Eating is a normal, daily living issue, right? So what makes people become anorexic? How does one move from eating without any concern to a very real fear of daily sustenance? There are many causes, both direct and indirect, which contribute to a person's anorexia. The reality for some people who fight this disorder, however, is that there is not necessarily a cause to pinpoint.
Let's start with a very broad and generic topic: genetics. Researchers have found that there are genetic predispositions for eating disorders in individuals.1 This simply means that some individuals are more susceptible to having anorexia nervosa than others. A predisposition in a person's genes does not necessitate an eating disorder of any sort. Rather, it is comparable to a genetic predisposition to any other mental illness, such as paranoia or schizophrenia. The key to genetics is to realize that while genes may be a factor, they are not necessarily the cause of an eating disorder.
So, if genetics cannot be rooted out as the cause, then what causes anorexia? Let's begin by looking at the more direct contributor to what makes people become anorexic: a person's environment. Often, when a child is growing up, there are many messages about food consumption, body image, etc. For example, my mother used to say, "I was as thin as you were at one time. I would love to be that thin again." The years of hearing this message (though my mom was slightly overweight but never obese) implied a subtle subconscious thought: I might get 'fat' when I got older. Though it was a harmless comment, the connotations from my mom's tone of wishing to be thinner and the implication that she would be "happier" carried over into my own struggle with anorexia in my adult years. Other comments would contribute to these thoughts, as family members debated "good" versus "bad" foods. These thoughts of good foods (meaning that they would not cause weight gain) versus bad foods (the "forbidden" foods that were high calorie and high fat foods) also played into my anorexic thought process of safe foods versus unsafe foods. As time wore on in my disorder, it became even more extreme. The good foods became more and more limited. Bad foods, however, were never allowed to be consumed.
Statements from peers can also affect a person. A child who is perpetually teased for being the "fat kid" could easily develop a fear of food that cycles into anorexia. Sports players and dancers often face coaches, parents and peers who have a certain image or weight of what the player or dancer should be. This external pressure can cause a "people pleasing" desire alongside of anorexia that will intensify the eating disorder.
A controlling relationship – whether parents, family, friends, or spouses – can trigger a person to control the intake of food in order to gain a sense of control. A controlling relationship is not necessarily abusive. Often times, a controller is attempting to show care and love; unfortunately, that form is not effective. In an abusive relationship, feelings of no control and a desire to be safe can also spark an eating disorder. Under my own abuser I often heard, "I don't want to have sex (it wasn't mutual, it was rape) with a skeleton." I had already begun to control my food intake and unknowingly begun a dance with anorexia. When he began saying these words, the desire to be "small and thin" in order to be safe became top priority.
Another common thread among many anorexics is a desire to be perfect. Whether this arises from internal and/or external sources does not matter. Perfectionism feeds into the endless cycle of being the "right weight" or the "right size" that is determined by the eating disorder mentality. The frightening issue with perfection within anorexia is the fact that no goal weight is ever good enough. Anorexics are not able to stop and be satisfied, the need for perfection continues to drive for more restriction.
Finally, stressful circumstances are another catalyst for anorexia. As stressors arise and continue to exist, they can make one feel out of control or overwhelmed. Restriction of food intake and control of weight can quickly become a coping mechanism to handle any emotions that seem unmanageable.
1. "Genetics Research: Why is it important to the field of eating disorders?" by Craig Johnson, PhD, Director, Eating Disorders Program, Laureate Psychiatric Clinic and Hospital
Indirect Causes of Anorexia
Another point of view to assess in the question of what makes people become anorexic is social media. A less common, but very real factor in anorexia are Pro-Ana diets and websites. These websites promote anorexia as a "lifestyle not a disease." While this was not where I learned or began my eating disorder, this online community was helpful in 'tips and tricks' of the trade. It was here that I could feel like my disorder was "normal," and that what I was doing was safe. These communities often help support the loss of weight (even to unhealthy BMI's), unhealthy consumption of calories (below 1200 calories a day), and over exercising despite the low caloric intake. Though these communities are not trying to cause harm and want to be safe, the "normalizing" of a disorder is incredibly dangerous and allows for the sustaining environment of anorexia rather than looking for recovery.
One final issue to deal with is media. It is not a direct cause, but the media does play a part in the perpetuation of anorexia. It is certainly not to be blamed for every anorexic issue; however, it does perpetuate the image of thin as "good and normal." The diet mentality of lose weight, eat only 1200 daily calories (the bare minimum to sustain life), have little fat on the body, etc. is constantly on display. For anorexics, this incessant influx of images, judgement on food and bodies (take a look at any summer time Hollywood magazine to see the 'best and worst bodies on the beach), and diet mentality increases the already elevated hyper-vigilance around food and the body.
So, what makes people become anorexic? The reality is that anorexia is not caused by any "one" thing. It can be a combination of any or all of the previously stated causes. It could be none of the above. Trying to pinpoint a cause can be difficult for one who is working toward recovery and requires assistance from therapists and supports. Whatever the cause or the catalyst of anorexia, it ultimately does not have to dictate recovery! A cause is simply a cause, it is not have the final say on the effect.
1. Personal therapy sessions at the Carolina House Eating Disorders Clinic, Durham, NC laid the foundation for this article.
*Disclaimer: This article is not a substitute for seeking medical advice. These thoughts are from personal experience as well as working with many young women who have struggled with anorexia. The hope of this article is not to be a therapeutic tool, but rather a piece to invoke insight on the many outside factors of eating disorders.