Eating disorders are considered to be among the most dangerous psychiatric conditions, with there being an eating-disorder-related death every 52 minutes. The gap between the dangers and understanding of eating disorders points to a need to learn more about how and why eating disorders manifest. We perhaps need to reconfigure our understanding of these types of conditions – to reexamine what an eating disorder is. This can lead us to a more holistic approach to eating disorders and, potentially, fewer barriers to access to eating disorder recovery.

What are eating disorders?

The most important thing to be aware of in discussions around eating disorders is that these types of conditions can take many different forms. Whilst discussions of conditions of some eating disorders have become more common in recent years, some eating disorders are significantly less known.

The following conditions are listed in the current edition of the International Classification of Diseases (or ICD):

• Anorexia Nervosa
• Avoidant Restrictive Eating Disorder (ARFID)
• Binge-Eating Disorder
• Bulimia Nervosa
• Orthorexia 
• Pica
• Purging Disorder
• Rumination Disorder
• Night Eating Disorder
• Unspecified Feeding or Eating Disorder
• Other Unspecified Feeding or Eating Disorder 

All of these conditions have very specific sets of diagnostic criteria. Anorexia nervosa symptoms, for example, are very different to the set of experiences someone had by someone with pica. This means that it is essential to recognise the plurality of eating disorders and to resist falling into stereotypes that can reinforce harmful or reductionist thinking. 

What influences eating disorders?

Eating disorders are all very different from one another. This means that there is not one key cause of an eating disorder, just as there is not one key cause for the development of any other mental health condition. Eating disorders can be related to a complex web of factors and experiences, which primarily fall into three key areas:

1. Genetic and Biological Factors
2. Social and Environmental Factors
3. Personal Factors 

Genetic and biological factors

Some researchers have linked eating disorders to genetics. They have done this through the identification of two key factors:

• family history of eating disorders (and/or related conditions)
• hormonal changes, or changes in the brain 

There is a lot of evidence to suggest that eating disorders can be generational diseases. Studies have found a ‘clustering of eating disorders’ in the families of individuals with anorexia nervosa and bulimia nervosa. This can be seen through the lens of environmental factors – it suggests that eating disorder symptoms are ‘learnt.’ However, twin studies have shown that ‘eating disorder symptoms themselves also appear to be moderately heritable,’ with 46 to 72% of binge eating, self-induced vomiting and food restriction behaviours being linked to a possible genetic component.

In the past several decades, focus on the onset of eating disorders in young women suggests that these types of conditions could be linked to the neural and hormonal changes associated with puberty in adolescence. However, recent research analysed by charity Beat indicates that eating disorders are experienced across lifetimes, with onsets happening as early as 6 or as late as 70. This reminds us to remember that eating disorders don’t discriminate and can, unfortunately, be experienced by anyone.

Social and environmental factors

Research in the late twentieth century led to the general understanding of eating disorders as a ‘representational disease’; conditions that are, on some level, related to exposure to specific media images, such as magazines, TV and film. This has typically been used to explain the high prevalence of eating disorders in young women. Examples of such social and environmental pressures, then, include:

• high exposure and engagement with images of bodies
• exposure and engagement with photoshopped, ‘filtered’, or otherwise edited images of bodies
• spending more time online
• engaging in sports (specifically those related to image, such as ballet or gymnastics)
• growing up around ‘diet culture’ in the household 
• being encouraged to restrict or adapt diet from a young age 
• bullying or abuse 
• stress or conflict at home 

In a lot of these situations, there is an onus or particular focus on the body. This can become very uncomfortable and lead to the development of hypervigilance of the body. This hypervigilance can then lead to the adoption of unhealthy behaviours to ‘regulate’ body image, or to regulate difficult feelings we have around our body and our lives in general.

Personal factors 

Whilst eating disorders have typically been linked to body image, this is not always the case. Eating disorders are often linked to difficult and complex feelings such as loss of control, trauma or overwhelm. Changing the way that we eat – whether consciously or unconsciously – can offer us a new form of control over our lives when we otherwise feel like everything else is outside of our grasp.  However, eating disorders can also be linked to a range of forms of emotional dysregulation and discomfort. This can often be the case when we are dealing with a range of difficult personal factors, such as:

• dealing with a mental health condition 
• dealing with obsessive and compulsive thoughts 
• difficulty managing difficult emotions 
• tendency to maladaptive behaviours 
• intense levels of stress
• being under lots of pressure 
• being part of a marginalised group
• being neurodivergent

Treatment for eating disorders 

Regardless of the situation and specific symptoms encountered, it is important to remember that engaging in disordered eating behaviour often does not feel like a choice. It can begin with an unconscious and conscious set of routines that develop and begin to dictate our engagement with food, our bodies, and the world around us. But support is available. Whether you are looking for bulimia treatment, help with ARFID, binge eating disorder treatment, or other avenues of support, eating disorder rehab can offer crucial, life-changing intervention. Treatment for eating disorders may seem daunting, but it can allow you the chance to regulate and reconfigure your relationship with food, your body, and yourself more holistically – giving you the opportunity to move forward with a greater sense of calm, contentment, and healthy control.