What Causes Eating Disorders?
If you’re trying to understand what causes eating disorders, you’re not alone. While we think of eating disorders as a modern phenomenon– and at the explosive rates we see them at today they certainly are– they are also brain based diseases that existed long before anyone considered being thin aspirational. Remember, food scarcity was the problem for most of human existence, so an aspirational body was historically a visibly well-fed body.
The History of Eating Disorders: Before Diet Culture
The earliest documented cases of what we now call anorexia nervosa occurred in Europe in the Middle Ages.
Back then it was called “anorexia mirabilis” or “holy anorexia” (yikes y’all). Then, as now, the symptoms were primarily observed in women. The people afflicted with this condition saw it as a means of purifying themselves before God by refusing all temptations of the body, including food.
St. Catherine of Siena (1347–1380) died at the age of 33 after chronically refusing food and inducing vomiting in the name of religious purification. When her church leaders ordered her to stop fasting, she said she could not— that her compulsion to continue starving was “an affliction”. She is just one example of what we now call anorexia manifesting long before the modern era.
Why am I telling you all this?
Eating Disorders Are Part of Human History, They’re Not Just About Thinness
What historical accounts show us is that eating disorders predate modern society and the pursuit of thinness for aesthetic purposes.
While eating disorders have their many alibis (religious purification, seeking control, or even gaining attention on social media) they are a part of the human experience across history.
That said, the modern prevalence of eating disorders is staggering compared to the historical cases we know of and is closely tied to the rise of the thin beauty standard in the 1960s (with earlier roots in the 1920’s flapper era, a sharp decline in thinness as an ideal in the 1940s-50s and a major resurgence in the 1960s).
So while culture and media clearly play a role, they are only one piece of the picture. Eating disorders tend to develop when biological vulnerability, personality traits, and life experiences all converge—not from any single cause in isolation.
The Brain-Based Nature of Eating Disorders
If exposure to Western media alone caused eating disorders, we would expect to see near-universal rates. But that’s not what we see, even though rates have risen sharply in cultures that were previously less exposed to Western media.
Part of the answer is that there is something different about the brains and temperaments of people who develop eating disorders. Eating disorders are increasingly understood as brain-based disorders.
Recent research suggests that people who develop eating disorders often:
Are more risk-averse
Prefer to do things “just right”
Experience the pain of failure and rejection more intensely
Are highly sensitive
May respond differently to starvation
Are more likely to have a history of trauma
Feel overwhelmed by intense emotions, both positive and negative
Seek control over both their bodies and their inner emotional world
The Role of Genetics and Epigenetics in Eating Disorders
The best theory we have for explaining eating disorders is called epigenetics.
While our DNA, our genetic code, is stable and fixed (like musical notes), epigenetic markers are the signals that influences how those genes are expressed (like dynamics and timing in sheet music).
DNA is fixed. Epigenetic markers are not.
Epigenetic markers can be influenced by factors such as stress and environment, which can change how those genes are expressed. This, in turn, can affect health outcomes. This means that some people who develop eating disorders have a genetic vulnerability to developing an eating disorder.
Without an appropriate trigger, the vulnerability lies dormant.
When activated, by stress, environment, or a host of other factors, an eating disorder can emerge. But genetic vulnerability is not destiny. It increases risk, but does not guarantee an eating disorder will develop.
We Still Don’t Fully Understand Eating Disorders
There’s still a lot we don’t understand about eating disorders.
While epigenetic theory continues to gain reputability, we can’t definitely explain why some people develop eating disorders and others don’t. This uncertainty is referred to as “agnosticism” within the eating disorder treatment community.
We do know that:
Eating disorders have existed throughout time
Modern media increases risk
Certain brain traits are associated with developing an eating disorder
Genetic predispositions are being increasingly triggered by our current social environment
We cannot predict who will develop an eating disorder. We do not know why some people with all of the above mentioned vulnerabilities do not develop an eating disorder.
One thing we know for sure?
Healing from an Eating Disorder is Possible
Full recovery from an eating disorder is possible.
You deserve to heal.
If you feel stuck, I can help.
If you’re in San Francisco or anywhere in California, you can learn more about my eating disorder therapy services here.
I would love to help you find freedom.
The contents of this blog are for informational purposes only. This blog is not intended to be a substitute for professional advice, diagnosis, or treatment that can be provided by your own mental health practitioner. If you have any specific concerns about your mental health, you should consult your doctor and you should not delay seeking medical advice, or treatment for your mental health, because of information on this blog.
Megan Bruce
Megan Bruce is a licensed therapist specializing in eating disorders, anxiety and ADHD. She is based in downtown San Francisco and sees clients in-person and virtually in the greater California area.
