Risk Factors
Many factors contribute to the risk of developing an eating disorder. In the United States, about 7 million females and 1 million males suffer from eating disorders.
Age
Eating disorders occur most often in adolescents and young adults. However, they are becoming increasingly prevalent among young children. Eating disorders are more difficult to identify in young children because they are rarely suspected.
Gender
Studies indicate that eating disorders occur predominantly among girls and women. About 90 - 95% of patients with anorexia nervosa, and about 80% of patients with bulimia nervosa, are female.
Ethnic Factors
Most studies of individuals with eating disorders have been conducted using Caucasian middle-class females. However, eating disorders also affect people of other races.
Socioeconomic Factors
Living in any economically developed nation on any continent appears to pose a risk for eating disorders. Within nations, eating disorders can affect people of all socioeconomic levels.
Personality Disorders
People with eating disorders tend to share similar personality and behavioral traits, including low self-esteem, dependency, and problems with self-direction. Specific psychiatric personality disorders may put people at higher risk for eating disorders.
Avoidant Personalities. Some studies indicate that many patients with anorexia nervosa have avoidant personalities. This personality disorder is characterized by:
· Being a perfectionist
· Being emotionally and sexually inhibited
· Having less of a fantasy life than people with bulimia or those without an eating disorder
· Being perceived as always being "good," not being rebellious
· Being terrified of being ridiculed or criticized or of feeling humiliated
People with anorexia are extremely sensitive to failure, and any criticism, no matter how slight, reinforces their own belief that they are "no good".
Obsessive-Compulsive Personality. Obsessive-compulsive personality defines certain character traits (being a perfectionist, morally rigid, or preoccupied with rules and order). This personality disorder has been strongly associated with a higher risk for anorexia.
Narcissistic Personalities. Studies have also found that people with bulimia or anorexia are often highly narcissistic (love of one’s own body) and tend to:
· Have a need for admiration
· Be hypersensitive to criticism or defeat
Accompanying Emotional Disorders
Many patients with eating disorders experience depression and anxiety disorders.
Obsessive-Compulsive Disorder (OCD). Doctors believe that eating disorders are variants of OCD. Obsessions are recurrent or persistent mental images, thoughts, or ideas, which may result in compulsive behaviors (repetitive, rigid, and self-prescribed routines) that are intended to prevent the manifestation of the obsession. Women with anorexia and OCD may become obsessed with exercise, dieting, and food. They often develop compulsive rituals (weighing every bit of food, cutting it into tiny pieces, or putting it into tiny containers).
Other Anxiety Disorders. A number of other anxiety disorders have been associated with both bulimia and anorexia, including:
· Phobias. Phobias often precede the onset of the eating disorder. Social phobias, in which a person is fearful about being humiliated in public, are common in both types of eating disorders.
· Panic Disorder. Panic disorder often follows the onset of an eating disorder. It is characterized by periodic attacks of anxiety or terror (panic attacks).
· Post-Traumatic Stress Disorder. Many women with serious eating disorders report a past traumatic event, and many exhibit symptoms of post-traumatic stress disorder (PTSD) -- an anxiety disorder that occurs in response to life-threatening circumstances.
Depression. Depression is common in people with eating disorders, for both anorexia and bulimia. Major depression is unlikely to be a cause of eating disorders, however, because treating and relieving depression rarely cures an eating disorder. In addition, depression often improves after anorexic patients begin to gain weight.
Being Overweight
Extreme eating disorder behaviors, including use of diet pills, laxatives, diuretics, and vomiting, are reported more often in overweight than normal weight teenagers.
Body Image Disorders
Body Dysmorphic Disorder. Body dysmorphic disorder (BDD) involves a distorted view of one's body that is caused by social, psychologic, or possibly biologic factors. It is often associated with anorexia or bulimia. People with this disorder commonly suffer from emotional disorders, including obsessive-compulsive disorder and depression. As part of obsessive thinking, some people with BDD may obsess about a perceived deformity in one area of their body, and may repeatedly seek cosmetic surgery to "correct" it.
Excessive Physical Activity
Highly competitive athletes are often perfectionists, a trait common among people with eating disorders.
Female Athletes. Excessive exercise is associated with many cases of anorexia (and, to a lesser degree, bulimia). In young female athletes, anorexia postpones puberty, allowing them to retain a muscular boyish shape without the normal accumulation of fatty tissues in breasts and hips that may blunt their competitive edge. Many coaches and teachers compound the problem by overstressing calorie counting and loss of body fat.
Male Athletes. Male wrestlers and lightweight rowers are also at risk for excessive dieting. Many high school wrestlers use a method called weight-cutting for rapid weight loss. This process involves food restriction and fluid depletion by using steam rooms, saunas, laxatives, and diuretics.
Early Puberty
There is a greater risk for eating disorders and other emotional problems for girls who undergo early menarche and puberty, when the pressures experienced by all adolescents are intensified by experiencing these early physical changes, including normal increased body fat.
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