The Role of Social Environmental Issues in Anorexia and Eating Disorder

Having better knowledge about what lies at the roots of an eating disorder, the world could improve in order to make the environmental triggers as small as possible. This is already happening slowly in the fashion industry, as mentioned earlier, but things could go a lot faster and there is always room for improvement. For example, children should get informed at a young age about the dangers of eating disorders and they should be told never to discuss someone’s weight. Parents should always keep an eye out for mental illnesses when they have adolescents living in their house, in order to be there for them if needed. If they are aware of the struggles or the predisposition to anorexia of their child, they should always take small steps when making big life changes, keeping their situation in mind.

Nature perspective

Historically, people have thought anorexia nervosa to be a purely psychiatric illness. Anorexics were told to “just stop”, as if it was a disorder of choice. But in the last 20 years, more and more research has been done to prove the opposite. And with success; in 2006, researcher Cynthia Bulik, professor at the University of North Carolina, was able to demonstrate that eating disorders are familial disorders, meaning that those with a first-degree relative - a parent, sibling or child - who had the disorder have a much higher risk of anorexia. She studied more than 31,000 twins and found out that if one of the twins was coping with any kind of eating disorder, the other most often also struggled with their weight to some capacity (Bulik, Sullivan, Wade, Kendler, 2000). This study, however, does not prove that genes play a part in this. Families often also have the same or similar lifestyles and living situations, therefore it could be that these results are a reflection of these factors. Bulik does mention that genes are definitely at work here but she doesn’t have the data to prove this statement or to say what gene that would be. Either way, she says, 'this is not a one-gene disorder. We will never find one gene that causes anorexia nervosa. It's a complex trait, and that's a real scientific term which means it's influenced by multiple genes and multiple environmental factors.' (Hitti, 2006) This year, progress was made again when for the first time ever, scientists were able to identify multiple specific gene variants linked to anorexia nervosa.

This study, yet again carried out and led by Dr Cynthia Bulik, consisted of an extensive analysis of the genetic information of roughly 17,000 patients with anorexia nervosa along with a comparison with the DNA of 55,500 people without the condition. In other words, the research team looked for specific genes in the anorexic patients that the “healthy” people didn’t typically have. Genetic epidemiologist Nicholas Martin, (2019) explained, 'We've got the first eight genes, but we know there are hundreds more genes to find, and we can only do that by broadening the study and recruiting more participants” (Dockrill, 2019). Bulik and her team discovered that multiple of these genetic markers are connected to metabolism. Prior to this research, metabolic abnormalities had only been linked to anorexia nervosa as a result of extreme dieting and starvation. Starvation is not a symptom of anorexia, starvation is a pre... of anorexia. It affects the brain and could even reduce its volume. This could increase anxiety, cause mood changes and create a loss of appetite. All of these factors could make someone more vulnerable for eating disorders and it could also make it more difficult to eventually return to normal dietary habits (Mayo Clinic Staff, 2018). But Bulik was able to prove that DNA-recorded metabolic differences could also contribute to the development of the disorder, not as a result of starvation. It is not yet understood what this link really means for modern science, but it seems logical that people that have metabolism-related differences in their DNA in some way have a biological predisposition to the condition (Dockrill, 2019). Next to these biological DNA aspects, psychological factors also play a part in the nature side of the anorexia development debate. There are, in fact, many personality traits that could influence the likelihood of someone developing anorexia.

First of all, extreme perfectionism, in other words, holding unrealistically high standards, is a personality trait often associated with anorexia nervosa. This peculiarity can have people feeling like they are never thin enough, and therefore never beautiful enough. They strive for perfection even when that could be fatal. One concerned man posted on an eating disorder support page that his “girlfriend with anorexia would rather die than therapy or gain weight” (anonymous, 2016). This woman knew that she had a serious problem, but she was so unhappy with herself that even though she was dangerously underweight she still didn’t feel satisfied with her weight, and she didn’t care that it might lead to her death (NEDA, 2016). Another very common personality trait that anorexic people often have in common, is having control issues. When you either feel like you need to control everything and you can’t, or you have lost control of a situation, one (obviously unhealthy) way that people cope with that is through controlling their body and their eating patterns. Researcher Emily Troscianko explains control-related anorexia as: “The sufferer attempts to take control of her life by exerting control over one section of her life, her diet and thereby her body, and illness develops when that exertion of control turns into its opposite, the state of being controlled by a pathological compulsion to control.” But maybe even more important, studies show that about two-thirds of people with eating disorders also suffer from anxiety disorders, most often obsessive-compulsive disorder, also called OCD (Cowden, 2019). Obsessive-compulsive manners can make it easier and more natural for anorexics to deprive themselves from food despite feeling hungry or to stick to their strict diets. People struggling with eating disorders also experience high levels of general anxiety as well. Anorexia nervosa, bulimia nervosa; these names themselves basically say it all, as anorexia nervosa literally means nervous loss of appetite. Nervous or, in other words, anxious patients may try to reduce their anxiety by restricting their eating, incidentally leading back to the control issues mentioned earlier (Mayo Clinic Staff, 2018).

Anorexia nervosa is related to all of these personality traits. But it doesn’t mean that when someone has any or all of these characteristics, they are bound to develop an eating disorder. Having those just increases the chances. If these ideas get better developed by means of further research that could provide a major breakthrough in eating disorder treatment. As mentioned before, there is no good way to treat anorexic patients at the moment. Patients often keep their struggles to themselves and let it go on for way too long, possibly until a point of no return (this is where metabolism comes into play). If they do get treated it is generally a combination of therapy and people keeping an eye on them. In the worst cases anorexics are enrolled in 24-hour care and possibly force-fed, having to give up all of their freedom just to stay alive. Imagine the possibilities if scientists were able to find genes directly related to anorexia nervosa, or other eating disorders. Not only could someones predisposition to anorexia be predicted before their birth, and therefore either be prevented or immediately dealt with, specific treatment or medicine could be invented to face the problems head-on, instead of having to take the long and uncertain route. Evaluation Undoubtedly, both nature and nurture play a part in the development of anorexia nervosa. Every argument mentioned in this report is a valid and potential cause of anorexia. However, it is not possible to prove how much influence each element has on someone struggling with anorexia nervosa, as it is based on qualitative research. In other words, the results are based on how people experience things rather than accurate numbers and hard proof. All arguments mentioned in favour of the nurture perspective are based on experience-based studies. Anything could be a cause of anorexia, but not everything is.

Sometimes there are underlying issues that the patient either doesn’t think of or doesn’t want to talk about. Moreover, this perspective addresses modern culture as an important factor of anorexia in today’s society. Rightfully so, because it is very obvious that the current ‘ideal’ body is thin and lean. However, historians and psychologists have found evidence that people have been dealing with anorexia related symptoms for hundreds or thousands of years, when there was no such thing as the ideal body or photoshop (Deans, 2011). On the other hand, the arguments on the nature side of the debate are based on quantitative research and would therefore seem to be more reliable. Yet, they show that people have certain genes, or specific personality traits that make them more likely to suffer from this disorder, but they don’t prove that these characteristics are the actual cause of it. Also, the nature perspective discusses personality traits, and even though they are most often recorded in your DNA (i.e. nature) they are influenced a lot by environmental factors (i.e. nurture), so the argument is less relevant to answer the question which side is more important, as it could be put forward to fit both perspectives. On top of that, almost all of the research into the link between genetics and anorexia nervosa was carried out by Dr Cynthia Bulik. There weren’t many other studies to back it up or to bring a different perspective on it, therefore one might argue that it is less reliable as a source. Either way, all arguments mentioned in this report were retrieved from reliable, unbiased sources and are written and supported by well-known and respected scientists and professors. Based on this alone can neither perspective be declared as stronger? However, based on all the previously mentioned counter-arguments, one could say that the nurture perspective is stronger. Especially in modern times. Conclusion Taking everything into consideration, it would be logical to answer the question: “what best explains the development of anorexia nervosa?” with nurture-based arguments, such as social pressure and modern media influences. Based on the information available and the research done up until now, it is difficult to prove the part nature plays in causing eating disorders. However, Dr Bulik’s studies sound promising and could eventually lead to a much different outcome of this debate. She has already proved that susceptibility to the disorder might be hereditary and she is continuing to study DNA-related anorexia. Therefore, I think this question cannot be answered with today’s knowledge. If anything, the development of anorexia can be explained as a build-up of multiple factors.

The unfortunate combination of obsessive-compulsive personality traits with certain environmental issues is often what lies at the root of an eating disorder. It would be interesting to do more research on this subject, especially because if a specific cause was to be found, we might be able to provide better treatment or to prevent numerous cases of anorexia nervosa. Right now, most people are treated with therapy and people in a very bad condition are institutionalized and force-fed. But all of this could be improved if we had more knowledge on the real factors underlying anorexia nervosa. Reflection After finishing writing this research report, my opinion on the subject hasn’t really changed, only I have become more informed about exactly how complex eating disorders like anorexia nervosa are. Before I did all of this research I just knew what I had heard on the news; that anorexia is a mental disorder caused by insecurity and body-shaming. Now I know that that could be an element in the development of anorexia, but it could just as well not be. I found it difficult to do good research on anorexia nervosa because there is no way to find quantitative studies on the causes of the disorder, as it is impossible to test that. Hence the unclear conclusion that further research needs to be carried out, using new testing techniques. I should have realised beforehand that this is a difficult subject to write about because there are so many things to take into consideration. Also, there were only a few scientific articles online discussing both the nature and nurture side of the development of anorexia nervosa, which made it more difficult for me to compare and contrast these perspectives, as nearly no one had done it before.