“What causes eating disorders?” This is one of the most frequent questions asked by people who have anorexia, bulimia, or binge eating disorder. There is no simple answer, according to Emmet Bishop, MD, medical director at Eating Recovery Center. modenook.com recently spoke with Dr. Bishop about this topic, as well as about treatment for these devastating illnesses.
Emmett Bishop, MD, FAED, CEDS, founding partner and medical director of adult services at Eating Recovery Center has more than 20 years experience in the treatment of eating disorders. He has served on the Board of Directors of the International Association of Eating Disorders Professionals since 1993 and is a past president. He has been a member of the Academy for Eating Disorders since its inception in 1993 and currently serves as an Academy Fellow. Dr. Bishop has been a member of the Editorial Board of Eating Disorders Journal of Treatment and Prevention and the American Journal of Psychiatry, as well as other professional journals.
Examiner: We have been told that eating disorders are complex conditions that can arise from a variety of potential causes. Still, people with eating disorders (and their families) often ask “what causes eating disorders?” What’s the “short answer” to this question.
Dr. Bishop: Unfortunately, there is no simple answer to this question. However, a common phrase that is often used is, “genetics loads the gun and environment pulls the trigger.” Eating disorders are spurred by the interaction of genes and environment. They are hereditary diseases; somewhere between 50 to 80 percent of the etiology of an eating disorder is related to genetics. Related to the environment, there is no overarching “cause” of an eating disorder, but rather, more specific environment conditions – individual stressors – that “pull the trigger.”
What advances have been made in understanding the genetic underpinnings of eating disorders?
It has been a progressive process. First, twin studies showed that eating disorders had a large genetic component. Then, linkage studies helped to identify certain chromosomes that carry eating disorders traits. Any way you look at it, eating disorders are polygenetic. There is no such thing as an anorexia nervosa gene or a bulimia nervosa gene. Rather, multiple traits contribute to these diseases. It is a huge task to identify which traits are served by which genes; we still have a long way to go in that area of research.
Do these genetic studies show a basis for all types of EDs (anorexia, bulimia, binge eating)?
Yes. They’re all highly hereditary.
How is temperament a predictor of EDs?
Temperament is probably one of the genetic factors or traits. It certainly plays a role in the development of eating disorders and in their maintenance. At Eating Recovery Center, we measure patients’ temperaments using a tool developed by Robert Cloninger called the Temperament and Character Inventory. We have found that certain temperamental traits are strongly associated with eating disorders. For example, high harm avoidance is almost universal with eating disorders patients. However, novelty-seeking temperaments sort by diagnosis. High novelty seeking is associated with binge eating disorder and bulimic behaviors, while low novelty seeking is associated with restricting behaviors. In addition, eating disorders tend to share temperamental traits with other disorders, such as OCD, a disorder with a high comorbidity rate in eating disorders patients.
What are some of the interpersonal/social factors that contribute to EDs?
The pressure to be thin is a huge social factor. The pressure to conform to a thin feminine or a muscular male “ideal” has been stated as one of the factors that can lead to dieting, and dieting leads to eating disorders. “Body perfection” for men and women has been the 20th century scourge, leading too many people to try to fit their body into a shape that does not follow their genetic predispositions. High stress is also a significant factor. Eating disorders thrive on stress, and serve as a “tool” to help people deal with anxieties and pressures.
What medications have you seen that aid in treatment?
No medication has really stepped forward as a specific treatment for anorexia. However, for bulimia, antidepressants, and specifically Prozac, have been used with success. However, eating disorders have a lot of comorbidity, and most patients also have depression or anxiety. We see a lot of reciprocal interactions between comorbidities. For example, depression worsens the eating disorder, the eating disorder worsens depression, and the cycle continues. We use medicine to come in and break the cycle; antidepressants are very helpful in that regard.
What is the most important advice you would give to someone struggling with an ED?
Be aware of your natural tendency to be a “do-it-yourselfer” and seek help. That is one of the biggest problems I see. People with eating disorders do not readily seek out help, and they try to handle their problems by themselves. Eating disorders are often self-prescribed solutions (e.g. “I’m out of control in my life, but in control of my eating”). It is an auto repair effort that doesn’t work. Teaching eating disorders sufferers to rely on other people to help them repair themselves is important. Although this does sound obvious, it can be very difficult for people with eating disorders.
Is there anything else you’d like to add?
Eating disorders are attempts to manage emotions. Sometimes we do not realize that managing emotions is not the solution but, rather, the problem itself. A lot of people get caught up in “how do I manage my emotions?” The eating disorder steps up as a solution that gets you in a lot of trouble. Recovery is about giving up the struggle to manage emotions and freeing yourself to live the life that you want to have.
Everybody Knows Somebody. Get involved in NEDAwareness Week 2012, February 26- March 3! Visit the NEDAwareness Week homepage under Programs & Events at www.NationalEatingDisorders.org to register today and learn more about how you can do just one thing to help raise awareness about eating disorders and become part of the solution. Helpline: 800 931-2237
Local NEDAwareness Events: n the Philadelphia area, a number of local colleges are hosting events, including a scale-bashing at West Chester University on March 1 and the Delta Phi Epsilon Candlelight Vigil at WCU. The Binge Eating Disorder Association (BEDA) conference, which begins March 2, and is being held at the Hyatt Regency in Philadelphia. The Renfrew Center foundation is sponsoring its Barefaced and Beautiful initiative.