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Literature Review
Possible Contributing Risk Factors to Eating Disorders
Allison Norris
GA: Amanda Culley
Professor: Robert Brannan
Nutrition 2200

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Introduction
There are many different risk factors involved when diagnosing eating
disorders, like anorexia, bulimia, and binge eating. These diseases are increasing in
more people everyday, making it crucial to understand what causes someone to fall
in such a devastating disorder. This review will cover an array of contributors:
mothers roles, gender, effect of media, sports emphasis, personality traits, and
stress-related life events.

The role of mothers and contributions to eating disorders

Many different studies have conducted that family roles, specifically
mothers, and the influence of your children can widely affect an individual and lead
to an eating disorder. Parents serve as role models, providing examples for
attitudes, coping skills, and eating habits, as well as setting standards for perfection,
ambition and acceptance (Hall & Cohn, 1992). When families take these to extremes,
this can show many negative affects. Studies have shown that whenever mothers
tend to restrict their diet, then children follow. A study has been done that shows
similarities between mothers and daughters restraint and dieting behaviors among
children as young as 10 years old (Hill AJ, 1990). This can make sense due to the fact
that a childs mother is their main role model, and whenever the mother is
restricting her intake, then this can lead to a childrens restrict in their intake due to
following and admiring the behavior.
Another study was conducted using 221 mother-child dyads that were
accessed using self-report measures. The results showed that the mother of children

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with a history of an eating disorder themselves had children that with significantly
higher symptoms of eating disorders. Also, mothers with a higher concern for their
childrens weight had a history of an eating disorder themselves (Allen, 2014). This
shows that mothers who had an eating disorder in the past have significant effects
on their own childs eating behavior.
A next study was done that was a completed survey done by 218 mother and
daughter pairs; The mothers completed survey items regarding the frequency of
weight talk by parents, and girls completed survey items assessing outcomes
including body dissatisfaction, weight control methods, and binge eating habits
(Bauer, 2013). The results showed that the more frequent comments mothers made
to their daughters about their weight, then the greater prevalence of extreme weight
control behaviors and greater prevalence of binge eating. The exact results were
that 4.2% of children whose parents did not make a comment on weight did not
have any of the weight control behaviors, while as high as 23.2% showed eating
disorder behaviors. There is quite a difference there that can support the fact of
mothers having a role in eating disorders.

The role of gender in eating disorders

Millions of Americans are afflicted with an eating disorder every year, and
most of them -- up to 90 percent -- are adolescent and young women. (Grohol,
2013); numerous studies show gender has much more a more significant risk in
playing a role in eating disorders. A study done surveyed 235 adolescent girls and
boys that highlighted questions such as self-esteem, reasons for exercise, and ideal

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body shape versus current body shape. The conclusions were that boys reported to
be heavier or lighter for their ideal weight, while girls only wanted to be lighter.
Also, with girls, body dissatisfaction was much more associated with a low selfesteem, while boys did not make this correlation. Women prefer body shapes that
are well below their current body shape and even smaller (Fallon and Rozin, 1985).
This is a leading factor for woman to create an eating disorder when the desire is
strong to be so thin.
Another study was done to show the prevalence of eating disorder habits
between men and women by taking a random sample of men and women and asking
binary questions. Results further more showed that there were significant results of
women who body-checked and also had more of loss of control when eating over
men (Furnham, Badmin, Sneade, 2002). Different studies proved this by reading top
10 magazines read by men and women; Findings showed that magazines for women
contained 10.5 times as many advertisements and articles promoting weight loss as
the men's magazines. (Anderson, 1992). According to all of these studies, it can be
sought out that eating disorder habits are more prevalent in women than men.

The role of media in eating disorders

The highest reported prevalence of disordered eating occurred during the
1920s and 1980s, the two periods during which the ideal woman was thinnest in
U.S. history (Boskind-White & White, 1983). This is in itself a prevalent finding that
can possibly correlate to the pressure and ideal image to being thin can cause
women to having eating disorders.

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Studies have shown that televisions increasing preoccupation with beauty,
thinness, and food (Garner, 1980; Silverstein, 1986; Toro, 1988). Media
advertisements that are targeted to young women all consist of thin woman and
unrealistic models. Women who are heavy viewers of thin and ideal media may be
at higher risk for an attitude of thinness being socially desirable, experience greater
body dissatisfaction, and use weight loss behaviors due to their standard of
comparison on the media (Biber, Leavy, Quinn, & Zoino, 2006).
A study done when asking participants how often they compare themselves
to models and actors /actresses when they see them on television showed
significant results. Correlations between comparison with media figures and
individuals having a low body dissatisfaction were shown, thus indulging in eating
disorder behavior (Strownman, 1996).
From 1959-1978, it was concluded that media beauty icons met the criteria
for anorexia nervosa (Wiseman, 1992). Even more so, another study analyzed
popular television shows among middle school girls. The conclusion was that 94%
of the women were thinner than the average American. (Levine, 1994). 83% of
teenage girls spend an average of 4.3 hours a week reading media magazines for
pleasure, and of that percent, 70% view the information as important fitness and
beauty tips (Levi, Smolak, Hayden, 1994). This strongly suggests that media can play
a role in obsessing over body image, therefore leading to behaviors of disordered
eating, body dissatisfaction, etc.

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The role of sports in eating disorders
Individuals who participate in sports can be under a great amount of
pressure to stay thin. Sports that emphasize greatly on appearance, such as ballet
and dance, are the greatest frequency for eating disorders (Brooks-Gun, Warren,
Hamilton, 1987). One study done compared the psychological profiles of athletes
with anorexics found many common traits, including high self-expectations,
perfectionism, competitiveness, repetitive exercise routines, compulsiveness, a
distorted body image, and preoccupation with weight and dieting (Hansen-Mayer,
2013). Another study was done that showed that female athletes are at high risk for
eating disorders and thus their sport activities lead to more risk factors of eating
disorders such as dieting. 75% of female gymnasts reported in using pathogenic
weight loss controls to keep their weight low for their athletic performance (Rosen
and Hough, 1988).
A different study compared 117 at risk athletes with a comparison group of
non-athletic athletes. Of these athletes 117 at risk athletes, 92 met the criteria for an
eating disorder. The results showed through interviews that eating disordered
athletes engaged in sports-specific training and even began dieting earlier compared
to a normal non-at risk athlete; they admitted that trigger factors for the onset of
disordered eating was increased training volume, or having to do a prolonged
dieting for their sport (Sundgot-Borgen, 1994).
Another study was done reviewing specific female athletes, and this showed
that the sport environment has a unique impact on athletes eating disorder
development. In particular, negative comments by coaches, modeling of eating

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disordered behaviors by other athletes, and sport performance pressure all
contributed to eating disorders (Arthur-Cameselle, Quatromoni, 2014).

The role of personality traits and behaviors in eating disorders

Patients with eating disorders are commonly believed to demonstrate
extremes of personality characteristics (Kleifield, 1994). Obsessive Compulsive
Disorder is a significant trait in patients with Eating Disorders. Eating disorders are
characterized by behaviors very much alike to that seen in Obsessive Compulsive
Disorder, such as obsessive thoughts about food and calories, food rituals, choosing
food based on color, shape, etc. (Ekern, 2012). Activities in OCD are done to reduce
anxiety, as is eating behavior patterns does so in eating disorders. During a study,
subjects with eating disorder in general scored higher than healthy individuals for
the Maudsley Obsessive Compulsive Inventory scores (Anderluh, 2003).
Another contributing trait is depression; many behavioral studies support
that there is a relation between eating disorders and high rates of psychopathology,
such as depression, anxiety, impulsiveness, and low-self esteem. Throughout
selected studies, there has been a significant association between binge eating and
depression (Araujo, 2010). Body dissatisfaction and depression appear to be hand in
hand, as there are links between depression and body dissatisfaction. (Keel,
Mitchell, David, Crowe, 2001).
Perfectionism and a sense of personal ineffectiveness are considered to be
major risk factors in the development of eating disorders (Bruch, 1973; Swift &
Wonderlich, 1988). This makes sense because it applies to the whole scheme of

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wanting things to be perfect and obsessing, such as weight and looking perfect. This
puts enormous pressure on individuals to be thin since todays society is driven
towards that.
Another personality factor is loss of control over things; eating disordered
individuals tend to want more control, and do so through the disease and control of
food intake and weight. This leads to a sense of empowerment. A study done of
comparing 45 individuals with eating disorders and 55 controls proved results of
significantly lower perception of control and self-esteem and higher concern over
mistakes, drive for thinness, bulimia, and body dissatisfaction than the control
group (Sassaroli, Gallucci, Ruggiero, 2008).

The role of stress-related life events and eating disorders

When we feel overwhelmed or out-of-control, we naturally try to find ways
to cope with these unpleasant feelings. For some, binge-eating or restricting calories
becomes a way of dealing with the stress. Gregoire, 2013). There have been several
studies done to demonstrate a correlation between individuals who have had
traumatic experiences who later develop eating disorders. One experiment
compared non-eating disordered individuals with an eating disordered group;
reports showed indeed higher rates of being beaten in childhood (36% versus 8%),
mother-child abuse (32% versus 4%), and sexual abuse (20% versus 0%) in
individuals with eating disordered versus non (Oliviarda, 1995). It was also noted
that five of six patients on an inpatient unit for eating disorders revealed an early
history of sexual abuse or incest (Sloan, Leichner, 1986).

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Higher rates of divorce have been observed in individuals with bulimia
nervosa as compared to controls (Boumann, Yates, 1994). A study was done with
1,810 female twins who were given a survey that assessed disordered eating. As
hypothesized, the twins with divorced families versus intact families would have
more of a heritability of disordered eating; the results indeed showed that the
disordered eating was a much higher ratio with divorced families than intact
families (Suisman, Burt, McGue, Jacono, & Klump, 2011).

Conclusion
All of the research behind the connection of the disease and specific risk
factors is progress. Mothers of children, female individuals, certain media, athletes,
specific personality traits, and stressful life events have all been backed up by
significant research to be possible underlying causes of eating disorders. Having the
knowledge, about media for instance, can make people more aware about what their
children are exposed toespecially women, since they are at higher risk.
Knowledge is power, and coming to understand this disease has certainly made
progress within the past years. Eating disorders have been recognized as a disease
for years (Engel, 1995), and are still on the rise today even more. If people know
what factors cause such an illness, perhaps such devastation could be prevented.

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