Eating disorders develop from various reasons. They are either genetic causes (nature), and environmental causes (nurture) and additionally could be both. There are three primary eating disorders. They are Anorexia (AN), Bulimia (BN) and Binge eating (BE). On the genetic, an imbalance in specific hormones can cause medical conditions leading to psychosis such as major depression, anxiety, and bipolar disorder. On the nurture side of things, there are many influences such as social pressure, idealization of body image, wanting to fit in with others, and personality factors such as perfectionism, and low self-esteem.
Natural characteristics are innate and inherited. They are passed in genes via DNA within the family. One such genetic trait, exhibited in primary relatives and passed down to individual children is hypothyroidism.
Hypothyroidism, characterized by an increase in thyroid-stimulating hormone (TSH), low free thyroxine (T4) and low triiodothyronine (T3) causes problems with weight loss, depression, and other medical disorders. “The hypothalamus brain, tells the pituitary gland what to produce, and the pituitary gland tells the thyroid gland what to produce,” (Mirella P. Hage, Sami T. Azar, J, 2011). Thus, the hypothalamus regulates the amount of TSH in the bloodstream by producing TSH Releasing hormone (TRH).
The thyroid gland functions to take iodine and convert it into thyroid hormones (T3) and (T4) by binding iodine in the bloodstream to the amino acid tyrosine (T). Once T3 and T4 produced float in the blood looking for more iodine to repeat the process. When the anterior pituitary gland detects low levels of T3 and T4 in the bloodstream, it produces TSH. It's a vicious cycle because if "T3 and T4 drop in the blood, TSH is manufactured to stimulate the thyroid gland to produce more T3 and T4" (Lin, Yang et. All, 2018).
When the thyroid gland malfunctions and produces very little T3 and T4 and the levels of TSH in the bloodstream increases to significantly high levels. Both T3 and T4 must stay constant in the blood, not only to keep iodine in check and produce a normal synthesis of DNA via tyrosine but “to control metabolism by converting oxygen and calories into energy,” (Mirella P. Hage, Sami T. Azar, J, 2011). Every cell in the body is dependent upon these two hormones for nutrients to function. High levels of TSH results in “hypothyroidism which contributes to mood disorders, bipolar disorders, depression, and anxiety,” (Juneja V, Nance M (2014), to name a few.
The lack of proper thyroid hormones in the bloodstream causes low energy levels, inability to lose weight as weight increases, depression, moodiness, bipolar disorder, anxiety, and difficulty in the ability to conceive a child. Further symptoms include dry hair and skin, brittle nails, fatigue, amenorrhea, inability to tolerate cold and if not treated, an “enlargement of the thyroid gland termed goiter” (Subho Chakrabarti, 2011). Thus, one surmise how these genetic factors concerning thyroid malfunction can lead to psychosis and eating disorders.
My family suffers from hypothyroidism. My maternal grandmother had hypothyroidism. My mother has it, and out of five children, 3 of the five have developed hypothyroidism. While genetics endocrine disorders play a factor in eating disorders, at least concerning hypothyroidism, nurture also plays a factor.
Nurture refers our exposure to stimulus from the world around us, which impact who we and include our early childhood experiences, parenting, our social relationships, and our surrounding culture. Additionally, there is an emphasis on the role of parents, other individuals, and the context in which one lives in assessing what primarily influences development.
An example of a nurturing influence is abuse. Abuse in children has a negative impact especially in their teenage years and well into adulthood. In a study conducted on twins of sexual abuse, studies show that abuse of one twin and not both led to the twin abuse developing an eating disorder and the other not. (Bolinskey, Neale, Jacobson, et al., 2004). Violence is one of many links to eating disorders.
Additionally, the inability to deal or cope with stressors plays a factor in eating disorders. Resilience in high-stress situations is directly related to individuals with eating disorders as a coping mechanism. According to Corstorphine et al., distress tolerance is, “the ability to ensure and accept negative effect, so that problem-solving can take place and it manifests itself as high emotional vulnerability and the inability to regulate emotion.” Such a state as described by Corstorphine et al. would make it very difficult for a woman in an abusive relationship to see a way out or escape the situation because she would not be able to emotionally regulate or control her emotions to rationally decide what to do.
My mother is a perfect example of this. She developed BED after marrying my father due to him being an alcoholic and being controlling my nature. His mother was controlling, thus a learned trait. Not only was he abusive to her and blamed her for everything, but he also was violent with my two older sisters'. The later he sexually molested, and my mother knew about it but turned a blind eye because she felt powerless against him. She could not think of a way to escape the situation with five children. I can say that it did and did not affect me as much as the others. It didn’t affect me because I managed to see a way out by going into the military right after high school to escape the abuse. As a child, my defense mechanism was to stay out of sight. I was always reading in my room and not in the same room as he was except at dinner time. Sometimes we'd have to wait until 10 pm to eat supper because we had to wait for him to come home and even then, he would be in a drunken state. The abuse did affect me because I married men like my father, but I escaped them. I have no desire to remarry and little tolerance for men in general. On a personal level, men or people in general who act like my father, I had little tolerance for and chose to stay at a distance. On a professional level, I play the part; I'm able to cope and help others cope and see choices they are unable to see because they feel stuck. The effects, however, of my childhood is not reversible. It’s not reversible for any of us. My mother, to this day, still struggles with BED and my youngest sister with anorexia.
Additionally, my daughter struggles with BED after being sexually abused by her half-brother at her father’s house on visitation after we divorced when she was just eight years old. I picked her up one day after work, and she asked me, "Mom, can I get pregnant if I have not started my period?" I said,"why are you asking me that?" She said, "because my Dad said I couldn't." After she told me about the abuse, there was an investigation, and her father put in jail. She started purging again at age nine because she felt guilty for him going to jail and because she blamed herself for telling me. I put her in intensive counseling and reassured her she did the right thing. Between the ages of 12-15 she went from purging to BED, it seemed, overnight. She was still in intense counseling and was also in and out of a mental institution four times. The last time, I kept her there for approximately 90 days. I did not take off from work to go and see her, and I told her when she got herself together and used her positive coping skills instead of the negative ones, I would think about letting her come home. I told her, "I have to trust you," and her counselors reinforced this.
Today she is now 18, and we are still working on only “eating a little bit” until you feel almost full and drink lots of water, but she still struggles with BED as she has unresolved issues with her father. She feels she’s had enough counseling. We regularly discuss her nonacceptance that her father will not admit to knowing about the abuse and didn't stop it.
According to the ANAD, National Association of Anorexia Nervosa and Associated Disorders, “30 million people of all ages suffer from an eating disorder; every 62 minutes, 1 person dies from an eating disorder; 13% of women over 50 engage in eating disorder behaviors, and 9.5% of active duty military personnel suffer from eating disorders.”
Nature and nurture play a factor in eating disorders; however, studies have proven that nurture, mainly due to the abundance of research, is more widely accepted as the leading cause of eating disorders than genetics. There has not been enough study in the field of genetics and eating disorders to prove that mutations of genes predisposition certain families or people to develop eating disorders and to discern which eating disorder they will have. As stated by Mazzeo & Bulik, 2010, “although many genetic studies conducted, they have yet to yield an unambiguous replicated finding.” They further state that “genetic research in eating disorders if frankly in its infancy," This leading us to rely on what we know and that is nurture. The behavior of those around us, our family, influences of TV and peers. Genetics plays a role in medical conditions, but eating disorders, they, in my opinion, are negative coping skills learned either through society, parents and peers. It comes down to choices. One makes either a positive or negative choice; both have consequences; it's just a matter of which consequence you are willing to succumb. I believe awareness is the start and talking about it. Some people, in my experience working on a psychiatric unit, is that they can’t talk about it, and my response to them is, “you’ve just taken the first step by admitting you can’t talk about “it” because there is an “it” to talk about and solve to rid you of this problem." Talking either one on one or in groups sharing stories is also tricky because there are those that feel too vulnerable to admit or are too ashamed of what they are doing due to public stigma. Awareness, acceptance, and empathy are vital in helping people with eating disorders and if implemented could increase the chance of positive eating habit and limit negative eating habits.
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