obsessive desire to gain muscle mass and an intense fear of being inadequately muscular. It can lead to excessive exercise and supplement use.

Causes of Eating Disorders

Eating disorders are caused by a complex interplay of genetic, biological, behavioral, psychological, and social factors.

Genetic Factors : Family and twin studies suggest a genetic predisposition to eating disorders.
Psychological Factors : Low self-esteem, perfectionism, and impulsive behavior are commonly associated with eating disorders.
Social Factors : Cultural pressures that glorify thinness and body shaming can trigger eating disorders.

Effects of Eating Disorders

The effects of eating disorders can be severe and far-reaching.

Malnutrition: Eating disorders often lead to severe malnutrition, resulting in vitamin and mineral deficiencies, weakened immune system, and fragile bones.
Gastrointestinal Issues: Individuals with eating disorders may experience digestive problems such as constipation, bloating, and acid reflux.
Cardiovascular Problems: Heart complications, such as irregular heart rhythms, low blood pressure, and increased risk of heart attack, can occur.
Dental Issues: Frequent vomiting associated with some eating disorders can lead to dental problems, including tooth decay and erosion.
Hair and Skin Problems: Hair loss, brittle nails, and dry, discolored skin are common physical effects.
Anxiety and Depression: Eating disorders are often co-occurring with anxiety and depression, exacerbating these mental health conditions.
Obsessive Thoughts: Individuals with eating disorders may become obsessed with food, body size, and weight, leading to distressing and intrusive thoughts.
Low Self-esteem: Persistent body dissatisfaction and distorted body image contribute to low self-esteem and poor self-worth.
Social Isolation: Eating disorders can lead to social withdrawal, isolation, and strained relationships with friends and family.
Emotional Instability: Mood swings, irritability, and emotional instability are common effects of eating disorders.
Secrecy and Deception: Many individuals with eating disorders engage in secretive behaviors related to eating, hiding their disordered eating habits.
Ritualistic Eating: Rigid food rituals and routines, such as eating specific foods in specific orders, are common among those with eating disorders.
Excessive Exercise: Over-exercising is often seen in individuals with certain eating disorders, leading to physical strain and potential injuries.
Food Hoarding or Bingeing: Some may hoard food or engage in secretive binge-eating episodes, followed by guilt and shame.
Electrolyte Imbalance: Frequent purging behaviors (vomiting, laxative use) can disrupt electrolyte balance, leading to potentially life-threatening conditions like cardiac arrhythmias.
Osteoporosis: Malnutrition can result in bone density loss, increasing the risk of fractures and osteoporosis.
Lanugo Hair: Fine, downy hair growth on the body, known as lanugo, may develop in response to malnutrition.
Organ Damage: Long-term consequences of eating disorders can include damage to vital organs, such as the liver and kidneys.
Menstrual Irregularities: In females, eating disorders can lead to amenorrhea (absence of menstruation) or irregular menstrual cycles.
Fertility Problems: Reduced fertility and complications during pregnancy may occur due to hormonal imbalances and nutritional deficiencies.

Treatment of Eating Disorders

Treating eating disorders generally involves a multidisciplinary approach, including medical care, nutritional counseling, and therapy.

Medical Treatment : Focuses on addressing any immediate health risks.
Nutritional Counseling : Helps in developing a healthy relationship with food.
Psychotherapy : Cognitive-behavioral therapy (CBT) is particularly effective in treating eating disorders.

Coping Strategies and Support

Support Groups : Sharing experiences with others facing similar challenges can be comforting.
Healthy Lifestyle Choices : Engaging in regular physical activity and eating a balanced diet can improve mood and health.
Professional Help : Seeking timely professional help is crucial for recovery.

In conclusion, Eating disorders are complex conditions that require a comprehensive understanding of their causes, effects, and treatment options. Awareness and education are key in preventing these disorders and encouraging those affected to seek help. As a community, it is vital to foster an environment where body positivity is embraced, and mental health is taken seriously.

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Diseases & Conditions
Eating disorders

Eating disorders are serious health conditions that affect both your physical and mental health. These conditions include problems in how you think about food, eating, weight and shape, and in your eating behaviors. These symptoms can affect your health, your emotions and your ability to function in important areas of life.

If not treated effectively, eating disorders can become long-term problems and, in some cases, can cause death. The most common eating disorders are anorexia, bulimia and binge-eating disorder.

Most eating disorders involve focusing too much on weight, body shape and food. This can lead to dangerous eating behaviors. These behaviors can seriously affect the ability to get the nutrition your body needs. Eating disorders can harm the heart, digestive system, bones, teeth and mouth. They can lead to other diseases. They're also linked with depression, anxiety, self-harm, and suicidal thoughts and behaviors.

With proper treatment, you can return to healthier eating habits and learn healthier ways to think about food and your body. You also may be able to reverse or reduce serious problems caused by the eating disorder.

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Symptoms vary, depending on the type of eating disorder. Anorexia, bulimia and binge-eating disorder are the most common eating disorders. People with eating disorders can have all different body types and sizes.

Anorexia (an-o-REK-see-uh), also called anorexia nervosa, can be a life-threatening eating disorder. It includes an unhealthy low body weight, intense fear of gaining weight, and a view of weight and shape that is not realistic. Anorexia often involves using extreme efforts to control weight and shape, which often seriously interfere with health and daily life.

Anorexia may include severely limiting calories or cutting out certain kinds of foods or food groups. It may involve other methods to lose weight, such as exercising too much, using laxatives or diet aids, or vomiting after eating. Efforts to reduce weight can cause severe health problems, even for those who continue eating throughout the day or whose weight isn't extremely low.

Bulimia (buh-LEE-me-uh), also called bulimia nervosa, is a serious, sometimes life-threatening eating disorder. Bulimia includes episodes of bingeing, commonly followed by episodes of purging. Sometimes bulimia also includes severely limiting eating for periods of time. This often leads to stronger urges to binge eat and then purge.

Bingeing involves eating food — sometimes an extremely large amount — in a short period of time. During bingeing, people feel like they have no control over their eating and that they can't stop. After eating, due to guilt, shame or an intense fear of weight gain, purging is done to get rid of calories. Purging can include vomiting, exercising too much, not eating for a period of time, or using other methods, such as taking laxatives. Some people change medicine doses, such as changing insulin amounts, to try to lose weight.

Bulimia also involves being preoccupied with weight and body shape, with severe and harsh self-judgment of personal appearance.

Binge-eating disorder

Binge-eating disorder involves eating food in a short amount of time. When bingeing, it feels like there's no control over eating. But binge eating is not followed by purging. During a binge, people may eat food faster or eat more food than planned. Even when not hungry, eating may continue long past feeling uncomfortably full.

After a binge, people often feel a great deal of guilt, disgust or shame. They may fear gaining weight. They may try to severely limit eating for periods of time. This leads to increased urges to binge, setting up an unhealthy cycle. Embarrassment can lead to eating alone to hide bingeing. A new round of bingeing commonly occurs at least once a week.

Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder includes extremely limited eating or not eating certain foods. The pattern of eating often doesn't meet minimum daily nutrition needs. This may lead to problems with growth, development and functioning in daily life. But people with this disorder don't have fears about gaining weight or body size. Instead, they may not be interested in eating or may avoid food with a certain color, texture, smell or taste. Or they may worry about what can happen when eating. For example, they may have a fear of choking or vomiting, or they may worry about getting stomach problems.

Avoidant/restrictive food intake disorder can be diagnosed in all ages, but it's more common in younger children. The disorder can result in major weight loss or failure to gain weight in childhood. A lack of proper nutrition can lead to major health problems.

When to see a doctor

An eating disorder can be difficult to manage or overcome by yourself. The earlier you get treatment, the more likely you'll make a full recovery. Sometimes people can have problem eating behaviors that are similar to some symptoms of an eating disorder, but the symptoms don't meet the guidelines for a diagnosis of an eating disorder. But these problem eating behaviors can still seriously affect health and well-being.

If you have problem eating behaviors that cause you distress or affect your life or health, or if you think you have an eating disorder, seek medical help.

Urging a loved one to seek treatment

Many people with eating disorders may not think they need treatment. One of the main features of many eating disorders is not realizing how severe the symptoms are. Also, guilt and shame often prevent people from getting help.

If you're worried about a friend or family member, urge the person to talk to a health care provider. Even if that person isn't ready to admit to having an issue with food, you can start the discussion by expressing concern and a desire to listen.

Red flags that may suggest an eating disorder include:

Skipping meals or snacks or making excuses for not eating.
Having a very limited diet that hasn't been prescribed by a trained medical professional.
Too much focus on food or healthy eating, especially if it means not participating in usual events, such as sports banquets, eating birthday cake or dining out.
Making own meals rather than eating what the family eats.
Withdrawing from usual social activities.
Frequent and ongoing worry or complaints about being unhealthy or overweight and talk of losing weight.
Frequent checking in the mirror for what are thought to be flaws.
Repeatedly eating large amounts of foods.
Using dietary supplements, laxatives or herbal products for weight loss.
Exercising much more than the average person. This includes not taking rest days or days off for injury or illness or refusing to attend social events or other life events because of wanting to exercise.
Calluses on the knuckles from reaching fingers into the mouth to cause vomiting.
Problems with loss of tooth enamel that may be a sign of repeated vomiting.
Leaving during meals or right after a meal to use the toilet.
Talk of depression, disgust, shame or guilt about eating habits.
Eating in secret.

If you're worried that you or your child may have an eating disorder, contact a health care provider to talk about your concerns. If needed, get a referral to a mental health provider with expertise in eating disorders. Or if your insurance permits it, contact an expert directly.

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The exact cause of eating disorders is not known. As with other mental health conditions, there may be different causes, such as:

Genetics. Some people may have genes that increase their risk of developing eating disorders.
Biology. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.

Risk factors

Anyone can develop an eating disorder. Eating disorders often start in the teen and young adult years. But they can occur at any age.

Certain factors may increase the risk of developing an eating disorder, including:

Family history. Eating disorders are more likely to occur in people who have parents or siblings who've had an eating disorder.
Other mental health issues. Trauma, anxiety, depression, obsessive-compulsive disorder and other mental health issues can increase the likelihood of an eating disorder.
Dieting and starvation. Frequent dieting is a risk factor for an eating disorder, especially with weight that is constantly going up and down when getting on and off new diets. There is strong evidence that many of the symptoms of an eating disorder are symptoms of starvation. Starvation affects the brain and can lead to mood changes, rigid thinking, anxiety and reduced appetite. This may cause severely limited eating or problem eating behaviors to continue and make it difficult to return to healthy eating habits.
A history of weight bullying. People who have been teased or bullied for their weight are more likely to develop problems with eating and eating disorders. This includes people who have been made to feel ashamed of their weight by peers, health care professionals, coaches, teachers or family members.
Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress. And stress may increase the risk of an eating disorder.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely it is that serious complications may occur. These may include:

Serious health problems.
Depression and anxiety.
Suicidal thoughts or behavior.
Problems with growth and development.
Social and relationship problems.
Substance use disorders.
Work and school issues.

There's no sure way to prevent eating disorders, but you can take steps to develop healthy eating habits. If you have a child, you can help your child lower the risk of developing eating disorders.

To develop healthy eating habits and lifestyle behaviors:

Choose a healthy diet rich in whole grains, fruits and vegetables. Limit salt, sugar, alcohol, saturated fat and trans fats. Avoid extreme dieting. If you need to lose weight, talk to your health care provider or a dietitian to create a plan that meets your needs.
Don't use dietary supplements, laxatives or herbal products for weight loss.
Get enough physical activity. Each week, get at least 150 minutes of aerobic activity, such as brisk walking. Choose activities that you enjoy, so you're more likely to do them.
Seek help for mental health issues, such as depression, anxiety, or issues with self-esteem and body image.

For more guidelines on food and nutrition, as well as physical activity, go to health.gov.

Talk to a health care provider if you have concerns about your eating behaviors. Getting treatment early can prevent the problem from getting worse.

Here are some ways to help your child develop healthy-eating behaviors:

Avoid dieting around your child. Family dining habits may influence the relationships children develop with food. Eating meals together gives you an opportunity to teach your child about the pitfalls of dieting. It also allows you to see whether your child is eating enough food and enough variety.
Talk to your child. There are many websites and other social media sites that promote dangerous ideas, such as viewing anorexia as a lifestyle choice rather than an eating disorder. Some sites encourage teens to start dieting. It's important to correct any wrong ideas like this. Talk to your child about the risks of making unhealthy eating choices.
Encourage and reinforce a healthy body image in your child, whatever their shape or size. Talk to your child about self-image and offer reassurance that body shapes can vary. Don't criticize your own body in front of your child. Messages of acceptance and respect can help build healthy self-esteem. They also can build resilience ⸺ the ability to recover quickly from difficult events. These skills can help children get through the challenging times of the teen and young adult years.
Ask your child's health care provider for help. At well-child visits, health care providers may be able to identify early signs of an eating disorder. They can ask children questions about their eating habits. These visits can include checks of height and weight percentiles and body mass index, which can alert you and your child's provider to any big changes.

Reach out to help

If you notice a family member or friend who seems to show signs of an eating disorder, consider talking to that person about your concern for their well-being. You may not be able to prevent an eating disorder from developing, but reaching out with compassion may encourage the person to seek treatment.

Feeding and eating disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Nov. 16, 2022.
Hales RE, et al. Feeding and eating disorders. In: The American Psychiatric Publishing Textbook of Psychiatry. 7th ed. American Psychiatric Publishing; 2019. https://psychiatryonline.org. Accessed Nov. 10, 2022.
Eating disorders: About more than food. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/eating-disorders. Accessed Nov. 16, 2022.
Eating disorders. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders/Support. Accessed Nov. 16, 2022.
What are eating disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders. Accessed Nov. 16, 2022.
Treasure J, et al. Eating disorders. The Lancet. 2020; doi:10.1016/S0140-6736(20)30059-3.
Hay P. Current approach to eating disorders: A clinical update. Internal Medicine Journal. 2020; doi:10.1111/imj.14691.
Bhattacharya A, et al. Feeding and eating disorders. Handbook of Clinical Neurology. 2020; doi:10.1016/B978-0-444-64123-6.00026-6.
Uniacke B, et al. Eating disorders. Annals of Internal Medicine. 2022; doi:10.7326/AITC202208160.
Fogarty S, et al. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eating Behaviors. 2016; doi:10.1016/j.eatbeh.2016.03.002.
Some imported dietary supplements and nonprescription drug products may harm you. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/some-imported-dietary-supplements-and-nonprescription-drug-products-may-harm-you. Accessed Nov. 16, 2022.
Questions and answers about FDA's initiative against contaminated weight loss products. U.S. Food and Drug Administration. https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/questions-and-answers-about-fdas-initiative-against-contaminated-weight-loss-products. Accessed Nov. 16, 2022.
Mixing medications and dietary supplements can endanger your health. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/mixing-medications-and-dietary-supplements-can-endanger-your-health. Accessed Nov. 16, 2022.
Lebow JR (expert opinion). Mayo Clinic. Dec. 1, 2022.
2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov. Accessed Feb. 3, 2023.
Long MW, et al. Cost-effectiveness of 5 public health approaches to prevent eating disorders. American Journal of Preventive Medicine. 2022; doi:10.1016/j.amepre.2022.07.005.
Health.gov. https://health.gov/. Accessed Feb. 7, 2023.
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The Different Causes of Eating Disorders

The various pathways from the root to the fruit

Overall Risk Factors
Specific Eating Disorder Risk Factors

Genetic Factors

Environmental factors, gene and environment interplay, epigenetics.

When a person gets sick, it's natural to want to understand why. With eating disorders, which are associated with many myths and negative stereotypes, the question of causation can be incredibly confusing.

The culture at large commonly blames eating disorders on oversimplified explanations, such as the media's promotion of unrealistically slender models or bad parenting. Even some health professionals buy into these overly simplistic explanations.

This article explores some of the risk factors that may increase the likelihood that a person might develop an eating disorder, including the impact of both environmental and genetic variables. It also discusses the potential causes of specific eating disorders, such as binge eating disorder, anorexia nervosa, bulimia nervosa, and purging disorder.

Watch Now: Common Signs of an Eating Disorder

Risk factors for eating disorders.

Many factors have been, or are being, studied as possible contributors to the development of eating disorders. Across all types of eating disorders, it is likely that mental health and body image-related factors play a significant role in causing eating disorders.

In general, most experts agree that eating disorders are complicated illnesses that stem not from a single cause but from a complex interaction of biological, psychological, social, and environmental factors .

Mental Health

Mental health risk factors can include anxiety, depression , low self-esteem, and trauma such as childhood sexual abuse . Social stressors, such as peer pressure and bullying , may also be involved.

Risk factors related to eating behaviors and body image may also be tied to the development of eating disorders. These could include:

Teasing and critical comments about weight
Body dissatisfaction
Having a fixation with a thin body

Family Dynamics

Family dysfunction has long been cited as a cause of eating disorders. However, families don't cause eating disorders in a simple, straightforward manner.

While growing up in a dysfunctional home could increase the risk for many psychological problems, including eating disorders, it does not condemn a child to an eating disorder or any other psychological disorder.

Some research suggests that family functioning characterized by high levels of rigidity may be associated with a higher risk of disordered eating behavior.

Other Factors

Early childhood feeding, eating, or gastrointestinal problems can also contribute to the development of eating disorders.

Scientists can’t say exactly what causes an eating disorder or predict who will develop an eating disorder. There are many different pathways to the development of an eating disorder.

Risk Factors for Specific Eating Disorders

Risk factor research focuses on identifying traits or experiences that precede the development of a specific eating disorder (not just the overall category of eating disorders). For a risk factor to be shown as a causal factor , the risk factor must come before the development of the eating disorder.

The risk factor(s) must also be capable of being manipulated to prevent the occurrence of the disorder. For example, smoking is a causal risk factor for lung cancer; it comes before the development of the disease, and not smoking reduces one’s risk of developing lung cancer.

Because eating disorders are relatively rare and diverse disorders, it is difficult and expensive to perform the large and long-term studies needed to better assess risk factors.

To date, there is limited research that has successfully demonstrated causality; however, a 2016 study found the following causal risk factors for specific eating disorders:

Anorexia Nervosa

People with anorexia nervosa restrict their food intake, have an intense fear of weight gain, and have a distorted perception of their weight and health. A low body mass index (BMI)—essentially, underweight—has been identified as a risk factor. However, anorexia nervosa can still happen in people with a BMI in the normal range.

Problems With BMI

Body mass index (BMI) is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.

Bulimia Nervosa

Bulimia nervosa , characterized by repeated episodes of binge eating and purging, has several identified risk factors. These include:

Believing that thinness is equivalent to attractiveness (thin-ideal internalization)
Having a negative body image (body dissatisfaction)
Perceiving external pressure to be thin
Dieting frequently
Taking weight loss supplements

Binge Eating Disorder

Binge eating disorder is similar to bulimia nervosa but without the purging aspect . This eating disorder was added to the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) in 2013.

One study noted that in girls, the following were associated with binge eating in adulthood:

Body dissatisfaction in adolescence
Depressive symptoms
Low self-esteem

A 2017 study suggested that negative urgency , described as a "tendency to act impulsively when distressed," is also involved.

Purging Disorder

Purging disorder is similar to bulimia nervosa, but in this case, the behavior is limited to purging without binge eating. The only causal risk factor identified by the 2016 research is dieting. Other research has suggested that risk factors for purging disorder are similar to those for bulimia nervosa and binge eating.

Identifying actual causal factors for a specific eating disorder is complicated. Determining whether these factors are present in an individual can be difficult. Also, the presence of these factors predicts higher risk but does not guarantee the development of an eating disorder.

Coming from a family with a history of eating disorders can increase a person's risk of developing an eating disorder. A portion of this increased risk could be due to the modeling of eating disorder-linked behaviors within a family (e.g., observing a family member dieting).

However, twin study research, which can isolate the role of genetics, suggests that approximately 40% to 60% of the risk for anorexia nervosa, bulimia nervosa, and binge eating disorder arises from genetic influence.

Latest Research

The largest and most rigorous genetic investigation of eating disorders ever conducted, the Anorexia Nervosa Genetics Initiative (ANGI), is currently underway in the United States, Sweden, Australia, the United Kingdom, and Denmark. This research could provide more information about the genetic profile that contributes to eating disorders.

These findings do not imply that there is a single eating disorder gene or even that genes cause eating disorders. Some individuals may inherit traits such as anxiety, fear, perfectionism, or moodiness that have been associated with the development of an eating disorder. These aspects of temperament have also been linked to several other disorders.

For some people, variations in several different genes contribute to traits that, in turn, increase or decrease their risk for eating disorders.

Prevalence in Families

Some people with eating disorders are able to identify several other family members who also have eating disorders. There are certain families in which the risk of eating disorders is much higher than in the general population, but such families are relatively rare.

Even a high-risk family history indicating an increased genetic risk does not mean a person is destined to develop an eating disorder. Conversely, not everyone with an eating disorder can identify another family member with one.

Most eating disorder cases are sporadic, with no family history. Given the smaller size of today’s families, there is often not enough data to determine whether a specific individual has a genetic tendency.

Eating disorders are stigmatized diseases, and family members often do not share their struggles with their disorder.

Much of the earlier research on eating disorders examined environmental risk factors. As a result, they are frequently blamed for causing eating disorders. Environmental factors include events and influences in an individual’s life, such as:

Diet culture
Social media
Weight teasing

Influences such as gender, ethnicity, or certain athletic settings can strengthen or lessen other environmental factors.

The tripartite model is one model for understanding some of the socio-cultural risk factors for eating disorders. It proposes that exposure to media, peer, and parental messages all contribute to whether a person idealizes thinness and engages in social comparison. Idealization and social comparison may lead to poor body image and various forms of disordered eating.

Society and culture influence eating behavior, as well as our concept of ideal body shape. However, such environmental factors cannot fully account for the presence of eating disorders. If they did, 100% of the people exposed to the environmental factor(s) would develop an eating disorder, which we know is not the case.

Protective Environmental Factors

Some environmental factors could help protect people from developing eating disorders. These could include:

Family meals
Eating breakfast
Emotional regulation skills
Mindfulness techniques

Techniques that help groups and individuals question and challenge unrealistic beauty ideals (including the glorification of thinness and the stigmatization of overweight people ) are also helpful and protective. People are starting to practice body positivity and neutrality .

Social and environmental changes, such as improving the status and power of women, reducing the objectification of both men and women, and increasing respect for people of all sizes and shapes, will benefit everyone , not just those at risk for eating disorders.

These changes help create kinder, safer, and likely more protective communities.

Neither genes (nature) nor environment (nurture) cause eating disorders independently. Eating disorders are likely the result of a complicated interplay of these factors.

Even when a precipitating factor (such as a traumatic event) can be identified, there is almost always a combination of other contributing factors that play a role. The precipitating factor is most likely the trigger that knocked over the first domino and tripped a cascade of events.

Genetic susceptibility may influence their response to specific stressors. For example:

A person genetically susceptible to an eating disorder may be more sensitive to weight-related teasing and have a heightened reaction to it (for instance, initiating a diet that snowballs into a disorder).
A person who is genetically vulnerable may continue dieting much longer than peers who diet and then stop.
A person with the temperament that commonly underlies anorexia nervosa (anxious and perfectionistic ) may seek out the types of social environments that contribute to the onset of dieting.

The emerging field of epigenetics, the study of whether, how, and when genes are expressed, offers further insight. Epigenetics explains that certain environmental factors determine the expression of genes or even turn specific genes on or off in the next generation.

The stress that parents experience alters their behavior and can turn genes on and off in offspring who were not even exposed to that stressor.

In terms of eating disorders, there is evidence that the longer a person has anorexia nervosa, the greater the chance they will have alterations in how their genes are expressed. It appears that malnourishment could turn on or off certain genes, which influence the course of the disorder. However, epigenetic studies of eating disorders are in their infancy.

Final Thoughts

Just as environmental factors can increase a person's susceptibility to an eating disorder, the converse is also true: Changing the environment can facilitate prevention and recovery. For example, growing up with warm, nurturing parents could mitigate genes predisposing someone to anxiety. However, chance and luck also play a role, and individuals vary in their genetic risk.

Even in the face of every preventative measure, some people with extremely high genetic risks may still go on to develop an eating disorder after just one or two triggering events that are outside of their control. Others with low genetic risk may show resilience to developing an eating disorder even in the face of many potential environmental risk factors.

When someone develops an eating disorder, it's no one's fault. The cause of eating disorders is too complex to attribute blame to any one person, event, or gene.

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237 .

For more mental health resources, see our National Helpline Database .

Cerniglia L, Cimino S, Tafà M, Marzilli E, Ballarotto G, Bracaglia F. Family profiles in eating disorders: Family functioning and psychopathology . Psychol Res Behav Manag . 2017;10:305-312. doi:10.2147/PRBM.S145463

Stice E. Interactive and mediational etiologic models of eating disorder onset: Evidence from prospective studies . Annu Rev Clin Psychol . 2016;12:359-381. doi:10.1146/annurev-clinpsy-021815-093317

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , 5th edition, Text Revision (DSM-5-TR); 2022. doi:10.1176/appi.books.9780890425787

Goldschmidt AB, Wall MM, Zhang J, Loth KA, Neumark-Sztainer D. Overeating and binge eating in emerging adulthood: 10-year stability and risk factors . Dev Psychol . 2016;52(3):475-483. doi:10.1037/dev0000086

Racine SE, VanHuysse JL, Keel PK, et al. Eating disorder-specific risk factors moderate the relationship between negative urgency and binge eating: A behavioral genetic investigation . J Abnorm Psychol . 2017;126(5):481-494. doi:10.1037/abn0000204

Allen KL, Byrne SM, Crosby RD. Distinguishing between risk factors for bulimia nervosa, binge eating disorder, and purging disorder . J Youth Adolesc . 2015;44(8):1580-1591. doi:10.1007/s10964-014-0186-8

Fairweather-Schmidt AK, Wade TD. Changes in genetic and environmental influences on disordered eating between early and late adolescence: A longitudinal twin study . Psychol Med . 2015;45(15):3249-3258. doi:10.1017/S0033291715001257

Thornton LM, Munn-Chernoff MA, Baker JH, et al. The Anorexia Nervosa Genetics Initiative (ANGI): Overview and methods . Contemp Clin Trials . 2018;74:61-69. doi:10.1016/j.cct.2018.09.015

van den Berg P, Thompson JK, Obremski-Brandon K, Coovert M. The Tripartite Influence model of body image and eating disturbance . Journal of Psychosomatic Research . 2002;53(5):1007-1020. doi:10.1016/s0022-3999(02)00499-3

By Lauren Muhlheim, PsyD, CEDS Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy.

Home — Essay Samples — Nursing & Health — Public Health Issues — Eating Disorders

Essay Examples on Eating Disorders

What makes a good eating disorders essay topic.

When it comes to selecting a topic for your eating disorders essay, it's crucial to consider a multitude of factors that can elevate your writing to new heights. Below are some innovative suggestions on how to brainstorm and choose an essay topic that will captivate your readers:

Brainstorm : Begin by unleashing a storm of ideas related to eating disorders. Delve into the various facets, such as causes, effects, treatment options, societal influences, and personal narratives. Ponder upon what intrigues you and what will engage your audience.
Research : Embark on a comprehensive research journey to accumulate information and gain a profound understanding of the subject matter. This exploration will enable you to identify distinctive angles and perspectives to explore in your essay. Seek out scholarly sources such as academic journals, books, and reputable websites.
Cater to your audience : Reflect upon your readers and their interests to tailor your topic accordingly. Adapting your subject matter to captivate your audience will undoubtedly make your essay more engaging. Consider the age, background, and knowledge level of your readers.
Unveil controversies : Unearth the controversies and debates within the realm of eating disorders. Opting for a topic that ignites discussion will infuse your essay with thought-provoking and impactful qualities. Delve into various viewpoints and critically analyze arguments for and against different ideas.
Personal connection : If you possess a personal connection or experience with eating disorders, contemplate sharing your story or delving into it within your essay. This will add a unique and personal touch to your writing. However, ensure that your personal anecdotes remain relevant to the topic and effectively support your main points.

Overall, a remarkable eating disorders essay topic should be meticulously researched, thought-provoking, and relevant to your audience's interests and needs.

Best Eating Disorders Essay Questions

Below, you will find an array of stellar eating disorders essay questions to explore:

How does social media contribute to the development and perpetuation of eating disorders?
What challenges do males with eating disorders face, and how can these challenges be addressed?
To what extent does the family environment contribute to the development of eating disorders?
What role does diet culture play in fostering unhealthy relationships with food?
How can different treatment approaches be tailored to address the unique needs of individuals grappling with eating disorders?

Eating Disorders Essay Prompts

Below, you will find a collection of eating disorders essay prompts that will kindle your creative fire:

Craft a personal essay that intricately details your voyage towards recovery from an eating disorder, elucidating the lessons you learned along the way.
Picture yourself as a parent of a teenager burdened with an eating disorder. Pen a heartfelt letter to other parents, sharing your experiences and providing valuable advice.
Fabricate a fictional character entangled in the clutches of binge-eating disorder. Concoct a short story that explores their odyssey towards self-acceptance and recovery.
Construct a persuasive essay that fervently argues for the integration of comprehensive education on eating disorders into school curricula.
Immerse yourself in the role of a therapist specializing in eating disorders. Compose a reflective essay that delves into the challenges and rewards of working with individuals grappling with eating disorders.

Writing Eating Disorders Essays: FAQ

Q : How can I effectively commence my eating disorders essay?

A : Commence your essay with a captivating introduction that ensnares the reader's attention and provides an overview of the topic. Consider starting with an intriguing statistic, a powerful quote, or a personal anecdote.

Q : Can I incorporate personal experiences into my eating disorders essay?

A : Absolutely! Infusing your essay with personal experiences adds depth and authenticity. However, ensure that your personal anecdotes remain relevant to the topic and effectively support your main points.

Q : How can I make my eating disorders essay engaging?

A : Utilize a variety of rhetorical devices such as metaphors, similes, and vivid descriptions to transform your essay into an engaging masterpiece. Additionally, consider incorporating real-life examples, case studies, or interviews to provide concrete evidence and make your essay relatable.

Q : Should my essay focus solely on one specific type of eating disorder?

A : While focusing on a specific type of eating disorder can provide a narrower scope for your essay, exploring the broader theme of eating disorders as a whole can also be valuable. Strive to strike a balance between depth and breadth in your writing.

Q : How can I conclude my eating disorders essay effectively?

A : In your conclusion, summarize the main points of your essay and restate your thesis statement. Additionally, consider leaving the reader with a thought-provoking question or a call to action, encouraging further reflection or research on the topic.

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Eating disorders are complex mental health conditions characterized by abnormal or disturbed eating habits that negatively affect a person's physical and mental health.

Anorexia Nervosa: Characterized by an intense fear of gaining weight, a distorted body image, and severe restriction of food intake leading to extreme weight loss and malnutrition.
Bulimia Nervosa: Involves cycles of binge eating followed by compensatory behaviors such as vomiting, excessive exercise, or laxative use to prevent weight gain. Sufferers often maintain a normal weight.
Binge Eating Disorder: Marked by recurrent episodes of eating large quantities of food in a short period, often accompanied by feelings of loss of control and distress, but without regular use of compensatory behaviors.
Orthorexia: An obsession with eating foods that one considers healthy, often leading to severe dietary restrictions and malnutrition. Unlike other eating disorders, the focus is on food quality rather than quantity.
Avoidant/Restrictive Food Intake Disorder (ARFID): Involves limited food intake due to a lack of interest in eating, avoidance based on sensory characteristics of food, or concern about aversive consequences of eating, leading to nutritional deficiencies and weight loss.
Pica: The persistent eating of non-nutritive substances, such as dirt, clay, or paper, inappropriate to the developmental level of the individual and not part of a culturally supported or socially normative practice.
Rumination Disorder: Involves the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. This behavior is not due to a medical condition and can lead to nutritional deficiencies and social difficulties.
Distorted Body Image: Individuals often see themselves as overweight or unattractive, even when underweight or at a healthy weight.
Obsession with Food and Weight: Constant thoughts about food, calories, and weight, leading to strict eating rules and excessive exercise.
Emotional and Psychological Factors: Associated with low self-esteem, perfectionism, anxiety, depression, or a need for control.
Physical Health: Can cause severe health issues like malnutrition, electrolyte imbalances, hormonal disruptions, and organ damage.
Social Isolation: Withdrawal from social activities due to shame, guilt, and embarrassment, leading to loneliness and distress.
Co-occurring Disorders: Often coexists with anxiety, depression, substance abuse, or self-harming behaviors, requiring comprehensive treatment.
Genetic and Biological Factors: Genetic predisposition and biological factors, like brain chemical or hormonal imbalances, can contribute to eating disorders.
Psychological Factors: Low self-worth, perfectionism, body dissatisfaction, and distorted body image perceptions play significant roles.
Sociocultural Influences: Societal pressures, cultural norms, media portrayal of unrealistic body ideals, and peer influence increase the risk.
Traumatic Experiences: Physical, emotional, or sexual abuse can heighten vulnerability, leading to feelings of low self-worth and body shame.
Dieting and Weight-related Practices: Restrictive dieting, excessive exercise, and weight-focused behaviors can trigger disordered eating patterns.

Treatment for eating disorders includes psychotherapy, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and family-based therapy (FBT), to address psychological factors and improve self-esteem. Nutritional counseling with dietitians helps develop healthy eating patterns and debunks dietary myths. Medical monitoring involves regular check-ups to manage physical health. Medication may be prescribed for symptoms like depression and anxiety. Support groups and peer support offer community and empathy, providing valuable insights and encouragement from others facing similar challenges.

As per the data provided by the National Eating Disorders Association (NEDA), it is estimated that around 30 million individuals residing in the United States will experience an eating disorder during their lifetime.
Research suggests that eating disorders have the highest mortality rate of any mental illness. Anorexia nervosa, in particular, has a mortality rate of around 10%, emphasizing the seriousness and potential life-threatening nature of these disorders.
Eating disorders can affect individuals of all genders and ages, contrary to the common misconception that they only affect young women. While young women are more commonly affected, studies indicate that eating disorders are increasingly prevalent among men and can also occur in older adults and children.

Eating disorders are a critical topic because they affect millions of people worldwide, leading to severe physical and psychological consequences. Addressing eating disorders helps in understanding their complex causes and improving treatment options. Exploring eating disorders essay topics raises awareness, promotes early intervention, and encourages support for those affected, ultimately contributing to better mental health and well-being.

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. 2. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731. 3. Brown, T. A., Keel, P. K., & Curren, A. M. (2020). Eating disorders. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (6th ed., pp. 305-357). Guilford Press. 4. Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. The Lancet, 361(9355), 407-416. 5. Herpertz-Dahlmann, B., & Zeeck, A. (2020). Eating disorders in childhood and adolescence: Epidemiology, course, comorbidity, and outcome. In M. Maj, W. Gaebel, J. J. López-Ibor, & N. Sartorius (Eds.), Eating Disorders (Vol. 11, pp. 68-82). Wiley-Blackwell. 6. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-358. 7. Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin, 130(1), 19-65. 8. Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: Prevalence, incidence, comorbidity, course, consequences, and risk factors. Current Opinion in Psychiatry, 29(6), 340-345. 9. Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406-414. 10. Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445-457.

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Essay on Eating Disorders

Students are often asked to write an essay on Eating Disorders in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Eating Disorders

Understanding eating disorders.

Eating disorders are serious health problems. They occur when individuals develop unhealthy eating habits that can harm their body. They often start with an obsession with food, body weight, or body shape.

Types of Eating Disorders

There are three main types of eating disorders: Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Each has different symptoms but all can be harmful.

Impact on Health

Eating disorders can damage important body parts like the heart and brain. They can also affect mental health, causing anxiety or depression.

Getting Help

If you or someone you know has an eating disorder, it’s important to seek help. Doctors, therapists, and support groups can provide treatment and support.

250 Words Essay on Eating Disorders

Introduction.

The most common types are Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Anorexia is defined by a refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Bulimia involves frequent episodes of binge eating followed by behaviors like forced vomiting to avert weight gain. Binge Eating Disorder is characterized by frequent overeating episodes but without subsequent purging actions.

Sociocultural Influences

Sociocultural factors play a significant role in the onset of eating disorders. The media’s portrayal of an ‘ideal’ body size and shape can contribute to body dissatisfaction and consequently, disordered eating behaviors.

Health Implications

The health implications of eating disorders are severe, impacting both physical and mental health. These can range from malnutrition, organ damage, to increased risk of suicide.

Eating disorders, therefore, are serious conditions that require comprehensive treatment. Increased awareness, early diagnosis, and interventions can significantly improve the prognosis and quality of life for those affected.

500 Words Essay on Eating Disorders

Introduction to eating disorders.

Eating disorders represent a group of serious conditions characterized by abnormal eating habits that can negatively affect a person’s physical and mental health. These disorders often develop from a complex interplay of genetic, psychological, and sociocultural factors.

The Types of Eating Disorders

The underlying causes.

Eating disorders are typically multifactorial and can’t be attributed to a single cause. They often coexist with other mental health disorders such as depression, anxiety, and obsessive-compulsive disorder. Genetic predisposition plays a significant role, suggesting that eating disorders can run in families. Sociocultural factors, including societal pressures to be thin, can also contribute to the development of these disorders.

The Impact on Physical and Mental Health

The physical consequences of eating disorders are profound and can be life-threatening. They range from malnutrition, heart conditions, and bone loss in anorexia, to gastrointestinal problems and electrolyte imbalances in bulimia. Binge eating disorder can lead to obesity and related complications like heart disease and type 2 diabetes.

Treatment and Recovery

Treatment for eating disorders typically involves a multidisciplinary approach, combining medical, psychological, and nutritional therapy. Cognitive-behavioral therapy (CBT) is often effective, helping individuals to understand and change patterns of thought and behavior that lead to disordered eating.

Early intervention is crucial for recovery. However, stigma and lack of understanding about these disorders can often delay treatment. Therefore, raising awareness and promoting understanding about eating disorders is essential.

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Introduction

Eating disorders affect men and women of all ages, although adolescents tend to be the age group that is more susceptible. This is because, as their bodies are changing, they may feel more pressure by society as well as peer groups to look attractive and fit in (Segal et al). Types of eating disorders include Anorexia, Bulimia and Compulsive Overeating, which can also be related to the first two. The reasons behind Eating Disorder usually stem from a reaction to low self-esteem and a negative means of coping with life and stress (Something Fishy). Eating disorders are also often associated with an underlying psychological disorder, which may be the reason behind the eating disorder or which may develop from the Eating Disorder itself. Mental health disorders that are often associated with Eating Disorder include Anxiety, Depression, Multiple Personality Disorder, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, BiPolar, BiPolar II, Borderline Personality Disorder, Panic Disorder and Dissociative Disorder. The longer a person suffers from ED, the more probable that they will be dealing with another mental illness, most likely Anxiety or Depression (Something Fishy). The eventual outcome of Eating Disorder can be deadly. “Some eating disorders are associated with a 10-15% mortality rate and a 20-25% suicide rate. Sometimes, anorexia, bulimia and compulsive eating may be perceived as slow suicide (Carruthers).” In order to prevent the deadly consequences of Eating Disorder and to prevent it from becoming more pervasive in society, it is necessary to recognize the correct treatment method for this disease. Traditional treatments have focused on providing risk information to raise awareness of the consequences of Eating Disorder (Lobera et al 263). However, since Eating Disorder is a mental illness, a more effective treatment is one that offers psychological evaluation, counseling and treatment. Cognitive Behavioral Therapy is emerging as a more robust and effective method that can be used not only to treat Eating Disorder but the associated mental illnesses that may accompany it.

The Problem

Eating disorder is pervasive in society and can have deadly consequences on those that suffer from it. Many time Eating Disorder goes undetected by family members and friends because those suffering will go to great lengths to hide their problem. However, there are some signs and symptoms that can be clues that a person is suffering from some sort of eating disorder. According to Segal, these signs can include:

Restricting Food or Dieting: A change in eating habits that includes restricting food or excessive dieting. The person my frequently miss meals or not eat, complaining of an upset stomach or that they are not hungry. A use of diet pills or illegal drugs may also be noticed.
Bingeing: Sufferers may binge eat in secret, which can be hard to detect since they will usually do it late at night or in a private place. Signs of potential bingeing are empty food packages and wrappers and hidden stashes of high calorie junk food or desserts.
Purging: Those who suffer from bulimia will force themselves to throw up after meals to rid their body of added calories. A sign that this is occurring is when a person makes a trip to the bathroom right after eating on a regular basis, possible running water or a fan to hide the sound of their vomiting. They may also use perfume, mouthwash or breath mints regularly to disguise the smell. In addition to vomiting, laxatives or diuretics may also be used to flush unwanted calories from the body.
Distorted body image and altered appearance: People suffering from Eating Disorder often have a very distorted image of their own body. While they may appear thin to others, they may view themselves as fat and attempt to hide their body under loose clothing. They will also have an obsessive preoccupation with their weight, and complain of being fat even when it is obvious to others that this is not the case.

There are several possible side effects from Eating Disorders, both physical and psychological. Physical damage can be temporary or permanent, depending on the severity of the eating disorder and the length of time the person has been suffering from it. Psychological consequences can be the development of a mental illness, especially depression and anxiety. Some sufferers of Eating Disorder will also develop a coping mechanism such as harming themselves, through cutting, self-mutilation or self-inflicted violence, or SIV (Something Fishy).

Physical consequences of Eating Disorders depend on the type of eating disorder that the person has. Anorexia nervosa can lead to a slow heart rate and low blood pressure, putting the sufferer at risk for heart failure and permanent heart damage. Malnutrition can lead to osteoporosis and dry, brittle bones. Other common complications include kidney damage due to dehydration, overall weakness, hair loss and dry skin. Bulimia nervosa, where the person constantly purges through vomiting, can have similar consequences as Anorexia but with added complications and damage to the esophagus and gastric cavity due to the frequent vomiting. In addition, tooth decay can occur because of damage caused by gastric juices. If the person also uses laxatives to purge, irregular bowel movements and constipation can occur. Peptic ulcers and pancreatitis can also common negative heath effects (National Eating Disorders Association). If the Eating Disorder goes on for a prolonged time period, death is also a possible affect, which is why it is important to seek treatment for the individual as soon as it is determined that they are suffering from an Eating Disorder.

Once it is recognized that a loved one may be suffering from an Eating Disorder, the next step is coming up with an effective intervention in time to prevent any lasting physical damage or death. The most effective treatment to date is Cognitive-behavioral therapy, an active form of counseling that can be done in either a group or private setting (Curtis). Cognitive-behavioral therapy is used to help correct poor eating habits and prevent relapse as well as change the way the individual thinks about food, eating and their body image (Curtis).

Cognitive-behavioral therapy is considered to be one of the most effective treatments for eating disorders, but of course this depends on both the counselor administrating the therapy and the attitude of the person receiving it. According to Fairburn (3), while patients with eating disorders “have a reputation for being difficult to treat, the great majority can be helped and many, if not most, can make a full and lasting recovery.” In the study conducted by Lobera et al, it was determined that students that took part in group cognitive-behavioral therapy sessions showed a reduced dissatisfaction with their body and a reduction in their drive to thinness. Self esteem was also improved during the group therapy sessions and eating habits were significantly improved.

“The overall effectiveness of cognitive-behavioral therapy can depend on the duration of the sessions. Cognitive-behavioral therapy is considered effective for the treatment of eating disorders. But because eating disorder behaviors can endure for a long period of time, ongoing psychological treatment is usually required for at least a year and may be needed for several years (Curtis).”

Alternative solutions

Traditional treatments for Eating Disorders rely on educating potential sufferers, especially school aged children, of the potential damage, both psychological and physical, that can be caused by the various eating disorders .

“ Research conducted to date into the primary prevention of eating disorders (ED) has mainly considered the provision of information regarding risk factors. Consequently, there is a need to develop new methods that go a step further, promoting a change in attitudes and behavior in the target population (Lobera et al).”

The current research has not shown that passive techniques, such as providing information, reduces the prevalence of eating disorders or improves the condition in existing patients. While education about eating disorders, the signs and symptoms and the potential health affects, is an important part of providing information to both the those that may know someone who is suffering from an eating disorder and those that are suffering from one, it is not an effective treatment by itself. It must be integrated with a deeper level of therapy that helps to improve the self-esteem and psychological issues from which the eating disorder stems.

Hospitalization has also been a treatment for those suffering from an eating disorder, especially when a complication, such as kidney failure or extreme weakness, occurs. However, treating the symptom of the eating disorder will not treat the underlying problem. Hospitalization can effectively treat the symptom only when it is combined with a psychological therapy that treats the underlying psychological problem that is causing the physical health problem.

Effectively treating eating disorders is possible using cognitive-behavioral therapy. However, the sooner a person who is suffering from an eating disorder begins treatment the more effective the treatment is likely to be. The longer a person suffers from an eating disorder, the more problems that may arise because of it, both physically and psychologically. While the deeper underlying issue may differ from patient to patient, it must be addressed in order for an eating disorder treatment to be effective. If not, the eating disorder is likely to continue. By becoming better educated about the underlying mental health issues that are typically the cause of eating disorder, both family members and friends of loved ones suffering from eating disorders and the sufferers themselves can take the steps necessary to overcome Eating Disorder and begin the road to recovery.

Works Cited

“Associated Mental Health Conditions and Addictions.” Something Fishy, 2010. Web. 19 November2010.

Carruthers, Martyn. Who Has Eating Disorders? Soulwork Solutions, 2010. Web. 19 November 2010.

Curtis, Jeanette. “Cognitive-behavioral Therapy for Eating Disorders.” WebMD (September 16, 2009). Web. 19 November 2010.

Fairburn, Christopher G. Cognitive Behavior Therapy and Eating Disorders. New York: The Guilford Press, 2008. Print.

“Health Consequences of Eating Disorders” National Eating Disorders Association (2005). Web. 21 November 2010.

Lobera, I.J., Lozano, P.L., Rios, P.B., Candau, J.R., Villar y Lebreros, Gregorio Sanchez, Millan, M.T.M., Gonzalez, M.T.M., Martin, L.A., Villalobos, I.J. and Sanchez, N.V. “Traditional and New Strategies in the Primary Prevention of Eating Disorders: A Comparative Study in Spanish Adolescents.” International Journal of General Medicine 3 (October 5, 2010): 263-272. Dovepress.Web. 19 November 2010.

Segal, Jeanne, Smith, Melinda, Barston, Suzanne. Helping Someone with an Eating Disorder: Advice for Parents, Family Members and Friends , 2010. Web. 19 November 2010.

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> Volume 37 Issue 2
> The Explanation of Eating Disorders: A Critical Analysis

Article contents

The explanation of eating disorders: a critical analysis.

Published online by Cambridge University Press: 29 April 2020

Eating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.

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Volume 37, Issue 2
Hannah Hawkins-Elder (a1) and Tony Ward (a1)
DOI: https://doi.org/10.1017/bec.2020.6

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J Eat Disord

Risk factors for eating disorders: findings from a rapid review

Sarah barakat.

1 InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia

4 Faculty of Medicine and Health, Charles Perkins Centre (D17), InsideOut Institute, University of Sydney, Level 2, Sydney, NSW 2006 Australia

Siân A. McLean

2 School of Psychology and Public Health, La Trobe University, Melbourne, Australia

Emma Bryant

3 Healthcare Management Advisors, Melbourne, Australia

Stephen Touyz

Sarah maguire, associated data.

Not applicable—all citations provided.

Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders.

The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021–2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper.

A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms.

Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-022-00717-4.

Plain English summary

Research into the risk factors associated with eating disorders (EDs) is necessary in order to better understand the reasons why people develop EDs and to inform programs which aim to reduce these risk factors. In the current study we reviewed studies published between 2009 and 2021 which had researched risk factors associated with EDs. This study is one review of a wider Rapid Review series conducted as part the development of Australia’s National Eating Disorders Research and Translation Strategy 2021–2031. The findings from this review are grouped into nine main risk factor categories. These include (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. Further research is needed to better understand the relationship between the risk factors, in particular the ways in which they may interact with each other and whether they cause the ED or are just associated with the ED.

Introduction

Eating disorders (ED) are complex psychiatric conditions associated with significant psychological and physical impairment. Individuals with EDs are at greater risk of suicide attempts, mortality, and poorer quality of life relative to both the general population and individuals with other psychiatric conditions [ 1 – 3 ]. Central to addressing the pervasive nature of EDs is understanding the circumstances which make individuals more vulnerable to developing these psychiatric conditions. The development of an ED is dependent on a myriad of variables ranging from sociocultural, to biological and genetic, and psychological factors. Despite the variation and complexity present in the aetiology of EDs, efforts have been made by researchers to identify risk factors which commonly predict onset [ 4 – 6 ]. Understanding the range of risk factors and their potential contribution to onset of an ED is crucial to identifying at risk groups and providing effective screening and prevention programs, as well as targeted interventions [ 7 , 8 ].

EDs can be severe and are often chronic in nature, particularly if not addressed in a timely manner. A recent study of ED patients identified an average delay of 5.28 years between ED symptom onset and treatment-seeking [ 9 ]. A factor considered to contribute to this delay is health professionals’ lack of awareness of indicators of disordered eating behaviours, meaning EDs often go unrecognised by treating clinicians [ 10 ]. Identification of risk factors for EDs offers an opportunity for targeted education of health professionals to assist in distinguishing patterns of psychosocial, biological, and genetic vulnerabilities for disordered eating even in the absence of any overt weight or dietary concerns [ 11 ].

Knowledge of the risk factors for EDs offers the opportunity for early identification of high-risk groups and in turn a timely and tailored response via avenues such as public policy development or initiation of targeted prevention programs [ 12 ]. Prevention and early intervention programs based upon aetiological models may help to prevent movement along the spectrum from at-risk to full threshold disorder [ 13 ]. Additionally, EDs are complex psychiatric conditions with a somewhat limited range of efficacious evidence-based interventions [ 14 , 15 ]. In addition, a significant number of patients with EDs do not respond to current evidence-based treatments [ 16 – 20 ]. As such, attempts to better understand the role of risk factors in aetiological and causal pathways of EDs are necessary in order to form more nuanced conceptualisations of these illnesses. This may inform the development of more effective treatments, especially for those with persistent and chronic course [ 21 ].

The current Rapid Review paper forms part of a series of reviews commissioned by the Australian Federal Government to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031[ 22 ]. This paper aims to identify and explore the risk factors associated with EDs by summarising the existing evidence related to aetiological underpinnings. Importantly, the review is inclusive of research which considers risk factors to be either causal in nature or associated with the onset of ED.

The Australian Government Commonwealth Department of Health funded the InsideOut Institute for Eating Disorders (IOI) to develop the Australian Eating Disorders Research and Translation Strategy 2021–2031 [ 1 ] under the Psych Services for Hard to Reach Groups initiative (ID 4-8MSSLE). The strategy was developed in partnership with state and national stakeholders including clinicians, service providers, researchers, and experts by lived experience (including consumers and families/carers). Developed through a two-year national consultation and collaboration process, the strategy provides the roadmap to establishing EDs as a national research priority and is the first disorder-specific strategy to be developed in consultation with the National Mental Health Commission. To inform the strategy, IOI commissioned Healthcare Management Advisors (HMA) to conduct a series of RRs to broadly assess all available peer-reviewed literature on the six DSM-5 listed EDs.

A RR Protocol [ 23 ] was utilised to swiftly synthesise evidence in order to guide public policy and decision-making [ 24 ]. This approach has been adopted by several leading health organisations including the World Health Organisation [ 25 ] and the Canadian Agency for Drugs and Technologies in Health Rapid Response Service [ 26 ], to build a strong evidence base in a timely and accelerated manner, without compromising quality. A RR is not designed to be as comprehensive as a systematic review – it is purposive rather than exhaustive and provides actionable evidence to guide health policy [ 27 ].

The RR is a narrative synthesis and sought to adhere to the PRISMA guidelines [ 28 ]. It is divided by topic area and presented as a series of papers. Three research databases were searched: ScienceDirect, PubMed and Ovid/Medline. To establish a broad understanding of the progress made in the field of EDs, and to capture the largest evidence base from the past 12 years (originally 2009–2019, but expanded to include the preceding two years), the eligibility criteria for included studies into the rapid review were kept broad. Therefore, included studies were published between 2009 and 2021, in English, and conducted within Western healthcare systems or health systems comparable to Australia in terms of structure and resourcing. The initial search and review process was conducted by three reviewers between 5 December 2019 and 16 January 2020. The re-run for the years 2020–2021 was conducted by two reviewers at the end of May 2021.

The RR had a translational research focus with the objective of identifying evidence relevant to developing optimal care pathways. Searches therefore used a Population, Exposure, Outcome (PEO) approach [ 29 ] whereby search terms are specified to identify literature relating to the population or group of interest (i.e., individuals of any age or background with the propensity to develop and eating disorder), exposure to the risk factors that are associated with the development of an eating disorder, and the outcome of interest (i.e., the development of an eating disorder). By using the three PEO components to guide the search strategy, the PEO approach aims to facilitate a thorough and systematic examination of existing literature. Purposive sampling focused on high-level evidence studies such as: meta-analyses; systematic reviews; moderately sized randomised controlled studies (RCTs) ( n > 50); moderately sized controlled-cohort studies ( n > 50), or population studies ( n > 500). However, the diagnoses ARFID and UFED necessitated a less stringent eligibility criterion due to a paucity of published articles. As these diagnoses are newly captured in the DSM-5 (released in 2013, within the allocated search timeframe), the evidence base is emerging and fewer studies have been conducted. Thus, smaller studies (n = < 20) and narrative reviews were also considered and included. Grey literature, such as clinical or practice guidelines, protocol papers (without results) and Masters’ theses or dissertations, was excluded. Other sources (which may not be replicable when applying the current methodology) included the personal libraries of authors, yielding four additional studies (see Additional File 1 ). This extra step was conducted in line with the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews [ 30 ].

Full methodological details including eligibility criteria, search strategy and terms and data analysis are published in a separate protocol paper [ 31 ]. The full RR included a total of 1320 studies (see Additional File 1 for PRISMA flow diagram). Data from included studies relating to risk factors for EDs were synthesised and are presented in the current review.

The Rapid Review identified 284 studies for inclusion in the ‘Risk Factors’ category. When referring to ‘risk factors’ in this review, we are not always referring to causal risk factors. Accordingly, some of the risk factors included in this review are correlated or associated with increased risk of an ED, without evidence of causation. As the aim of a Rapid Review is to broadly synthesise findings, we did not narrow to studies only providing evidence regarding the causal relationship of risk factors. Rather, the current review focused on a range of research including prospective, experimental and correlational studies to identify a large number of potential correlates which have risk capacity for EDs. According to the Kraemer et al. (2001) criteria, this review covers research related to the following technical terms: “correlate” (a measure associated with the outcome), “risk factor” (a measure which precedes the outcome), and “causal risk factor” (a risk factor, which when manipulated, causes a change in the outcome) [ 32 ]. Therefore, the factors identified in this review are associated or predictive factors, unless in cases where a causative link has been demonstrated. A summary of the key risk factors associated with EDs is provided in Table Table1 1 and are discussed in this section. Results are subdivided into nine categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A full list of included studies for this topic, including population, aims, design, and outcome measures is available in Additional File 1 .

Risk factors associated with EDs

Risk factor category	Features of risk factor	Associated ED
Genetic	See Sect. and Table 2 for details	AN, BN, BED
Gut microbial dysbiosys	CIpB)	AN
Autoimmune disease	Diabetes, inflammatory gastrointestinal disease	AN, BN, EDNOS
Childhood weight status	Low BMI	AN
	High BMI	BN, BED
Relationship with parents	Parent perception that the child is overweight	AN-BP, BN, BED, PD
	Parental teasing about weight	AN-BP, BN, BED
	Perceived pressure from parents to eat	ARFID
Neglect/abuse/trauma		AN, BN, BED, PD
	Post-traumatic stress disorder	BED
Personality traits	Perfectionism	AN-R, A-AN
	Obsession	AN-R, A-AN
	Impulsiveness	AN-BP, BN, BED, PD
Comorbid conditions	Obsessive compulsive disorder	AN
	Social anxiety disorder	BN, AN
	Borderline personality disorder	BN, BED, PD
	Bipolar disorder	BN, BED
	Depression	All EDs
Social/environmental	Exposure to ‘thin ideal’	All ED
	Body dissatisfaction	BN, BED, PD
	Early puberty development	BN, AN
	Food insecurity	Binge eating behaviours
	High educational attainment	Restricting type ED behaviours
	Involvement in elite sports	All ED

ED eating disorder; AN anorexia nervosa; BN bulimia nervosa; BED binge eating disorder; EDNOS eating disorder not otherwise specified; BMI body mass index; AN-BP anorexia nervosa (binge-purge subtype); PD personality disorder; ARFID avoidant restrictive food intake disorder; AN-R anorexia nervosa (restrictive subtype); A-AN atypical AN

1. Genetics: endocrines and neurotransmitters

Genetic risk factors and polymorphisms (variations in gene expression), relating to core EDs have been widely studied. Research conducted within twins and family groups as well as large-scale genomic studies have indicated a genetic component to risk of Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) [ 33 ]. Incidence rates in individuals with a parent with a history of ED have been found to be over twice as high compared to individuals with parents with no history of an ED [ 34 ]. Familial studies have demonstrated a strong genetic association for AN in particular. An individual is 11 times more likely to develop AN if they have a relative with the disorder as compared to someone with no family history. Similarly, an individual is 9.6 times more likely to develop BN, and 2.2 times more likely to develop BED if they have a relative with the disorder [ 33 ]. Evidence of genetic risk factors for other EDs is growing [ 33 ], although there have been no genetic studies to date conducted with Avoidant Restrictive Food Intake Disorder (ARFID) [ 35 ].

Anorexia nervosa and bulimia nervosa

Genetic factors have been shown to strongly contribute to both AN and BN [ 36 ]. There is evidence to suggest approximately half of the genetic factors implicated in AN and BN are shared between the disorders, with the remaining 50% being unique to one or the other [ 36 ]. An older study of Norwegian twins found some support for different features of AN being more heritable than others; having found weight/shape concern to have greater genetic association than low BMI and amenorrhea [ 37 ]. In contrast the landmark 2019 study by two international genome-wide association consortiums found that both metabolic and anthropometric related genetic loci associated with BMI lowering alleles have strong correlations with AN [ 38 ].

Hereditary patterns of EDs have been shown to disproportionately affect females [ 34 ]. In a sample of adolescent twins aged 15 to 17, Baker et al. (2009) found females were at greater genetic risk for disordered eating than males [ 39 ]. This is consistent with earlier evidence suggesting drive for thinness and body dissatisfaction showed lower heritability in males [ 40 ]. Baker et al. [ 39 ] found that only half of the genetic risk factors predicting drive for thinness and body dissatisfaction in females predicted the same traits in males. A possible explanation for this difference was offered in a study of French and German cohorts whereby inherited variations in an estrogen receptor gene (ESR1) significantly increased risk of restrictive eating and subsequently development of AN restrictive subtype (AN-R) [ 41 ].

Comorbidities

Genetic risk has been implicated in co-occurrence of EDs and other psychiatric diagnoses. Genetic associations have been found between Attention-Deficit/Hyperactivity Disorder (ADHD) and all EDs, with the strongest correlation to binge/purge-type ED behaviours [ 42 , 43 ]. Strong positive genetic associations have also been identified between AN and other psychiatric comorbidities, including Obsessive Compulsive Disorder (OCD), major depressive disorder, suicidality, schizophrenia, neuroticism, autism, and neurodevelopmental delay [ 44 – 48 ]. Genetic risk for comorbid AN and Generalised Anxiety Disorder (GAD) has also been identified [ 46 , 47 ].

The contribution of comorbid mental health disorders to ED risk and outcomes are further discussed in Sect. Results and in another topic paper of the Rapid Review, ‘Psychiatric Comorbidities and Medical Complications.’

Genes and polymorphisms

Several genomic studies have attempted to locate specific gene loci implicated in the development of EDs. See Table Table2 2 for a summary of genes and polymorphisms identified in ED genomic studies. A recent genome-wide association study published in 2021 has suggested that there is a distinct difference in the underlying biology between binge-type EDs (BN and BED) and AN. The study reported that both BN and BED shared genomic variant with overweight and obesity, whereas the directions of these associations were reversed for AN [ 49 ].

Genes and polymorphisms identified in the development of EDs

ED	Polymorphism (allele)	Function
AN		Cell adhesion molecule 1
		O-6-methylguanine-DNA methyltransferase
		Cell and tissue-specific gene transcription
		Polypyrimidine tract binding protein primarily expressed in the brain
	G861	5-hydroxytryptamine receptor 1B
	rs13338499	Agouti-related protein (appetite stimulator)
	5-HTTLPR (S)	Serotonin transporter
	rs2254298	Oxytocin receptor
	rs3798577	Estrogen receptor
	rs2291635	Cholesterol metabolism/BMI
	rs550942	Ciliary neurotrophic factor receptor
BN	rs928554	Estrogen receptor
	Rs1049353	Cannabinoid receptor
	5-HHTLPR	Serotonin receptor
	Rs1800497(Taq1A)	Dopamine receptor D2

	Rs4680 (Va1158Met)	Catechol-O-methyltransferase
	Rs9939609	BMI and fat mass
	Bc11	Glucocorticoid receptor
	rs1078947	Tyrosine receptor kinase (obesity and mood disorder related)
	rs6198	Glucocorticoid receptor
BED	Rs696217	Ghrelin
		Melanocortin 4 receptor
	rs6277	Dopamine receptor D2
	rs1800497
	Rs1800497 (Taq1A)	Ankyrin repeat and kinase domain containing 1
	Rs2270912	Dopamine transporter 1
	Rs2863130
	5-HHTLPR	Serotonin transporter
	Rs1799971 (118A/G)	Dopamine receptor D2
	Rs6265 (Val66Met)	Brain derived neurotropic factor
	rs1558902	BMI and fat mass

ED eating disorder; AN anorexia nervosa; BN bulimia nervosa, BED binge eating disorder

Genetic susceptibility to AN was explored in a landmark meta-analysis of 33 datasets from international genome-wide association studies. Watson et al. [ 38 ] compared the DNA of almost 17,000 individuals with AN to the DNA of 55,000 people without AN around the world. Eight loci associated with significant risk of developing AN were identified [ 38 , 50 ], including genetic correlations with certain psychiatric, anthropometric, and metabolic traits, as well as physical activity. Positive associations were found for physical activity, anxiety and schizophrenia disorders, and HDL cholesterol. Negative associations were found for metabolic (including glycemic), lipid, and anthropometric traits including fat mass, fat-free mass, BMI, obesity, type 2 diabetes, fasting insulin, insulin resistance, and leptin [ 48 ]. Analysis of causality revealed a bi-directional relationship between potential AN genes and risk for low body mass index (BMI). However, there is stronger evidence that low-BMI-causing alleles increase risk of AN than there is for AN-risk genes leading to low BMI [ 38 ].

A study of Norwegian adolescents found an association between poor appetite and undereating, and the COMT gene, which is responsible for regulating dopamine levels through the production of the COMT enzyme [ 51 ]. Brain studies of patients with AN have indicated that, due to disturbances in regular serotonin and dopamine reward pathways, individuals with AN may use restricted eating as a mechanism to reduce anxiety [ 52 ]. In one study of patients with AN and BN, mutations in genes with heightened expression in brain tissue (CNTF, NTRK) were associated with a higher minimum lifetime BMI and earlier ED onset [ 53 ].

Six genetic polymorphisms have been associated with the development of BN in people with obesity [ 54 ]. Of the six genetic polymorphisms, three are thought to be related to the neuroendocrine receptors of dopamine, serotonin, and cannabinoid. This association is supported by evidence that genetic variations which lead to low dopamine production and neurotransmission are associated with an increased risk of binge/purge type EDs [ 55 ]. The remaining three polymorphisms identified in BN aetiology were associated with an estrogen receptor, the production of an enzyme expressed in brain tissue, and the FTO gene (which has a role in BMI regulation) [ 54 ]. While dopamine and serotonin receptor genes (DRD2 and SLC6A4, respectively) are implicated in the development of both BN and BED, differing polymorphisms in these genes appear to be associated with increased risk of developing one disorder over the other [ 54 ]. Further, triallelic 1 variations in a serotonin receptor allele (5-HTTLPR) have also been observed to contribute to compulsive personality traits and the development of AN, BN, and eating disorder not otherwise specified (EDNOS) [ 56 , 57 ]. A polymorphism of the oxytocin receptor gene (OXT-R) was also found to distinguish between risk of onset for restricting type EDs or binge/purge type EDs, indicating the potential role of oxytocin in the development and maintenance of EDs [ 58 ]. Additional research has identified an association between a polymorphism in a neurotransmitter inhibition gene (HTR1B) and an increased risk of developing BN as well as greater severity of AN symptoms, including low BMI [ 59 ].

Expression of genes associated with the production of appetite and weight control endocrines (leptin, melanocortin, and neurotrophin) are thought to have a role in ED development and severity [ 45 ]. A case–control study by Zeeland et al. [ 60 ] found a significant number of AN participants with a polymorphism in a cholesterol metabolism gene (EPHX2), which was also associated with lower BMI (see Table Table2). 2 ). Yilmaz et al. (2014) examined 20 single-nucleotide polymorphisms 2 (SNPs) in the endocrine system genes in a sample of individuals with BN (n = 745) and AN (n = 245). Although no significant differences were observed between either ED diagnosis or control participants, two SNPs associated with regulation of BMI were found to have an impact on disease severity (See Table Table2) 2 ) [ 61 ].

Consequences of variations in endocrine signalling in individuals with ED also include reduced capacity for interoception 3 particularly relating to gastric interoception. A systematic review of interoception in individuals with ED found the strongest correlations were observed in individuals with AN who consistently had lower gastric interoception relating to satiety and self-reported fullness, while individuals with BN were found to have lower pain interoception resulting in higher pain thresholds. However, researchers were unable to ascertain whether lack of gastric interoception in individuals with AN was a result of conscious processing of satiety cues or disruptions in endocrine signalling [ 62 ].

Non-shared vs. shared environments

A Swedish study of female monozygotic (identical) and dizygotic (fraternal) twins aged between 20 and 47 found that nonshared environmental factors between twins had a greater impact on ED risk than shared environmental factors [ 36 ]. This finding was further supported by a study of an Australian twin sample, which concluded that nonshared environmental factors contributed to the genetic factors associated with weight loss behaviours and overeating behaviours in AN and BN, respectively [ 63 ]. Shared environmental factors were not observed to have an impact on disordered eating behaviours [ 63 ].

Exposure to childhood trauma has been linked to polymorphisms in genes expressed in the glucocorticoid receptor pathway which are associated with increased risk of developing BN, binge eating, and loss of control over eating [ 51 , 64 – 66 ]. This finding is supported by research conducted by Monteleone et al. [ 67 ], who found significantly lower levels of cortisol in individuals with AN and BN with a history of childhood maltreatment than healthy controls and those ED patients with no history of childhood trauma. Exposure to childhood trauma was also found to interact with gene expression through creating higher levels of DNA methylation 4 in women with BN [ 68 ]. Analysis of evidence from seven studies found a strong additive effect for serotonin transporter 5-HTTLPR polymorphism combined with childhood experiences of physical and sexual abuse in the development of BN [ 69 ]. Childhood trauma and abuse as a risk factor for EDs, particularly related to environmental influence, will be further discussed in Sect. Results .

Binge eating disorder

Variation in genes linked to appetite and satiety modulating hormones such as ghrelin are often implicated in the development of BED, as well as several genes related to regulation of BMI and fat storage. A study of 4,360 adolescents aged 14 or 16 found that frequency of binge eating was associated with expression of a polymorphism in the FTO gene, thought to play a role in BMI and obesity [ 70 ]. Further, mutations of the MC4R gene, involved in metabolism and feeding, is also associated with BED and obesity [ 71 , 72 ].

As previously discussed, polymorphisms in genes responsible for the production of neuroendocrine receptors such as dopamine and serotonin are also commonly associated with BN and BED [ 54 ]. Reward responses to food have long been implicated in the development and perpetuation of BED. The expression of two alleles in the dopamine D2 receptor has been found to be positively associated with BED in a sample of 230 individuals with obesity [ 73 ]. The authors concluded that expressions of these alleles was associated with hypersensitivity to reward, likely having a causal relationship with BED [ 73 ]. In a study of female twins in the US, increased binge eating frequency was also found to be associated with genetic factors related to the personality traits neuroticism and conscientiousness [ 74 ].

Night eating syndrome

Genetic research relating to Night Eating Syndrome (NES) is less developed than the primary EDs. Work in animal models has implicated variants of the VGF, a gene responsible for production of a neuropeptide precursor in NES aetiology [ 75 , 76 ]. One familial study was identified assessing the heritability of NES involving families where at least one parent had obesity. Night eating symptoms in mothers were strongly associated with similar behaviours in their sons and daughters, while no such correlation was observed for fathers [ 77 ]. Interestingly, the association was slightly stronger in sons (r = 0.19) than in daughters (r = 0.15), whereas heritability relationships are typically stronger in female offspring in other ED diagnoses [ 34 , 77 ]. This finding was further supported by evidence from a Swedish twin registry study where males were more likely to endorse night eating traits associated with genetic factors, while females were more likely to endorse binge eating [ 76 ]. Further research is required to understand any potential genetic risk factors associated with NES.

There is considerable evidence pointing to genetic risk in the development of EDs, with the highest heritability conferred for AN [ 33 , 34 ]. Females are also at greater genetic risk for disordered eating in comparison to males [ 39 ]. When considering the specific genetic variations thought to contribute to increased ED risk, genetic associations have been found between EDs and other psychiatric comorbidities, however the type of comorbidity differs according to the ED diagnosis. For binge-type EDs (BN and BED) strongest genetic correlations are observed with ADHD [ 42 , 43 ] whilst AN has strong correlations with OCD, MDD, suicidality, schizophrenia, neuroticism, autism, and neurodevelopmental delay [ 44 – 48 ]. In a similar manner, genetic correlations with metabolic traits appear to differ between ED diagnoses, such that BN and BED have been found to share genomic variants with overweight and obesity [ 49 ] whereas potential AN genes uphold a bi-directional relationship with low BMI [ 38 ]. Genes associated with other metabolic functions, including appetite and weight control endocrines (leptin, melanocortin, neurotrophin) have also been implicated in ED development and severity, however fewer differences between ED diagnoses are apparent. Polymorphisms in the genetic loci responsible for neurotransmitters associated with reward processing and appetite regulation hormones, including dopamine, serotonin, and cannabinoid have been identified as a risk factor across several ED diagnoses including AN, BN, and EDNOS [ 45 , 50 – 62 ]. Additionally, genetic polymorphisms in the glucocorticoid receptor pathway responsible for the stress response have been linked to individuals who have experienced trauma and are associated with increased risk for BN [ 51 , 65 , 66 ].

2. Gastrointestinal microbiota and autoimmune reactions

Gastrointestinal microbiota.

The role of gut microbiota and immune system reactions in the development and perpetuation of EDs is an emerging field, however is receiving growing attention. Endocrines produced in the gastrointestinal (GI) tract communicate with the brain to regulate functions of appetite and satiety. Given the role of these functions in EDs, it is thought that dysregulation of the gut microbiome may be partially responsible for ED psychopathology [ 78 – 80 ]. A review of evidence on the gut microbiome suggests that the growth cycle of gut bacteria and their metabolites 5 may contribute to patterns of accelerated and/or prolonged satiety in AN and periodic lack of satiation in BN [ 78 ]. In a study of 33 AN patients undergoing refeeding, Hanachi et al. [ 81 ] found the AN patients to have significant gut microbial dysbiosis compared with 22 healthy controls.

Several studies of AN have investigated the role of a protein (CIpB) produced by the Escherichia Coli ( E. Coli ) bacteria. The CIpB protein has a similar structure to the human hormone responsible for simulating secretion of satiation peptide YY. The peptide YY has been detected in high levels in the blood plasma of individuals with AN compared to healthy controls [ 78 , 82 , 83 ]. Peptide YY levels have also been found to be elevated among individuals with AN-R as compared to those with AN-BP and healthy controls [ 84 ]. Intestinal infections and chronic inflammation can lead to large increases in the number of E. coli bacteria in the GI tract, therefore increasing the levels of peptide YY and potentially increasing risk of ED [ 83 ]. The CIpB protein produced by E. Coli also prompts an immune reaction whereby autoantibodies are created. The position on the receptor for this autoantibody has been shown to differentiate between risk for BN and BED or AN [ 78 ]. Despite such emerging evidence indicating a role for gut microbiome dysregulation in EDs, researchers consider much of the evidence to be in an observational phase or using murine models 6 and lacking the capacity to explain aspects of ED pathology [ 79 , 85 ].

Autoimmune and autoinflammatory diseases

Gut microbiota are also known to interact with autoimmune responses, which have been investigated as a potential risk factor for EDs. In a large population-based cohort study, autoimmune and autoinflammatory diseases were identified as a significant predictor in the development of EDs and were associated with a 36% increased chance of developing AN. Interestingly, risk of BN and EDNOS was much higher at 73% and 72%, respectively [ 86 ]. Among a sample of patients hospitalised for EDs in Finland, higher prevalence of type 1 diabetes and Crohn’s disease was observed compared with healthy controls [ 87 ]. A recent meta-analysis has also identified a bidirectional association between coeliac disease and EDs. In particular, patients with AN are at a significantly greater risk of coeliac disease than healthy adults without AN [ 88 ]. Further, researchers argue that symptoms of ED commonly mimic those of chronic inflammatory GI and endocrine disease, including inflammatory bowel disease and diabetes type 1 and 2, emphasising the importance of screening for possible co-occurrence [ 89 ]. Unlike the vast majority of other risk factors associated with EDs, autoimmune and autoinflammatory diseases represented a greater risk for male participants as compared to females [ 86 ].

As a type of autoimmune disease, diabetes is commonly associated with EDs. There is a substantial evidence base indicating an increased prevalence of disordered eating behaviours among individuals with both type 1 and type 2 diabetes [ 90 , 91 ]. However, much of the evidence is observational and there are limitations in distinguishing between avoidance of certain food groups due to presence of an ED versus a feature of diabetes management [ 92 , 93 ]. Nevertheless, high rates of ED behaviours not related to food restriction (e.g., excessive exercise, vomiting, and laxative abuse) have been observed in adolescents and adults with diabetes [ 94 , 95 ]. Insulin manipulation or restriction has also been observed in adolescents with diabetes resulting in poor glycaemic control and poorer outcomes [ 89 , 90 , 94 – 96 ]. Interestingly, a study of adults has revealed that weight/shape overvaluation was lower in participants with diabetes (31.5%) compared to those who did not have diabetes (41.2%). The authors suggest that this may indicate that BED, as an ED for which weight/shape overvaluation is not a diagnostic criteria, may be of particular concern among adults with diabetes [ 97 ].

In terms of biological risk factors, evidence has largely focused upon proteins produced by gut bacteria, which have been implicated in dysregulation of appetite and satiety in individuals with EDs. The metabolites of gut bacteria are thought to play a role in disordered eating patterns, including prolonged satiety in AN and periodic absence of satiety in BN [ 78 – 80 ]. For example, a protein produced by E. Coli bacteria has been found to mimic the structure of the satiation peptide YY, a protein that is higher in individuals with AN as compared to healthy controls [ 83 , 84 ]. Findings such as these have led researchers to consider intestinal infections and chronic inflammation as a potential risk factor for EDs. However, research in this field is emerging, with further studies needed to better understand the association between gut microbiome dysregulation and EDs. Large studies have indicated that having an autoimmune or autoinflammatory disease, such as Crohn’s disease, inflammatory bowel disease, diabetes type 1 and 2, and coeliac disease, is also significantly associated with increased risk of BN and EDNOS, and to a lesser extent, AN [ 90 – 95 ].

3. Childhood and early adolescent experiences

A range of childhood experiences have been linked to the development of EDs later in life, including in-utero exposures, family dynamics and parental characteristics, childhood weight, and experiences of abuse and trauma.

In utero exposures

There is evidence to suggest that exposure to certain levels of hormones during foetal development could increase risk of ED development later in life. In a large cohort study of women in the UK, daughters whose mothers had a lifetime diagnosis of BN were found to have been exposed to high levels of prenatal testosterone in the womb, which was implicated in an increased risk of BN and binge eating [ 98 ]. However, a large multinational twin study was unable to find any link to in utero exposure to sex hormones and ED onset later in life [ 99 ].

Research has indicated that in-utero exposure to high levels of cortisol through maternal stress is associated with later development of ED [ 100 , 101 ]. A further study in the UK found that individuals who were born preterm had an increased risk of ED associated with structural brain alterations linked to underdevelopment [ 102 ]. Additional risk factors include the use of substances during pregnancy (e.g., nicotine) and maternal illness leading to malnutrition (e.g., anaemia), which have also been linked to an increased risk of AN and BN in the child later in life [ 103 ].

Risk factors conferred during foetal development are further supported by findings that risk of BED is associated with high weight at birth or being large for gestational age, while AN was associated with low weight at birth. No significant foetal developmental risk factors have been identified for BN [ 104 ]. Moreover, stressful events experienced by mothers in the year prior or during pregnancy, in particular the death of a close relative in the six months preceding pregnancy, have been shown to have an impact on the development of feeding or EDs in infants and toddlers [ 105 ]. Feeding issues in babies of mothers who had an ED diagnosis during pregnancy were also noted in this cohort [ 106 ].

A recent systematic review identified an association between AN and older maternal age, preterm birth (< 32 weeks), lower birth size, and maternal health complications (e.g., preeclampsia, eclampsia). The review also reported an association between BN and maternal stress during pregnancy [ 107 ].

There appears to be an impact of pregnancy upon the eating behaviours of women with an ED diagnosis. One study has found that ED behaviours across diagnoses tended to improve significantly during the pregnancy period, although this may not be maintained after [ 108 ]. It has also been reported that pregnancy is associated with remission of BN but an increased risk of BED onset [ 109 , 110 ]. Women with a history of psychosocial adversities have been found to possess a significantly greater risk for BN during pregnancy [ 111 ].

Family dynamics and parental characteristics

Research has shown that children are more likely to develop an ED if their parents display characteristics commonly associated with ED psychopathology, such as drive for thinness and perfectionism [ 112 ]. Specifically, maternal history of an ED has been shown to be associated with higher rates of emotional eating in children as young as four years old [ 113 ]. The children of women with lifetime AN have also been found to exhibit deficits in cognitive functioning, including social understanding, visual-motor function, planning, and abstract reasoning [ 114 ].

Additionally, Larsen et al. [ 115 ] reported that general parental psychiatric illness is associated with increased risk of BN and EDNOS. The authors also identified the experience of childhood adversity and significant family disruption as significant risk factors for development of BN and EDNOS. Interestingly, no associations between childhood adversities and risk of AN could be identified by authors, although a separate study identified maternal depressive symptoms as a predictor of AN [ 116 ].

Adopted individuals have also been identified as having a greater risk of binge eating and extreme weight loss behaviours, as well as increased risk of a lifetime diagnosis of an ED [ 117 ]. Other parental characteristics which have been associated with ED behaviours include high maternal BMI at 16 weeks’ gestation and when their child is eight years old, high maternal education attainment, and low parental self-esteem [ 118 – 120 ].

Individuals’ perceptions of the quality and nature of their parental relationship has been investigated as a potential risk factor for development of an ED. Research has found that female individuals diagnosed with AN or BN report significantly lower perceived emotional connectedness prior to disorder onset than their healthy sisters. In a family-based study of 332 female individuals, low emotional connectedness conferred a greater risk of developing BN over AN-R [ 121 ]. Further, females who report low maternal warmth have a higher risk of developing binge/purge type EDs [ 122 ]. Low parental warmth appears to be a risk factor for ED development in females but not males [ 123 ]. A study of AN patients and their healthy siblings found that both siblings in these families perceived low maternal care and high maternal overprotection. Siblings affected by AN developed insecure attachment compared with their siblings and had higher preoccupation with relationships, while healthy siblings were able to develop secure attachment and low need for approval and high self-transcendence [ 124 ]. Other risk factors include an oppressive parental relationship and childhood unhappiness [ 122 ].

Parents’ communication about food, as well as parental eating behaviours, have been shown to be a significant risk factor for EDs in their children. Several studies have found that exposure to disordered eating behaviours such as dietary restriction in parents is likely to have an impact on the early development on EDs in children, beyond the influence of genetics [ 125 , 126 ]. One study identified maternal distress as a mediating factor in the relationship between maternal ED and infant feeding difficulties [ 127 ]. Maternal dieting and poor communication among family members have also been associated with long-term risk for restrictive disordered eating [ 128 ]. Conversely, parental conversations regarding healthy eating, rather than dieting or weight, and regular family meals were found to be protective against development of EDs among child and adolescent samples in Europe and the US [ 129 , 130 ]. Parental pressure to eat, early negative experiences with food, and high disgust sensitivity were found to predict picky eating behaviours associated with ARFID. Parental encouragement around food in childhood was observed as a protective factor. Being male was also found to be a significant risk factor for adult picky eating behaviour and potential ARFID [ 131 ].

The experience of stressful life events, including bereavement, separation from family members, or involvement in an accident have been found to have an impact on ED development, in particular BN and BED. The occurrence of three or more events in combination with external criticism of weight or shape has been shown to be significant predictors in the year prior to BN onset [ 132 ]. No significant differences were observed between BN and BED in terms of the number or types of events experienced prior to onset [ 133 ].

Childhood weight

Research on the association between childhood weight and risk of eating pathology in later years is ambiguous. Several studies have reported that higher weight during childhood poses an increased risk of developing an ED in later years, including among culturally and linguistically diverse (CALD) individuals, as well as males [ 134 – 138 ]. Analysis of specific ED behaviours among adolescents in the US between 1999 and 2010 found that ED symptomatology and weight/shape concern persisted beyond adolescence for individuals who were overweight. Contrastingly, for non-overweight individuals, unhealthy weight control behaviours and body dissatisfaction decreased over time [ 139 ]. Other studies have found that adolescents with a weight history in the overweight range experience a significantly greater drop in BMI, higher levels of ED psychopathology and comorbid mental health difficulties, and take much longer to be identified than adolescents without a history of overweight [ 140 ], 141 .

Contrastingly, explorations of the association between weight history and AN specifically have found that low baseline BMI is a significant risk factor for development of both atypical AN and AN [ 38 , 142 , 143 ].

It has been suggested that parental perception of their child as being overweight may be a more powerful predictor of ED development than the child’s weight itself [ 118 , 144 , 145 ]. The significant impact of parental behaviours on ED risk has been supported by a study comparing individuals with BN to healthy controls and individuals with other psychiatric conditions. While being overweight or obese in childhood was identified as a risk factor, high maternal expectations and negative parental attitudes about weight and obesity in childhood were more strongly associated with the onset of BN among participants [ 146 , 147 ]. These risk factors are also associated with onset of BED [ 148 ]. Negative parental attitude towards childhood weight, including parental teasing about weight, has been shown to have a strong positive association with ED behaviours in both males and females, in particular binge eating behaviours [ 146 , 149 , 150 ]. Parental comments about their child’s weight and eating behaviours are also significantly associated with increased drive for thinness and body dissatisfaction [ 151 , 152 ].

Abuse and trauma

Experience of childhood trauma and abuse has been consistently identified as a non-specific risk factor for the development of EDs, although these experiences are more strongly associated with binge-purge type disorders such as BN, BED, and AN-BP [ 153 – 157 ]. Evidence from several studies suggests that emotional abuse is a significant predictor of binge/purge symptomology in women, while sexual abuse and physical neglect were associated with symptoms in men [ 158 – 160 ]. Sexual harassment has also been identified as a risk factor for EDs however little is known about the causal relationship or the role of mediating factors [ 161 ]. Attempts to investigate the association between types of childhood trauma and specific ED diagnoses have found that emotional abuse is a risk factor for all core ED symptoms [ 162 ]. A large-scale study of young adults in the US found that participants who reported multiple types of maltreatment in childhood were almost twice as likely to report binge eating and skipping meals as compared to those who reported no or low maltreatment [ 163 ]. Verbally abusive fathers have been shown to be strongly associated with AN-BP and BN, and verbally abusive mothers influence the development of BN [ 164 ].

Studies conducted in groups of women with obesity have found relationships between binge eating and childhood abuse and neglect. The severity of the abuse, rather than the type of abuse, appears to have a role in the development of BED and severity of food addiction [ 165 , 166 ]. A recent study has found that childhood food neglect is associated with increased risk for BN and BED even after adjusting for other adverse experiences and financial difficulties experienced during childhood [ 167 ]. A study on the impact of childhood emotional abuse and ED risk found that low self-perception and self-esteem caused by the abuse contributed to an increased risk of BED and NES [ 168 ]. Further, individuals with both an ED diagnosis and a history of childhood trauma and abuse have been found to have increased risk of lifetime suicide attempts [ 169 , 170 ].

The experience of childhood bullying has been found to increase risk of AN, and to a lesser extent BN, in children and adolescents [ 171 – 173 ]. However, increased risk of EDs was not found to carry on into early adulthood [ 171 ]. Weight-based teasing has also been associated with emotional eating, eating in the absence of hunger, and disordered eating attitudes and behaviours [ 174 ]. Consistent with existing evidence, an observational study of 182 adolescents receiving treatment for EDs found bullying was the most common form of trauma experienced by patients [ 175 ]. Assessment of the impact of cyberbullying also found the experience predicted onset of AN, BN, and EDNOS in a group of individuals with an ED diagnosis and increased ED symptomology and depression among a group of high-risk individuals [ 176 ]. Exposure to online content and risk of ED development is discussed further in Sect. Gender .

An overview of the evidence regarding the impact of early experiences in terms of ED risk has identified a range of factors starting from the in-utero environment through to adolescence. In-utero exposure to high levels of testosterone, cortisol, or substances have been associated with increased risk of EDs [ 98 – 100 , 102 , 103 ]. There is also evidence to linking high birth weight to BED and low birth weight to AN [ 104 ]. Weight persists as a risk factor throughout childhood and adolescence, with research findings that high maternal expectations and negative parental attitudes about weight are also associated with ED risk. The quality and nature of one’s parental relationship is considered another risk factor for EDs, such that lower ratings of parental warmth or emotional connectedness have been reported by individuals with AN and BN as compared to their healthy siblings [ 121 – 124 ]. Experiences of childhood adversity, significant family disruption, childhood trauma (including neglect and emotional or sexual abuse) are well-documented risk factors, with evidence suggesting that they are most likely to contribute to the development of binge/purge type disorders (AN-BP, BN, BED, PD) [ 115 , 153 – 156 ]. Researchers have also suggested that the link between EDs and trauma is likely to be underestimated due to non-disclosure [ 207 ].

4. Personality traits and comorbid mental health conditions

Traits such as anxiety, perfectionism and obsessive-compulsivity are frequently associated with increased risk of EDs and may play a substantial role in the severity of symptoms, response to treatment, and risk of relapse [ 178 ].

Perfectionism, impulsivity, compulsiveness, and avoidance motivation

Rather than being linked to diagnostic type, a meta-analysis of personality traits (Farstad et al., 2016) found a more robust association with specific behaviours and symptomatology. Studies have shown that relative to controls, individuals with ED have elevated levels of perfectionism (setting of excessively high standards for performance, accompanied by overly critical self-evaluation); neuroticism (tendency to experience negative effects such as anger, anxiety, self-consciousness, irritability, emotional instability, and depression); impulsivity, particularly negative urgency (tendency to engage in impulsive behaviour when experiencing strong negative emotion); compulsivity (tendency toward overcontrolled behaviour); avoidance motivation (tendency to move away from or avoid situations associated with punishment); sensitivity to social rewards; introversion; and self-directedness (goal-oriented behaviour) [ 178 – 186 ].

Perfectionistic traits are common in both AN and BN. A systematic review and meta-analysis concluded that individuals with AN tended to place greater emphasis on high personal standards, while individuals with BN were more likely to perceive high levels of parental criticism [ 178 ]. The contribution of perfectionism to ED symptomatology (including dietary restriction and shape and weight overvaluation) was further supported by Joyce et al. [ 180 ] in a community-based sample of women. The study was inconclusive as to whether perfectionism was the cause of the ED symptoms. However, a significant positive association between perfectionism and weight and shape overvaluation was observed [ 180 ].

Among a sample of adolescent females recruited from an ED service in Australia, researchers found both a direct relationship between perfectionism and AN symptoms as well as an indirect relationship when mediated by depression [ 187 ]. The two different relationships were found to be equally viable, further supporting the notion of a reciprocity of symptoms between anxiety, depression, and AN, which are preceded by perfectionism.

In a 10-year follow-up study of university-aged adults in the US perfectionism was associated with the onset of AN, BN, and EDNOS and found to contribute significantly to disorder maintenance [ 188 ]. The tendency toward perfectionism in AN has been linked to a trait of vulnerable narcissism, ‘hiding the self,’ described as an unwillingness to show one’s faults or needs to others. The ability to exhibit control over emotional needs and relationships was correlated with AN-R in a comparison study involving individuals with AN and BN. However, the cross-sectional design was unable to determine whether this trait preceded AN-R and the sample size was relatively small [ 189 ].

Obsessiveness has also been found to be strongly associated with AN. Among a clinical sample of patients with AN and atypical AN, obsessiveness was positively correlated with a drive for thinness, a key aspect of AN symptomatology. The study did not find any significant differences between AN and atypical AN in terms of obsessive behaviours [ 190 ].

Studies seeking to assess personality traits contributing to differences in clinical presentation between restricting and binge/purge ED subtypes conclude that alexithymia – the inability to identify or verbally describe feelings or emotions – plays a role in the emotional dysregulation displayed by both AN-R and BN patients [ 191 , 192 ]. Higher levels of alexithymia have been associated with greater risk of re-hospitalisation in a three-year follow-up study of women with both AN and BN [ 193 ]. Prefit et al.’s [ 194 ] meta-analysis of studies into EDs and associated personality traits found lack of emotional awareness and inability to regulate emotions leading to maladaptive ED symptomology was not diagnosis specific [ 194 ]. Findings from the meta-analysis support Brown et al. (2018), suggesting a need for emotion-focused treatment approaches such as dialectical behaviour therapy (DBT) [ 192 , 195 ].

While binge/purge presentations are consistently associated with impulsivity and greater emotional dysregulation [ 196 , 197 ], one study demonstrated no significant differences in ability to regulate emotions between AN-R and BN patients with high levels of alexithymia [ 192 ]. However, in another study involving clinical samples of AN-R, AN-BP and BN patients, individuals with AN-R were found to have fewer fluctuations in mood than individuals with AN-BP and BN. Only in groups exhibiting binge/purge symptomology were these behaviours observed as a method for alleviating negative affect [ 198 ]. Similarly, among a group of 139 female college students, lower impulsivity in addition to lower self-esteem was found to be associated with AN risk [ 199 ]. A recent systemic review has warned that due to methodological limitations in the studies conducted to date, there is insufficient evidence to support the characterisation of AN and BN as being low and high in impulsivity, respectively [ 200 ].

Individuals with binge/purge subtypes EDs, including AN-BP, BN, BED and various OSFEDs, have been found to have higher levels of avoidance motivation, impulsivity, emotional dysregulation, anxiety, depression, and paranoia than healthy controls [ 178 ]. Within a clinical sample of AN patients, individuals displaying binge/purge symptoms were more likely to engage in non-suicidal self-injurious behaviour and have lower self-directedness and co-operation than individuals with AN only [ 201 ]. However, the literature is inconclusive as to whether these traits contribute to ED onset or are symptoms of it.

Several studies have observed high levels of impulsivity in individuals with BN, with these individuals commonly displaying negative urgency, lack of planning and sensation seeking. Farstadt et al. (2016) in their meta-analysis also argue a role for compulsiveness (i.e., the tendency towards overcontrolled behaviour), suggesting that the interaction of personality traits such as impulsiveness and compulsiveness can have implications for ED symptomology and disorder severity [ 161 , 180 , 183 , 184 ]. In this manner, impulsivity was found to have a significant impact on the types of ED symptomatology displayed by the individual and clinical presentation [ 178 , 195 ]. In contrast, Waxman [ 195 ] found no significant differences in impulsivity between ED diagnoses. Waxman [ 195 ] suggested that while there is a lack of evidence from longitudinal studies to determine conclusively that impulsivity is a risk factor in the development of ED, evidence from studies using proxy measures such as delinquency found these behaviours preceded BN onset. One further study has reported an association between NES and impulse control disorder [ 202 ]. It has also been suggested that impulsivity and addiction-like mechanisms may explain the association between ED psychopathology and both high-risk sexual behaviours and substance misuse [ 203 , 204 ].

A study of 83 sister pairs found participants with a lifetime ED diagnosis displayed higher levels of internalising behavioural issues (social withdrawal, anxiety, depression) and/or externalising behavioural problems (aggression and delinquency) than their healthy sisters [ 205 ]. Internalising behaviours were found to be a strong predictor for AN-R, while externalising behaviours were strongly associated with later onset of bulimic symptoms and BN [ 205 ].

Two models illustrating risk of bulimic behaviours among young females have attempted to account for both the role of personality traits and traditional ED concepts of the ‘thin ideal’ [ 206 ]. Pearson’s integrated model of risk combines the ‘state-based’ pathway, which shows binge eating as an impulsive lack of control behaviour and purging as a compulsive correction, and the ‘trait-based’ pathway, which emphasises negative urgency as a consistent tendency toward impulsivity and stress alleviation through binge eating. The ‘trait-based’ pathway also considers the role of inherited ED risk and predisposing childhood exposures [ 206 ]. Pearson et al. argue that integration of the ‘trait-based’ model considers the important role of heritability and negative urgency that is absent from the Stice model [ 207 ]. Further investigation of disease models of bulimic behaviour by Dakanalis et al. [ 208 ] indicate that risk factors are more complex than can be mapped by the dual pathway model, citing bi-directional relationship between dietary restriction and negative affect.

Negative urgency has also been found to be an independent predictor of food addiction among individuals displaying binge-eating symptomology [ 209 ]. A further study by Utschig et al. [ 210 ] indicated that fear of negative evaluation from others is a predictor for body dissatisfaction and pressure to be thin, contributing to an internalised ‘thin ideal’ in individuals with BN and feeding into the state-based model. Fear of negative evaluation is considered an aspect of social anxiety and relates to heightened sensitivity to social rewards, a trait found to be elevated across ED diagnoses [ 178 , 210 ].

Personality disorders

The central role of certain personality traits in the perpetuation and potential development of ED symptomology reflects established relationships between some personality disorders and EDs [ 211 – 213 ]. Comorbidity studies have found borderline personality disorder (BPD) to most commonly occur with BN and other binge/purge ED subtypes [ 212 ]. This finding is supported by research on personality traits in EDs where avoidant behaviours and low emotion regulation flexibility are elevated in bulimic-type disorders and also a core feature of BPD [ 178 , 212 , 214 ]. However, some researchers argue that the co-occurrence of EDs and personality disorders may have been inflated in previous studies [ 215 ]. In a sample of 132 females with ED, prevalence of any personality disorder was 21%, lower than in other studies where reported figures were between 27 and 95% [ 215 ]. However, findings from von Lojewski et al. [ 215 ] were consistent with existing evidence that BPD traits were significantly associated with binge/purge EDs compared with AN-R. Individuals with comorbid BPD and ED were also more likely to report self-induced vomiting as compared to any other personality disorder. Co-occurrence of EDs and BPD has also been associated with increased risk of engaging in non-suicidal, self-injurious behaviours within a clinical sample [ 212 ]. Meta-analysis of 20 studies published between 1987 and 2010 found comorbidity of BPD with EDNOS (now OSFED) to be 38%, and 29% with BED. Researchers indicated that ED and personality disorder comorbidity are more common among individuals with AN and BN than BED and EDNOS [ 216 ]. However, among patients with BED or EDNOS, avoidant personality disorders were found to be the most common, followed by BPD [ 216 ]. It should however be noted that two of three studies identified by the Rapid Review concerning ED and personality disorders were restricted to relatively small clinical samples without control groups. They were also limited by their cross-sectional design in their capacity to investigate the temporal relationships between disorders.

Anxiety, mood disorders and psychiatric comorbidities

Co-occurring and preceding mental health conditions, particularly those with shared genetic and experiential influences such as anxiety and mood disorders, are also risk factors for EDs. While it is difficult to assess which condition precedes the other without use of prospective study designs [ 217 ] these relationships have been widely studied in AN and BN, and there is some evidence for anxiety and mood disorders including depression and bipolar disorder preceding ED symptomatology. Evidence from a three-year prospective study of 615 pairs of twins in the US suggests elevated risk for AN is associated with higher levels of depression and anxiety in combination with a high drive for thinness, rather than either risk factor alone [ 218 ]. There is less conclusive evidence on the relationship between BN, anxiety, and depression although some preliminary research was identified indicating several key symptoms were shared between the three disorders [ 219 ].

Mood disorders

In clinical ED populations, prevalence of mood disorders is frequently high [ 220 ]. In one study, major depressive disorder (MDD) was found to affect 64% of individuals with AN-R and over 75% of binge/purge ED subtypes (AN-BP, BN). Sequencing of disorder onset found that mood disorders preceded ED onset in a third of the AN-R cases and 40% of the AN-BP/BN cases. The remaining comorbid cases were either co-occurring or onset following ED diagnosis. These findings from Godart et al. [ 220 ] indicate that depressive disorders can be both a predictor and consequence of ED, as well as a comorbidity caused by malnutrition further complicating management and treatment of EDs.

Assessment of the temporal relationship between depression and disordered eating in an eight-year longitudinal study found depressive symptoms predicted increases in BN behaviours, which in turn predicted increases in depressive symptoms [ 221 ]. These findings indicate there may be a reciprocal relationship between the two conditions. A reciprocal relationship was also identified in a larger cohort of adolescent females where individuals who reported depressive symptoms were twice as likely to engage in overeating and binge eating at four-year follow-up, and individuals reporting overeating and binge eating were also more likely to report depressive symptoms at follow-up [ 222 ].

Anxiety disorders

There is evidence to suggest that anxiety is the most commonly occurring comorbidity with ED [ 223 ]. Childhood anxiety disorders have repeatedly been found to precede the onset of an ED, particularly AN [ 224 – 228 ]. Studies have identified a greater incidence of childhood obsessive–compulsive traits in individuals diagnosed with AN in comparison to control groups without an ED [ 177 ]. Micali et al. [ 211 ] conducted a longitudinal study of 231 young people diagnosed with OCD over a nine year period. Of the 126 participants who completed the follow up assessment, 12.7% had a diagnosis of an ED. Such findings highlight predictive value of childhood anxiety disorders in the later development of EDs, especially AN.

A reciprocal relationship between GAD and AN was indicated in a large twin study by Thornton et al. [ 229 ] whereby having GAD significantly increased likelihood of AN and having AN significantly increased likelihood of GAD. The group with AN and GAD had the lower mean adult BMI than both AN only and GAD only groups and healthy controls. These findings indicate the presence of comorbid mental health conditions may exacrerbate EDs and increases severity of symptoms. Sihvola et al. (2009) found co-occurrence of MDD and GAD at age 14 was strongly associated with onset of ED at follow-up (age 17). Weaker associations were observed for both MDD and GAD alone [ 230 ].

Ciarma and Mathew [ 231 ] investigated the relationship between social anxiety disorder (SAD) and disordered eating among adults aged between 18 and 35 living in the community. This study found self-esteem and stress reactivity resulting from interpersonal conflict to be partial mediators, indicating that ED symptoms can be elicited by heightened responses to stress from social conflict and negative self-view. However, the partial mediation effect observed indicated that other unidentified factors may also have a role in the relationship. A further study of adolescents found evidence of a bidirectional relationship whereby depression and anxiety were risk factors for disordered eating behaviours, which in turn led to increased depression and anxiety [ 232 ].

Prevalence of social anxiety was also found to be high among a separate clinical sample of Australian adults with an ED, where 42% were found to have social phobia. It was also the most commonly diagnosed anxiety disorder within each of the ED subtypes, including 33% of those diagnosed with BN, 26% for AN and 25% for EDNOS. Investigations into the temporal relationship between ED diagnosis and anxiety disorder have found many individuals have anxiety prior to their ED diagnosis [ 225 – 227 ]. However, in one systematic review, this was supported only by the included retrospective case–control and cohort studies, and was not supported by evidence from prospective studies included in the review [ 227 ]. This discrepancy highlights the potential role of recall bias that may be present across studies relating to anxiety and EDs [ 227 ]. OCD and SAD also tend to precede onset of ED, and BN in adolescence may increase risk of SAD and panic disorders in adulthood [ 233 ].

In some individuals, shame has been found to predict later onset of BN and social anxiety, indicating a shared risk factor for both conditions [ 234 ]. Impaired psychosocial functioning and capacity to maintain interpersonal relationships associated with shame or shyness was also found to predict ED onset among adolescents in the US [ 235 ].

Psychiatric comorbidities of ED diagnoses other than AN/BN

Evidence relating to mental health comorbidities for EDs other than AN and BN is less developed. Studies conducted investigating BED and NES are confined to clinical samples with cross-sectional designs, highlighting a need for further work in this area, especially considering the high prevalence of psychiatric comorbidities detected in individuals with these diagnoses. Among patients receiving treatment for BED, 74% had a lifetime psychiatric disorder diagnosis, and 43% had a current diagnosis [ 236 ]. In a population of overweight and obese patients with severe mental illness, 25% were diagnosed with NES and 6% with BED [ 237 ]. Other studies measuring NES in patient samples with depression and bipolar disorder (BD) found the prevalence to be 32.5% and 8.8% respectively [ 238 , 239 ]. Higher prevalence of NES was detected in both depression and BD groups compared with healthy controls, indicating increased risk among these individuals.

ED and BD comorbidities are also commonly reported in research, with association between BD and BN/BED considered particularly significant, although the casual and temporal relationships between the disorders are not well understood [ 240 – 242 ]. While it is likely that some risk factors are shared, lack of data regarding disorder onset limits commentary on the relative risk BD confers to the development of ED [ 241 ]. One review found incidence of BD to be 4.7 times higher in individuals with BN, 3.6 times higher in individuals with BED and 3.5 times higher for binge/purge ED subtypes overall. Due to the low prevalence of AN and BD in the general population, an accurate estimation of this comorbidity is difficult to obtain [ 241 , 243 ]. BD in individuals with ED is associated with increased severity of core symptoms including body dissatisfaction, weight/shape concern, eating concern, impulse regulation, interoceptive awareness and perfectionism [ 244 ]. Mood instability is also significantly higher in individuals with a BD/ED comorbidity compared to those with BD alone. Systematic review of BD and its clinical correlates by McDonald et al. [ 245 ] suggests this finding indicates shared aetiology between ED and BD through emotional dysregulation.

ADHD and autism spectrum disorders

There is an emerging body of literature exploring associations between EDs and attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs), however few have examined the conditions as risk factors in the development of ED. A 2016 meta-analysis of twelve studies found a three-fold increased risk of ED among individuals with ADHD [ 246 ]. Similarly, a 2020 matched cohort screening study found the same three-fold increase—almost one third of children and adolescents with ADHD were at risk of ED, compared to 12% of healthy controls. Here, BMI was a statistically significant predictor of risk [ 247 ]. Impulsivity and inattention symptoms of childhood ADHD have been positively associated with the development of overeating and bulimic-type behaviours in adolescence [ 248 ]. A longitudinal study of a large sample of adolescents reported that the onset of emotional and behavioural issues, including those associated with ADHD and conduct disorder, was observed to occur prior to the onset of disordered eating behaviours [ 249 ].

A 2013 systematic review found elevated rates of ASDs in ED populations compared with healthy controls, however, six of the eight studies in this review were based on longitudinal research using the same community sample [ 250 ]. The authors suggested a need to integrate appropriate, well-structured ASD assessment tools into routine care of ED service users, with the prevalence of ASD traits potentially contributing to ‘high treatment resistance to conventional therapies’ [ 250 ]. Dell’ Osso et al. [ 251 ] tested such an instrument in a sample of 138 individuals meeting DSM-5 criteria for an ED and 160 controls. They found significantly higher autism spectrum traits in participants with EDs, particularly verbal and non-verbal communication, inflexibility and adherence to routine, and restricted interest and rumination. Individuals with restrictive EDs were more likely to display ASD traits. Similarly, as part of a large, population-based prospective study of women and their children, Schaumberg et al. (2021) found autistic-like social communication difficulties during middle childhood were associated with BN symptoms during adolescence in both males and females [ 252 ]. They also discovered that misattribution of faces as sad or angry at 8.5 years of age was associated with a diagnosis of AN and purging behaviours at age 14. Contrarily, Dinkler et al. [ 253 ] in their prospective twin cohort study found no association between traits of autism in nine-year-old children and a later AN diagnosis, as well as noting a marked elevation in restricted/repetitive behaviour and interests only in the subgroup of individuals with acute AN. They questioned previous reports of elevated prevalence of ASD in AN and instead wondered if autistic traits may be best conceptualised as an epiphenomenon of the acute phase of AN.

Post-traumatic stress disorder

Although there is a large body of evidence relating to childhood trauma and abuse as a risk factor for the development of ED, few studies were identified investigating the role of post-traumatic stress disorder (PTSD) specifically as a risk factor. No distinction was made in the search methodology for this review between complex trauma and early childhood adverse events, with all studies captured under the search term ‘risk factors.’ Studies presented in this section, focused on the link between diagnosed PTSD and development of ED.

Results from two cohort studies observed an association between PTSD and severity of ED symptoms as well as relatively high prevalence rates within sample populations [ 254 , 255 ]. Among a patient sample in Sweden who had experienced trauma either prior to ED onset, after onset or within a year of onset, lifetime prevalence of PTSD was observed to be 24.1% [ 255 ]. An almost identical PTSD prevalence was found within a smaller ethnically diverse sample of obese women with BED in the US, at 24% [ 254 ]. Analysis of the impact of timing of trauma exposure on ED symptom severity in the Swedish sample found the association was only significant in the group who had experienced trauma in the same year of their ED diagnosis [ 255 ]. This analysis was not undertaken in the US study. Brewerton et al. [ 256 ] assessed adults entering ED treatment at seven US sites and found 49.3% had PTSD. It was found that individuals who were significantly more symptomatic had a higher propensity towards binge-type disorders and reported worse quality of life than those without PTSD. Co-occurrence of PTSD and AN was reported by Reyes-Rodriguez et al. (2011) as part of their cross-sectional study of 753 women with AN. They found 13.7% of the sample of AN patients also met criteria for PTSD with childhood sexual traumas being the most common traumatic event associated with the diagnosis [ 257 ].

Evidence from three studies relating to EDs in veteran populations—a meta-analysis (Barlett and Mitchell [ 259 ]); a retrospective chart review (Forman-Hoffman et al. [ 258 ]); and a retrospective cohort study of female veterans (Mitchell et al. [ 260 ])—found an association between increased ED prevalence and PTSD and trauma. Through a telephone interview with 1004 veterans, Formann-Hoffman et al. [ 258 ] determined that 16% of their sample had a lifetime ED with many of the cases also experiencing comorbid PTSD or lifetime sexual trauma. However, increased risk for ED among the veteran population could not be solely attributed to trauma, as unhealthy weight control behaviours are also common in this population due to strict weight and fitness requirements within the military [ 259 – 261 ].

The prevalence of personality traits appear to differ according to the ED diagnostic category. Elevated levels of perfectionism are common amongst AN and BN, obsessiveness strongly associated with AN, and binge/purge presentations consistently associated with impulsivity and greater emotional dysregulation, whereas lack of emotional awareness is not ED specific and common amongst most ED diagnoses [ 178 – 183 , 196 ]. Although co-occurrence of ED and personality disorders has been consistently identified in studies of comorbidity (e.g., BPD and binge/purge EDs), mood and anxiety disorders represent the most common psychiatric comorbidities in individuals with EDs (e.g., MDD affects over 75% of binge/purge EDs, SAD affects 42% of adults with an ED) [ 212 , 220 , 223 , 225 – 227 ]. There is also good evidence to suggest that the presence of a diagnosable childhood anxiety disorder (e.g., OCD) precedes the onset of an ED later in life [ 177 , 211 ]. Other psychological factors which appear to contribute to the risk of EDs include diagnoses of PTSD, ADHD, or ASD [ 246 , 250 , 254 ].

5. Gender differences

EDs impact a higher number of females with greater symptom severity. While common risk factors are shared across genders, such as low self-esteem and high shape/weight concern, males have been identified as less likely to engage in severe dieting behaviours compared with their female counterparts [ 262 , 263 ].

Puberty is a period of significant risk for ED development in both males and females. Research has implicated increased production of sex hormones during puberty, in particular estrogen, in the onset of EDs [ 264 ]. Evidence has consistently demonstrated that early onset of puberty is strongly associated with increased risk for ED development in both young males and females. Favaro et al. [ 265 ] linked earlier age of menarche with a younger mean age of onset of AN and BN. It has been suggested that if an individual experiences changes to their body shape, associated with menarche, at an earlier time than their peers, this may lead to heightened body dissatisfaction and which in turn may contribute to early the onset of EDs.

Despite the commonality between males and females in terms of the risk of ED development posed by puberty, it had been suggested that bodily changes experienced during this time possess a stronger impact for females as compared to males. It is thought that changes to one’s body shape move females further away from the thin ideal, whereas the changes for males move them closer to ideals around muscularity [ 266 ]. These findings have been supported by a cohort study, which found that bulimic symptoms and body dissatisfaction were associated with early puberty in females and late puberty in males [ 267 ]. Similarly, having a higher BMI comparative to peers has been associated with ED risk among teenage girls but not boys in a US school cohort [ 265 ].

Comorbidity

Research into gender differences has found that an equal proportion of male and female adolescents with an ED experience comorbid anxiety or depression [ 268 ]. A further four-year retrospective study in male adolescents with a diagnosed ED supported the assertion that comorbid anxiety and depression posed considerable ED risk to males [ 269 ]. Research has also identified increased prevalence of compulsive disorders, including gambling and substance use, among males as compared to females in a cohort of individuals at risk of ED [ 270 ]. While male ED risk has been associated with compulsive and depressive symptoms in these studies, evidence presented in a longitudinal study of adolescents found depression to be associated with higher ED symptomology in 12-year-old girls but not in boys [ 271 ]. Further research into EDs and depression in males is required to clarify the impact of this association.

Gender roles

Gender roles have been investigated as a potential contributor to ED risk. Exposure to media ideals has been found to be associated with increased body dissatisfaction and ED symptomology in university-aged males [ 272 ]. Research has also indicated that increased femininity in heterosexual males is negatively associated with muscle dissatisfaction [ 273 ]. Weak associations have also been found between femininity in women and eating pathology and body satisfaction. Among both sexes, masculinity was found to have a significant negative relationship with eating pathology, also conferring modest protection to body dissatisfaction [ 273 ].

Interactions between societal gender roles and sexual orientation is also known to play a role in ED risk with researchers suggesting that greater social body image pressures are present among gay males. A systematic review of disordered eating among sexual minority individuals has reported that elevated ED symptomology exists across all LGBTQI + groups as compared to heterosexual males and females [ 274 ]. A further study of men aged 18 to 35 found that disordered eating and body dissatisfaction was higher in gay and bisexual men compared to heterosexual men, as was susceptibility to social messaging around body image [ 275 ]. The occurrence of body image disorders has also been found to be higher among sexual minorities as compared to heterosexual samples [ 276 ]. A recent study involving a sample of transgender and gender non-binary individuals reported that increased internalised transphobia was associated with increased likelihood of disordered eating symptoms [ 277 ]. There is insufficient evidence currently available to separate risk of engagement in specific types of ED behaviours according on sexual identity [ 274 ].

The literature indicates that whilst both males and females are susceptible to risk factors for EDs such as early puberty onset and elevated weight/shape concerns, it appears that these factors have a stronger impact upon females as compared to males in terms of risk of developing disordered eating behaviours and psychopathology (e.g., severe dieting, bulimic symptoms and body dissatisfaction) [ 292 , 294 , 297 – 300 ]. Recent findings also indicate that LGBTQI + groups are at a higher risk of ED symptomology and body image disorders as compared to heterosexual individuals [ 305 – 307 ].

6. Socio-economic status

Despite the pervasive view that EDs disproportionately affect more affluent groups, evidence suggests that disordered eating behaviours occur at similar rates across all income levels and regardless of employment status [ 278 ]. Differences between socio-economic status (SES) seem to emerge in the types of disordered eating. Specifically, a positive correlation has been reported between non-fulltime workers and binge eating and purging behaviours. Also, a trade or certificate qualification has been shown to be positively associated with strict dieting as compared to groups with no higher education [ 278 ]. In contrast, a large study conducted in Sweden failed to find a relationship between social class and household income and incidence of EDs in females. However, in males, lower household income was associated with increased risk of BN and EDNOS, although the study observed a very low rate of BN in males [ 279 ].

Recent studies in the US have found low food security to be a predictor for disordered eating behaviours [ 280 ]. Among higher SES adolescents, binge eating behaviours were associated with weight-related teasing by family members [ 281 ]. In an adult sample, experience of low food security was more common among individuals with BN and BED as compared to healthy weight controls [ 282 ]. Lower food security in these individuals was associated with more frequent binge eating episodes and, in individuals with BN, unhealthy compensatory behaviours [ 282 ].

High levels of parental education have also been identified as a predictor of EDs [ 119 , 283 ]. Higher educational attainment by both parents as well as maternal grandparents has been associated with higher incidence of AN, BN, and EDNOS equally across diagnoses in females [ 279 , 284 ]. In males a positive association was found between parental education and AN, but not for BN or EDNOS [ 279 ].

Research into sociocultural risk factors for EDs suggests that income has little impact on overall ED risk although available evidence points to specific indicators that have an influence [ 278 ]. Higher education attainment is associated with restrictive ED behaviours, while experience of food insecurity is associated with binge-type behaviours and EDs [ 279 , 282 , 284 ].

7. Ethnic minority

Although there is no evidenced association between ethnic background and the risk of ED onset, specific aspects of ED psychopathology do appear to differ between ethnic groups [ 285 , 286 ]. A cohort study of females aged between nine and 22 years old found those with an ED were more likely to be non-Hispanic White, come from well-educated households, and be well-educated themselves [ 287 ]. A recent study of a treatment-seeking community sample in US found that Black individuals displayed higher rates of BED as compared to other ethnic groups, however overall Asian and Black individuals were less likely to report ED symptoms than White individuals [ 288 ]. Significantly higher thin ideal internalisation has been observed among Asian-American participants as compared with other groups [ 285 ]. Additionally, the association between fear of losing control of eating and depressive symptoms has been found to be stronger in Asian and Pacific Islander minorities than other ethnic groups [ 289 ]. In a study comparing thin-ideal internalisation among young Australian and Malaysian women, a stronger association between body dissatisfaction and restrained eating practices was observed in the Australian sample [ 286 ].

Further investigation of ethnic minority status has implicated perceived ethnic discrimination as a risk factor in ED development. In a cohort of college students, perceived discrimination based upon one’s ethnicity was associated with increased prevalence of key ED symptoms including restraint, weight/shape concern, body dissatisfaction and bulimia [ 290 ]. Perceived discrimination was also found to increase drive for muscularity among males in the sample but not drive for thinness among females. These findings indicate a potentially growing risk for ED in CALD individuals [ 290 ].

A small body of evidence was identified in the current RR regarding the association between ethnic minority status and ED risk. Of the studies reviewed, unique associations have been found between particular ethnic groups and specific aspects of ED psychopathology. For example, in comparison to other ethnic groups, higher rates of BED have been observed in Black-Americans and greater thin ideal internalisation in Asian-Americans [ 286 , 289 ]. Given that a significant proportion of ED research has been conducted using White/Caucasian participants, greater research efforts are needed to better understand the features of EDs in ethnically diverse groups.

8. Body image and social influence

Weight/shape concern, overvaluation of weight/shape and drive for thinness, referred to here using the term body image concerns, are key concepts in ED [ 291 , 292 ]. Along with the social and cultural factors that contribute to body image concerns, these concerns have been extensively investigated as risk factors for the development of EDs. Research in this area has been concentrated among women and girls whose body image concerns are characterised by a focus on low body weight and the thin-ideal [ 293 ], but greater recent focus on men and boys with regard to the muscular/lean ideal has been seen due to increasing recognition of muscle orientated EDs in males. Engagement with particular environments that shape social norms for appearance and promote pursuit of the ideal body shape or weight, or involvement in certain activities with a culture of strict dieting and excessive exercise is encouraged, such as college level or professional sports, are also well studied risk factors in ED literature.

Body image and appearance ideals

Studies using prospective designs have found evidence for body image concerns predicting development of EDs and ED behaviours. In an eight-year longitudinal study of adolescent girls, higher levels of perceived pressure to be thin, thin-ideal internalisation, and body dissatisfaction were significant predictors of later onset ED (BN, BED, and purging disorder) [ 294 ]. Among an adolescent sample, dissatisfaction with weight and shape, but not overvaluation or preoccupation, was a predictor of onset of an ED after 12 months [ 295 ]. The authors suggest that while body dissatisfaction may impart risk for ED development, the other body image-related constructs of overvaluation and preoccupation, may indicate presence of ED psychopathology. A systematic review of the impact of anti-obesity public health messages has found that endorsement of thin ideals and drive for thinness are exacerbated in response to exposure to messages which are stigmatising towards individuals who are overweight or obese [ 296 ]. In a large longitudinal sample of adolescent boys and girls, body image concerns predicted binge eating over 5 years to young adulthood [ 297 ] and persistent disordered eating 10 years later among both males and females [ 298 ], and body dissatisfaction, preoccupation with body weight and shape, and overvaluation predicted increases in disordered eating 15 years later, particularly in females [ 299 ]. Similarly, in a cohort of this sample characterised as having BMI in the overweight category, higher body image concerns predicted prevalence and onset of disordered eating (binge eating and extreme weight control behaviours) over five years [ 300 ]. Findings for body image concern as a risk factor for development of AN are mixed. In this regard, a systematic review of 46 longitudinal studies by Glashouwer et al. [ 301 ] with a pooled sample of 4,928 patients with AN was unable to definitively determine whether body dissatisfaction was a causal factor in disorder onset.

Media, social media, and the internet

The impact of media depictions of appearance ideals on ED symptoms have been examined with studies of varying methodologies. A meta-analysis of laboratory-based experimental studies found that viewing idealised images resulted in a small but non-significant increase in body dissatisfaction. However, exposure to these images was found to have a greater impact on groups considered at high-risk for developing EDs [ 302 ]. Of note, there were no differences observed in the impact of these images based on gender, indicating that men and women are equally affected by media portrayals of idealised bodies [ 302 ].

Among 574 women aged between 14 and 36, social expectations to be thin were found to mediate the relationship between protective self-presentation and disordered eating [ 303 ]. This finding aligns with research on exposure to negative parental attitudes regarding weight to be a risk factor in the later development of ED, discussed previously [ 118 , 303 ].

As with traditional media, the effects of portrayal of idealised bodies on the internet and on social media has been explored. Among young women, use of social media was found to impact weight and shape concerns [ 304 ] and among a predominantly female sample of participants with AN, use of appearance-focused social media was found to be associated with higher levels of ED symptoms [ 305 ]. A systematic review found that general internet use was associated with body image and eating concerns [ 306 ]. Further exploration of problematic internet use suggested excessive use of social media was associated with increased risk of AN and BN, while video gaming was associated with risk of BED [ 307 ]. However, recent proliferation of pro-AN or pro-ED websites and social media networks may create online environments that are more detrimental to the health of individuals at risk of ED than other forms of media. Even among females with normal BMI and no history of ED, one week of exposure to pro-ED website content resulted in a significant reduction (20%) in calorie intake among participants compared to groups who were exposed to other website content including health and fitness websites [ 308 ]. Dangers associated with pro-ED websites is not restricted to females, with a content analysis study finding that up to 25% of participants on pro-AN forums are male, suggesting that these sites may have a substantive negative impact with males engaged with these sites expressing negative experiences including body dissatisfaction [ 309 ].

Body image concerns are a well-known risk factor for EDs. High levels of body dissatisfaction and internalisation of the thin ideal have been found to be predictors of ED onset, whereas related constructs of overvaluation and preoccupation with weight and shape are considered to reflect current ED psychopathology [ 270 – 277 ]. Exposure to the thin ideal via either traditional media or social media is associated with greater risk of an ED, with evidence suggesting that both males and females are equally impacted by this content [ 278 – 283 ].

9. Elite sports, female athlete triad, and excessive exercise

Engagement in activities that accept or promote strict dieting practices and endorsement of low body fat has the potential to contribute to development and maintenance of ED symptoms [ 310 ]. Consistent with this, EDs among elite and college/university level athletes were observed at higher rates than in non-athlete comparison groups [ 311 ], although no difference in prevalence of EDs was found between athletes engaged in sports with an emphasis on aesthetics and/or weight and athletes engaged in sports without this focus. The female athlete triad (FAT), characterised by low energy availability (through increased physical activity or dietary restriction), amenorrhea and low mineral bone density, is considered a consequence of training for elite level sports and pursuit of lean physiques [ 312 ]. Features of FAT have also been observed in elite para-athletes (n = 260) with no difference in risk between genders or sport type [ 313 ].

In relation to ED behaviours, among elite athletes (n = 224), high prevalence of clinically significant ED symptomology (22.8%) has also been found [ 314 ].Similarly, in a sample of college level female gymnasts and swimmers (n = 325), 4.6% (n = 15) engaged in intentional vomiting, 1.5% (n = 5) used laxatives and 2.5% (n = 8) used diuretics for weight control. Additionally, 10.5% (n = 3.4) engaged in binge eating two or more times a week, while almost all participants engaged in binge eating once a week, 96.6% (n = 314) [ 315 ]. However, in a smaller UK sample of male and female gymnasts (n = 51) no purging behaviours were observed, although 31% of male gymnasts in this group scored highly on ED self-report questionnaires [ 316 ].

However, other studies have not found these differences between athlete and non-athlete groups. For example, a cohort study comparing elite and non-elite athletes to controls (n = 725) was also unable to find any differences between the three groups in terms of ED behaviours. However, it did highlight distinct differences associated with social pressures and influences on body image and weight in athletes versus non-athletes. There is some evidence to suggest that unlike female athletes, male athletes are not at greater risk of developing EDs than non-athletes [ 317 ]. Evidence from a meta-analysis of 31 studies of ED athletes indicated that, with the exception of wrestling, male athletes were not at greater risk of disordered eating than non-athletes. Although, researchers noted that studies were heterogenous and measurements were impacted by the potential inappropriateness of ED assessment tools for male populations [ 318 ].

Among non-elite populations, recognising excessive physical activity or exercise levels among women in the community is particularly important in risk assessment of ED, as these individuals were found to be 2.5 times as likely to have an ED diagnosis than non-excessively exercising individuals [ 319 ]. Furthermore, participation in activities promoting lean body types such as yoga and pilates has also been highlighted as a potential risk factor for ED development. However, in a large cohort study (n = 2,287) of young adults no association was found between participating in yoga and pilates and ED symptomology among female subjects but increased risk of unhealthy and extreme weight control behaviours as well as binge eating was observed in males [ 320 ]. Further research is required to understand the unique associations identified in this study.

Similar to athletic settings, other physical activity pursuits take place in environments that may promote ED symptoms. A systematic review and meta-analysis observed higher rates of ED among dancers, where dancers were found to have three times greater risk of having AN or EDNOS but not BN, than the general population and risk was particularly heightened among ballet dancers [ 321 ].

Involvement in elite sports is a potential risk factor for disordered eating behaviours among both male and female athletes [ 311 – 317 ]. Increased attention should be paid towards excessive exercise by non-elite populations in the community as risk factor for EDs and to support screening and early intervention activities [ 318 – 320 ].

This review to aimed to summarise recent peer-reviewed evidence relating to risk factors associated with EDs. An extensive number of research studies were identified, exploring a multitude of risk factors. For the purposes of this review, the research findings were broadly characterised into nine primary categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent experiences, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, (9) and elite sports.

Identification of the recent evidence relating to key risk factors offers valuable knowledge to researchers, clinicians, and policy makers, such that it may inform the development of evidence-based approaches for the care and treatment of individuals with EDs. An understanding of risk factors is essential for the development and refinement of aetiological models [ 8 ]. In a recent review of existing models of disordered eating, Pennesi and Wade [ 21 ] reported that very few of the existing theoretical models (18.5%) have informed the development of effective interventions. The authors call upon researchers to use empirically supported risk-factors to modify existing theories, which then can inform prevention and treatment interventions [ 21 ].

The findings of the current review can be used to determine which risk factors are differentially appropriate targets for prevention, early intervention, and/or treatment efforts [ 322 ]. For example, modifiable risk factors such as negative parental comments towards weight and eating behaviours may be best approached using targeted prevention parenting programs to assist with modelling of healthy eating patterns and family dialogue. There is evidence to suggest targeted prevention programs addressing early signs of disordered eating in adolescents (e.g., the Body Project, StudentBodies2-BED ) are effective in significantly reducing future onset of EDs [ 323 , 324 ]. They represent a targeted, efficient way of addressing modifiable risk factors rather than approaching the population as a whole in a largely non-specific manner.

Identifying risk factors which are less amenable to modification, such as genetic risk factors and autoimmune conditions, may represent an opportunity for enhanced screening measures to recognise early signs of disordered eating prior to onset of full ED diagnosis. Research has identified low levels of screening and poor detection rates of EDs by health practitioners, in particular non-stereotypical presentations of EDs in primary care settings [ 325 – 327 ]. A noteworthy outcome of the current review pertains to the growing field of evidence supporting increased risk of EDs within the sexual minority groups as compared to heterosexual samples. Given the high levels stigma surrounding both LGBTQI and EDs, particularly for young males, it is of particular importance that clinicians thoroughly assess for disordered eating behaviours within sexual minority groups [ 328 , 329 ]. Accordingly, the findings of this review may offer an opportunity for advances in the development of resources (e.g., screening instruments) to assist practitioners in recognising evidenced risk factors for EDs.

Finally, awareness of comorbid psychiatric illnesses or personality traits may inform targets for treatment interventions, including as specific programs for individuals with comorbid personality disorders and ED. Enhanced Cognitive Behaviour Therapy (CBT-e) offers an example of the way in which comorbid psychological traits, considered to be “external” to the ED itself, can be addressed to create a more efficacious, tailored treatment for patients [ 330 ]. The inclusion of additional treatment targets to address comorbid psychological mechanisms (clinical perfectionism, core low self-esteem, and interpersonal problems) allows for cognitive behaviour therapy treatment to meet the needs of non-responders for whom comorbid psychopathology may have interfered with their treatment response [ 331 ].

Additionally, given the search strategy of the review adopted a timeline which overlaps between two versions of the Diagnostic and Statistical Manual of Mental Disorders [ 332 ], namely Version 4 and 5 (i.e., DSM-IV and DSM-5), our findings were able to highlight inconsistences in the degree of research conducted across various ED diagnoses. In particular, the findings demonstrate that considerably less is known about the risk factors associated with EDs which were recently included as formal diagnoses in the DSM-5, including ARFID, BED, rumination disorder, and pica, highlighting the need for more focused research efforts to be put towards these diagnoses.

In this review, gaps in the existing literature were identified. Many of the research studies included in the review adopted a cross-sectional study design and therefore focused upon associations and correlations between EDs and potential risk factors. Consequently, some studies were limited in their capacity to delineate temporal or causal relationships, or how in fact the associations connect the factor with the illnesses. For example, although an understanding of psychiatric comorbidities of EDs (e.g., perfectionism, impulsivity etc.) provides value, without longitudinal research it is difficult to disentangle whether these traits contribute to ED onset or are symptoms of it. Similarly, identification of trauma and abuse as a risk factor for eating disorders needs further clarification as this association has been described for many other mental health conditions such as anxiety and depression [ 333 ], and is not likely a specific association to eating disorders. Additionally, several of the studies included in the current review were not able to distinguish between factors related to onset and factors related to maintenance in EDs, which represents an important differentiation of different classes of risk factors and their influence [ 207 ]. It is possible that some of the constructs reviewed in the present paper have a role as maintenance factors, even if they may not have a role as a causal risk factor. An understanding of whether one psychiatric condition precedes another can assist clinicians in treatment planning and inform sequencing of treatment targets. Taken together, these considerations represent a limitation in our ability to understand the implications of these identified risk factors. For risk factors which have relied heavily upon cross-sectional studies, future research is encouraged to adopt experimental or prospective study designs to better capture the nature of the variable being examined.

Several of the studies included in the review examined risk factors in isolation from one another and thus assessment of their association with EDs occurred as though they were independent contributors of risk. This is markedly distinct from real world environments in which EDs develop in response to a multitude of risk factors and consequently, weakens the ecological validity of the reported findings. An understanding of the ways in which various risk factors interact with each other (e.g., whether they are cumulative in nature), is necessary to form a detailed conceptualisation of illness profiles for both clinicians and researchers, which can in turn inform the development of targeted interventions. Conversely, in the absence of this information, the mechanisms of change are less clear. Future research would benefit from adopting an approach towards risk factors as co-occurring, interactional variables as opposed to a siloed view.

Given the attempt to summarise peer-reviewed ED literature in a broad-reaching and prompt manner, there are some limitations of the review. First broad search terms, required to fulfil the purpose of the large series of rapid reviews, of which this paper forms part, were used to collate evidence, which may have compromised the specificity of the included studies for individual ED diagnoses and/or phenotypes and individual risk factors. Additionally, research studies were excluded if they reported on unpublished data, implementation research, or if they were observational studies; and included studies were mostly limited to those conducted in Western cultures with high-resource health systems. Finally, having a specified time period for the review meant that seminal studies conducted prior to the start date were not included.

Conclusions

This review has identified risk factors for which a substantial evidence-base exists as well as emerging areas requiring further investigation (e.g., ADHD) and ED diagnoses where there is less available evidence (e.g., BED, ARFID). A broad review of the literature has been provided, however future studies are required which critique the strength of evidence of the causal nature of these risk factors.

Acknowledgements

The authors would like to thank and acknowledge the hard work of Healthcare Management Advisors (HMA) who were commissioned to undertake the Rapid Review. Additionally, the authors would like to thank all members of the consortium and consultation committees for their advice, input, and considerations during the development process. Further, a special thank you to the carers, consumers and lived experience consultants that provided input to the development of the Rapid Review and wider national Eating Disorders Research & Translation Strategy. Finally, thank you to the Australian Government—Department of Health for their support of the current project.

Abbreviations

ED	Eating disorder
BN	Bulimia nervosa
AN	Anorexia nervosa
BED	Binge eating disorder
AN-R	Anorexia nervosa (restrictive subtype)
ARFID	Avoidant restrictive food intake disorder
AN-BP	Anorexia nervosa (binge-purge subtype)
EDNOS	Eating disorder not otherwise specified
A-AN	Atypical anorexia nervosa
BMI	Body mass index
NES	Night eating syndrome
ADHD	Attention-deficit/hyperactivity disorder
ASD	Autism spectrum disorder
DBT	Dialectical behaviour therapy
BPD	Borderline personality disorder
MDD	Major depressive disorder
SAD	Social anxiety disorder
BD	Bipolar disorder
PTSD	Post-traumatic stress disorder
SES	Socioeconomic status
CALD	Culturally and linguistically diverse
FAT	Female athlete triad

Author contributions

PM, ST and SM oversaw the Rapid Review process; AL carried out and wrote the initial review; SB, SMC and EB wrote the first manuscript; all authors edited and approved the final manuscript.

The RAPID REVIEW was in-part funded by the Australian Government Department of Health in partnership with other national and jurisdictional stakeholders. As the organisation responsible for overseeing the National Eating Disorder Research & Translation Strategy, InsideOut Institute commissioned Healthcare Management Advisors to undertake the RAPID REVIEW as part of a larger, ongoing, project. Role of Funder: The funder was not directly involved in informing the development of the current review.

Availability of data and materials

Declarations.

Not applicable.

ST receives royalties from Hogrefe and Huber, McGraw Hill and Taylor and Francis for published books/book chapters. He has received honoraria from the Takeda Group of Companies for consultative work, public speaking engagements and commissioned reports. He has chaired their Clinical Advisory Committee for Binge Eating Disorder. He is the Editor in Chief of the Journal of Eating Disorders. ST is a committee member of the National Eating Disorders Collaboration as well as the Technical Advisory Group for Eating Disorders. AL undertook work on this RAPID REVIEW while employed by HMA. A/Prof Sarah Maguire is a guest editor of the special issue “Improving the future by understanding the present: evidence reviews for the field of eating disorders.”

1 having three different alleles at the same locus.

2 Polymorphism is a DNA sequence variation.

3 perception or awareness of sensations inside the body.

4 DNA methylation is a process that controls the expression/suppression of a gene without changing the genetic sequence.

5 Small molecules formed in or necessary for metabolism.

6 Models using rates and mice.

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22 Hollywood Clinic, Ramsay Health Care, Perth, Australia

Kelly Griffin

Scott griffiths.

23 Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia

Ashlea Hambleton

Amy hannigan.

24 Queensland Eating Disorder Service, Brisbane, QLD Australia

25 Hunter New England Local Health District, Sydney, NSW Australia

26 St Vincent’s Hospital Network Local Health District, Sydney, NSW Australia

Phillipa Hay

27 Brain and Mind Centre, University of Sydney, Sydney, Australia

Francis Kay-Lambkin

28 School of Medicine and Public Health, University of Newcastle, Sydney, NSW Australia

Michael Kohn

29 Westmead Hospital, Sydney, Australia

Eyza Koreshe

Isabel krug.

30 Healthcare Management Advisors, Victoria, Australia

Jake Linardon

Randall long.

31 College of Medicine and Public Health, Flinders University, Adelaide, SA Australia

Amanda Long

32 Exchange Consultancy, Redlynch, NSW Australia

Sloane Madden

33 Eating Disorders Service, Children’s Hospital at Westmead, Sydney, NSW Australia

Danielle Maloney

Sian mclean.

34 The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia

Thy Meddick

35 Clinical Excellence Queensland, Mental Health Alcohol and Other Drugs Branch, Brisbane, QLD Australia

Jane Miskovic-Wheatley

Deborah mitchison, richard o’kearney.

36 College of Health and Medicine, Australian National University, Canberra, ACT Australia

Shu Hwa Ong

Roger paterson.

37 ADHD and BED Integrated Clinic, Melbourne, VIC Australia

Susan Paxton

38 Department of Psychology and Counselling, La Trobe University, Melbourne, VIC Australia

Melissa Pehlivan

Genevieve pepin.

39 School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC Australia

Andrea Phillipou

40 Swinburne Anorexia Nervosa (SWAN) Research Group, Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, VIC Australia

Judith Piccone

41 Children’s Health Queensland Hospital and Health Service, Brisbane, QLD Australia

Rebecca Pinkus

Bronwyn raykos.

42 Centre for Clinical Interventions, Western Australia Health, Perth, WA Australia

Paul Rhodes

Elizabeth rieger, sarah rodan, karen rockett, janice russell.

43 Central Clinical School Brain and Mind Research Institute, University of Sydney, Sydney, NSW Australia

Haley Russell

Fiona salter.

44 Ramsay Health Care, Perth, Australia

Susan Sawyer

45 Department of Paediatrics, The University of Melbourne, Melbourne, Australia

Beth Shelton

46 National Eating Disorders Collaboration, Melbourne, VIC Australia

Urvashnee Singh

47 The Hollywood Clinic Hollywood Private Hospital, Ramsey Health, Perth, Australia

Sophie Smith

48 Sydney, NSW Australia

Evelyn Smith

Karen spielman, sarah squire.

49 The Butterfly Foundation, Sydney, Australia

Juliette Thomson

Marika tiggemann.

50 College of Education, Psychology and Social Work, Flinders University, Adelaide, SA Australia

Ranjani Utpala

Lenny vartanian, andrew wallis.

51 Eating Disorder Service, The Sydney Children’s Hospital Network, Westmead Campus, Sydney, Australia

Warren Ward

52 Department of Psychiatry, University of Queensland, Brisbane, Australia

Sarah Wells

53 University of Tasmania, Hobart, TAS Australia

Eleanor Wertheim

Simon wilksch, michelle williams.

54 Royal Hobart, Tasmanian Health Service, Hobart, TAS Australia

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Eating Disorders

What are eating disorders.

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

What are the signs and symptoms of eating disorders?

Anorexia nervosa.

Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.

There are two subtypes of anorexia nervosa: a "restrictive " subtype and a "binge-purge " subtype.

In the restrictive subtype of anorexia nervosa, people severely limit the amount and type of food they consume.
In the binge-purge subtype of anorexia nervosa, people also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes—eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.

Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

Symptoms include:

Extremely restricted eating
Extreme thinness (emaciation)
A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
Intense fear of gaining weight
Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

Thinning of the bones (osteopenia or osteoporosis)
Mild anemia and muscle wasting and weakness
Brittle hair and nails
Dry and yellowish skin
Growth of fine hair all over the body (lanugo)
Severe constipation
Low blood pressure
Slowed breathing and pulse
Damage to the structure and function of the heart
Brain damage
Multiorgan failure
Drop in internal body temperature, causing a person to feel cold all the time
Lethargy, sluggishness, or feeling tired all the time
Infertility

Bulimia nervosa

Bulimia nervosa is a condition where people have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or over overweight.

Chronically inflamed and sore throat
Swollen salivary glands in the neck and jaw area
Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
Acid reflux disorder and other gastrointestinal problems
Intestinal distress and irritation from laxative abuse
Severe dehydration from purging of fluids
Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

Binge-eating disorder

Binge-eating disorder is a condition where people lose control over their eating and have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
Eating even when you're full or not hungry
Eating fast during binge episodes
Eating until you're uncomfortably full
Eating alone or in secret to avoid embarrassment
Feeling distressed, ashamed, or guilty about your eating
Frequently dieting, possibly without weight loss

Avoidant restrictive food intake disorder

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.

Dramatic restriction of types or amount of food eaten
Lack of appetite or interest in food
Dramatic weight loss
Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause
Limited range of preferred foods that becomes even more limited (“picky eating” that gets progressively worse)

What are the risk factors for eating disorders?

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Researchers are using the latest technology and science to better understand eating disorders.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

How are eating disorders treated?

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

Individual, group, and/or family psychotherapy
Medical care and monitoring
Nutritional counseling
Medications

Psychotherapies

Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appears to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. The Food and Drug Administration’s (FDA) website has the latest information on medication approvals, warnings, and patient information guides.

How can I find a clinical trial for an eating disorder?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

NIMH’s Clinical Trials webpage : Information about participating in clinical trials
Clinicaltrials.gov: Current Studies on Eating Disorders : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country

Where can I learn more about eating disorders?

Free brochures and shareable resources.

Eating Disorders: About More Than Food : A brochure about the common eating disorders anorexia nervosa, bulimia nervosa, and binge-eating disorder, and various approaches to treatment. Also available en español .
Let’s Talk About Eating Disorders : An infographic with facts that can help shape conversations around eating disorders. Also available in en español .
Shareable Resources on Eating Disorders : Help support eating disorders awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about eating disorders.
Mental Health Minute: Eating Disorders : Take a mental health minute to watch this video on eating disorders.
Let’s Talk About Eating Disorders with NIMH Grantee Dr. Cynthia Bulik : Learn about the signs, symptoms, treatments, and the latest research on eating disorders.

Research and statistics

NIMH Eating Disorders Research Program : This program supports research on the etiology, core features, longitudinal course, and assessment of eating disorders.
Journal Articles : References and abstracts from MEDLINE/PubMed (National Library of Medicine).
Statistics: Eating Disorders

Last Reviewed: January 2024

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

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Your chance of acceptance, your chancing factors, extracurriculars, discussing my eating disorder in college essays – too personal or potentially impactful.

Hey guys, so here's the thing – I’ve battled with an eating disorder, and it’s been a significant part of my high school experience. Should I write about overcoming this challenge in my essays, or would it be better to choose a less sensitive subject?

Your courage in facing and overcoming such a personal challenge is commendable. When choosing an essay topic, the key is to focus on how the experience has shaped you and enabled personal growth. If you believe that your journey with an eating disorder has been a transformational part of your high school experience and has changed you in a significant way, it is worth considering as an essay topic.

However, ensure that your narrative is one of resilience and that it showcases how this experience has helped you build up your strengths, rather than solely focusing on the struggle itself. For example, avoid graphic descriptions of what you dealt with, as they may be uncomfortable for admissions officers to read, especially if they have struggled with eating disorders themselves—remember, you never know who is going to be reading your essay.

Rather, focus on how overcoming the hardship of this experience has taught you important life skills, by talking about accomplishments or formative experiences that were enabled by the abilities you developed as a result of your struggle with your eating disorder. This approach will give colleges what they are interested in in any personal statement, which is your ability to persevere and how your experiences have prepared you for the challenges of college life.

In summary, this topic is not too personal if framed correctly. If you're wondering if your approach is working, you can always check out CollegeVine's free peer essay review service, or submit it to an expert advisor for a paid review. Since they don't know you, they can provide an objective perspective that will hopefully give you a sense of how an actual admissions officer would read you essay. Good luck!

About CollegeVine’s Expert FAQ

CollegeVine’s Q&A seeks to offer informed perspectives on commonly asked admissions questions. Every answer is refined and validated by our team of admissions experts to ensure it resonates with trusted knowledge in the field.

How To Recognize Eating Disorders: Indicators And Telltale Symptoms

Eating disorders can compromise a person’s health and well-being in a variety of ways, yet they’re not always easy to recognize. An individual with an eating disorder often goes to considerable lengths to conceal their unhealthy behavior from others, and they may be reluctant to admit, even to themselves, that they have a mental illness. Correctly identifying that someone has a disorder of this kind may require watching for a combination of certain telltale warning signs.

Some of these eating disorder indicators can involve attitudes or habits that demonstrate an excessive concern with food, weight, or appearance. Others may be direct signs of the behavioral symptoms of anorexia or bulimia. Individually, these indicators aren’t necessarily problematic. However, when someone is displaying multiple potential warning signs of an eating disorder, it may be worth having a conversation with them about their health. If you believe you could be living with an eating disorder, consider reaching out to a therapist for support and guidance.

What are eating disorders?

An eating disorder can be described as a serious mental health condition that goes well beyond simple picky eating or occasional overindulgence. According to the American Psychiatric Association, this type of illness is usually defined by a “ severe and persistent disturbance in eating behaviors ,” typically accompanied by negative thoughts and emotions.

Current medical practice recognizes seven distinct categories of eating disorders.

#1: Anorexia nervosa (AN)

Possibly the most widely recognized eating disorder, anorexia nervosa (also known as “AN” or simply “anorexia”) is defined by a combination of the following:

Restriction of eating to the point that caloric energy intake is lower than the amount the body requires, leading to severely underweight status
Persistent attempts to avoid gaining weight, typically motivated by a distorted body image and/or an intense fear of being fat

In addition to restricting food intake, some people with anorexia may experience episodes of binge eating — short bouts of compulsive overeating — followed by compensatory behaviors intended to avoid weight gain, such as excessive exercise.

#2: Bulimia nervosa (BN)

Bulimia tends to be similar to anorexia in that it often involves a pathological fixation on reducing body weight or becoming slim. However, its principal symptom is usually a recurring pattern of binge eating followed by excessive attempts to avoid weight gain. This typically includes “purging” behavior, such as deliberate vomiting or inappropriate use of laxatives or diuretics.

#3: Binge eating disorder (BED)

As indicated by the name, binge eating disorder is a condition typically involving repeated binge episodes . What sets it apart from anorexia and bulimia is that these binges are rarely followed by purging or other unhealthy attempts to compensate for the food consumed.

#4: Avoidant/restrictive food intake disorder (ARFID)

People with avoidant/restrictive food intake disorder don’t normally experience the same preoccupations about body weight and appearance seen in anorexia and bulimia. Instead, these individuals usually have severe sensory discomfort related to specific kinds of food or an exaggerated fear of choking or vomiting due to overeating. As a result, they may eat a sharply restricted diet, often limiting themselves to a handful of foods they consider “safe.”

#5: Rumination disorder

Sometimes called “rumination syndrome,” this condition tends to be most commonly seen in children, but it can also affect adults in some cases. Rumination disorder generally involves a habit — often partly involuntary — of repeatedly regurgitating food after eating it.

A person with pica may experience a strong urge or compulsion to swallow non-food items or substances. The exact items consumed can vary from person to person, but common examples include clay, soil, paint chips, buttons, paper, and eggshells. Pica is another eating disorder that tends to be significantly more common in children than adults.

#7: Other specified feeding and eating disorders (OSFED)

This category generally includes other kinds of disordered eating behavior that don’t precisely fit into the categories above, though they often have very similar pathologies . One example is atypical anorexia nervosa, in which a person displays the same behavioral and cognitive symptoms as in standard AN but isn’t underweight at the time of diagnosis.

Indicators of anorexia or other restrictive eating disorders

The following signs and symptoms might indicate the presence of anorexia nervosa:

Rapid weight loss
Excessive interest in calories, dieting, weight loss, and related topics
Frequent self-criticism related to appearance (especially body shape and weight)
Distorted body image ( perceiving oneself as overweight or fat despite appearing thin to others)
Reluctance or refusal to eat with others, with frequent excuses or denial that they’re hungry
Ritualistic food behaviors, such as chewing repetitively or rearranging food on the plate
Frequent weakness, dizziness, or fatigue
Feeling cold most of the time, often wearing multiple layers to compensate
Fine hair growing on the body (lanugo)
Dressing in loose clothing to hide body shape
Thin, brittle hair and nails
Dry or yellowing skin
Constipation and other gastrointestinal disruptions
Difficulty concentrating or thinking clearly
Social withdrawal or isolation
Irritability or mood swings
Absent or irregular menstrual periods in women

These indicators can also be present in other eating disorders involving significant food restrictions, such as ARFID.

Indicators of bulimia or purging behavior

Aside from the characteristic symptoms — binge eating and purging — what are the indicators of bulimia?

Some physical and behavioral symptoms may match those seen in anorexia. For example, both disorders can involve an overly intense focus on body shape and weight gain or loss, as well as avoiding eating around others. Individuals with bulimia may also experience gastrointestinal difficulties and dizziness or faintness, often resulting from dehydration.

Other indicators may be specific to bulimia-related binge eating and purging, including the following:

Repeatedly disappearing or visiting the bathroom after eating
Expressing feelings of shame about food
Hiding food or attempting to conceal food-related garbage
Buying large amounts of food, diuretics, or laxatives
Fluctuating weight
Frequent sore throat or hoarse voice
Swelling of glands in the cheeks and neck
Scarring on the fingers or knuckles
Dental yellowing or decay
Tachycardia due to electrolyte imbalance
Acid reflux and other forms of gastrointestinal distress
Burst blood vessels in the eyes

These signs may also be seen in various “other specified eating disorders” when they involve purging behaviors.

Indicators of binge eating disorder

Binge eating disorder can be associated with high levels of shame , which frequently leads people with this condition to conceal the evidence of their disordered eating behavior. This can make it difficult to identify from the outside. If you frequently eat until you’re painfully full and sense that you are unable to stop, this can be a strong indicator that you might have BED — but how can people recognize this illness in their loved ones?

The following could be signs of binge eating disorder:

Hiding stores of food, especially unhealthy “comfort” foods
Dieting often without apparent weight loss
Frequently eating alone or concealing eating
Expressing shame, guilt, and other negative emotions about food
Unexplained weight gain
Loss of sexual desire

Long-term eating disorder health impacts

Prolonged eating disorders may lead to more serious symptoms than those described above. In some cases, these mental disorders may go unrecognized until their health consequences become pronounced enough that they’re apparent to third parties or drastically interfering with daily function.

These medical complications can vary based on the specific pathology involved. Anorexia and other food-restricting illnesses may impact virtually every part of the body through malnutrition, leading to effects like those listed below:

Neurological deficits
Heart tissue atrophy and cardiac arrest
Vision loss
Respiratory weakness, sometimes causing aspiration of food or vomit
Skeletal weakness and fracture
Weakened infection resistance

Bulimia can have various health effects, including the following:

Kidney dysfunction
Gastrointestinal dilation or rupture
Irregular heartbeat
Damage to the esophagus
Cardiomyopathy

Long-term issues linked to binge eating disorder are typically linked to obesity and high blood sugar. For example, metabolic syndrome and type 2 diabetes can be common pathologies. Gastrointestinal damage or dysfunction can also result from the physical effects of overeating.

Risk factors for developing an eating disorder

While successfully recognizing and treating eating disorders can have a dramatic positive effect on the well-being of those affected, preventing them from developing may be even more beneficial. Researchers have identified several possible risk factors for these conditions that may help identify who could benefit the most from preventative measures.

These factors include the following:

A family history of eating disorders
Other mental illnesses, including ADHD, obsessive-compulsive disorder, and depression
Trauma, including childhood abuse or neglect

Sociocultural eating disorder risk factors

Evidence suggests that societal factors may also play a role in promoting unhealthy eating behaviors. Researchers have found that internalizing beauty standards and cultural messaging that emphasize the importance of thinness can significantly increase the likelihood of developing an eating disorder.

Talking to someone you think may have an eating disorder

If you think that someone you know may be exhibiting some of the signs of an eating disorder, encouraging them to seek help could make a significant difference in their long-term well-being. However, it can also be challenging, since people with these conditions are often resistant to the idea that their behavior is problematic.

When you first bring up the subject, it may be helpful to avoid directly suggesting that they have an eating disorder. Instead, you may simply want to explain that you’re worried they may be exhibiting some unhealthy eating habits. Emphasizing your concern for their well-being, rather than raising questions about their mental health, may prevent a defensive reaction.

You might also benefit from avoiding speculation. Instead, you can simply point out behaviors you’ve directly observed and explain why you think they might be detrimental. Asking about any sources of stress or challenging emotions and letting them know you’re there for them if they need support can be helpful. If the other person is receptive to your concerns, you can suggest that they might want to talk about what they’re experiencing with a therapist.

Effective eating disorder treatments

If you or someone you know needs help with an eating disorder, talking with a physician is often a good idea. Medical supervision may be crucial for safe and healthy eating disorder recovery.

Successful treatment also typically involves evidence-based psychotherapy. The methods that have been found effective for eating disorders include those listed below:

Cognitive behavioral therapy (CBT)
Interpersonal therapy (IPT)
Family-based therapy (FBT)
Dialectical behavior therapy (DBT)
Exposure therapy
Acceptance and commitment therapy (ACT)
Mindfulness-based therapies

Online treatment for eating disorders

Some people with eating disorders opt for therapy delivered over the internet, which can offer some advantages in terms of convenience. Since you can attend online therapy from home, it’s often easier to schedule, which can be helpful when you’re trying to manage the many facets of eating disorder recovery.

Research on the benefits of online eating disorder treatment is in its early stages, but the current evidence suggests that it can work well for many people. For example, one review from 2023 examined more than a dozen trials of online cognitive behavioral therapy (ICBT) for eating disorders. The authors found that the evidence supports the effectiveness of this treatment method , though more studies may be needed for confirmation.

Some red flags for eating disorders are behavioral, such as an obsession with dieting and body shape or a tendency to frequently skip meals. Others are physical, such as brittle hair or decaying teeth. When multiple warning signs appear together, it may be a strong indicator that an individual needs help. If you or a loved one are living with an eating disorder, consider seeking help by contacting a licensed mental health professional online or in your local area.

Understanding Eating Disorders: Family Therapy For Comprehensive Care Medically reviewed by April Justice , LICSW
Eating Disorders And Eating Habits: How Healthier Eating Habits Can Address Disordered Eating Medically reviewed by April Justice , LICSW
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COMMENTS

Analytical Essay on Eating Disorders: Causes and Effects
However, as defined by Ranna Parekh (2017), "eating disorders are actually illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions". In fact, these eating disturbances are related to the insufficient or excessive food intake that eventually has a negative effect on human well ...
PDF A Review of the Physiological Causes and Effects of Eating Disorders
Combining the results. of several studies, researchers found that between 0.9% and 2.0% of females and 0.1% to 0.3%. of males will develop anorexia as well as that between 1.1% and 4.6% of females and 0.1% to. 0.5% of males will develop bulimia (Statistics & Research on Eating Disorders, 2022).
Eating disorders
Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated.
Essay on Eating Disorder [Edit & Download], Pdf
This essay aims to delve into the various aspects of eating disorders, exploring their types, causes, effects, and treatments, providing a comprehensive understanding for students and individuals keen on understanding this intricate topic.
Eating disorders
Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely it is that serious complications may occur. These may include: Serious health problems. Depression and anxiety. Suicidal thoughts or behavior. Problems with growth and development.
Eating Disorder: The Causes and Effects
Abstract: Eating disorders (EDs) are a group of psychosomatic disorders characterized by. abnormal eating behavior and psychological disorders, with high mortality and easy. chronicity. Eating ...
Factors associated with eating disorders in adolescents: a systematic
In the present review, the results show that the main factors associated with eating disorders were psychological-type with a prevalence of the factor inherent the dissatisfaction with body image (16 ─ 18, 21, 25, 27, 29, 31, 32, 35). Literature refers that dissatisfaction with body image increases significantly in adolescence due to ...
What Are the Causes of Eating Disorders?
Risk Factors for Eating Disorders. Many factors have been, or are being, studied as possible contributors to the development of eating disorders. Across all types of eating disorders, it is likely that mental health and body image-related factors play a significant role in causing eating disorders. In general, most experts agree that eating ...
(Pdf) Eating Disorders in Adolescence: Social Causes and Consequences
Eating disorders are complex diseases that affect mostly. adolescents and are considered to be the third m ost common. chronic disease in ad olescent women (Gold en et al., 2 003). Currently, they ...
Argumentative Essay on Eating Disorders
Get original essay. Eating disorders are complex conditions that can stem from a variety of factors, including societal pressures, genetic predispositions, and psychological triggers. Society's obsession with unrealistic beauty standards and the constant portrayal of idealized body images in the media can contribute to low self-esteem and body ...
Eating Disorder Essay • Examples of Argumentative Essay Topics
2 pages / 809 words. Eating Disorders (EDs) are serious clinical conditions associated with persistent eating behaviour that adversely affects your health, emotions, and ability to function in important areas of life. The most common eating disorders are anorexia nervosa, binge-eating disorder (BED) and bulimia nervosa.
Cause And Effect Essay On Eating Disorders
An individual may feel very angry or even have high levels of depression and anxiety. One may feel stressed out and be very lonely. All this feeling contributes to the development or cause of an eating disorder. Another role caused by the psychological aspect can be low self-esteem. With all, you gain feelings of inadequacy or lack of control ...
Essay on Eating Disorders
The physical consequences of eating disorders are profound and can be life-threatening. They range from malnutrition, heart conditions, and bone loss in anorexia, to gastrointestinal problems and electrolyte imbalances in bulimia. Binge eating disorder can lead to obesity and related complications like heart disease and type 2 diabetes.
Eating Disorders, Essay Example
Eating disorders affect men and women of all ages, although adolescents tend to be the age group that is more susceptible. This is because, as their bodies are changing, they may feel more pressure by society as well as peer groups to look attractive and fit in (Segal et al). Types of eating disorders include Anorexia, Bulimia and Compulsive ...
The Explanation of Eating Disorders: A Critical Analysis
A systematic review of dialectical behavior therapy for the treatment of eating disorders. Eating Disorders, 20, 196 - 215. doi: 10.1080/10640266.2012.668478 CrossRef Google Scholar PubMed. Berkman, ND, Lohr, KN and Bulik, CM (2007). Outcomes of eating disorders: A systematic review of the literature.
What Are the Causes of Anorexia Nervosa?
activate behaviors related to anorexia. get in the way of healing and recovery. In addition, the following factors can be linked to the cause of anorexia: genetics. brain chemistry. family ...
Current approach to eating disorders: a clinical update
The conceptualisation of eating disorders has expanded rapidly in the last 10 years to include binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID) in addition to anorexia nervosa and bulimia nervosa. These are now recognised as four well‐conceptualised disorders, which have been reclassified as Feeding and Eating ...
Cause and Effect Essay on Eating Disorders
Bulimia and anorexia are both very dangerous, and can be life threatening. Both are very common among teens and young adults. Eating disorders are becoming more familiar for this generation to feel accepted and in this society. Anorexia Nervosa is a prolonged disorder of eating due to loss of appetite. This disorder affects many women and a few ...
The Link Between Mood And Food: Can Depression Cause Eating Disorders
The relationship between depression and eating disorders is often cyclical, with symptoms of each condition potentially exacerbating the other. For example, eating disorders can cause various physical effects, such as nutritional inadequacies, electrolyte abnormalities, and hormonal imbalances.
Risk factors for eating disorders: findings from a rapid review
Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder ...
Can Stress Cause Eating Disorders? Understanding The Connection
Can stress cause eating disorders? Stress can trigger disordered eating habits, which, if left unaddressed, can develop into an eating disorder.To understand why, it can be helpful to understand how stress can disrupt eating patterns—stress hormones can cause some people to lose their appetite, while others may experience intense cravings for comfort foods, potentially leading to under- or ...
Eating Disorders
In life-threatening situations, call 911. Symptoms include: Extremely restricted eating. Extreme thinness (emaciation) A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight. Intense fear of gaining weight. Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape ...
The Long-Term Effects Of Eating Disorders And The Path To Recovery
Eating disorders are severe mental health conditions that often extend far beyond concerns about food and weight. The long-term effects of eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder can be devastating, affecting both physical health and mental well-being.
Emotional Effects Of Eating Disorders: How An Eating Disorder Impacts
Emotional effects of eating disorders can include a sense of hopelessness, self-loathing, and high levels of shame and guilt. There is hope for eating disorder recovery, though, and speaking to an online therapist could be a beneficial first step. ... A number of factors may cause eating disorders. Diet culture, unrealistic beauty standards ...
Discussing my eating disorder in college essays
When choosing an essay topic, the key is to focus on how the experience has shaped you and enabled personal growth. If you believe that your journey with an eating disorder has been a transformational part of your high school experience and has changed you in a significant way, it is worth considering as an essay topic.
Eating disorder symptoms, types and causes
Eating disorders are serious conditions that can lead to long-term physical health effects - but recovery is possible with eating disorder treatment. In this post, we explain some of the signs and symptoms of eating disorders, possible causes and how to get help for yourself or a loved one.
How To Recognize Eating Disorders: Indicators And Telltale Symptoms
An eating disorder can be described as a serious mental health condition that goes well beyond simple picky eating or occasional overindulgence. According to the American Psychiatric Association, this type of illness is usually defined by a " severe and persistent disturbance in eating behaviors ," typically accompanied by negative thoughts ...

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