Understanding Eating Disorders Educational Series (Part 2)

Are you one in a hundred?

That’s the official statistic for the people impacted by an eating disorder, though it is likely a vast underestimate.

For the past few weeks, I’ve been discussing diet and wellness culture, food addiction, and eating disorders.

After the conclusion to my three-part series on the cautions and caveats of labeling food as addictive,* and a little detour to explore all things about essential oil therapy, I began my discussion on eating disorders.

I provided an overview and some statistics on them so that you could recognize if you or your loved ones could be suffering from one.

Eating disorders can be fatal and are insidious.

We need to pay attention.

We are living within a diet culture mindset that preys upon our insecurities, worships thinness, portrays unattainable beauty standards, and views purification of the body as a sanctity.

These memes are being used manipulatively and dangerously to reinforce restrictive food practices in our society.

Alarmingly, rather than people receiving intervention at the start of a disordered dietary pattern, the wellness space has started to promote some of this behavior as “healthy.”

My concern is that our current “health” approach,  if not careful, could be perpetuating and fueling part of the mental health crisis of health anxiety, false anxiety, and eating disorders.

I am on a mission to combat this ravenous beast!

We must inform ourselves of what are and what are not nourishing habits around food. Otherwise, we could mistake true sustenance for shallow goals disguised as virtuous.

Equipped with the facts and clarity on what is “normalized” and what is truly diagnosable as an eating disorder, perhaps I may be able to shed some light and hope that one can have a nurturing relationship with food and still be healthy.

Keeping with my vision, I will now get into several risk factors and characteristics of eating disorders. Next, I will review specific categories as outlined by the DSM-V (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).

At the end of the series, I will discuss why a program that focuses on acceptance and emotional coping might be more helpful than trying to restrict, shame, and control the behavior that results from one already feeling out of control.

Please take this knowledge to heart. You may be able to save someone’s life, or your own.

If you are a healthcare provider, this post could be a wake-up call for you.

*Note on Food Addiction: Although health influencers often refer to food addiction as though it is a clinical diagnosis, it is still being explored and some of the theories are not holding up in clinical trials. At the time of this post, it has not officially been classified in the DSM-V (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) under substance use disorders. Furthermore, there are many overlaps between what is considered an “eating addiction” and eating disorders and diet culture mentality. If you’d like more details on this topic, click here.

The Risk Factors of Eating Disorders

It is important to be educated about the risk factors of eating disorders. This helps with addressing root causes and may decrease stigma. If one can understand that eating disorders are the result of a complex interaction of genetic, biological, and social factors, one may be less apt to harshly judge themselves or others.

Eating disorders are not simply based on willpower, the desire to be thin and fit into diet culture, and/or poor coping mechanisms. Though these facets could influence them greatly (as mentioned above), there is so much more going on under the surface of eating disorders. (source, source, source)

Brain Health Factors

I will now go through several risk factors for eating disorders, divided into biological and psychological categories, but keep in mind this is not a complete picture. All brain health aspects, as listed below, always need to be considered for every mental health diagnosis:

• Inflammation and oxidative stress
• Genetic variations (such as SNPs related to MTHFR, DRD2, DRD4, COMT, CBS, and serotonin transporters (5HTT))
• Nutrition and assimilation
• Dietary triggers and deficiencies (including cerebral folate deficiency)
• Mitochondrial dysfunctions and imbalances
• Hormonal imbalances
• Stress & cortisol levels
• The microbiome
• Environmental toxicants
• Blood sugar levels
• Stealth infections
• Childhood adversity
• Emotional tone and spirituality
• Brain trauma
• Hyper or hypo-activity in a brain region
• …and more (mold, medications, functional neurology, etc.)!

Biological Risk Factors in Eating Disorders

Now let’s look at some biological factors associated with eating disorders. (source)

Genetics: A first-degree relative (i.e., parent or sibling) with an eating disorder increases a person’s risk of developing an eating disorder. Similarly, a close relative with a mental health condition also increases one’s risk.

This could relate to a psychosocial interaction as much as a genetic predisposition. For example, studies have demonstrated the impact mental health and messaging has on parenting outcomes and social behaviors in children. (R, R, R) One study reported, “Early etiological investigations suggested that the family (Kluck, 2008), particularly the perceived pressure from parents (Rodgers, Paxton, & Chabrol, 2009), media and peers as important sociocultural sources of influence on eating disorders.”

Dieting behavior: Weight-controlling behavior and partaking in dieting increases one’s risk. (See above.)

Negative energy balance: The National Eating Disorders Association (NEDA) states: “Burning off more calories than you take in leads to a state of negative energy balance. Many people report that their disorder began with deliberate efforts to diet or restrict the amount and/or type of food they were eating in the form of dieting. Other causes can include growth spurts, illness, and intense athletic training.” (source)

If your brain doesn’t have proper nourishment, it’s hard to make truly nurturing choices. Furthermore, some studies are exploring if food restriction causes an activation of reward circuitry in some people and/or drives them to exercise more as a compensatory survival mechanism (i.e., foraging for food). Both mechanisms would reinforce this dysfunctional cycle. (source, source)

Type 1 (insulin-dependent) diabetes. According to NEDA, “Recent research has found that approximately one-quarter of women diagnosed with type one diabetes will develop an eating disorder. The most common pattern is skipping insulin injections, known as diabulimia, which can be deadly.” (source)

Brain Patterns: Research has shown an altered reward response in the brain with binge-eating disorder. Undernutrition has also been linked to brain shrinkage in anorexia. These brain changes could prolong mental health problems and lead to treatment resistance.

Metabolic Deregulation: Dr. Bulik is an authority in anorexia and eating disorder research. She stresses the interplay of environmental factors and underlying biological factors that drive symptoms in eating disorders:

“Indeed, Dr. Bulik’s recent research has led her to suggest a fullscale “reframing” or re-conceptualization of eating disorders (EDs). Her most influential contribution has been to suggest that EDs not only have psychiatric roots but also roots in malfunction of the body’s metabolic systems, which regulate how energy (sourced, ultimately, in food) is supplied to our organs.” (Brain and Behavior Research)

Click here to see her “9 Truths” document about eating disorders.

Microbiome – Emerging research is demonstrating that there could be a connection between the microbiome and eating disorders due to the gut-brain axis.

Psychological Risk Factors in Eating Disorders

According to NEDA, the following are psychological risk factors to eating disorders: (source)

• Perfectionism. This is one of the strongest risk factors, especially self-oriented perfectionism. This involves setting unrealistic high expectations for oneself.
• Body image dissatisfaction. Body image encompasses how you feel both about and in your body. People with eating disorders are more likely to report higher levels of body image dissatisfaction and an internalization of the appearance ideal. 
• Personal history of an anxiety disorder. Research has shown that a significant subset of people with eating disorders, including two-thirds of those with anorexia, showed signs of an anxiety disorder (including generalized anxiety, social phobia, and obsessive-compulsive disorder) before the onset of their eating disorder.
• Behavioral inflexibility. Many people with anorexia report that, as children, they always followed the rules and felt there was one “right way” to do things.

One interesting 2007 paper theorized a psychosomatic link between the body, mind, and brain in eating disorders. These manifest as “(1) alterations of the body and its functioning, (2) in personality traits, (3) in the difficulty of recognizing and coping with emotions, and (4) in the management of anger and impulsiveness.” The abstract suggests that understanding this interaction could help with ED treatment. (source)

Summary on Risk Factors

As you can see, many complex, interacting factors are involved in the manifestation of eating disorders. This means that “fixing” eating patterns or forcing someone to eat or stop binging will only be surface band-aids that can backfire.

One with an eating disorder needs an expert who will consider the biological, social, and psychological components and get appropriate, integrative treatment.

What would also really help, in my opinion, is if more health influencers could focus on:

(1) body acceptance

(2) healthy practices as a means to an end, not the end goal

(3) discuss what drives someone to live a more vibrant life

(4) stop portraying food as the ultimate determinant of morality in wellness

(5) stop stigmatizing body size

6) start focusing equally on people’s health, passions, purpose, relationships, and socioeconomics, not their appearance

What do you think?

Please share your thoughts below.

Click here to learn more about my approach to whole-person, mind-body care.

Free resources and more education are also available to you here.

Stay tuned for an upcoming opportunity that can support you in holistic mind-body-heart-soul healing. (Join my newsletter below to learn more.)

Many blessings.

*Important Note:

If you struggle with mental health or an eating disorder, please reach out for professional support.

You may also wish to consider implementing holistic resources and partnering with a naturopathic doctor.

For example, I offer mind-body support for general mood issues using a functional medicine and wellness-oriented approach. I also practice using a non-diet, HAES approach to nutrition.