When a teenager starts struggling with food or body image, as many do, most parents begin to ruminate on the same two questions: What causes eating disorders? And how do eating disorders start?
The truth is, there’s no single cause. Eating disorders develop from a combination of risk factors involving mental health, family, culture, and life experiences. While having some of them raises a person’s risk, it doesn’t guarantee an eating disorder will develop. Understanding these risk factors and how they may interact can help, especially during stressful periods of development.
Genetic or biological risk factors
Eating disorders tend to run in families. Family, twin, and adoption studies consistently show that genes contribute to a person’s risk of developing anorexia nervosa, bulimia nervosa, and binge eating disorder.
Genetic differences help explain why some people are more susceptible than others. A 2019 genetic study identified eight DNA regions associated with anorexia nervosa. Researchers also found that some genetic factors are shared with other mental health conditions and metabolic traits, such as blood sugar and fat levels, suggesting that anorexia nervosa has both psychiatric and metabolic components.
Genes raise risk, but they don’t decide the outcome. A person with a family history may never develop an eating disorder, and a person with no family history can still develop one. This makes genetics just one part of the complex picture of eating disorder risk.
Psychological or mental health risk factors
How a young person thinks and feels about themselves matters too. A review of studies with adolescents ages 11 to 19 found associations between disordered eating and body dissatisfaction, low self-esteem, anxiety, perfectionism, impulsivity, and a habit of escaping or avoiding hard feelings.
Mental health conditions and eating disorders often show up together. In a national survey of more than 10,000 US teens, most of the teens with an eating disorder also met the criteria for at least one other mental health disorder, such as depression.
Because the two so often appear side by side, it helps to know the broader signs of mental illness in teens and young adults.
Eating disorders can also occur alongside substance use. Understanding the overlap between eating disorders and substance use helps families recognize when a teen may need support for both concerns.
Environmental factors like social media, influencer culture, peers, trauma, etc.
Biology and personality aren’t the whole picture. The world around a young person shapes risk too.
Social media and influencer culture
Social media gets a lot of the blame, and the research shows something different from the headlines. Researchers have found that using social media sites was linked with poorer body image and more disordered eating.
Most of the evidence shows a link, not a cause, so it can’t prove social media leads to eating disorders. It does point to appearance comparison as one possible reason. Influencer culture, with its steady stream of other people’s bodies, gives teens plenty of chances to make those comparisons.
Peers and family
Friends and family play a part. The same review of adolescent risk factors found that pressure from friends to be thin predicted later disordered eating, and that conflict with friends or feeling cut off from them was tied to eating problems.
At home, a strong emphasis on weight and appearance was associated with more eating problems, as was lower family closeness.
Trauma
Painful experiences raise risk as well. Between 21 and 59 percent of people with eating disorders reported maltreatment in childhood, such as abuse or neglect, depending on the type of eating disorder. Among people with no mental health condition, the range was 1 to 35 percent. Those who reported maltreatment also tended to develop their eating disorder earlier and experience more severe symptoms.
Not everyone who experiences trauma develops an eating disorder, and many people with an eating disorder don’t report a trauma history. Still, trauma in young people often looks different from what adults expect, so knowing how childhood trauma shows up in adolescents can help families connect the dots.
What age do eating disorders typically start?
Eating disorders most often begin in adolescence or early adulthood, a stretch of rapid change in identity, appearance, and self-control. The median age of onset is 18 for anorexia nervosa and bulimia nervosa, and 21 for binge eating disorder.
Among teens, the reported prevalence of eating disorders rises slightly with age. About 2.4 percent of 13- and 14-year-olds have had an eating disorder, compared with 2.8 percent of 15- and 16-year-olds and 3.0 percent of 17- and 18-year-olds. The median ages come from adults looking back on their own history, so they’re estimates, and an eating disorder can appear before or after these ages.
Can eating disorders be prevented?
Not entirely, but risk can be lowered. Because what causes eating disorders is a mix of factors, no single step can prevent one. Still, researchers found promising results for a few approaches.
For example, media literacy programs teach students to question the images and messages they see, which can help reduce concerns about weight and body shape in both girls and boys. Additionally, programs that ask participants to argue against the pressure to be thin lowered eating disorder symptoms. But cognitive behavioral therapy programs, a form of talk therapy that targets unhelpful thoughts and habits, had the biggest effect on dieting nine months later.
The cumulative effects of these programs are small to moderate, however, and researchers still don’t know whether these programs meaningfully reduce how many people develop an eating disorder. The risk factors above do point to everyday steps at home, though.
When to seek professional help
Overall, the picture is complicated to decipher, and research is ongoing. Knowing the risk factors alone cannot determine whether someone has an eating disorder.
Early detection and treatment are important for a full recovery, but if you’re not sure what you’re seeing, knowing the most common warning signs of an eating disorder can help you decide whether it’s time to ask for an evaluation.
Unfortunately, many teens never receive treatment. In that same national survey, most of those with an eating disorder hadn’t received treatment for it, and each type of eating disorder was linked to higher rates of suicidal thinking. These findings highlight the importance of recognizing eating disorder symptoms and seeking help as early as possible.
Eating disorders are serious health conditions with real causes, and nobody chooses them. Reaching out early improves the chance of a full recovery. A pediatrician or family doctor is a reasonable first step, and parents can find more guidance on how to support a teenager with an eating disorder while they arrange care.
To learn more about mental health disorders or to seek the help of a mental health professional, do not hesitate to call Turnbridge. Turnbridge is a recognized mental health treatment provider with both inpatient and outpatient programs for young men and women. Call 877-581-1793 to speak with a treatment specialist today.