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The causes of anorexia nervosa have nothing to do with food intake. However, it is indeed an eating disorder. If 40% of people with anorexia suffer from psychological disorders, the “mental” part of anorexia is not exclusive.
This well-known multifactorial disease is still intriguing: What are the factors that trigger, precipitate or even perpetuate the disorder? How does anorexic behavior develop and why? Genetic, family, physiological predispositions, perfectionism, giftedness or traumatic experience are all reasons to investigate.
1. What causes anorexia nervosa?
In general, there are three triggers for anorexia:
- A food restriction: Two thirds of people with anorexia mention having gone on a diet in the months preceding the onset of the disorder.
- A depressive state: 20% of people suffering from anorexia report feelings of depression prior to the disease.
- An unexpected reduction in energy intake: Whether following a digestive disease or a viral infection, loss of appetite promotes entry into this food spiral.
But other causes also lead to the development of the disease. Like emetic bulimia or binge eating, anorexia nervosa is an ED whose origins are multifactorial.
Cause 1: Psychological and Cognitive Causes
Anorexia nervosa (or anorexia nervosa ) depends on many psychological and cognitive factors. This eating disorder can occur as a result of a psychic disorder, trauma, or settle in certain types of personalities.
Among the psychological disorders predisposing to the disease, we find:
- Obsessive Compulsive Disorders (OCD)
- Social phobia
- Trauma such as sexual abuse
- Depressive and anxiety disorders
Cognitive and emotional deficits are often seen in people with anorexia.
There are also personalities associated with anorexia, such as:
- The obsessive personality
- The avoidant personality
- borderline personality
- Perfectionism (present at all stages of anorexia)
- The lack of self-esteem
Cause 2: Socio-Cultural Factors or the Idealized Body
A large number of studies mention body dissatisfaction as a triggering factor for anorexia nervosa. It is this difficulty in achieving this "ideal body" that generates these increasingly strict diets and this fear of gaining weight that maintains the food spiral. The latter is also just as much a cause as one of the symptoms of anorexia.
But it's not so much the social pressure that pushes to enter the disease. It is rather your degree of adhesion to these “values of thinness”: the way in which you are going to integrate this social message in a personal way. And perceive the cult of the body as a value anchored in yourself.
Cause 3: Family Factors
There are family factors predisposing to anorexic behavior. Among them are:
- Frequent dietary restrictions in one of the parents.
- The presence of a family member who suffers from anorexia (creating 4 times more risk of developing this TCA)
- A depressive tendency within the home.
Beyond these behaviors, the quality of family relationships is a key factor, because the appearance of anorexic eating disorder would come in response to this family environment: faced with a difficulty in finding one's place or expressing oneself in one's family, for example.
Among these family climates predisposing to anorexia, there are:
- Lack of communication or avoidance of conflict
- A parent who is not very receptive or very demanding
- Unpleasant remarks or teasing about physical appearance
Cause 4: Genetic Factors Predisposing to TCA
All the studies confirm it: there is a genetic basis for anorexia nervosa. And in particular, genes predisposing to the disease. A study conducted with twin girls highlights the genetic impact on anorexia nervosa.
The probability of developing this disorder is ten times greater, when it comes to real twins, for example.
What is "transmitted" is less the disorder itself, but the tendency to addictive behavior: some people are more genetically programmed to develop an addiction.
Among these "trigger" genes, some are associated with the metabolism of the anorexic person, that is to say, the way in which his body stores and manages energy.
Concretely, an anorexic person may have a genetic predisposition so that his metabolism burns more energy. She will also be less prone to obesity and more inclined towards physical activity. This illustrates this tendency to the well-known hyperactivity of the disease and to bigorexia.
The way your body manages your energy stores can therefore also contribute to your disorder.
Genetic factors are also among the causes of bulimia.
Cause 5: Physiological Factors That Sustain Disease
Certain physiological disturbances maintain the disease. At the neurological level, they feed the anorexic routine. At the hormonal level, they influence the feeling of satiety, but also the mood. This can lead to the maintenance of the disease over time.
Neurological causes: the impact on motivation and mood
The latest advances in research reveal a link between anorexia and the alteration of certain brain areas. In particular, those of decision-making and motivation.
This neuronal deregulation perpetuates the disorder, because it alters the capacities of “adaptation” and “change”: the anorexic person will have less motivation to eat or to break his routine. And, in this case, his decision-making is more guided by habit.
We also evoke in the anorexic course, a certain cognitive rigidity, and in particular a lack of cognitive flexibility (the capacity to pass from one task to another). This would hinder the possibility of breaking the vicious cycle of the disease. Because an alteration of this capacity induces behaviors and mental movements that persevere.
In addition, emotions have an impact on eating, whether they promote the absorption of large quantities of food or, conversely, the refusal to eat.
Hormonal imbalances: a disturbed feeling of hunger
Hormonal imbalances can contribute to anorexic behavior, while being both a consequence of the disease. Anorexia can develop in particular, because of a disorder in the level of the hormone which stimulates the appetite: ghrelin.
Scientists highlight its dual role on the feeling of hunger: either this hormone is less sensitive and this reduces appetite, or ghrelin is more active and this creates aversion and anxiety when eating food.
This hormonal disturbance perpetuates anorexia nervosa, by creating an erroneous perception of feelings of hunger.
There is also a decrease in the activity of serotonin, the "happiness hormone" in people with anorexia that regulates mood and emotionality. This promotes depressive feelings in the experience of the disease.
Cause 6: The need for control and the feeling of being overpowered
Among the causes of anorexic behavior, the need for "control" occupies a central place, while in other eating disorders like binge eating, it is the loss of control that is at the heart of the disease. The need for control is the concept most widely recognized by all specialists in eating disorders.
If you have anorexia nervosa, you have strict control over your diet. And thereby, on the vital needs of your body. This control is also linked to a feeling of "omnipotence" which feeds the vicious circle of the disease. Resisting also means pushing your limits, challenging yourself and feeling empowered to do so.
Control through food rationalization
Food rationalization is a way to meet your need for "control". In front of food, you can feel frightened, as if fascinated. But it is the caloric load of your diet that determines your decision to like a dish or not. And therefore, to allow you to consume it.
This food rationalization leads you to make a strict sorting: between prohibited foods (starchy foods, fried foods, sweets, etc.) and authorized foods (0% dairy products, green vegetables, etc.). But above all, it gives you a feeling of overpowering linked to this imperturbable organization.
Watching those around you eat more than you can induce this feeling of overpowering. It can also represent this emotional need to find your place in the family, for example.
Body image control: purgative anorexia
Despite your bodily appearance, your perception of yourself is altered. You feel fat with this feeling of never reaching your goal. This need to control your body image is never fulfilled.
You can adopt several types of conduct to control your body image:
- Compensatory behaviors: diet, fasting, intensive sport: this is restrictive anorexia.
- Purging behaviors: your need for control can lead to binge eating mixed with vomiting or taking laxatives. We are talking here about purgative anorexia.
Weigh-ins are another way to “stay in control” of your body. This “very measured” approach is sometimes done down to the millimetre.
You can weigh yourself ten times a day or measure yourself with a tape measure. Making sure your body doesn't bulk up is one way to have total control over your body.
This once again gives you a feeling of overpowering, a sort of adrenaline rush (which is also found in other forms of addiction).
Cause 7: The refusal of nurturing dependence
Refusing to eat is also refusing “a good family meal”. And according to the families, food represents “the fruit of daily work” or even sharing and the pleasure of being together. Refusing to eat can then represent your opposition to a heavy family climate.
In order to avoid blame, if you suffer from anorexia nervosa, you may tend to hide your food deprivation and adopt strategies such as: cutting your food into small pieces and arranging them in such a way as to give the illusion of filling your plate. Or eat slowly to be able to say that your dish is “too cold”…
If your refusal to eat is not masked, your disorder may reflect a desire to obtain the attention of those close to you. The objective is often to avoid marital conflicts or to assert your “nurturing” independence.
Concretely, to prove that you are independent. You attest to this logic of self-dependence through food deprivation. In this case, anorexia nervosa would be an unconscious strategy in adolescents, to fight against a feeling of dependence on their parents. The choice of food is not trivial. Food refers to childhood and the maternal figure.
2. How does anorexia nervosa develop in a person?
This eating disorder does not settle in a person by chance. If the predictive and perpetuating factors are the subject of 30 years of research, it is sometimes difficult to identify the psychological mechanisms that push a person to become anorexic.
They are, however, at the heart of the management of anorexia: how does the disorder develop? What are the key points that feed the vicious circle? What is hidden behind this insatiable quest for self? The workings of the anorexic mind are complex and it is essential to grasp the meaning. At the risk, sometimes, of feeding the spiral of the disease.
Anorexia sets in through a rejection of the sexualized body
Puberty is often the starting point of the disease. It is a central period in the construction of self-image, body and identity. It is also the moment of the discovery of sexuality.
The refusal to accept beginner sexuality is a psychological cause of the entry into anorexia nervosa. The disorder translates in a symbolic way, that the teenager denies his body.
To deprive oneself of food translates this refusal of sexual maturity by blocking the natural development of the body, because wanting to remain "thin" means preventing one's body from developing.
But anorexia in adolescents is also a kind of "refuge" which helps to appease a fear of growing up and fill an inner void (emotional, social, etc.). This disorder often comes to compensate for a brilliant personality, who performs in many areas and in his studies for example, but who has no social investment or who goes out little.
After a while, the adolescent may feel a void. This constant pressure weighs on his shoulders and becomes too invasive. It is often at this moment that the person switches: when his brain no longer has a decompression valve and the notion of the pleasure of living no longer exists at an age where it is supposed to dominate.
This void is then made concrete by the body.
Psychological mechanisms underlying anorexic disorder
There are three psychological mechanisms underlying the development of anorexic disorder:
- A deficit of interoceptive awareness: the inability to tell the difference between your physical needs (such as hunger) and your emotional needs;
- A body image disorder: the impossibility of perceiving yourself as you really are;
- A feeling of ineffectiveness or helplessness.
A fragile interoceptive awareness: A feeling of disconnected hunger
If you are anorexic, in this case, you are disconnected from your feeling of hunger, and your vital need is confused with your emotional need. Specifically, you may feel full after consuming very little food. Simply, because you are unable to recognize your vital need.
This inability to recognize hunger involves this loss of appetite and these contradictory feelings. This mechanism is found in physical hyperactivity: when the anorexic person refuses to "recognize" his fatigue.
Several hypotheses explain this phenomenon of "interoceptive awareness disorder": Some neuroimaging studies evoke a frequent cognitive functioning in people suffering from anorexia: an inability to differentiate between "pleasant and unpleasant" sensations. This difficulty would be due to a disturbance of brain areas related to decision-making (the striatum).
From the point of view of clinical research, this TCA would come to respond to childhood disorders and in particular, to an inability of the mother to recognize the physical and emotional needs of the child. Non-validated needs that would lead to confusion in the recognition of the anorexic person's own needs.
A distortion of the body image: dysmorphophobia
If you suffer from this eating disorder, the perception of your body image is altered. If you look at yourself in a mirror, you may be shocked by “how skinny you are” and the next moment your mental image takes over.
This phenomenon that we find in the anorexic experience is a psychological disorder known as dysmorphophobia. It translates an obsession linked to a defect in his appearance, disconnected from objective criteria.
Concretely, despite your thinness, you pay all your attention to your weight. Or on a part of your body that obsesses you, and your desire to lose weight is insatiable. This distortion of the image of your body implies that it becomes the center of your concerns despite your undernutrition.
A search for identity
This inability to perceive yourself as you are implies a permanent bodily dissatisfaction. But also a negative and subjective evaluation of your body: in comparison to your current body compared to an ideal body.
The search for "identity" is at the heart of this insatiable quest. Because, by failing to become what you want to be, you fail to define yourself and this fuels the vicious cycle of disease.
For lack of "self-awareness" and because of this dysmorphophobia, the objective is never achieved. And self-esteem is increasingly weakened.
The disorder also allows you to identify with something, and to give meaning to this quest for identity: “I am anorexic”. In the same way as in the phenomena of addiction: “I am an alcoholic” for example.
A feeling of ineffectiveness or helplessness
Among the testimonies of the anorexic experience, there is the feeling of helplessness or ineffectiveness. It is translated jointly with other feelings:
- A feeling of general inadequacy
- A feeling of insecurity
- A feeling of loneliness
- A feeling of loss of control
Very often people with anorexia see themselves as non-decision makers in their lives. And this feeling of inefficiency refers to this dependence on others. It would seem that this feeling is born when the teenager is confronted with a lack of confidence in his own resources. Combined with an important perfectionism, which would lead him to feel helpless.
Low self-esteem is also a predictive factor in the development of anorexia nervosa.
If "global" self-esteem refers to sub-categories of "self-concept": "physical", "social", "emotional" or "academic" (relating to school results), the anorexic experience would illustrate a deficiency in the “sub-domains” of overall self-esteem: the “social” or “emotional” self for example, involving an overinvestment of the “physical self” (which includes physical appearance and physical strength).
Concretely, the adolescent who is failing at school or socially withdrawn, would compensate by overinvesting the “physical sphere” of his esteem. To cancel this feeling of inefficiency or powerlessness and to be "accepted" in another way.
3. Who can be affected by anorexia nervosa?
Anorexia nervosa usually occurs in adolescence. 87% of people with anorexia are between 15 and 25 years old.
Puberty plays a major role in the onset of the disorder. This fear of evolving towards a woman's body or an “adult world”, predisposes the onset of illness. Body transformations, but also overweight are risk factors.
Adults are also affected. Just like the elderly who often refuse to eat at the end of life: the disorder comes to translate a depression, a withdrawal or a delirious state.
There are certain environments more affected by this disorder. In particular, when the body is idealized or at the center of professional activity.
Populations at risk of developing anorexia nervosa include:
- Young ladies
- People with a low or high body mass index
- Teenagers with weight issues
- Teenagers with psychological difficulties
- People who practice dance, high-level sport or modeling
- Individuals with conditions that involve diets (such as type 1 diabetes).
The risk factors of these target populations are related to the obsession with body image and body dissatisfaction. But also to this quest for the ideal of thinness.
Specific forms: male anorexia and athletic anorexia
The widespread idea that evokes anorexia as a female disease is false. In fact, this eating disorder affects one man for every ten women.
Anorexic men are also more affected than women by pathological family heredity. There is a majority of anorexic men who grew up with family illnesses such as: schizophrenia, alcoholism, depressive disorders, anxiety disorders...
Unlike women, anorexia nervosa in men most often begins in prepuberty, from the age of 12.
This type of disorder is found in adolescents who encounter sexual identity difficulties. He may feel a lack of power or masculinity, which may be due to an obsession with a flaw in his body. Often, this obsession is focused on his genitals. This will hinder his relational life.
The risk of anorexia nervosa for men is higher in top athletes than in the general population and in particular in men who practice body-building and wrestling.
The pressure exerted by those around them (parents or trainers) favors maintaining them in the disease. The strict diets imposed on these athletes disrupt their body image on a daily basis. In these environments, weight management is critical to performance, which fuels the vicious cycle.
In general, there is a high frequency of male anorexia in activities that aim for an ideal of thinness: dancers, models, marathon runners, jockeys, swimmers, etc.
We speak of athletic anorexia when the person has not yet become addicted. Here are 6 signs that predict the onset of the disease in athletes:
- An appreciation of sports activity
- An increase in physical activity
- A decrease in appetite
- A devaluation of food
- A decrease in food intake
- Weight loss In this case, the athlete's body is instrumentalized.
There is another form of male anorexia called reverse anorexia (or muscular dysmorphia.) It concerns athletic men who wish to increase their proportion of lean body mass by weight training, for example. This TCA involves major health risks.
4. Is giftedness really a predisposition to this eating disorder?
Yes, research is being carried out to investigate this link between anorexia and high potential, in particular because there are many high potential anorexic people, but also because giftedness and this eating disorder have common quests and deficiencies: search for identity, the desire to deny a part of oneself, the feeling of inefficiency, perfectionism...
A common quest: The search for identity and intellectual anorexia
From birth, the gifted child is in search of identity. Very early on, he questions the world around him and adopts a singular behavior. The parent may find it difficult to understand and respond to the child's needs. Growing up, the gifted adolescent may experience rejection and feel different from others.
These questions not heard or understood by the other weaken their identity construction. For protection, he will tend to close in on himself and conceive of inhibition as synonymous with integration: wanting to deny himself, canceling his own functioning is a way of “being identical to others”.
This can lead him to adopt anorexic behaviors, which translate this self-negation, but also the desire to "reduce this too much" of his person: this too much intelligence, questions, this "more" which causes him so many mockery and suffering.
Concretely, the TCA would help it to pass “unnoticed”. This insatiable quest for self is common to the anorexic experience.
Common deficiencies: self-esteem and recognition of needs
Just as in anorexia, we find in people with HPI, a lack of self-esteem, but also difficulties in feeling recognized in their needs. This can result in this feeling of non-recognition of their intelligence for example…
These lacks can create an alteration of the self-image in the HP subject, who may want to compensate for this discrepancy between his "inner" image and his "social" image: by over-investing, as in the anorexic, the "concept of the physical self” in the absence of the “social” self-concept.
Concretely, to fill this social void, he will bet on physical appearance. A mode of operation that is found in the anorexic course.
There are also other traits common to both profiles: perfectionism, the will to control or even analytical thinking.
If giftedness is above all an affective and psychic suffering, it is a predisposition to TCA.
5. Bottom line
Understanding the causes of your anorexia nervosa means understanding the “mental” part of it.
If it is less a question of food than a desire to define yourself (and a succession of failures to achieve this goal), it is by going through a more concrete way of defining yourself that you (re)take over your body, but also of yourself.
And it is by investigating the source of your eating behavior: the emotional and psychic object that animates this disorder, that you will take this correct look at yourself.
If you recognize yourself in this article or if you recognize a loved one, do not hesitate to contact a psychologist to accompany you or your friends.
- Cultural shifts in the symptoms of Anorexia Nervosa: The case of Orthorexia Nervosa
- Gastrointestinal symptoms in anorexia nervosa: A prospective study
- Depression in anorexia nervosa and bulimia nervosa: discriminating depressive symptoms and episodes
- The psychiatric history of anorexia nervosa and bulimia nervosa: Weight concerns and bulimic symptoms in early case reports
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