What are eating disorders?

Eating disorders are so challenging, and one of the reasons is that what causes eating disorders is complicated. Eating disorders are complex and multi-layered. The people who develop eating disorders are worthy of so much compassion and love. I hope this article brings some color to the conversation and helps you understand eating disorders more clearly.

I’m sharing all my knowledge of decades living with an eating disorder and several years in full recovery. I’ve built on my own experience with many years spent researching and studying eating disorders. And I’ve also interviewed hundreds of professionals who treat eating disorders, people who have eating disorders, and parents who have kids with eating disorders.

From my perspective, the information currently available about eating disorders is clinical, dispassionate, and biased. These rigid clinical diagnoses and behavioral descriptions of eating disorders keep us locked in place. We miss the larger truth of why eating disorders occur and what comprehensive treatment looks like.

What follows is a wholehearted description of how I see eating disorders right now. This is personal but also factual. I’m not going to give you a boring, dispassionate account of the technicalities of eating disorders. Rather, this is an attempt to share the human reasons we suffer. And, hopefully, how we can find our way to recovery.

Remember that each eating disorder is unique. Therefore, this article is just one lens through which to view eating disorders.

What causes eating disorders?

A combination of biological, psychological, and social factors contribute to eating disorder development. 

Biological:

• Genes appear to play a role in eating disorder development. There is not a single gene recognized as the cause of eating disorders. But there are numerous genes that researchers have identified as common among people who develop mental disorders. This may explain why eating disorders typically show up alongside other disorders like anxiety, depression, substance abuse, etc.

• Epigenetics is a sort of code that triggers genetic activity. A person may have the genes that underlie mental disorders. But researchers agree that genes alone don’t cause mental disorders. Epigenetic triggers come from environmental conditions beginning in utero. They can even pass through generations in a family. It appears that epigenetics can be shaped by trauma, abuse, and neglect (physical and emotional).

• Neuroception is a body-based sensation of being either safe or unsafe. Developed by Dr. Stephen Porges, neuroception means that neural circuits in the body distinguish safety or threat and cue the body to respond physiologically, emotionally, and cognitively. When neuroception senses emotional and physical threats, the body responds with a state of fight, flight, freeze, or shutdown. This impacts every aspect of the physical and emotional experience of being alive. A person who has an eating disorder is often living in a heightened state of threat, sensing danger in their body and mind and seeking comfort and safety in their eating disorder behaviors.

Psychological:

• Anxiety is a common partner to eating disorders. Since it can be hard to spot, it may be helpful to know what anxiety looks like. In its more active form it looks like perfectionism, people-pleasing, and codependency. In its less active form it may look like procrastination, avoidance, and withdrawal. Other signs include chronic shame, stress, and worry.

• Emotional regulation skills are likely protective against eating disorders. Emotional regulation is something children learn from parents beginning in infancy and extending through early adulthood. When adequately developed over time, a person becomes able to self-regulate. Sometimes we miss emotional developmental milestones. When this happens, a person will have trouble self-soothing and responding appropriately to everyday stress and disruption.

• A person who has an eating disorder may believe that their identity – who they are – is based primarily on what they look like and what they do. This belief can lead a person to try and “perform goodness.” When this happens, a false self takes over and the true self is hidden in shame and unworthiness. This can happen when a family and/or society teaches a person that they need to change who they are and how they behave to be loved. Healing takes place when the true self is allowed to emerge and be loved as-is.

• Mental disorders often appear in clusters, and eating disorders are part of a larger psychological ecosystem. Disorders that commonly show up with eating disorders are autism, attention deficit hyperactivity disorder, anxiety, depression, suicidality, self-harm, substance abuse, and obsessive compulsive disorder. These disorders should be addressed holistically. Otherwise, an eating disorder may fail to recede, morph into something else, or return after treatment.

Social: 

• Families are a child’s first social group. And family norms and structure shape how a child feels about themselves and the world. Families don’t cause eating disorders. However, family beliefs and behaviors about emotions and bodies can contribute to an eating disorder. For example, many parents are not aware of the role of emotional co-regulation. Therefore their kids may miss emotional developmental milestones. Additionally, many families accidentally enforce and encourage disordered eating. Therefore they may pass along harmful messages about food and bodies based on their own cultural training.

• There is a strong connection between diet culture and weight stigma and eating disorders. These two conditions lay the groundwork for the thoughts and behaviors that comprise an eating disorder. Diet culture is founded in the belief that bodies can and should be weight-controlled using food restriction and exercise. Weight stigma is discriminatory acts and beliefs against people who live in larger bodies. Diet culture and weight stigma are pervasive in our culture. And they are likely the driver behind increasing rates of eating issues in the United States. Since the BMI levels were arbitrarily lowered in 1998, the weight loss industry has grown dramatically. In 1985 the U.S. weight loss industry was valued at $10 billion in annual revenue, but today it is worth at least $72 billion.

As a culture we assume weight loss is a personal goal, but it is in fact a money-making industry.

• Cultural group oppression:
  • There is evidence that people who are not heterosexual and/or cis-gender are at higher risk of eating disorders. LGBTQ+ people are chronically oppressed in our culture. And self-repression is often required to maintain physical and emotional safety in a hostile culture.
  • While they can impact anyone, females are at higher risk than males. The most likely reason for this is the cultural oppression of females in a patriarchal, male-dominated culture. The chronic objectification of the female body leads women to self-objectify. Then they naturally fall into unhealthy pursuit of the “thin ideal” or “wellness culture.”
  • People of color are much less likely to receive a diagnosis for an eating disorder. But they are at least as likely (if not more likely) to have symptoms. The trauma of living as a person of color in a white-dominant culture likely contributes to eating disorders.

Why do people get them?

There are so many factors that contribute to eating disorders. One way to view them is as coping mechanisms. I believe they develop in response to unmanaged stress and emotional dysregulation. In our culture, stress is chronic, and many people are raised without adequate emotional regulation development. Thus, coping behaviors become essential to function within our high-pressure society. Eating disorders join shopping, gambling, gaming, sex, using drugs and alcohol, and other addictions, compulsions, and obsessions as a way to cope with life. 

An eating disorder is just another way to numb a person from the pain of being human in our society. Dieting* is constantly prescribed and weight loss is celebrated. Thus, an eating disorder often begins with a well-intentioned plan to feel better and meet societal goals. There are many false and misleading health claims associated with diet plans and weight loss. And these actively promote eating disorder beliefs and behaviors. 

While not everyone who diets will develop an eating disorder, almost all eating disorders** begin with a diet. 

*defined as any effort to lose/control weight using food and/or exercise 

**with the exception of ARFID 

What are the most common types of eating disorders?

According to research published by Hay et. al. in 2017, the rates of eating disorders are as follows:

47% OSFED. The most common eating disorder is a catch-all category called other specified feeding or eating disorder (OSFED). This category includes a mix of eating disorder behaviors.

22% BED. The second most common eating disorder is binge eating disorder. This often involves a restrict-binge cycle in which a person restricts food and then binge eats. 

19% Bulimia. This often involves a restrict-binge-purge cycle. A person restricts consuming calories for an extended period of time. Next, they eat and then seek to purge the calories consumed with vomiting, laxative use, and/or over-exercise.

8% Anorexia. This is characterized primarily by restriction and being medically underweight. It is the only mental disorder that has a BMI requirement for diagnosis.

5% ARFID. The only eating disorder that is not technically associated with a desire to lose weight. ARFID typically involves restricting food and appears to be due to sensory and emotional drivers.

While these categories may be helpful, it’s important to remember that all eating disorders are mental disorders. This means that regardless of the specific behaviors, effective treatment must get beneath the behaviors to address the underlying thoughts, beliefs, and emotional dysregulation that drives them.

A path forward

This description of eating disorders hopefully adds some flavor and nuance to what you’ve seen elsewhere. But of course each eating disorder is unique. And I can’t possibly capture the vast nature of these complex mental disorders in a single article. I hope that if you have an eating disorder, you get help and find your path to healing.

And if you love someone who has an eating disorder, please remember that there is a lot you can do to help recovery. Eating disorders are so much more than a personal problem, which means loved ones can make a significant impact.

See Our Parent’s Guide To The Different Types Of Eating Disorders