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Why do some people develop eating disorders?

Why do some people develop eating disorders?
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Considering eating disorders are so common, you might be curious to know what causes an unhealthy relationship with food. The long and the short answer is both your genetics and societal influences.

“We say that genetics load the gun and environment pulls the trigger,” explains Bonnie Brennan, a senior clinical director at an eating recovery centre. “Genetic predisposition, though not necessary, can play a big part in the risk.”

In fact, a study published in 2017 in the American Journal of Psychiatry shows that in addition to the psychosocial component, biological factors also play an extremely important role in the onset of anorexia nervosa. “More research is needed to determine the prevalence of eating disorders among those of different races and ethnicities, but we do see symptoms of eating disorders across all populations,” says Brennan.

A big life change can evoke an eating disorder

A big life change can evoke an eating disorder
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You might not realise you have a predisposition to anorexia or binge eating (especially if your parents never discussed their struggles with you) until something life-altering or impactful happens to you (aka a trigger). “Those at higher risk may also be struggling with other mental health and substance use problems, stressors, or exposure to activities that emphasise size and weight,” says Brennan. “We also see eating disorders develop in response to life stage changes such as puberty, going to college, mid-life challenges, and loss of relationships.”

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It’s not just anorexia that’s deadly

It’s not just anorexia that’s deadly
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Though anorexia tends to get more media coverage, there are several types of what’s known as body dysmorphic disorder (unhealthy relationships with body image). Anorexia is classically defined as someone who severely restricts their kilojoule intake – either by not eating or exercising heavily to burn kilojoules. Bulimia is characterised by a rollercoaster of binge eating, followed by purging – making themselves throw up or have diarrhoea. “Exercise-orexia,” though not an official diagnosis, is the name given to people who exercise compulsively. Orthorexia is a condition of being hyper-focused on eating only the healthiest, cleanest foods. Another less well-known disorder is binge eating, in which you scoff down more than what’s comfortable, with no control over your actions. A review of studies published in 2018 in the journal F1000 Research suggests that antidepressants and various cognitive behavioural therapy modalities are effective treatments in reducing the severity of body dysmorphia, but there are a significant percentage of patients who are treatment-resistant. All of these conditions can be life threatening and dangerous, and they all have similar warning signs.

Sign #1: you think about food all the time

Sign #1: you think about food all the time
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Take a moment and reflect on the past few hours of your day. Whether you were spending time with pals, running errands, or working, what thoughts consumed your mind? If food is at the forefront of your consciousness nearly all the time – how you’re going to eat it and prepare it, what you might do to make up for eating behaviours that you have determined are unacceptable – you could be heading down an unhealthy road. “Having an obsessive focus on food to the point of it inhibiting your daily life can be a warning sign of an eating disorder,” says Claire Mysko, chief executive officer of The National Eating Disorders Association (NEDA). “Although being aware of nutritional quality isn’t a problem in and of itself, there is a presentation of disordered eating called orthorexia, which occurs when an individual becomes fixated on healthy eating to a point of actual damage to their well-being.” If you’re anxious about how much mental energy you’re dedicating to kilojoules, nutritional value, and food quantity, consider recording how often these thoughts come along. You can bring this information to your doctor, who can help you understand how to control and reduce these instances.

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Sign #2: dieting makes you feel confident

Sign #2: dieting makes you feel confident
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Brennan says that a high percentage of patients reported that trying out a diet and seeing results was what caused their eating disorder to begin. While it might seem harmless to eat healthier and shed kilos, it’s less about the physical act of dropping weight, and more about how it makes you feel, and how you define yourself as a person. “Often what starts as an innocent attempt to diet or eat healthy can kickstart an eating disorder, as the individual quickly finds that their new behaviour ‘solves other problems,’ such as increasing peer acceptance, soothing anxiety, or getting attention in a new way,” Brennan explains. Many experts now say diets in general don’t work and that intuitive eating is better for your body.

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Sign #3: you’re avoiding dealing with something big

Sign #3: you’re avoiding dealing with something big
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No matter how rosy your life appears to your friends on social media, part of being human is enduring the natural ups and downs of life. However, if you’ve recently experienced a death in the family, a scary car accident, or even a disappointing breakup, you might be inclined to skip through the recovery steps and instead, focus on something you feel you can control. “In times of great stress, people tend to revert to past coping strategies as a way to feel more in control, which can include eating disorder behaviours,” says Mysko. “Change in routine can heighten anxiety, something we are seeing now during the Covid-19 pandemic. It’s important that individuals feel supported and have access to resources in order to understand various ways of coping.”

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Sign #4: you scrutinise every nutrition label

Sign #4: you scrutinise every nutrition label
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You want to make sure you’re not eating overly processed foods riddled with unnecessary added sugar or chemicals. But if you’re spending hours looking over ingredients on food labels, you might be developing a dangerous obsession. People with orthorexia nervosa, in an attempt to be a healthy eater, start to eliminate more and more foods they perceive as “bad,” and will only allow themselves to eat “good” foods. But when you begin to give whole groups of food a positive or negative connotation, you often miss out on essential ingredients and nutrients that your body needs to function properly. A review of studies published in 2018 in Frontiers in Psychology suggests that people who live in a culture that elevates the virtues of healthy living are most at risk for developing orthorexia. “Our bodies are not meant to follow rigid, prescribed diets for long periods of time,” Brennan says. “They’ve evolved over time to need certain combinations of nutrients to keep us going and keep us healthy.”

Sign #5: you’re getting increasingly rigid about food choices

Sign #5: you’re getting increasingly rigid about food choices
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If you always modify your food order at restaurants to the point that it raises eyebrows with your friends, it might be time to re-examine your motivation. The stricter you become with what you eat, the less enjoyment you get out of your meal. “A hyper-focus on what you are eating, or not, can negatively affect a person’s relationship with food long term as well as negatively impact normal life activities,” says Mysko. “Obsession with food, along with the ordinary pressure to look a certain way, can be extremely dangerous. Unfortunately, society plays a role in perpetuating the notion that foods are ‘good’ or ‘bad’”. If this sounds like you, you may want to seek guidance and consultation from a registered dietitian about your nutritional needs and how to balance your diet.

Sign #6: you are obsessed with how much you weigh

Sign #6: you are obsessed with how much you weigh
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There are so many numbers that arguably matter more than how much you weigh – your resting heart rate and your cholesterol level, to name a few. So, if you have a sudden, paralysing, hyper-focused viewpoint on those numbers down by your toes, you may be developing a dysfunctional relationship with the scale. “Do you find that you are secretly weighing yourself more often than normal? Is your mood for the day dramatically changed by the number on the scale? This could be a silent sign of an eating disorder developing,” says Brennan.

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Sign #7: you use laxatives to drop weight

Sign #7: you use laxatives to drop weight
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Laxatives can be helpful occasionally for people with digestive problems; they’re not meant as a weight-loss aid. “Laxatives, cleanses, diuretics and diet pills are often abused by people who are desperate to see the number on the scale go down,” says Brennan. “If you find yourself in a co-dependent relationship with your scale, try putting it away or having a friend store it for you for a while. If you need to weigh yourself in order to follow medical advice, talk with your provider about alternatives to having a scale in the home, such as using the scale at a gym or pharmacy one time per week.” It can be very freeing to have your day start without the tyranny of the number on the scale.

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