Although often overlooked, eating disorders are real, devastating, and growing issues in todays society.  In the US alone, 30 million individuals are affected by eating disorder and their prevalence is increasing over the years.  Eating disorder are a serious issue and can be life threatening which leads to the importance that their understanding needs to increase.  Since eating disorders are very complex illnesses and factors can vary from patient to patient, it leaves the understanding of what eating disorders are and what causes them unclear.  However, today there is a widely accepted diagnoses for eating disorders and research done does provide a look into what plays a role in eating disorders.  When looking into the causes and risk factors that go into eating disorders, many people blame eating disorders are sociocultural factors such as the media but besides the commonly known sociocultural factors, there are genetic and biological risk factors that influence the development of eating disorders and those factors need not to be overlooked.

While historic research has been done to reveal that eating disorders existed in "ancient times," they were "certainly not to the same extent, and possibly not in the same way, as at present" (Polivy & Herman 188).  Currently, eating disorders are a growing issue in society and "the rate of development of new cases of eating disorders has been increasing since 1950" (Get the Facts).  In the United States today, it is estimated that eating disorders affect 20 million women and 10 million men (Wade, Keski-Rahkonen, & Hudson) and anorexia nervosa specifically is the "third most common chronic illness among adolescents" (Eating Disorders Statistics).  Only 5% of American Females posses the "ideal" body that is commonly advertised (Eating Disorders Statistics), however there is a huge desire for thinness is society.  This desire is also now reaching girls younger and younger and in fact, "42% of 1st-3rd grade girls want to be thinner" and "81% of 10 year olds are afraid of being fat" (Get the Facts).  These concerns continue to follow girls through life and can result in the development of eating disorders. 

Along with eating disorders comes a number of complications but what many don't know is that they are in fact life threatening.  On November 17, 2010, 28-year-old French model Isabelle Caro died after suffering from anorexia nervosa for years. However, this is just one example of an eating disorder taking a life and Caro specifically followed a recent string of deaths of fashion models from eating disorder in 2006 and 2007 (Rodenbough, 2013).  In 2009 a study was conducted by colleagues at the American Journal of Psychiatry which revealed that eating disorders have the highest mortality rate for any psychiatric disorder.  The study in 2009 revealed that the mortality rate for anorexia is 4% and for bulimia nervosa the rate is 3.9% (Eating Disorders Statistics).  Knowing that eating disorders hold the highest mortality rate, it is important that research is being done to better understand the disorders in order to attempt to reduce their mortality rates. 

With the research that has been done to date, there is a widely accepted criteria for diagnosing eating disorders, which is one step toward a better understanding of eating disorders.  In today's society, the three most common eating disorders seen are anorexia nervosa, bulimia nervosa, and binge eating disorder.  According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anorexia nervosa is classified by a) restriction of energy intake relative to requirements, leading a significantly low body weight in the context of age, sex, development trajectory, and physical health, b) intense fear of gaining weight or of becoming fat, even though at a significantly low weight, and c) disturbance in the way which one's body weight or shape is experienced (2013).  When one possesses anorexia, because the body is restricted from the necessities it needs to function, the illness starts to take a toll on the individual's body.  Some of the common health consequences of anorexia nervosa include: abnormally slow heart rate and low blood pressure which increases the chance of heart failure, reduction of bone density, muscle loss and weakness, severe dehydration which can cause kidney failure, and fainting, fatigue, and overall weakness (Get the Facts).  Anorexia nervosa takes a major toll on the body and as stated before, can result in the worst consequence, death.

The DSM-5 classifies bulimia nervosa by a) recurrent episodes of binge eating, b) recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medication, fasting, or excessive exercising, c) a and b must both occur, on average, at least once a week for 3 weeks, d) self-evaluation is unduly influenced by body shape and weight, and e) the disturbance does not occur exclusively during episodes of anorexia nervosa (2013).  Bulimia nervosa also takes a toll on one's body as the purging involved can effect one's digestive system and major organ functions.  Some of the health consequences related to bulimia nervosa include:  electrolyte imbalances which can lead to irregular heartbeats and possibly heart failure and death, potential for gastric rupture, inflammation and possible rupture of the esophagus, tooth decay and staining, and chronic irregular bowel movements and constipation (Get the Facts).

Lastly, the DSM-5 classifies binge eating disorder by a) recurrent episodes of binge eating, b) binge eating episodes associated with at least three of the following: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of embarrassment, or feeling disgusted with oneself, depressed, or very guilty after overeating, c) marked distress regarding binge eating is present, d) the binge eating occurs, on average, at least once a week for three months, and e) the binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa (2013).  Again, binge eating also starts to take a toll on the body of the individual that possesses the disorder.  The health consequences resulting from binge eating are often the same of those resulting from obesity and include:  high blood pressure, high cholesterol, heart disease, type II diabetes mellitus, and gallbladder disease (Get the Facts).

 However, while being able to diagnose eating disorders and know their common side effects, eating disorders are still very complex and difficult to understand.  What is even more difficult to understand about eating disorders is the risk factors that go into an individual developing an eating disorder.  There has been a number of research done to determine what factors have an influence and studies show there are a number of different sociocultural, family, individual, and genetic factors.  The main sociocultural factors include the media's obsession with slimness and peer influence.  As for the family factors, they include hostility, negativity, competitiveness, and constant criticism from family members.  Individual factors include self esteem issues, body dissatisfaction, obsessive thoughts, genetics, perfectionism, and lack of internal awareness (Polivy & Herman, 191-202). 

The sociocultural factors that go into eating disorders are often what society thinks are to blame for the prevalence of eating disorders today.  It is very commonly argued that the media's idea of and obsession with thinness is to blame for the body dissatisfaction and drive for thinness that many girls possess.  However, as Polivy and Herman argue, "exposure to the media is so widespread that if such exposure were the cause of eating disorders, then it would be difficult to explain why anyone would not be eating disordered" (192).  The other major sociocultural factor often blamed is peer influence.  Peer influence can add to the pressure individuals feel to be thin and the pressure one feels to live up to society's expectation of thinness.  However, analysis of research has been done and states that "not all peers are equally concerned about attaining a slim physique, so blanket condemnation of peer influence of pressure is unwarranted" (Polivy & Herman 193).

Family influence is also known to play a major role in the development of eating disorders.  Studies show that families of individuals with eating disorders are often involved, intrusive, hostile, coercive, competitive, dissatisfied, and negative (Polivy & Herman, 194).  Families are often known to encourage eating disorders by praising those for their slimness or being dissatisfied with the weight of the individual and encouraging the individual to lose weight.  Research has also shown "Mothers who themselves have an ED tend to have a negative influence on their children's attitudes and behaviors, feeding them irregularly, using food for nonnutritive purposes, and expressing concern about their daughters' weight as early as the age of 2" (Polivy & Herman 194).  This research has shown that this can be a serious risk for the child to develop an eating disorder later on in life.  Conversely, some conclude that "many of these (family dysfunctions) characteristics are regarded as secondary to the presence of an ill family member, rather than causative" (Ward, Ramsay & Turnbull 279).

There are also many individual factors that go into eating disorders.  These individual factors are a large reason why eating disorders are so complex and mysterious because these factors can vary greatly from person to person.  Different individual factors can include: past experiences, obsessiveness, conformity, reduced social spontaneity, self-esteem issues, impulsivity, body dissatisfaction, neuroticism, perfectionism, dissociation, and lack of internal awareness (Polivy & Herman 195-204; Culbert, Racine & Klump 1146-1148; Kaye, Klump & Strober 301).  However, with these factors varying from person to person it would be hard to blame eating disorders on these factors alone.  The variation in factors opens the doors to idea that there may be more to blame that just the sociocultural, family and individual factors.  The idea most commonly explored today, is the possibility of genetic and biological factors.

Over the last decade, numerous research has been done to prove the genetic and biological risk factors of eating disorders. Schellenberg agrees that "in eating disorders, genetics, in interplay with environmental factors, individual sensitivity and social pressure, contributes, in a somehow mysterious way, to generate these still scarcely understood conditions" (2012).   Many twin and family studies point to the idea of biological factors and show that in identical twins if one twin suffers from an eating disorder, the other is far more like to suffer from a similar illness (Sohn).  According to Anorexia and Bulimia Nervosa those studies have shown that "with regard to major affective illness, studies of AN probands have yielded familial risk estimates in the range of 7% to 25%" and "likewise, studies of BN probands have shown, with rare exceptions, that their first-degree relatives are several times more likely to develop affective disorders than are relatives of control subjects" (306).  Twin studies also reveal that "50-83% of the variance in anorexia nervosa and bulimia nervosa is genetic" (Polivy & Herman 202).  Genome studies have shown that there are links between different chromosomes and eating disorders, especially chromosome 1 which can harbor genes linked to the most severe form of anorexia (Sohn).  

Other studies show that eating disorders are linked to different personality traits, such as anxiety, that are hard-wired to the brain which supports the idea of biological factors.  Anorexics tend to have a type A personality, in which the individual is a perfectionist and more anxious and rigid (Sohn).  Those traits as well as obsessiveness are associated with eating disorders as they can translate into one developing an unhealthy body image which leads to the person doing everything they can to fix their body image.  Research done to study the effects of serotonin and dopamine also provide evidence of biological factors.  "Serotonin s involved in body weight regulation, specifically in eating behavior, and has also been implicated in the development of eating disorders" (Bulik, Slof-Op't Landt & Van Furth 268).  Research done exploring the idea of the serotonin 1D gene "looks promising" and shows linkage to anorexia nervosa (Bulik, Slof-Op't Landt & Van Furth 268).  Bulik also reports "repulsion to food, weight loss, hyperactivity, menstrual abnormalities (amenorrhea), distortion of body image, and obsessive-compulsive behavior have all been related to dopamine activity" (268).  However, even with this research providing evidence of genetic and biological factors, the studies have not been able to relate the conditions back to a single, shared risk factor which is a reason that eating disorders are still far from being completely understood.  

While it is generally widely accepted in today's world that eating disorders are a result of different genetic and environmental factors, some argue that the evidence supporting the idea that genetics play a role is not reliable.  In Behavior Genetics and Eating Disorders (1997), Hewitt concludes, "although there is consistent evidence of genetic factors influencing vulnerability to eating disorders, the details are far from clear."  Hewitt makes a great point; even though there is evidence to support the idea that eating disorders can be influenced by genetics, it still is difficult to understand just how much of an influence they have.  However, the research done does point to the conclusion that genetics factors exist and with those findings, further research is being done to better understand those factors.  Also, Giordano argues that while twin studies do provide evidence that there are higher concordance rates for monozygotic twins with eating disorders than dizygotic twins, the results from those studies remains unclear.  Giordano states that, "To render these results more reliable, it would be necessary to study identical twins brought up separately, and to assess whether there is also a concordance rate among identical twins brought up separately, and what this is" (Schellenberg).  However, if both types of twins, monozygotic and dizygotic, are studied non separated, why does that cause an issue in the research?  The fact of whether or not the twins have been separated should not cause an issue as long as both the monozygotic and dizygotic twins are not separated.  While those who argue that the genetic and biological factors are unclear and not supported well enough make good points, the disorders as a whole are unclear and difficult to understand so I would not say the issue lies in whether or not genetics and biology play a role.  The issue is we are unable to completely understand eating disorders, what they are, and what their causes are as a whole.

It is safe to say that eating disorders are a large problem in society and it is important to recognize the issue and work towards helping those affected by them.  However, in order to be able to help those affected, we have to be able to understand eating disorder and what all goes into them before we can treat them.  Numerous amounts of research has been done to provide evidence for the sociocultural, family, individual, genetic, and biological factors that play a role in the development of eating disorders.  Yet, even with this research, many often overlook the genetic and biological factors which is arguably the most important issue to look at.  It is important for the understanding of eating disorders to grow that these factors not be overlooked but yet even explored more with research in order to work towards better treatments for eating disorders.  Once society and researchers are able to look at eating disorders as a whole and all the risk factors associated with them, doors can open to allow the best understanding of eating disorders to emerge which can lead to the best therapies being provided for victims of eating disorders and maybe lives can be saved.

