Identifying anorexia risk factors

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Eating disorders, specifically anorexia nervosa (AN), are complex and serious psychiatric disorders. Those with AN are at five times higher risk of death than the general population. They are also 18 times more likely to die from suicide than the general population. (1) Individuals with AN have poor outcomes due to the chronicity of the disorder, despite numerous interventions and advances in treatment that have been developed in recent decades. (1)

Anorexia nervosa carries a high risk of relapse and low cure rate. To date, there are no approved medications for AN. The main treatments for AN are behavioral and psychological interventions. But, the good news is there is decent evidence that behavioral and psychological interventions can be extremely helpful and even curative, depending on the individual. (1) Below is a look at the leading anorexia risk factors that make certain people more vulnerable to this eating disorder than others.

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Developing anorexia risk factors

In a meta-analysis of the 2,000 plus eating disorder studies that researchers reviewed, anorexia nervosa had the least amount of evidence to point to specific bio-psycho-social risk factors, despite AN being the most severe in terms of clinical outcome, medical complications, and survival. (1)

There is clearly no single factor that can be attributable to “causing” an eating disorder in a given individual. However, researchers have looked to see if there are any risk factors or predisposing factors that seem to be associated with risk for developing an eating disorder.

Disordered eating behavior in childhood as a risk factor for anorexia 

A longitudinal study that collected data on 4,760 children evaluated their eating habits in childhood and followed them into adulthood. (2) The study found statistically significant associations between AN and persistent undereating and persistent fussy eating in adolescence, (2) implying that disordered eating in early childhood and adolescence may be a risk factor for the formal development of an eating disorder later in life.

Culture and geography as anorexia risk factors 

Developed, western societies have a higher prevalence of AN. It is hypothesized that this might be in part due to the cultural emphasis on thinness, beauty, and self worth. (6)

Female gender as a risk factor for anorexia

On average, girls develop AN between 16-17. (9) Socially, teenagers depend heavily on the opinions of their friend groups, and are more sensitive to bullying and teasing. As they age, their sense of self worth comes more from family and work accomplishments, which is why clinicians see some teens with anorexia nervosa recover in middle age. (6)

Athleticism as an anorexia risk factor 

Participation in certain athletics tends to be a risk factor for AN. This is thought to be attributable to the intense pressure put on athletes to succeed, although this has never been proven, and may vary depending on the individual. For example, one study found that dancers have a three times higher risk of suffering from eating disorders compared to their peers. (4) One study showed that as many as 54% of fashion models had a BMI that met criteria for AN. (11) The fashion industry has taken great strides in the last 10 years to reduce the incidence of AN in their models.

Personality traits as an anorexia risk factor 

Researchers have found the following personality traits and emotional proclivities to be highly associated with AN: (1)

  • Feelings of body dissatisfaction.
  • Initial negative personality affect.
  • Initial perceived pressure to be thin.

While there is no clear or certain way to predict the development of an eating disorder, there do tend to be some common personality traits, behaviors, and gender differences that might predispose an individual to developing an eating disorder. General familiarity with these risk factors might help friends, family, and clinicians to identify risk factors in their loved ones and patients early to help prevent the long term complications of disordered eating.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Solmi M, Radua J, Stubbs B, Ricca V, Moretti D, Busatta D, Carvalho AF, Dragioti E, Favaro A, Monteleone AM, Shin JI, Fusar-Poli P, Castellini G. Risk factors for eating disorders: an umbrella review of published meta-analyses. Braz J Psychiatry. 2021 May-Jun;43(3):314-323. doi: 10.1590/1516-4446-2020-1099. PMID: 32997075; PMCID: PMC8136381.
  2. Herle M, Stavola B, Hübel C, Abdulkadir M, Ferreira DS, Loos RJF, Bryant-Waugh R, Bulik CM, Micali N. A longitudinal study of eating behaviors in childhood and later eating disorder behaviors and diagnoses. Br J Psychiatry. 2020 Feb;216(2):113-119. doi: 10.1192/bjp.2019.174. PMID: 31378207; PMCID: PMC7000294.
  3. Breithaupt L, Köhler-Forsberg O, Larsen JT, Benros ME, Thornton LM, Bulik CM, Petersen L. Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls. JAMA Psychiatry. 2019 Aug 1;76(8):800-809. doi: 10.1001/jamapsychiatry.2019.0297. Erratum in: JAMA Psychiatry. 2019 May 8;: PMID: 31017632; PMCID: PMC6487907.
  4. Arcelus J, Witcomb GL, Mitchell A. Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis. Eur Eat Disord Rev. 2014 Mar;22(2):92-101. doi: 10.1002/erv.2271. Epub 2013 Nov 26. PMID: 24277724.
  5. Giel KE, Junne F, Zipfel S. Reconsidering the Association Between Infection-Related Health Care Use and Occurrence of Eating Disorders: Chicken or Egg? JAMA Psychiatry. 2019 Nov 1;76(11):1212. doi: 10.1001/jamapsychiatry.2019.2186. PMID: 31411638.
  6. Allison S, Warin M, Bastiampillai T, Looi JCL, Strand M. Recovery from anorexia nervosa: the influence of women's sociocultural milieux. Australas Psychiatry. 2021 Oct;29(5):513-515. doi: 10.1177/10398562211010796. Epub 2021 May 3. PMID: 33939932.
  7. Bombak A. Obesity, health at every size, and public health policy. Am J Public Health. 2014 Feb;104(2):e60-7. doi: 10.2105/AJPH.2013.301486. Epub 2013 Dec.
  8. Penney, T. L., & Kirk, S. F. (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American journal of public health, 105(5), e38–e42. https://doi.org/10.2105/AJPH.2015.302552. 
  9. Volpe U, Tortorella A, Manchia M, Monteleone AM, Albert U, Monteleone P. Eating disorders: What age at onset? Psychiatry Res. 2016 Apr 30;238:225-227. doi: 10.1016/j.psychres.2016.02.048. Epub 2016 Feb 22.
  10. Forsberg S, Lock J. The relationship between perfectionism, eating disorders and athletes: a review. Minerva Pediatr. 2006 Dec;58(6):525-36. PMID: 17093375.
  11. Preti A, Usai A, Miotto P, Petretto DR, Masala C. Eating disorders among professional fashion models. Psychiatry Res. 2008 May 30;159(1-2):86-94. doi: 10.1016/j.psychres.2005.07.040. Epub 2008 Mar 19. PMID: 18355925.

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