As a clinician who works with eating disorders, I cannot tell you how many times I have heard the same question posed over and over again by clients and their loved ones: “Kristin, what caused this eating disorder?” There is normally a sense of desperation in this question hoping that I will somehow have the magic key that unlocks the door that has the secret cure for this eating disorder. There is a hope that we can identify the one thing that explains this entire disorder and if we can address that one experience, chemical imbalance, or personality trait, everything will get better. This person will be cured. The desperation comes from a deep desire to do anything necessary to lessen the pain. The desperation comes from a confusion around how the happy-go-lucky, careless little 5 year old girl grew up to be a 23 year old woman struggling with overwhelming emotional pain that she had figured out how to numb with an eating disorder so she didn’t have to show the world what she was actually experiencing internally.

If you ask people with eating disorders if they would have initially chosen to engage in whatever behavior is active in their current disorder if they knew what they know now, most would say they never would have engaged in that behavior the first time. But the thing is they didn’t know. Just like every person on earth, they were wired to find relief for their distress. And the behavior they engaged in worked to lessen or sometimes eliminate their distress temporarily, which is what continued the behaviors. They just weren’t planning on the behaviors they used to find relief and control eventually being the things that would start to control them.

We all develop defense mechanisms to lessen emotional distress and discomfort. We call these coping skills. Each person develops different coping skills based on a variety of biological, psychological, social, and environmental factors. Some coping skills we stereotypically think of include activities like journaling, exercising, talking with a supportive person, creating art, and listening to music. But in all reality, a coping skill is anything that helps us change what we are feeling or numb our distress. How many of us enjoy shopping for example? Or maybe we are the people who throw ourselves into our work to get away from everything going on at home. For some of us, we turn to substances like alcohol to take the edge off. Others turn to food intake or output. Some of us utilize control and perfectionism as ways to cope. Regardless of what we utilize, it all has the same purpose: to provide us with relief.

The challenge with this is that some of the coping skills we use to gain relief and re-establish our control when we are feeling out of control end up being the things that eventually make us most out of control. Most coping skills are healthy in moderation; however, even some of the most seemingly harmless coping skills like work, food, and exercise can become problematic when used in excess or when they start to take precedence over other important aspects of our lives. So let’s talk about what contributes to the determination of which coping skills we end up engaging in. As referenced above, we’ll break it down into three separate categories: biological, psychological, and social/environmental. Please note this is not an exhaustive list of possible contributing factors but is being utilized to provide examples of what some contributing factors may be. Other factors may apply more specifically to you; please feel free to substitute your personal examples as you read through this list.

Biological Contributing Factors

  1. Genetics
    1. There are researched correlations in the occurrence of mental health disorders in almost every mental illness when comparing presence of mental illness in family members.
  2. Neurochemistry
    1. If we have naturally imbalanced neurotransmitters (chemicals that help us stabilize our mood, assist us with emotion regulation, and allow us to feel pleasure), we are more prone to developing unhealthy coping responses.
  3. Prenatal Environment
    1. What was going on while we were in our mothers’ uteri also affects the ways our brains develop. For example, if our mother was under a lot of stress during her pregnancy, we would be exposed to higher levels of cortisol as our brain was developing. This may imbalance our natural level of neurotransmitters. If our mother used substances, our brains and bodies developed while depending on those substances which makes us much more likely to develop an addiction later in life.

Psychological Contributing Factors

  1. Stress and Anxiety
    1. The levels of consistent stress and anxiety in our lives have an impact on our need to find relief. Higher levels of stress are associated with greater likelihoods of engagement in unhealthy coping mechanisms, particularly if self-care is something we also struggle to find time for or believe we are worthy of.
  2. Trauma
    1. When most people think of trauma they think of unwanted sexual experiences, combat, physical violence, and experiences like car accidents; however, trauma is really anything that threatens our life as we know it. For example, losing an important person or relationship, parental divorce, being a victim of theft, natural disasters, constant chaos, and consistent unpredictable environments all are experiences that will cause the same response in our brains as what we stereotypically think of as trauma. Witnessing others experiencing traumatic events can also cause similar responses. When our brain experiences severe trauma or is repeatedly exposed to traumatic situations, it can develop a consistent state of anxiety. If we don’t have the ability to re-establish our safety and process these experiences with a supportive family member, friend, or helping professional, our brain can remain anxious and on-guard as a way to try to protect us. We may be hyper-aware of our surroundings and need to know what is going on at all times around us. We may experience nightmares, flashbacks, or intrusive images of the experience. We may not feel safe in relationship and maintain emotional or physical distance from people. We may experience somatic responses like stomach aches, headaches, and muscle tension. If we experience trauma, we are likely to find something to minimize the distress we experience in the aftermath.
  3. Grief and Loss
    1. Arguably, grief is one of the most painful emotions in human existence, and it is also an emotion that all of us are destined to experience at some point as we will lose important people, jobs, material items, pets, and situations throughout our lives. Each time we lose something important, it will hurt. The more it hurts, the more important that person or thing was to us. Navigating that pain is always challenging.
  4. Mental Illness
    1. All mental illnesses creates various levels of distress for the people they affect. If not effectively treated, people are likely to find other ways to cope with the emotional overwhelm that is present due to mental illnesses.
  5. Self-Worth & Self-Esteem
    1. How much a person believes they are worth and how much confidence they have in their abilities also impacts what they chose to engage in to cope and how often they feel distressed.
  6. Shame & Guilt
    1. Dr. Brene Brown identifies there is a significant difference between shame and guilt. When things don’t go as planned, guilt tells us “I made a mistake. I need to do better next time or I need to do something to repair this.” Shame tells us “I am a mistake.” Guilt has a positive correlation with changing behaviors; however, shame has an inverse correlation with behavior change. If we believe we are inherently flawed, damaged, unloved, etc., in addition to creating a level of hopelessness in our ability to change situations if we are the problem, we also experience emotional distress around our worthiness.
  7. Perfectionism
    1. People who are perfectionistic and focused on meeting other people’s expectations for approval are more prone to developing maladaptive coping responses because they base their worth on an impossible standard.

Social/Environmental Contributing Factors

  1. Media
    1. In a culture that glorifies and idealizes thinness and beauty in women, direct and subliminal messages are continuously sent that our image and our worth have a direct correlation.  We receive messages from TV shows, movies, magazines, news programs, advertisements, and social media that all show us what is “most desirable.” If we do not fit into society’s expectations of how we are supposed to look or act, we are taught we are less than, particularly if this ideal is also reinforced in our relationships with family, friends, school, church, or other places in our communities.
  2. Social Media
    1. On social media sites like Facebook, Instagram, Tumblr, and Snap Chat, our society is inundated with the gifts of likes, loves, shares, and comparisons every single day. Yet again, a superficial and incredibly powerful way to assess our value and our worth based on the number of friends we have, the number of likes we receive on a the pictures we post, and the ways our lives look in comparison to the filtered perceptions of the lives our friends post about. Theodore Roosevelt once said, “Comparison is the thief of joy.” In addition to robbing our joy, social media tends to distort our expectations of what is normal and exacerbate any insecurities we may have.
  3. Family Norms and Expectations
    1. The way we were raised and what we were taught was acceptable (directly or indirectly) has an impact on how we learn to respond when life is going well and when life gets hard. If, for example, it was directly or indirectly unacceptable or perceived as weak to express emotion, when things get hard, I will find other ways to relieve my distress. If I live in a home where we have a lot of secrets or don’t talk about the hard things like anniversaries of important events, harmful events that happened to family members, or Aunt Sally who everyone knows is a lesbian but no one talks about, I learn that it is not okay and potentially shameful to talk about (much less experience) anything outside of what my family perceives is okay or normal. If I grew up in a family where it was normal and acceptable for people to get drunk or fight on a regular basis, I will learn that is what is to be expected. Conversely, if I grew up in a home where open communication was promoted, physical safety was ensured, and support was provided, I have more access to opportunities to cope in healthier, safer ways.
  4. Peer Influence
    1. As humans, we are easily influenced by who surrounds us and what the group norms are. For example, you will notice that high schoolers who hang out in the same group normally dress and behave similarly. If it is normal to value body image and beauty, that will likely become important to each person in that group. The same theory applies to behaviors. If it is normal to have a few drinks with your friends at 16, that behavior will likely be engaged in. If it is normal to have open communication about how someone is feeling, that will be encouraged in interactions. Who we surround ourselves with can either promote health and wellness or add challenges to our recovery journeys.
  5. Safety of living environment
    1. If I live in an environment that is regularly unsafe or chaotic, in order to feel less anxious and on edge, I am going to need to do something to help me cope. This environment could be physically unsafe or emotionally unsafe. As humans we crave predictability. It helps us feel safe. Unpredictable environments cause internal distress and anxiety, particularly if there is also a lack of emotional and physical safety available.
  6. Accessibility
    1. How much access do I have to engage in unhealthy behaviors? Is the drug dealer on the corner down the street or do I have to go looking for it? Do I have access to health and support services if I need it? What kind of access do I have to educational opportunities?
  7. Engagement in faith or religion
    1. Faith can be a strong asset in maintaining health or a contributing factor to exacerbated engagement in unhealthy behaviors. If a faith has a shame or punishment-based theology, that has been shown to be correlated with exacerbated rates of mental illness. Conversely, if a faith has a higher power who is loving and caring and/or provides a strong support system with its members, that can be beneficial in developing healthy coping responses.
  8. Opportunities to engage in healthy coping skills
    1. What opportunities for engagement in healthy activities exist? Is it possible for me to engage in sports, the arts, yearbook, volunteering or other activities that may provide me with healthy outlets?
  9. Healthy support
    1. Having healthy support through a mentor or supportive adult reduces the likelihood of engagement in unhealthy, maladaptive, or risky behaviors.
  10. Occupation
    1. Some occupations that are focused on body image or have consistently high stress levels involved make someone more likely to develop an unhealthy or maladaptive coping response

So when clients or families ask me what caused this eating disorder to develop the hard news and the promising news is that I cannot provide one answer because there are an endless number of potential contributing factors in determining why we cope in the ways we do. The promising news is that because there are so many potential contributing factors, there are also just as many actions we can take to change what is going on around us and inside us that can move us one step closer to recovery.

Water’s Edge Counseling and Healing Center has assisted countless clients in identifying and processing through the contributing factors that led to engagement in maladaptive coping behaviors. We understand that these behaviors have a valid purpose and work with our clients to get those needs met in alternative healthier ways. If you or someone you love is struggling with an eating disorder or other mental health concern, you should not have to navigate this alone. We would be honored to provide support and walk alongside you in moving towards a life of freedom and recovery. Our team would be happy to answer any questions you may have and ensure you are set up with the support you deserve. Please reach out to our team by calling (952) 898-502.