Potential Causes Of Eating Disorders In Teens: Understanding The Research

Eating disorders often cause an unhealthy fixation on food, body shape, or weight loss and can develop at any age, including in adolescence. Identifying and treating eating disorders early may lessen some of the adverse effects and save lives. Similarly, identifying risk factors for eating disorders may help families in early prevention or early identification. Below, explore common eating disorders and the causes of eating disorders in teens. 

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Eating disorders in teens: The prevalence 

Research published in the Journal of the American Medical Association revealed that about one in seven males and one in five females experience an eating disorder at some point in their lives. Their findings show that across the lifespan, the prevalence of eating disorders begins to climb after age 10 and peaks around age 20 in both sexes. For that reason, many who experience an eating disorder first develop it in or near their teenage years.

Anorexia nervosa in teens

Research shows that anorexia nervosa is the deadliest psychiatric disorder and has a peak age of onset between 15 and 19 years old. Experts once suspected anorexia nervosa was a developmental disorder occurring during puberty. However, with time, research has shown that anorexia can develop in both children and adults. 

People with anorexia nervosa significantly restrict the food they eat to lose weight because they view themselves as overweight, regardless of their body size. This distorted body image leads to an intense fear of gaining weight. Some people with anorexia nervosa also engage in binge-eating and purging episodes in which they vomit or take laxatives to rid themselves of the food they binged.

Causes of anorexia nervosa in teens

Experts aren't entirely sure what causes anorexia nervosa in teens. However, they've identified potential risk factors. The following may be contributing factors in the development of anorexia nervosa:

• Genetics: Researchers have found genes that are more common among people with anorexia nervosa. Some genes more common in people with anorexia nervosa are also more common in other disorders, like obsessive-compulsive disorder (OCD) and depression.
• Dieting: Going on weight loss diets or engaging in dieting behavior, like calorie counting, may play a role in the development of anorexia nervosa among some people. Experts have hypothesized that people with specific genes may be more vulnerable to developing eating disorders, and the food restriction associated with dieting could cause sensitive individuals to develop the disorder. 
• Higher weight: Some people with anorexia nervosa formerly had obesity or were overweight. Having a higher than recommended body mass index (BMI) could potentially lead to a person engaging in unhealthy dieting behavior and ultimately developing anorexia nervosa.
• Thoughts and beliefs: People who have internalized the idea that a thin body is ideal are more likely to develop anorexia nervosa. Those who have low self-esteem and are perfectionistic are also more likely to develop the condition. 
• Social media: While more research is needed, links have been found between social media and eating disorders like anorexia nervosa. Experts suggest that the unsupervised use of social media by youth may expose them to factors that encourage disordered eating.
• Family eating practices: While experts stress that parents are not to blame for their teens' eating disorders, the home environment has been found to contribute to a child's or adolescent's eating habits, including disordered eating. For example, a teen may pick up their parents' unhealthy tactics to stave off weight gain, or they may develop their own habits to avoid binge eating or other unhealthy behaviors they see at home. 
• Gender: Both cisgender and transgender girls face a higher risk of developing anorexia nervosa compared to boys, possibly to meet beauty ideals that laud women for being thin. Some experts suspect that eating disorders are under-recognized in boys due to diagnostic criteria. To meet masculine beauty ideals, boys with eating disorders may be trying to gain weight by building muscle rather than losing weight. However, boys can and do have anorexia nervosa. 
• Other mental health disorders: Anorexia nervosa often overlaps with other mental health disorders. However, more research is needed to identify if developing a psychiatric disorder could cause an eating disorder in some people. Teens with anorexia nervosa may be more likely to have depression, anxiety, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder (ADHD).
• Athletics: Athletes in certain sports face a higher risk of anorexia nervosa. Sports in which a low body weight is considered ideal or provides an advantage may pose a greater risk. For example, long-distance running, gymnastics, figure skating, and martial arts may promote a thinner physique.
• Physical illnesses: Physical illnesses that require a teen to adhere to dietary restrictions, like diabetes or inflammatory bowel disease, may increase disordered eating.

Bulimia nervosa in teens

Like anorexia nervosa, bulimia nervosa generally develops in adolescents. Bulimia impacts up to 1% of adults and 2% of youth. In addition, the condition also stems from an obsession with body size or shape and a fear of gaining weight. People with bulimia nervosa have regular episodes of binge eating, followed by behaviors meant to compensate for the overeating, like vomiting, the use of laxatives, fasting, or excessive exercise.

Causes of bulimia nervosa in teens

The same studies examining contributing factors to anorexia nervosa also look at what increases a person's risk of developing bulimia nervosa. Genes may predispose a person to developing bulimia nervosa while dieting, parents' encouragement of dieting, and social media may also play a role. People who are transgender, athletes, or chronically ill can also face a higher risk. Finally, those with ADHD or other mental disorders are also more likely to have bulimia nervosa. However, more research is needed to understand whether one can cause the other.

Binge eating disorder in teens

Binge eating disorder tends to show signs later than anorexia nervosa and bulimia nervosa, often beginning in late adolescence or early adulthood. Binge eating disorder may also be more likely to appear in adulthood than other disorders. However, the condition can and does develop among teenagers.

When a person has binge eating disorder, they engage in what seems like uncontrollable overeating episodes. At these times, they may eat much faster than usual, eat despite not feeling hungry, and eat until their body is uncomfortably full. Often, people binge eat alone out of embarrassment. They may hide or be secretive about their eating habits. After binge episodes, they may feel disgusted, depressed, or guilty. Unlike people with bulimia nervosa, those with binge eating disorders do not engage in compensatory behaviors after binge eating.

Causes of binge eating disorder in teens

As with other eating disorders, genetics may play a role in the development of binge eating disorder. One study of binge eating disorder found that multiple factors present in childhood could increase the chance a person develops binge eating disorder as an adolescent. These factors include eating when one isn't hungry, a higher body mass index (BMI), anxiety, depression, dissatisfaction with one's body, and a lack of emotional control. Like other eating disorders, binge eating disorder is associated with ADHD and other mental disorders.

Avoidant restrictive food intake disorder (ARFID) in teens

Avoidant restrictive food intake disorder differs from other eating disorders in that it doesn't involve an unhealthy preoccupation with body weight, shape, or size. Rather, people with ARFID often avoid or restrict entire food groups or types of food due to aversion to the taste, texture, or some other quality of the food itself. People with ARFID do not restrict their eating to change their weight, appearance, or size. Their restrictions tend to stem from feelings of disgust or fear related to food, but they can result in weight loss or nutrient deficiencies.

ARFID is a newer disorder, so it hasn't been as widely studied as other eating disorders. However, ARFID appears to occur most commonly among children and adolescents. Adults can also be diagnosed more rarely. Studies have returned a wide range of prevalence for the disorder in the general population, showing that 0.3% to 15.5% of people may have ARFID. 

Causes of ARFID in teens

Some experts say that ARFID may have the widest range of causes of any eating disorder. Some people may develop ARFID after having a negative experience during or after eating, such as choking or vomiting. Others may not feel hungry often or be turned off by the sensory characteristics of many of their food options. ARFID can also be associated with anxiety, digestive problems, a history of vomiting or choking, food allergies, ADHD, and autism spectrum disorder.

Other eating disorders in teens

Eating disorders and mental health in teens

Eating disorders are mental health disorders. That said, developing eating disorders may put people at risk of developing other mental health disorders. The reverse may also be true, as developing a mental health disorder like ADHD, depression, or anxiety may increase a person's risk of developing an eating disorder. More research is needed to clarify the relationship between eating disorders and other psychiatric disorders. 

Therapy and mental healthcare for eating disorders in teens

Teenagers who may be at risk for developing an eating disorder or are living with one may benefit from therapy. Therapy provides a safe space in which a person can talk through beliefs and behaviors related to eating and weight that they may not be comfortable discussing with others in their lives. Remote therapy provides the added comfort of attending sessions from home or any location with an internet connection. Platforms like BetterHelp for adults and TeenCounseling for teens aged 13 to 19 may be more accessible and cost-effective for families. 

Remote treatment options for eating disorders increased during the COVID-19 pandemic. A 2022 peer-reviewed article overviews remote eating disorder treatment for adolescents. The study authors share that family-based treatment (FBT) and cognitive-behavioral therapy (CBT) are evidence-based approaches that appear effective and long-lasting, as remote treatment makes therapy accessible for many.