Risk factors for Eating disorders are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Eating disorders makes the chances of getting a condition higher but does not always lead to Eating disorders. Also, the absence of any risk factors or having a protective factor does not necessarily guard you against getting Eating disorders.

The National Association of Anorexia Nervosa and Associated Disorders estimates that there are 8 million people in this country suffering from eating disorders, and there are more cases being reported in the eight-to- eleven-year-old bracket every day. The American Anorexia/Bulimia Association estimates that 1 percent of teenage girls in the United States develop anorexia nervosa, and approximately 5 percent of college women in the United States have bulimia.

The staff at East Tennessee Children’s Hospital offers the following warning signs for helping to detect both anorexia nervosa and bulimia nervosa.

Anorexia danger signs include significant weight loss; continual dieting (even though the child is already thin); feelings of fatness by the child even after weight loss; fear of weight gain; lack of menstrual periods; preoccupation with food, calories, nutrition, and/or cooking; a preference to eat in isolation; compulsive exercise; insomnia; brittle hair or nails; and social withdrawal.

What increases the likelihood of developing an eating disorder?

1. Female gender
2. Body dissatisfaction
3. Dieting; eating in secret
4. Neurochemical changes, particularly around the onset of puberty
5. Participation at the top levels of sports that tie body weight to performance
6. Obsessive thoughts and behavior
7. Difficulty moving from one train of thought or plan of action to the next
8. Perfectionist tendencies; avoidance of risks
9. Perception that thinness is important to mother
10. Media images and fashion magazines
11. Personal or family history of eating disorder, obesity, substance abuse, and/or depression
12. Personal history of teasing or harassment
13. Childhood physical or sexual abuse
14. Personal history of anxiety problems, particularly an intense fear of engaging in social activities
15. Relocation to a culture that worships thinness from one that doesn’t

Puzzles Within the Puzzle
At the beginning of this chapter, we referred to the possible causes of eating disorders (biology, culture, personality, and relationships) as pieces of a jigsaw puzzle that need to be put together. In Western societies, almost all girls are exposed to the thin body ideal, but relatively few get eating disorders. What accounts for this discrepancy? The likelihood is that genetic predisposition to eating disorders helps set the stage for the individual to succumb to cultural pressures. But there is probably a lot more to it.

It turns out that each of the four major puzzle parts is complex in itself. For example, the biology piece includes not only genetics, but also neurochemical changes that take place around the onset of puberty. In Chapter 6, we introduced the chemical serotonin as one of a number of neurotransmitters that transport messages from one brain cell to another. Serotonin helps regulate mood, anxiety, and eating behavior. Research suggests that imbalances in serotonin contribute to the long-term mood issues, obsessions (repetitive, unwelcome thoughts), and perfectionism that characterize eating disorders. Evidence that selective serotonin reuptake inhibitors can be helpful to patients with eating disorders provides an additional clue that serotonin may be involved in the development of these illnesses.

The personality piece of the puzzle is also multifaceted. A number of people with eating disorders are inhibited, others are impulsive, and some fall between these two poles. While Holly is gregarious and Yvette is slightly shy, it is not unusual for people who develop these conditions to have a history of extreme anxiety in social situations, a problem that can continue after a return to healthy eating. Many questions remain. Is intense fear of socializing linked to genetics? Do the obsessions (repeated thoughts) and compulsions (driven behaviors) that characterize eating disorders have genetic roots? Like Holly, some individuals with current or past anorexia have trouble changing gears to accommodate change. Is this a genetics issue, a serotonin problem, or both? Why is dieting a risk factor for some people and not for others? Research on these issues is ongoing.

The good news is that while the exact causes of eating disorders remain unknown, the clues that researchers have uncovered can help inform strategies for preventing these illnesses and treating them in their earliest stages. In next section, we will detail what you can do to send your child a healthy message and help prevent illness.

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David B. Herzog, M.D., Debra L. Franko, Ph.D., Pat Cable, RN

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David B. Herzog, M.D., is the Harvard Medical School Endowed Professor of psychiatry in the field of eating disorders at Massachusetts General Hospital and the director of the Harris Center at Massachusetts General Hospital.
Debra L. Franko, Ph.D., is a professor in the Department of Counseling and Applied Educational Psychology at Northeastern University and the associate director of the Harris Center at Massachusetts General Hospital
Pat Cable, RN, is the director of publications at the Harris Center.