Eating Disorders are a classification of severe psychiatric illnesses that typically originate in adolescence but can persist well into adulthood. Eating disorders are more prevalent in women but still impact the male population. Descriptors of Anorexia Nervosa (AN) include limitation/control of energy intake, which results in a low body weight, anxiety about weight gain, and body dysmorphic disorder (BDD). The diagnosis splits into two classifications: Anorexia Nervosa Restrictive (AN-R) and Anorexia Nervosa Binge and Purge (AN-B/P). Restricting refers to the limitation or control of caloric intake, including strict rules around food, like safe foods or foods that are entirely off-limits. It is also often paired with over-exercising. Binge eating and purging refer to episodes of extreme eating in one sitting and then later removing the food from the body before it processes through either vomiting, laxatives, or diuretics. Eating disorders like anorexia are complex and serve cases that need to be understood from a bio-psycho-social perspective. They incorporate risk factors in all three facets of a client’s makeup. This blog will aim to explore the complex web of challenges that impact individuals with anorexia nervosa and provide guidance for treatment options.
Anorexia is often referred to as a perfect storm of risk factors from a bio-psycho-social model. This model refers to the 360-degree analysis of factors one may endure on a biological, psychological, and sociological level that may contribute to diagnosing any disorder. Specific to Anorexia, the following analysis explores potential risk factors along those three categories.
Biological:
From a biological perspective, many studies confirm that individuals who struggle with eating disorders are often born with a disposition to heightened anxiety. Many studies highlight that those who navigate symptoms of anorexia may have a larger orbitofrontal cortex, which can impact someone’s appetite or desire for caloric intake. There is often a sensitivity to the dopamine circuit in the brain, where additional dopamine is released over time during extreme fasting. It can build up throughout adolescence if a meal is skipped due to a busy schedule, fasting for religious reasons, and restricting caloric intake for dieting reasons. This additional release of dopamine highlights this experience during fasting as a positive one, and it can often be repeated later in life to achieve that same emotionally positive effect. Another biological factor that heavily impacts individuals who may develop AN is high cognitive control, where the ability to regulate behaviors can become overly rigid in response to emotional regulation or lack thereof. It creates a biological vicious cycle of a desire to restrict food to achieve a dopamine release in the short term while creating long-term, rigid, maladaptive behavioral patterns that solidify the longer they are practiced.
Other Biological risk factors may include:
- Family history of diet
- Family health history
- Type 1 Diabetes
- Large orbitofrontal cortex
Psychological:
At a psychological level, the two most prominent risk factors are perfectionism and control, as well as negative self-image, specifically body image. These two risk factors can often feed off each other. Still, they tie to a means of trying to regulate emotional responses to other parts of life that they don’t have control over, specifically a poor distress tolerance or ability to regulate uncomfortable emotions. When there is a traumatic event, such as assault, parental divorce, or loss of a loved one, the individual may feel that the negative emotions they experience as a result are so overwhelming and out of control that they need to ground themselves by coping with maladaptive behaviors to get control. It can often be a short-term benefit with a long-term negative impact. It can allow the individual to feel like they have control of their emotions while also controlling their caloric intake and weight/appearance. It then feeds into negative body image and low self-esteem, especially when individuals have a rigid belief in how their bodies should look.
94% of individuals with Anorexia Nervosa also had a co-occurring mental health disorder, most commonly Generalized Anxiety Disorder (GAD), Obsessive-compulsive disorder (OCD), and Major Depressive Disorder (MDD). Symptoms from these diagnoses often highlight the spectrum of risk factors that are prevalent in individuals with AN from a bio-psycho-social perspective. GAD is the most common co-occurring disorder as it ties closely into rigid negative thought patterns and a perfectionist desire to control outcomes to manage anxious thoughts and feelings. Depressive disorders integrate with anorexia due to the poor self-image and discontent with the individual’s body. There are many correlations where, in some extreme cases of anorexia, certain maladaptive restrictive behaviors can be a form of self-harm. OCD is also very common, as rigid and obsessive thoughts, I’m not thin enough, can often be calmed with compulsive and controlling behavior: restricting and over-exercising.
Other Psychological Risk factors may include:
- Perfectionism
- Novelty-seeking traits
- History of physical or sexual abuse
- Neuroticism
- Co-Occurring Disorders
- Low Self-Esteem
- Body Image Distortion
Sociological:
Perhaps the most influential aspect that ties together the biological and psychological risk factors for so many are the social aspects to which individuals are exposed. For one, the societal obsession with being thin and losing weight is observed and glorified through advertisements, entertainment, and popular culture fashion trends. Trends are often synonymous with glorifying the perfect body, and the discourse around that body is typically fit, especially for women, who are usually very thin. It makes adolescent females particularly vulnerable to developing restrictive eating habits, including anorexia. Many organized sports that young folks partake in often prioritize extreme fitness, which layers with a strong subtext of diet and exercise. It is particularly strong in the worlds of ballet, gymnastics, and track and field, amongst others.
Society and culture at large award weight loss and thinness, which can observably be passed down from generation to generation through habits, communication, and relation to food/diet. The way that a parent speaks about their relationship to food, like caloric intake, as well as negative self-talk around body image, is often the first impression of how children internalize their maladaptive behaviors. It often leads to clusters of family members passing down traits of eating disorders through generations.
Other Sociological Risk factors may include:
- Exposure trends around diet culture
- Positive/negative reinforcement around food and exercise
- Strict regulations in organized sports
- Lack of parental support/positive role models
Treatment:
If you or someone you know is presenting or challenged by some of the risk factors discussed above, it is essential to seek professional intervention. Recovery from all eating disorders can be very challenging, even when supported by a team of professionals. Depending on the severity of the symptoms, a specific level of care may be needed, ranging from inpatient residential, partial hospitalization, or outpatient individual therapist, psychiatrist, AND nutritionist. The gold standard of care for anorexia in adults is Enhanced Cognitive Behavioral Therapy (CBT-E) as well as Family-Based Therapy for adolescents. CBT-E is split into four stages over 20-40 weeks and focuses on reintegrating positive eating habits and patterns as well as highlighting and addressing triggers and barriers to treatment. FBT is separated into three stages over a similar period, and it focuses on strengthening the family unit as a whole and providing support and healthy behavior patterns for all involved.
