What are some external influences that may lead a person to be at risk for anorexia?

The cause of anorexia nervosa is believed to be multifactorial with psychological, environmental, and biological factors believed to all play a role.

However, some people can have several risk factors without being affected, whereas other individuals who would not be considered at high risk may develop symptoms of anorexia nervosa. Therefore, the specific causes of the condition are still unclear.

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Psychological factors

There are certain personality and behavioral traits that are associated with anorexia nervosa and thought to be involved in the development of the condition. These factors include:

• History of depression or anxiety
• Poor handling of stress
• Excessive fear or doubt about the future
• Restraint of emotions
• Tendency towards perfectionism
• Feeling obsessive and/or compulsive
• Phobia of being fat

Environmental factors

There are several influences from the surrounding environment that can have an impact on the likelihood that an individual will be affected by anorexia nervosa.

The culture and societal norms in modern society place high importance on physical beauty and, in Western culture, a thin frame is usually considered to be more beautiful. This concept is reinforced by media messages in magazines and online sources that focus on the physical beauty and minor flaws of celebrities.

Likely as a result of these idealizations places on the female gender, young women are more likely to be affected by the disorder than men. Interestingly, men who identify as homosexual or transgender are also at an increased risk of anorexia as compared to heterosexual men.

Pressure to conform to an idealized body image can also have an impact on the health of an individual and increase their risk of being affected by anorexia nervosa. For example, people who work or participate in activities such as dancing or athletic sports face more pressure to keep their body shape in line with the accepted standards.

Other environmental factors may include:

• Stress at school or work
• Physical and/or sexual abuse
• Difficult family relationships
• Bullying about body weight or shape
• Stressful life events (e.g., loss of job, relationship breakdown)

In many cases, anorexia originates from a strict diet that becomes excessive and unhealthy, leading to a pathological mindset and outcomes.

Biological factors

There appears to be a familial link to anorexia and individuals with a family history of eating disorders, depression, or substance misuse in that these individuals are more likely to be affected. In fact, an individual with a close relative with anorexia is ten times more likely to suffer from anorexia nervosa than someone with no family history.

This association may be due to the presence of a genetic link that is inherited from the parents. It could also be an acquired trait from environmental circumstances, such as developing negative thoughts about body image similar to other members of the family.

The brain and hormonal level changes during puberty are also thought to be associated with anorexia nervosa, and the incidence of the condition is highest during this time. In particular, feelings of stress, anxiety, and low self-esteem are thought to trigger anorexia.

An abnormal biochemical makeup of the brain may also be involved. The hypothalamic-pituitary-adrenal axis (HPA) regulates the release of neurotransmitters such as serotonin, norepinephrine, and dopamine, which affect the mood and appetite of the individual. Individuals with anorexia nervosa often have decreased levels of serotonin and norepinephrine, suggesting that they may be involved in the pathology of the condition.

References

Further Reading

Last updated Apr 10, 2021

The elements that contribute to the development of an eating disorder are complex, and involve a range of biological, psychological and sociocultural factors. An individual’s susceptibility to developing an eating disorder is best understood as a complex interaction between these factors, and the presence of risk factors will vary from person to person.   

Awareness of the risk factors can support opportunistic screening and sensitivity of the professional to the complexities of a person’s experience.  

Compelling evidence from family and twin studies indicates that a strong genetic component influences the development of eating disorders, in particular anorexia nervosa (1).   

There are biological and genetic, psychological and behavioural, and socio-cultural factors which may increase the vulnerability to developing an eating disorder.

• families with a history of eating disorders and other mental health conditions  

• high body weight in childhood  

• early start of menarche (<12yrs)  

• transition stages with major physical and social changes such as adolescence, pregnancy, postpartum, and menopause   

• higher parental body weight  

• genetic predisposition towards specific traits such as perfectionism (see psychological factors)   

• dieting  

• perfectionistic traits  

• heightened sensitivity or inability to cope with negative evaluations  

• stress  

• obsessive-compulsive traits or disorder  

• neurodiverse individuals  

• depression or depressive features  

• anxiety, including social anxiety and avoidance of social interaction  

• substance misuse  

• overvaluing body image in defining self-worth  

• dissatisfaction with body weight and shape  

• low self-esteem or feelings of inadequacy  

• harm avoidance or traits such as excessive worrying, anxiety, fear, doubt and pessimism  

• individuals who have experienced trauma, abuse, neglect or post-traumatic stress disorder (PTSD)  

• adopting and aspiring to cultural ideals of thinness, muscularity and leanness  

• pressure to achieve and succeed  

• peer pressure  

• teasing or bullying, especially when focused on weight or body shape  

• troubled family or personal relationships  

• family dieting  

High-risk groups and presentations 

Based on the known risk factors for eating disorders, high-risk groups and presentations have been identified and require specific attention by health professionals that may work with people from these identified groups.  

• Females, especially during biological and social transition periods (e.g., onset of puberty, change in relationship status, pregnancy and postpartum, menopause, change in social role)  

• Children and adolescents; although eating disorders can develop at any age, risk is highest between 13 and 17 years of age (2) 

• Competitive occupations, sports, performing arts and activities that emphasise thin body shape/weight requirements (e.g., modelling, gymnastics, horse riding, dancing, athletics, wrestling, boxing)  

• Minority groups (e.g., LGBTQIA+).  

These are people who:  

• are seeking to lose weight  

• are experiencing weight loss, intentional or unintentional  

• are following a diet that limits energy intake, requires calorie counting or eliminates a food or food group  

• are on restrictive diets due to food intolerances or allergies (e.g., coeliac disease, irritable bowel syndrome)  

• are experiencing comorbid conditions which cause weight loss or gain/focus on body, weight, shape and eating (e.g., type 1 and type 2 diabetes), polycystic ovary syndrome, coeliac disease)  

• are experiencing mental health conditions including anxiety and depression  

• are experiencing neurodevelopmental conditions (e.g., autism spectrum disorder) 

• are experiencing low self-esteem  

• are experiencing substance misuse  

• have a history of trauma  

• have current or historical experience of food insecurity  

• have perfectionist or compulsive personality traits.  

Protective factors

Research has shown that there are protective factors that may reduce the likelihood of developing an eating disorder. As with risk factors, protective factors tend to be grouped. These groups include:

• High self-esteem• Positive body image

• Critical processing of media images (i.e. media literacy)

• Problem solving and coping skills

• Belonging to a family that does not over-emphasise weight and physical attractiveness
• Eating regular meals with the family

• Belonging to a culture that accepts a range of body shapes and sizes• Involvement with sport or industry where there is no emphasis on physical attractiveness or thinness

• Peer or social support structures and relationships where weight and physical appearance are not of high concern 

Body acceptance occurs when a person is able to accept, appreciate and respect their body, and this acceptance can make a person less susceptible to developing an eating disorder. Furthermore, body acceptance improves self-esteem, self-acceptance, and healthy outlook and behaviours. 

For more information, go to the NEDC Body Image page.  

A healthy relationship with food and eating includes:  

• eating at regular intervals including regular main meals and snacks  

• eating a variety of different foods from all food groups  

• eating an appropriate quantity of food to meet individual health and development requirements  

• eating with others or alone with equal ease  

• eating with flexibility, spontaneity and for enjoyment  

• listening to our body’s cues; eating when you are hungry and stopping when you are full  

• eating that does not interfere with everyday life  

 For more information, go to the NEDC Disordered Eating and Dieting page.

For many, social media provides an accessible and powerful toolkit for finding information, building relationships and promoting a sense of identity and belonging. For others, online communities can be an unsafe space, and being aware of the risks can help people take the appropriate precautions to ensure safe use. It is important to develop the ability to critically access, analyse, evaluate, and safely create media.

For more information about media literacy programs, go to the NEDC Media Literacy page.

References

1. Bulik CM, Blake L, Austin J. Genetics of eating disorders: what the clinician needs to know. The Psychiatric clinics of North America. 2019;42(1):59-73. 

2. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. Full guideline. NICE; 2017. 

3. Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. 1999;318(7186):765-8.