Why do people develop eating disorders?
The question of why people develop eating disorders is a difficult one to answer. It may be that there is no one answer, or too many answers. There are many factors that appear to trigger the development of eating disorders. We are fairly confident about the role of some, but the importance of others is still unclear.
There are certainly plenty of theories about the influences that are thought to be important in causing anorexia or bulimia nervosa. Some people are convinced that certain kinds of family problems or childhood traumas could be a cause. Others blame the media or the pervasive influence of the fashion industry.
Still others may emphasise anything from sexual politics to zinc deficiency.
Whenever you find lots of competing theories about something, it is a fair bet that no one has really got to the bottom of the problem. In that sense, there is perhaps no answer to the question of what causes eating disorders. In another sense, there may be as many answers to the question as there are sufferers. In very general terms, eating disorders seem to be linked with and may be triggered by unhappiness and emotional difficulty. The roots of such unhappiness are specific and personal. No two people are exactly alike. So any statements about the causes of eating disorders will be generalisations. Nevertheless, generalisations can be useful as a guide. The following possible causes are considered important when trying to understand why eating disorders occur.
THE FEAR OF FATNESS AND THE DESIRE TO BE SLIM
Eating restraint is a part of almost all eating disorders. The most common reason for restraining eating is to try to lose weight. The whole situation may become complicated, but many people who end up with an eating disorder seem to start off simply trying to slim.
Of course, the reason why someone decides to start slimming in the first place may already be complex. By definition someone who sets out to lose weight is dissatisfied with herself or, at the very least, with some aspect of her body. Often the dissatisfaction may be more than just unhappiness with her shape and appearance. It may become focused on the body because the slimmer feels that weight and shape are both of great importance and relatively easily controlled and changed. These are widely held ideas.
SOCIAL PRESSURES
Within our culture being slim is associated with being attractive, healthy and successful. This is especially true for women. Plumpness, although prized in the past, is now disparaged.
Furthermore, there is a major industry which claims to provide all the advice and the means that the slimmer needs to achieve a new figure and through that a new self-confidence. The slimming industry is closely linked with fashion, advertising and the media. All together they exert a powerful influence on women, especially young women. But this is a general influence. Taken on its own, it cannot explain why some women develop eating disorders but most do not. Furthermore, it may be argued that the media reflect the wider culture as much as they promote it. It is the familiar problem of the chicken and the egg.
FAMILY INFLUENCES
It seems to be the case that both anorexia and bulimia nervosa tend to run in families. Recent research suggests that susceptibility to eating disorders can be inherited. The evidence for genetic transmission is stronger in the case of anorexia nervosa than it is for bulimia nervosa. However, it is certainly true that most children learn much of their eating behaviour and attitudes from their parents. The family is likely to be important in both of these ways.
There is also much theorising about the possible role of other kinds of family influences. For instance, it has been suggested that anorexia nervosa sufferers come from families who are very close emotionally, but where it is difficult for them to develop a sense of their own individuality and independence. Again, it is difficult to be sure whether particular ways of relating are causing the problem or are caused by it, or a bit of both. ‘Normal’ families vary a great deal. Furthermore, it is difficult to be sure what should be the ‘normal’ reaction of a family to the apparently wilful self-starvation of one of its members.
This having been said, it would be surprising if such family factors did not have some influence on the development of eating disorders. However, it is not yet clear whether particular styles of family interaction increase the risk of a person developing an eating disorder. Certainly no one pattern applies to all sufferers.
CHILDHOOD TRAUMAS
Another idea which has been widely considered is the role of bad experiences in childhood, particularly sexual abuse. Until fairly recently, the whole issue of childhood sexual abuse was largely neglected. This is no longer so. It is now clear that a substantial minority of children have been sexually exploited by adults. It is also clear that such abuse can have lasting effects upon that child as she or he grows up. These effects are likely to include an increased vulnerability to psychiatric illness in general. Around a third of women with eating disorders report some sexually abusive experience, and this may have played some part in the development of their disorder. However, women with other kinds of emotional illness report at least as many such experiences.
Thus there is unlikely to be any specific link between eating disorders and sexual abuse, over and above the general effect of such abuse making those so abused more vulnerable to psychiatric illness. But people who develop eating disorders have probably had more than their fair share of troubles of all kinds in their childhood. This may be especially so for those suffering from bulimia nervosa.
LOW SELF-ESTEEM
It is difficult to define any one type of young woman who is especially likely to develop an eating disorder. However, two features do seem to be characteristic of many sufferers.
First, most have low self-esteem. They have real doubts about their own worth and competence. These doubts are often kept hidden and may be dealt with in all sorts of ways, from social retreat to exhibitionist bravado. Nevertheless, whatever appears to be the case on the outside, inside the sufferer feels very unsure of herself.
The second feature characteristic of many sufferers is that they find it difficult to deal openly with problematic emotions. They tend to try to keep the lid on difficult feelings. This may have something to do with their personality, for instance they may be obsessional and perfectionist.
It may also be something in their circumstances, such as a particular fear of upsetting or damaging other people. Either way, they are frightened that things will get out of control. Somehow these ideas about emotional control get mixed up with ideas about the control of weight and eating.
In general, eating disorders seem to arise in the midst of the difficult business of growing up and developing as a person. The chances of developing an eating disorder may be influenced by a whole range of factors to do with the person herself, her family, their circumstances and the society in which they live. And, of course, there are all those unknown and unpredictable factors that we tend to call luck or the lack of it.
