User:Tara Fishback/sandbox

Introduction
Eating disorders are often identified by obsessions with food intake, body shape, and weight. The average age of onset for most eating disorders range from 18-21 years-old. In 2003, 1.2% of Americans were diagnosed with Binge Eating Disorder, .3% were diagnosed with Bulimia Nervosa, and .6% were diagnosed with Anorexia Nervosa. These prevalence rates have only increased since that time. The etiologies of eating disorders differ from patient to patient, however in the literature, there are some patterns that have emerged. There is a large body of research reviewing the impacts psychological, developmental, and sociocultural stressors and factors that may lead to eating disorders.

Traumatic Experiences
There is evidence to suggest that a history of trauma may influence the development of eating disorder symptomatology. A study examined a group of 98 patients with eating disorders and found that 25% of those patients had experienced traumatic events, and scored significantly higher on the Dissociation Questionnaire (DIS-Q). The researchers also found that 12% of the participants experienced dissociative experiences significant enough to indicate dissociative disorders.

Patients who have eating disorders and a history of childhood trauma have poor treatment outcomes. In a study examining 73 patients with eating disorders, researchers found that emotional abuse, physical neglect, and sexual abuse were all significant predictors of eating disorder symptomatology. The researchers found that depression was a mediator of this relationship, while obsessive-compulsive symptoms were not. These results suggest that experiences of childhood trauma are important to assess in patients who have eating disorders, especially in patients who are experiencing poor treatment outcomes. These results also suggest that regardless of traumatic childhood experiences, depression is a predictor of future eating disorder symptomology.

Obsessive Compulsive Disorder
Obsessions with food intake, body weight, and shape are hallmark symptoms of eating disorders, which has led researchers to examine the role that obsessive compulsive disorder may play in the etiology of eating disorders. Researchers found that out of self-esteem, obsessive compulsive symptoms, locus of control, and depression, obsessive compulsive symptoms were the best predictor of eating disorder symptomatology. Separate researchers also found that in patients with eating disorders, there was a positive relationship between the severity of the eating disorder and presence of obsessive compulsive disorder. The researchers also concluded while there are common traits between the presentations of eating disorders and obsessive- compulsive disorder, the clinical presentation is different.

Researchers have also investigated the relationship between experiencing obsessive compulsive disorder (OCD) as a child and developing an eating disorder later in life. This was a longitudinal study in which 231 children who were diagnosed with OCD were assessed over the course of 9 years. After 9 years, at follow up, 12.7% of the participants had developed an eating disorder. There was also a relationship between female gender and persistent OCD with and eating disorder diagnosis at follow up.

Society and Culture
There are two main perspectives when it comes to cultural factors as etiologies for eating disorders. The first perspective is that the etiology stems from the societal culture, and the second perspective is that it stems from the familial culture.

The researchers backing the first perspective, societal, often reference the higher prevalence of eating disorders in Western cultures, and in women, specifically women who are involved in aesthetic sports or careers such as gymnastics, modeling, and volleyball. The research surrounding the societal perspective also emphasizes the power that cultural standards play, such as the “thin ideal.” These societal beauty standards are so powerful that it is often the case that even women without eating disorders, are still often unsatisfied with their body. Researchers have found that one of the most pervasive societal factors impacting beauty standards is exposure to media. Exposure to today’s media is positively correlated with negative body image and the development of eating disorders.

The other perspective, familial, posit that when one experiences or develops a distorted body image, it stems from familial influences. Researchers of this perspective often bring to light the argument that although all women are exposed to societal beauty standards, not all women develop eating disorders. Researchers have also found that daughters are most likely to diet in families where mothers described them as overweight and commented on their weights. Keel and colleagues also found that daughters’ weight dissatisfaction was associated with their fathers’ own weight dissatisfaction, and comments on their daughter’s weight.

Race
If one zooms out and looks at the research surrounding eating disorders from a birds eye view, they would likely think that eating disorders almost only effect White, high SES, cis-het women. And this is not the case. There is a grossly limited amount of eating disorder research studying non-white and non-female populations, which is so incredibly problematic.

Amongst the few studies looking at Black populations, researchers found that Black, adolescent, females are more likely to exhibit bulimic behavior than their White counterparts. Recurrent binge eating was found to be more common among Black women than among White women and Black women were more likely to report fasting and the use of laxatives. A third research study found Anorexia to be less common in Black Americans, however, researchers found that Black Americans may develop Anorexia at a younger age, and suffer with symptoms of Anorexia for longer than White Americans.

Conclusion
Based on the literature today, there are many hypothesized etiologies for eating disorders. Some of the factors found to be risk factors for eating disorders are traumatic experiences, a history of obsessive compulsive disorder, and exposure to negative societal and familial influences. That being said, not all people who experience these risk factors, go on to develop an eating disorder. For this reason, it is important that clinicians examine all potential etiologies when treating patients who have eating disorders.