Risk Factors

Reviewed by Amy Baker Dennis, PhD, FAED

Eating disorders are complex mental illnesses that affect people from diverse backgrounds. Risk factors are characteristics, conditions, behaviors, or variables that increase the likelihood of an individual developing a particular health or mental health related problem. Researchers have identified a range of biological, psychological, and sociocultural risk factors that may be present in those with eating disorders.1 The risk factors listed below apply to those with anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified feeding or eating disorders (OSFED). Information on avoidant/restrictive food intake disorder (ARFID) and pica risk factors are listed separately.

Biological


  • Having a close relative with an eating disorder. Studies of families have found that having a first-degree relative (like a parent or sibling) with an eating disorder increases a person’s risk of developing an eating disorder.1
  • Having a close relative with a mental health condition. Similarly, issues like anxiety, depression, and addiction can also run in families, and have also been found to increase the chances that a person will develop an eating disorder.2 Learn more about co-occurring disorders here.
  • History of dieting. Many people report that their disorder began with deliberate efforts to diet or restrict the amount and/or type of food they were eating. For example, a history of dieting and other weight-control methods is associated with the development of binge eating.3
  • Low energy availability (LEA) is a state in which the body does not have enough energy to support all of its functions because the individual is expending more energy than they are taking in through foods and liquids. Often this is the result of a lack of knowledge about nutritional needs, intensive athletic training or a combination of restrictive dieting and excessive exercise. LEA can be the result of an eating disorder or increase one’s risk of developing an eating disorder and can be found in athletes, those with high energy needs, and/or individuals who underestimate the amount of energy (nutrition) needed for their physical and psychological processes to fully function.4,5
  • Type 1 (insulin-dependent) diabetes. Research has found that up to 39% of women and 15% of men with type one diabetes will develop an eating disorder. The most common pattern is skipping insulin injections, known as diabulimia, which can be deadly.6

Psychological


  • Perfectionism. One of the strongest risk factors for an eating disorder is perfectionism, especially a type of perfectionism called self-oriented perfectionism, which involves setting unrealistically high expectations for yourself.7,8
  • Cognitive inflexibility. Difficulty with going back and forth between different tasks or mental states has been found to be a risk factor for the development of anorexia nervosa.9
  • Impulsivity. Being prone to impulsivity or taking actions without consideration of the consequences, especially when experiencing negative emotions, has been linked to an increased risk of binge/purge types of eating disorders (i.e. anorexia nervosa/binge purge subtype or bulimia nervosa).10
  • Emotional dysregulation. Research has found that having difficulty regulating emotions or having a lack of emotional awareness is a risk factor for all types of eating disorders.10
  • Avoidance motivation. The tendency to avoid thinking, feeling or doing things that are distressing or that may lead to punishment are associated with elevated rates of eating disorders compared to people who do not have a tendency to engage in this type of behavior.10
  • Body image dissatisfaction. Body image encompasses how you feel both about and in your body. It’s sadly not uncommon to dislike your appearance, but people who develop eating disorders are more likely to report higher levels of body image dissatisfaction and an internalization of the appearance ideal.10
  • Personal history of a mental health condition. Research has shown that a significant subset of people with eating disorders, experience mood disorders like depression and anxiety disorders (including generalized anxiety, social phobia, and obsessive-compulsive disorder) before the onset of their eating disorder. For example, studies have found that approximately 90% of individuals with an eating disorder also experience depression and 67% have experienced signs of an anxiety disorder.11
  • Personal history of a substance use disorder. Studies have found that up to 50% of individuals with eating disorders use alcohol or illicit drugs, a rate five times higher than the general population. In addition, approximately 35% of individuals who were dependent on alcohol or other drugs also have eating disorders, a rate 11 times greater than the general population.12,13

Social


  • Weight stigma. Weight stigma is discrimination or stereotyping based on a person’s weight, and is damaging and pervasive in our society. The message that thinner is better is everywhere, and researchers have shown that exposure to this can increase body dissatisfaction, which can lead to the development of disordered eating behaviors such as bingeing or restriction or a full blown eating disorder. 14 
  • Teasing or bullying. Being teased or bullied – especially about weight – is emerging as a risk factor in many eating disorders.8 The harmful effects of bullying have received increased attention in recent years, starting an important national conversation. Individuals with eating disorders are up to three times more likely to have experienced bullying or teasing about their appearance than those without an eating disorder.15
  • Appearance ideal internalization. Buying into the message of the socially-defined “ideal body” may increase the risk of an eating disorder by increasing the likelihood of dieting and food restriction.16
  • Acculturation. People from racial and ethnic minority groups, especially those who are undergoing rapid Westernization, may be at increased risk for developing an eating disorder due to complex interactions between stress, acculturation, and body image.17,18
  • Limited social networks. Loneliness and isolation are some of the hallmarks of anorexia nervosa and binge eating disorder; many with the disorder report having fewer friends and social activities, and less social support.19,20 For example, a study of sister pairs found that participants who were diagnosed with an eating disorder had higher rates of social withdrawal and other behavioral issues compared to participants who did not have eating disorders.8 Whether this is an independent risk factor or linked to other potential causes (such as social anxiety) isn’t clear.
  • Personal experiences of trauma. Studies have found that a significant subset of people with eating disorders have experienced past trauma, such as physical, sexual, or emotional abuse and that childhood trauma can be a risk factor for the development of all types of eating disorders.10

Sources


[1] Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at:
https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/

[2] Redgrave, G. W., Coughlin, J. W., Heinberg, L. J., & Guarda, A. S. (2007). First-degree relative history of alcoholism in eating disorder inpatients: relationship to eating and substance use psychopathology. Eating behaviors, 8(1), 15–22. https://doi.org/10.1016/j.eatbeh.2006.01.005

[3] Hilbert, A., Pike, K. M., Goldschmidt, A. B., Wilfley, D. E., Fairburn, C. G., Dohm, F. A., Walsh, B. T., & Striegel Weissman, R. (2014). Risk factors across the eating disorders. Psychiatry research, 220(1-2), 500–506. https://doi.org/10.1016/j.psychres.2014.05.054

[4] Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A. K., Meyer, N. L., Sherman, R. T., Tenforde, A. S., Klungland Torstveit, M., & Budgett, R. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British journal of sports medicine, 52(11), 687–697. https://doi.org/10.1136/bjsports-2018-099193

[5] Torres-McGehee, T. M., Emerson, D. M., Pritchett, K., Moore, E. M., Smith, A. B., & Uriegas, N. A. (2021). Energy Availability With or Without Eating Disorder Risk in Collegiate Female Athletes and Performing Artists. Journal of athletic training, 56(9), 993–1002. https://doi.org/10.4085/JAT0502-20

[6] Corbett, T., S. J. (2020). Disordered eating and body image in adolescents with type 1 diabetes. Diabetes Care for Children & Young People, 9: DCCYP053. Available at: https://www.diabetesonthenet.com/wp-content/uploads/e61ab456c4e302c6539c5037e668519a-1.pdf

[7] Stackpole, R., Greene, D., Bills, E., & Egan, S. J. (2023). The association between eating disorders and perfectionism in adults: A systematic review and meta-analysis. Eating behaviors, 50, 101769. Advance online publication. https://doi.org/10.1016/j.eatbeh.2023.101769 

[8] Vicent, M., Gonzálvez, C., Quiles, M. J., & Sánchez-Meca, J. (2023). Perfectionism and binge eating association: a systematic review and meta-analysis. Journal of eating disorders, 11(1), 101. https://doi.org/10.1186/s40337-023-00817-9

[9] Steegers, C., Dieleman, G., Moskalenko, V., Santos, S., Hillegers, M., White, T., & Jansen, P. W. (2021). The longitudinal relationship between set-shifting at 4 years of age and eating disorder related features at 9 years of age in the general pediatric population. The International journal of eating disorders, 54(12), 2180–2191. https://doi.org/10.1002/eat.23633

[10] Barakat, S., McLean, S. A., Bryant, E., Le, A., Marks, P., National Eating Disorder Research Consortium, Touyz, S., & Maguire, S. (2023). Risk factors for eating disorders: findings from a rapid review. Journal of eating disorders, 11(1), 8. https://doi.org/10.1186/s40337-022-00717-4

[11] Zanella, E., & Lee, E. (2022). Integrative review on psychological and social risk and prevention factors of eating disorders including anorexia nervosa and bulimia nervosa: seven major theories. Heliyon, 8(11), e11422. https://doi.org/10.1016/j.heliyon.2022.e11422

[12] Bahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis. Psychiatry research, 273, 58–66. https://doi.org/10.1016/j.psychres.2019.01.007

[13] National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2003). Food for Thought: Substance Abuse and Eating Disorders. New York, National Center on Addiction and Substance Abuse. https://www.ojp.gov/ncjrs/virtual-library/abstracts/food-thought-substance-abuse-and-eating-disorders

[14] Vartanian, L. R., & Porter, A. M. (2016). Weight stigma and eating behavior: A review of the literature. Appetite, 102, 3–14. https://doi.org/10.1016/j.appet.2016.01.034

[15] Lie, S. Ø., Rø, Ø., & Bang, L. (2019). Is bullying and teasing associated with eating disorders? A systematic review and meta-analysis. The International journal of eating disorders, 52(5), 497–514. https://doi.org/10.1002/eat.23035

[16] Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. Journal of child psychology and psychiatry, and allied disciplines, 56(11), 1141–1164. https://doi.org/10.1111/jcpp.12441

[17] Song, S., Stern, C. M., Deitsch, T., & Sala, M. (2023). Acculturation and eating disorders: a systematic review. Eating and weight disorders : EWD, 28(1), 39. https://doi.org/10.1007/s40519-023-01563-2

[18] Becker, A. E., Burwell, R. A., Herzog, D. B., Hamburg, P., & Gilman, S. E. (2002). Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. British Journal of Psychiatry, 180(06), 509–514. https://doi.org/10.1192/bjp.180.6.509

[19] Leonidas, C., & Dos Santos, M. A. (2014). Social support networks and eating disorders: an integrative review of the literature. Neuropsychiatric disease and treatment, 10, 915–927. https://doi.org/10.2147/NDT.S60735

[20] Sampedro-Piquero, P., Zancada-Menéndez, C., Bernabéu-Brotons, E., & Moreno-Fernández, R. D. (2022). The Relationship between Binge Drinking and Binge Eating in Adolescence and Youth: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 20(1), 232. https://doi.org/10.3390/ijerph20010232