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Are Eating Disorders Born or Made?

By Madison Nguyen

TRIGGER WARNING: The following article goes into detail about eating disorders which may be upsetting to some readers. 

Ideas of the “perfect body” have existed throughout the entirety of human history across cultures; think of the Western emphasis on a “snatched waist” or a “thigh gap.” With the use and popularity of social media as these body trends rapidly change people feel discontent with their body and aspire to standards that they cannot achieve. There is a clear connection between social stressors and the development of eating disorders, but not every person who experiences these pressures develops an eating disorder. Research points to genetics or converging psychiatric disorders as factors that affect the onset of eating disorders. The current framework ignores the biological influences and suggests that people can be cured by promoting healthy relationships with social media. Our upbringing and cultural practices  shape our genetic expression (epigenetics) and affect how we function. EDs cause tremendous stress on our bodies as we lose the ability to properly uptake necessary nutrients from food. These results are evident in physical symptoms such as extreme fluctuations in weight and muscle loss and a decrease in mental well-being through anxious thoughts about food and mood swings. Rates of diagnosed EDs are increasing and with such a significant associated mortality rate, we need to increase efforts in expanding our understanding of EDs. 

Before addressing current research focusing on the underlying biological factors in EDs, I will provide a framework that demonstrates how to navigate such a sensitive topic. To do so, I spoke to Dr. Sophia Choukas-Bradley, the Director of the Teen and Young Adult Lab (TAYA) and Assistant Professor of Psychology at the University of Pittsburgh, to create a knowledge foundation that will facilitate this conversation about ED. 

What are the largest factors that put young people at risk for developing EDs?

“EDs are heritable, meaning that there are strong genetic influences and it is believed that those genetic influences have implications for biological and cognitive risk factors. But there are also many other risk factors…for example, social media-related risk factors, interpersonal risk factors such as norms set by peers and parents”

EDs are a difficult topic to navigate in conversations, is there anything we can do to approach opening up the conversation? 

“Be aware of language that perpetuates weight stigma. Weight stigma and fear of fat plays a big role in the development of ED, and sociocultural messages about our worth as people being defined by appearance. Just being mindful as it is problematic to make generalizations about people’s personalities based on other aspects of their physical self such as gender, race, and ethnicity is really important to not make assumptions. Certainly not to verbally talk about negative biases of people based on weight.” 

How does one struggling with an ED know what treatment is best for them?

“Depends on the ED. If someone is struggling with an ED in Pittsburgh, there are good treatment options through UPMC as well as other organizations.” 

UPMC’s Center for Eating Disorders provides both inpatient and outpatient care with resources to educate an ED patient’s support network on how to best support them. One of the largest barriers to receiving treatment is the stigma around EDs; social pressures portray EDs as something to achieve for the sake of fitting body standards. It needs to be explicitly stated that the normalization of EDs and promotion of restrictive eating is extremely harmful for us and our relationship with our bodies. These pressures extend beyond social media and into our own social circles through the people we interact with, behaviors that we engage in, and our culture. The treatment of an ED requires time and care by the patient and their support network to confront the stigma and anxieties associated with an ED diagnosis. 

The focus of this article is not to discredit the sociocultural influences on the development of ED, but to bring to light the biological factors that can also govern our relationship between ourselves, our food, and our bodies. Understanding that EDs are heritable allows us to focus on preventative care for populations that are genetically predisposed to developing an ED. Such treatment is important because the development of EDs in young people can affect their bodies for the rest of their lives. It is crucial to intervene early to prevent long-lasting effects. Recent research investigates the development of EDs while considering the intersection between genetics and psychology. The goal is to explore new treatments of EDs that confront the intense decline in mental and emotional well-being from a genetic perspective.

One such study is the “Eating Disorders Genetic Initiative (EDGI): study protocol,” which is also “the largest genetic study of eating disorders ever to be conducted and is designed to rapidly advance the study of the genetics of…major eating disorders”. Through genotyping thousands of saliva samples across the world, the EDGI aims to find a correlation between genes and EDs. They identify genetic factors that influence the stability and fluctuation of EDs through weight loss and retention as well as eating pathology. Which can be used to develop a treatment that considers all aspects of a patient’s genetics, lifestyle, and environment (precision medicine). This data provides insight into new methods that clinicians can use to identify patients who are predisposed to developing EDs. Another article published in 2020 by Munn-Chernoff studied the phenotypic genetic association between EDs and substance abuse disorders. This is key when considering the treatment process for those struggling with EDs. Such as cognitive behavioral therapy (CBT) which focuses on learning healthy habits and addressing faulty ways of thinking associated with substance use that can further perpetuate the ED and vice versa. By understanding the connection between ED and substance use disorders, therapists and psychiatrists can approach treatment from a holistic perspective that recognizes the influence these disorders have on each other. 

Eating disorders are complicated and extremely nuanced, and they require careful attention and care by the person afflicted as well as their support system. We need to be mindful of our language when discussing EDs because there are stigmas that dissuade people from seeking help. Actively avoiding language that promotes a fear of fat and weight creates a safe, accepting environment to facilitate these conversations. Not every patient is successful in treatment and some risk relapsing due to social pressures promoting unhealthy habits and harmful messages. Using biological and sociocultural factors for our framework, we recognize that some people are predisposed to EDs, which makes it even more difficult to overcome and control an ED. Using a biological perspective to understand the development of ED allows for new treatments that focus on hormones, microbiomes, and genetic factors. This offers novel potential treatments for patients who have not had success with conventional cognitive and behavioral therapies. Increasing rates of EDs across the world call to action new ways of understanding and executing ED diagnoses and treatments. To end this article, I want to emphasize that the fault is not on those who suffer from eating disorders. It is impossible to avoid media that promotes unhealthy habits and behaviors, and constant exposure to such media has serious consequences on our mental and physical wellbeing. We must be mindful of our language and ensure that we do not fall into stigmas that further prevent  people from seeking help. You are not alone in your struggles with eating disorders, and I urge you to break the cycle by reaching out for help and starting the conversation with your loved ones. 

UPMC Center for Eating Disorders

(412)-624-1000

3811 O’Hara Street

Eighth floor 

Pittsburgh, PA 15213

National Eating Disorder Association

Call or text (800)-931-2237

Crisis Text line, text “NEDA” to 741741