In the United States alone, an estimated 8 million individuals struggle with an eating disorder. To many people, such an affliction might seem silly. Ostensibly, one should be able to simply eat more, right? What is an eating disorder, and how have they established themselves with such great prevalence in our country? The fact of the matter is, eating disorders are not so simple. The term “eating disorder” is an umbrella that casts a large shadow over many separate and distinct incarnations such as anorexia nervosa, bulimia, muscle dismorphia, as well as food maintenance syndrome, to name a few. The differences in individual expression of eating disorders makes it very difficult to simply categorize them, let alone ascertain their specific causes and potential treatments. Furthermore, eating disorders often come pre-packed with some psychopathology as well. In fact, eating disorders have been found to be connected in some way with almost every single well known psychiatric disorder such as chronic depression and bipolar disorder. Their causes and their nepenthe have yet to be fully determined. Also, the immense body of research in the topic is riddled with the influence of the classic and still raging debate regarding the importance of nature versus nurture.
The effects of upbringing (nurture) in catalyzing the development of an eating disorder seem clear and numerable. Many researchers point demonstrate the obvious: the American society has created an unobtainable standard of physical appearance that has left young children far more vulnerable to feeling low ratings of person appearance, which has likely enforced the disgustingly high prevalence of eating disorders as well as mood disorders. Schreiber (1996) reports that 40% of girls aged nine and ten are already trying to lose weight. Such is the true price of the unrealistically proportioned barbie doll, as it appears to represent more of a cartoonish caricature than a true woman. The heroines (but more often damsels in distress) found in every Disney movie ever made reflects this sad trend as well with their corset-tortured waists. Furthermore, the social bi-products of our myspace generation as well as the fine programming on MTV have both enforced a personal obsession with our own appearance at a level unprecedented. The influence of nurture in catalyzing eating disorders seems clear. But is there more to it than that? Can one, for example, simply have genes that leave them more likely to experience an eating disorder in their lifetime?
Some researchers think so. Many brain imaging studies have demonstrated that, on average, people with eating disorders (specifically anorexia and bulimia) exhibit non-normal function in the neurotransmission of serotonin and dopamine. This seems quite interesting because serotonin controls the regulation of mood, appettite, and impulse control; while a failure of one’s dopaminergenic systems might experience atypical reward-seeking behaviors, a disturbed or disoriented decision making process, and an unbalanced appetite. Mikolajczyk, Gryzwacz, and Samochowiec (2009) were interested in whether genes that can alter serotonin and dopamine levels would have a statistical connection with the occurrence of eating disorders. They identified one gene in particular, catechol-O-methyltransferase (COMT), that seems to be related to such disturbances, and it also has been implicated as a possible culprit of psychosis and mood disorders. They demonstrated that two specific genotypes (different allele configurations in the COMT gene) left women five times more likely to have an eating disorder and seven times more likely to have bulimia. This is strong evidence that some element of nature is at play in here. This begs the question: if researchers have found a gene that might cause eating disorders, could they also find a medicine to cure it as well? Unfortunately, the answer is seldom so simple.
Rossi (2010) closely observed the efficacy of different psychiatric treatments in a sample size consisting of pre-adolescent girls. These treatments mostly consisted of both a therapy component and a medicinal component, consisting of a battery SSRI’s, tricyclics, first and second antipsychotics…pretty much the works. These researcher note that there exists no evidence which suggests that any of these drugs can be benificial in alleviating an eating disorder on their own. However, therapy often works very well. This particular study found that a combination of therapy and medication seems to offer the best hope of returning to a normal, healthy weight and dispelling personal feelings of inadequacy. As far as treatments go, neither nurture nor nature should be discounted. The complexity of the affliction is such that an effective assault against it must be multi-pronged. But like most other related studies, this work suffers from limitations such as small sample sizes and purely correlative data. In the future, a vast amount of work awaits researchers if they ever hope to find a “cure” for eating disorders. In order for better treatments to be found, the researchers must be able to better understand the causes.
On Psychology and Neuroscience 
I’m really fascinated in the subject of eating disorders because it seems to be an area of psych that is far less researched (biologically) than most. I was not aware of any arguments for the nature side, so I’m glad you found information on that. There must be more influencing the occurrence (or lack or occurrence) of EDs than just society’s ideals- we all live in this society and are subjected to these messages, but we don’t all have eating disorders. I can see why not that much is known biologically, because any abnormality found in the brain may also be due to a comorbid disorder, or could be caused by the presence of the disorder. Confusing!
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Eating disorders, to me, are some of the most perplexing ailments. I find it difficult to fully understand the pathology and thought processes involved in such disorders, thought I can definitely understand the HUGE impact of the media and pop culture on the way in which young women (and even men) learn about what is ‘acceptable’ regarding body type and image.
What I find even more disturbing is the insane number of “Pro-Ana” websites and blogs that are on the internet. These websites chronicle severe anorexia and bulemia, and even treat the disorders as something that is positive and good (what?!?!). These kinds of websites show pictures of extremely emaciated women who are ‘celebrating’ their skeletal figures and encouraging others to practice their eating disorders. What scares me is that these individuals do not see the point in help, and perhaps these are the people that need it most.
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I, too, am very interested in the subject of eating disorders and find it to be such a complex disease. One in which I can’t fully wrap my head around. One of my closest friends has been suffering from an eating disorder for many years now. It is hard for me to understand it and thus to help her. I want to help her and everyday I want her to eat more and exercise less; but I can’t tell her that. Why isn’t it as simple as just eating more? As Mike states, there has been some evidence to suggest that there is a specific gene that made women more likely to have bulimia. In the case of my friend, this all makes sense. Her mom has suffered from an eating disorder and now she is suffering from a similar disease, showing evidence for the genetics of the disease. It has taken over her life and everything is centered around food.
On another note, I lead a 5th grade girls group through Hardy Girls Healthy Women. One of our topics was “loving your body”. As my co-leader and I talked with the girls, we had them tell us what they love about their body. One of the girls, a small, average size girl, revealed her stomach to the group and said she thinks she is too fat. This really saddened me. Whether she was doing it for the attention or really believed she was fat, was heartbreaking. Our society places way too much emphasis on both women and men’s self-images.
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I distinctly remember learning about eating disorders when I was about 11 or 12 because a program was explaining how Disney characters have unrealistical figures or body proportions. I recall being quite astounded by the fact that the cartoon figures were representations of human. Before then, the thought that I was supposed to resemble the female Disney characters hadn’t even crossed my mind. To me it seemed like all the media on how the media distorts our perception of what we are suppose to look like might be the culprit. I think it is important for individuals to differentiate between the airbrushed models in the media and real, functioning people (individuals that need to lift grocery bags or go for a run to release stress, rather than to just burn calories).
My mother mentioned that the 3 signs of a developing eating disorder are:
1. a controlling mother
2. Becoming a vegetarian
3. Eating cereal for more than one meal a day
I have no idea if these are close to factual, but the idea that eating disorders may be genetic is intriguing in that most signs and symptoms seem to develop from the environment of the individual.
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I once read this article in Nature of Neuroscience about Ghrelin sensitivity during social stress. Apparently, Ghrelin might have some anxiolytic/antidepressant effects when it is administered to mice after they have experienced social defeat. Since Ghrelin is released when we are hungry, the results might have profound implications for people with body image disorders. Perhaps one could enjoy the anxiolytic/antidepressant effects of Ghrelin??
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Mike, I find the first study you mentioned very intruiging. When I was in London, I took a health and welfare class, and we looked at the correlation between eating disorders, birth weight, and health of the mothers. This paper collected data from hospitals and patients and showed that children (mostly girls) that are born underweight tend to be malnutrioned and that their mothers did not eat as well either. But what was interesting is that these girls did not develop eating disorders. It was siblings of these people, children who tend to weigh more being born after the first child, that developed eating disorders even though they should be more healthy. They never looked at the genes or neurotransmitter levels in the girls, however I wonder if this could be researched using animal models. Although this could be one weird explanation for how people develop eating disorders, I think that there are a lot of psychological and societal influences on the psyche of people who develop these disorders.
On a completely random note, I think we tend to forget that obesity is classified as an eating disorder, and a lot of research based on “eating disorders” is based on anorexia and bulimia… There is a lot of research done concerning obesity, but for some reason I feel like it’s categorized differently…
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I agree with you Natasha, we often too forget about obesity when discussing eating disorders. I think this may have to do with the fact that sometimes obesity is the result of pure biology, and sometimes it’s a result of behavior such as laziness. Also, obesity could be blames on an addiction to food. There are many different reasons behind obesity but it shouldn’t be forgotten in wake of anorexia or bulimia.
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Eating disorders are such an interesting topic because it really does seem like something that society has created. We always hear about the nurture side of the argument and seldom hear about the biological side, so it is really interesting to hear that component. Overall it seems to be classified as a more psychological disorder than clean bio problem. I think that is why there is a different stigma around the issues of eating disorders. It can’t really be explained by a chemical imbalance alone or a malfunction in one area of the brain, so people tend to think it is a problem with the individual and how they think. This carries a much heaver burden then being able to blame it solely on biology.
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This is quite an interesting find. I never thought about eating disorders as part of the genome and always (naively) assumed that eating disorders were forced upon society through media, family upbringings, or depression. Often, I don’t look at eating disorders causing other psychotic disorders but the other way around where eating disorders were due to disorders, but after reading about this, it could easily be argued the other way around. It would be nice to see in the future if alleviating drugs for this infamous way to lose weight could be utilized.
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I find it really interesting that there may be underlying biological causes of eating disorders. I know many girls who have or have had eating disorders (bulimia and anorexia) and I’ve always attributed it to their upbringing (exposure to media, mother’s obsessions with their daughter’s weight, etc.) but the truth is that all girls are exposed to unrealistic body images through the media and not all girls suffer from these disorders. A study I found on female twins looked at the shared genetic and environmental risk factors of anorexia nervosa and major depression. It estimated that anorexia has a heritability of 58%! I never considered that abnormal neurotransmitter and hormone levels could be the cause of these disorders, but clearly there are some biological factors that contribute to these illnesses. Hopefully research will continue to examine the biological causes, so those who suffer from these disorders can get the proper treatment and recover.
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