Risk Factors for Eating Disorders

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop eating disorders with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing eating disorders. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk.

A number of factors can play a role in your risk of developing an eating disorder. Emotional stress, generated by significant life events, often precedes the onset of an eating disorder in susceptible individuals.

The following factors have been found to increase the risk of developing an eating disorder:

Gender

Females are much more likely than males to develop an eating disorder. Only an estimated 5%-15% of people with anorexia or bulimia and an estimated 35% of those with binge eating disorder are male.

Socioeconomic Factors

People living in economically developed nations appear to have a higher risk for developing eating disorders. Studies suggest that, within economically developed countries, the risk for bulimia may be higher among lower socioeconomic groups.

Age

Eating disorders are most prevalent in people (usually girls and young women) between the ages of 12 and 25, although they can occur in children and older adults.

Genetics and Biochemical Factors

Recent studies suggest that abnormalities in brain pathways involving the neurotransmitter serotonin persist after recovery from certain eating disorders. These findings lead to speculation that serotonin and other similar natural chemical substances within the brain may have a causative role in anorexia . Further studies will be needed to confirm such speculations. Some genes have also been found to be associated with eating disorders in certain individuals. Further research may bring new insights into the causes and treatments of these perplexing disorders.

Athletics and Certain Professions

Athletes, such as dancers, jockeys, gymnasts, runners, wrestlers, and cheerleaders, tend to be at higher risk for eating disorders. Many coaches and teachers encourage thinness to achieve a competitive edge. They may advocate calorie counting and inappropriate loss of body fat. There is also a higher risk of eating disorders in models, actresses, entertainers, sorority members, and socialites, all of whom may experience social pressures to be thin.

Early Puberty

Girls who experience early puberty are more at risk for developing an eating disorder. Since they mature physically faster than their peers and have an increase in normal body fat, they may feel isolated and under greater pressure to restrict their food intake.

Personality Factors

Certain personality factors seem to increase a person’s risk of developing an eating disorder. People with eating disorders tend to be perfectionists who have high expectations of themselves and others. In spite of being high achievers, they may have low self-esteem and identity problems. They are prone to dichotomous thinking (i.e., seeing everything as good or bad, a success or a failure). This thinking carries over to issues about weight, where thin is good and thinnest is best.

Fear of change and difficulty coping with stress are common in people who have eating disorders. They may also fear criticism, avoid sexuality, or act out impulsively. Among people with eating disorders, there are high rates of borderline personality disorder, avoidant personality disorder, obsessive-compulsive personality disorder , and narcissism.

Emotional Disorders

People with emotional disorders, such as depression , obsessive-compulsive disorder, and anxiety disorders (ie, panic disorder , post-traumatic stress disorder , and generalized anxiety disorder ), are at greater risk for developing an eating disorder. In fact, between 40%-96% of all people with eating disorders experience depression or anxiety disorders.

Family Influences

Negative influences within a family can play a role in eating disorders. Some studies suggest that eating disorders are more prevalent in people where one or both parents are overprotective, detached, critical, rigid, or ineffective at resolving conflict.

A person may be more at risk for developing an eating disorder if he or she has parents who have psychiatric disorders or who abuse alcohol or other addictive substances. Research suggests that daughters of mothers who have a history of eating disorders may be at higher risk for an eating disorder. Eating disorders are also more common in families where there is pressure to be thin.

Social and Cultural Pressures

Beauty standards in Western culture focus on youth and thinness. Images of thin, beautiful, successful people are constantly portrayed in the media. These and other pressures, such as pressures from appearance-obsessed peers and romantic partners, lead to higher rates of eating disorders in people in Western culture.

History of Sexual Abuse

A history of sexual abuse is common in women with eating disorders, especially those with bulimia. Studies have found rates of sexual abuse to be as high as 35% in women with bulimia.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Johnson JG, Cohen P, Kotler L, Kasen S, Brook JS. Psychiatric disorders associated with risk for the development of eating disorders during adolescence and early adulthood. J Consult Clin Psychol. 2002;70(5):1119-1128.

Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61:348-358.

National Eating Disorders Association website. Available at: http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=337 .

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/ .

Steiner-Adair C, Sjostrom L, Franko DL, et al. Primary prevention of risk factors for eating disorders in adolescent girls: learning from practice. Int J Eat Disord. 2002;32(4):401-411.

Yager J, Devlin MJ, Halmi KA, et al. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. American Psychiatric Association; 2006. Available at: http://www.psych.org/psych_pract/treatg/pg/EatingDisorders3ePG_04-28-06.pdf . Accessed April 8, 2007.



Last reviewed April 2007 by Janet Greenhut, MD, MPH

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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