Lynn Sucher, MC, LPC, CEDS, NCC
Those of us who work with clients suffering from eating disorders understand the complexity of this disorder. In the past ten years, there has been a significant amount of research done on the genetic link to eating disorders, brain imaging and the bio-social aspect of the disorder. This lends itself to the question “has this research actually led to changes in the treatment of eating disorders?” The answer is that while some of the research substantiates the theories and treatment methods many clinicians have been using for years, and there is movement toward evidence based treatment, many aspects of eating disorders still remain elusive.
Dr. Ken Weiner, founder and medical director of the Eating Recovery Center, in Denver Colorado, is a board certified psychiatrist and leader in the field of eating disorders. Dr. Weiner believes the roots of an eating disorder are 40%-50% biological and 50%-60% psycho-social. Dr. Weiner states “If a mother or sister suffers from anorexia, there is a twelve times greater than normal risk that an individual will develop anorexia.”
One of the most interesting predictors of an eating disorder is temperament. Dr Weiner looks at temperament as “hard wiring.” Individuals struggling with anorexia are often anxious, perfectionistic, have poor self esteem, low novelty seeking behavior, and have high risk avoidance. People suffering from bulimia have many of the same temperamental aspects as anorexia. The big difference seems to be the propensity for individuals suffering from bulimia to have high novelty seeking behaviors, such as sexual promiscuity or substance abuse issues. Clinicians specializing in eating disorders recognize the impulsive nature of bulimia and the rigidity of anorexia, however on many levels, bulimia and anorexia mirror one another.
Dr. Anita Johnston, founder and director of the ‘Ai Pono EDIOP and Anorexia and Bulimia Center of Hawaii, also believes temperament plays a part in the development of eating disorders. She talks of temperament as “thin skinned individuals.” These are people who feel more deeply than others and often absorb other’s feelings as well. They are intuitive and emotionally sensitive, usually picking up quickly on family dynamics which may be unwelcome information to the family system. Dr. Johnston sees being “thin skinned” as a predictor of an eating disorder.
Psychological components include low self esteem. Developing healthy self esteem is a crucial factor in the recovery process. Many clinicians see low self esteem as a family of origin issue, more “nurture” than “nature.” However, some of the new research suggests self esteem may be genetically based. This could mean an individual might be parented with a specific goal of healthy self esteem and yet, still develop low self esteem. If it is genetic, there is a good chance that at least one parent is also suffering from low self esteem. Therefore, having a parent with low self esteem also becomes one of the predictors of an eating disorder.
Another predictor is a dieting parent who may lead a child or young adult to begin to diet, or a parent who is obsessed with exercise, fat, weight, or body image. This family of origin or psychodynamic issue is often seen in the development of an eating disorder. If the genetic propensity is present, and you have a parent with low self esteem or food issues, and are “thin skinned,” the climate is right to produce an eating disorder.
There are also social components that may help pave the way for an eating disorder. The pressure to be thin, the billion dollar diet industry, the acceptance of plastic surgery and of course, the media are all recognized as societal influences. However, without the biological or genetic component, social pressures alone are not enough to predict an eating disorder.
As we begin to better understand the predictors of eating disorders, prevention and early intervention should make a difference in the number of individuals who suffer from this complex and dangerous disorder. Each predictor needs to be recognized and as research in the field advances, the hope is to see fewer men and women suffer from eating disorders.