What Causes Anorexia?

Developmental Factors for Anorexia Nervosa

By Jeanne Rust, Phd

Because anorexia nervosa typically begins during adolescence, developmental issues are thought to play an important etiological role. Researchers have found early eating conflicts such as struggles with food and unpleasant memories surrounding meals. Most authors agree that the challenges during adolescence include the need to establish independence, a well-defined personal identity, fulfilling relationships, and clear values and principles to govern one's life.

For adolescents, it is typical and normal to have problems with family and peers. However, it is not clear what is normal for adolescents with eating disorders. Disturbed parental-child relationships are reported in the literature. Eating disorders may mirror certain dysfunctional roles, conflicts, or interactional patterns within a family.

I always need to be clear at this point when discussing families. This discussion is not about blaming families or trying to make the eating disorder someones fault. It is about simply looking at family dynamics in an effort to guide the families into healthier behaviors.

Depression has been implicated as a nonspecific risk factor, and higher levels of depressive symptoms as well as anxiety and self-consciousness are seen in adolescents with anorexia nervosa. A number of psychiatric traits are commonly found in patients with anorexia nervosa and bulimia nervosa, including mood disorders. Many of these traits are developed prior to the development of the eating disorder and many developed secondary to malnutrition. Studies have shown that there is a risk of 7 percent - 25 percent for developing major depression in families of eating disorder patients. Anxiety disorders, personality disorders, and substance abuse are also common psychiatric conditions in the eating disorder population.

In addition to familial connections, attachment processes and their role in the development of psychological disturbances underlying dysfunctions of eating behavior have assumed an important place in the study of eating disorders. The attachment relationship, according to attachment theory, is an interplay between the baby's attempts to stay close to the primary caregiver, initially the mother, in times of threat and the ability of the primary caregiver to respond to the infants needs.

Attachment theory proposes that secure attachment occurs when babies develop the expectation that the parent will be available, will meet their needs appropriately, and let them know they are cared for. Insecure attachment happens when the expectation that the parent is available is not realized and personal self-worth does not develop because of perceived inaccessibility or inappropriate responsiveness of the caregiver. Hilde Bruch describes abnormal attachment patterns quite simply. Abnormal attachment involves a mother who superimposes on her infant daughter her own concept of the infants needs such that the infants needs and impulses remain poorly differentiated. This results in a sense of separateness and ineffectiveness that underlies the development of the eating disorder.

There is still much to be learned about attachment processes and how they affect eating disorders, particularly through the different developmental stages of the child.

Jeanne Rust, PhD is the CEO and Founder of Mirasol, a treatment program for women with anorexia, bulimia, obesity, and binge eating disorder. Her treatment philosophy is integrative combining the best of the medical model of treatment with the most effective alternative ones.