What Are The Causes Of Anorexia Nervosa?

Medically reviewed by April Justice, LICSW
Updated October 10, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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Determining the cause of an eating disorder can be complicated. However, acknowledging the symptoms and feelings behind it can often be the first step toward healing. 

Today, we’ll discuss potential causes of anorexia nervosa: an eating disorder that’s generally defined by persistent refusal of food and extreme fear of weight gain, among other symptoms.

Read on to learn more about what anorexia is, possible causes and the role that therapy can play in a full recovery.

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Living with an eating disorder?

Understanding eating disorders 

Eating disorders are complex mental health conditions involving disordered eating behaviors, intense fear of gaining weight, and distorted body image perceptions. Here are two of the most common types of eating disorders: 

  • Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight and a distorted body image, often leading to severe restrictions in eating behaviors and a dangerously low body weight. 

  • Bulimia nervosa involves cycles of binge eating followed by purging to prevent gaining weight, which can result in serious health issues such as low blood pressure and other complications of anorexia, bulimia, and similar eating disorders. 

The development of anorexia and other eating disorders can be influenced by factors like family members' attitudes toward body weight and image, highlighting the need for family-based support. To manage these long-term conditions, it’s often crucial to find a doctor experienced in treating eating disorders and to engage with support groups that can provide both emotional and practical assistance.

What is anorexia? 

Beyond food aversions, restriction, and a distorted body image, people with anorexia may have difficulty maintaining a normal body weight. Anorexia isn’t always a primary mental health condition and may occur alongside orthorexia: which is often defined as an obsessive concern with eating healthy, often paired with excessive exercise.

Health professionals may divide anorexia into two subtypes:

  • Restricting: Those who live with this type of anorexia may limit how much they eat throughout the day, which may or may not be impacted by their body image. 

  • Eating/purging: People who live with this type of anorexia may consume large amounts of food, making themselves throw up or using laxatives to “get rid” of the food. This may or may not have an emotional component underlying the behavior.

Some people with anorexia may also be diagnosed with other eating disorders, such as bulimia nervosa or binge-eating disorder (BED). A person with anorexia may experience these conditions simultaneously, or at different points in their lives. 

Ultimately, eating disorders can be about more than just food — often pointing to unresolved feelings or traumatic experiences that drive a need for self-control and mastery. It takes time, patience, and self-compassion to make a sustained recovery, but with proactive treatment, recovery can be possible.

What are the causes of anorexia? 

Researchers and healthcare professionals have yet to identify a singular cause for anorexia. Generally, a combination of genetic, biological, behavioral, psychological, and social factors can increase a person’s risk of developing this disorder. 

Below, we’ve summarized how these factors influence the likelihood of developing anorexia, how they can play a role in the progression of this eating disorder, and how understanding these causes can streamline the path to treatment. 

1. Genetics

Researchers have studied the role of genetics in eating disorders — and have encountered potentially surprising findings. To date, studies of families and twins have suggested that eating disorders run in families due to common genetic factors. Additionally, recent research indicates that genetic contributors to anorexia are related to both psychological and metabolic factors. This research can potentially allow researchers to identify more genetic factors linked to anorexia and other eating disorders. 

2. Metabolic risk factors

One of the largest studies of anorexia, conducted in 2019, was the first to highlight metabolism as a potential contributor to the disorder, based on figures from 16,992 anorexia cases gathered from 17 countries.

For people with anorexia, this can imply that in addition to psychological factors, biological differences in metabolism may also influence extreme weight loss and “relapse”. 

Therapy, in this context, along with other supportive strategies, can still be an effective way to address the underlying mindset and thought patterns associated with anorexic behaviors.

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3. Cultural pressures

While cultural pressures are not the sole contributor to anorexia, it’s impossible to dismiss the effect of beauty standards and weight stigma on our mental health. Across cultures, many TV shows, movies, social media, and other forms of content present thin bodies as the ideal or standard. 

Today, many activists and mental health care advocates speak openly about the enduring impact of weight stigma and fatphobia, in both daily life and healthcare settings. In some cases of anorexia, messaging from a TV show, doctor, or another authority can catalyze or worsen existing anxieties around weight loss.

4. Environment

While a person’s environment includes their culture, it also encompasses family dynamics and relationships that can influence their behaviors around food and weight. 

Naturally, individuals respond differently to family dysfunction, dieting, ideals of thinness, and other environmental risk factors for anorexia. The impact of environment also depends on a person’s age, gender identity, personality traits, and other individual factors, which can interact with genetic risks. 

As a result, two people – even siblings – can grow up in a similar environment, yet emerge with different mentalities around food, exercise, and body image. 

5. Preexisting mental health conditions

People with anorexia may live with other mental illnesses, such as depression, anxiety, obsessive compulsive disorder, personality disorders, or substance use disorders. Studies indicate that between 55% and 95% of people diagnosed with an eating disorder will experience another psychiatric disorder in their lifetimes. 

While the co-occurrence of other mental health conditions is common among people with eating disorders, it’s not always possible to determine whether the eating disorder “caused” the other illness, or vice versa. Nevertheless, these additional diagnoses can complicate both the symptoms and treatment of anorexia.

6. Brain chemistry

According to the National Eating Disorders Association, researchers have identified neurobiological differences in the brains of people with anorexia. 

Studies show that when people with anorexia are actively experiencing the disorder, they have significantly lower levels of serotonin: a brain chemical that controls everything from learning and sleep to mood and appetite. Even after recovering from anorexia, people tend to have elevated serotonin levels, which can correspond with higher anxiety and obsessive behaviors.

People with anorexia may also have elevated levels of dopamine: a brain chemical linked to pleasure, reward, memory, hormones, and other essential processes. In people with anorexia, researchers believe that the over-production of dopamine can lead to anxiety, harm avoidance, and the ability to go without pleasurable things like food. 

7. Brain structure

During puberty, young people experience hormonal shifts and changes in brain structure, which may “turn on” a person’s genetic susceptibility to disordered eating, according to a 2013 study

While more research is needed to understand the connection between hormones and brain structure, parents and other adults can still model healthy behaviors around food, exercise, and body image, especially during puberty: a critical risk period for anorexia and other eating disorders. 

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Treatment options for anorexia

Typically, the treatment for anorexia can involve a combination of therapy and restoring the person to a healthy weight and diet. Treatment will vary depending on your specific needs, and history, however — which is best given by a qualified medical practitioner. For many people with anorexia, therapy can be an essential part of the recovery process. Speaking with a therapist can help one to unravel the possible causes of the disorder and potentially pave a path toward a healthier future. 

Traditional talk therapy and cognitive behavioral therapy (CBT) are both research-backed options for patients with anorexia. A licensed therapist may use a combination of CBT and other techniques to help patients identify the connection between their thoughts, feelings and behaviors, potentially working toward changing their behaviors around food and exercise.

Online therapy for anorexia recovery: How can it support those living with anorexia? 

Today, many people use online therapy to support their eating disorder recovery and other mental health goals. Platforms like BetterHelp can connect patients to licensed therapists, and clients can schedule sessions at a time and place that works best for their schedules. Many BetterHelp therapists specialize in supporting people with anorexia and related mental health concerns.

Online therapy for anorexia recovery: Is it valid?

In general, online therapy is shown to be effective and continues to improve. A 2019 review of digital therapies for eating disorders, including anorexia, suggests that online therapies successfully reduced symptoms as well as anxiety disorder manifestations and depression — based on results from 23 studies.

Takeaway

In most cases of anorexia, a person’s symptoms can develop from a combination of factors. If you’re recovering from anorexia, your doctor and mental healthcare provider may be able to help you understand the possible causes and design a treatment plan that works best for you. Online therapy can be a useful tool to support your recovery. BetterHelp can connect you with a licensed therapist in your area of need.
Healing from eating disorders is possible
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