Editing Eating disorder (section)

== Causes ==
There is no single cause of eating disorders.<ref>{{Cite web | vauthors = Guarda A |title=Expert Q&A: Eating Disorders |url=https://www.psychiatry.org/patients-families/eating-disorders/expert-q-and-a |access-date=December 28, 2023 |website=American Psychiatric Association}}</ref>

Many people with eating disorders also have [[body image disturbance]] and a comorbid [[body dysmorphic disorder]] (BDD), leading them to an altered perception of their body.<ref name="CT">{{cite journal |vauthors=Ruffolo JS, Phillips KA, Menard W, Fay C, Weisberg RB |title=Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance |journal=The International Journal of Eating Disorders |volume=39 |issue=1 |pages=11–9 |date=January 2006 |pmid=16254870 |doi=10.1002/eat.20219 |doi-access=free}}</ref><ref name="CT4">{{cite journal |vauthors=Grant JE, Kim SW, Eckert ED |title=Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality of body image |journal=The International Journal of Eating Disorders |volume=32 |issue=3 |pages=291–300 |date=November 2002 |pmid=12210643 |doi=10.1002/eat.10091}}</ref> Studies have found that a high proportion of individuals diagnosed with body dysmorphic disorder also had some type of eating disorder, with 15% of individuals having either anorexia nervosa or bulimia nervosa.<ref name="CT" /> This link between body dysmorphic disorder and anorexia stems from the fact that both BDD and anorexia nervosa are characterized by a preoccupation with physical appearance and a [[Body image disturbance|distortion of body image]].<ref name="CT4" />

There are also many other possibilities such as environmental, social and interpersonal issues that could promote and sustain these illnesses.<ref name="CT2">{{cite journal | vauthors = Bulik CM, Hebebrand J, Keski-Rahkonen A, Klump KL, Reichborn-Kjennerud T, Mazzeo SE, Wade TD | title = Genetic epidemiology, endophenotypes, and eating disorder classification | journal = The International Journal of Eating Disorders | volume = 40 | issue = Suppl | pages = S52–S60 | date = November 2007 | pmid = 17573683 | doi = 10.1002/eat.20398 | s2cid = 36187776 | doi-access = free}}</ref> Also, the media are oftentimes blamed for the rise in the incidence of eating disorders due to the fact that media images of idealized slim physical shape of people such as models and celebrities motivate or even force people to attempt to achieve slimness themselves.<ref>{{cite journal | vauthors = Derenne J, Beresin E | title = Body Image, Media, and Eating Disorders-a 10-Year Update | journal = Academic Psychiatry | volume = 42 | issue = 1 | pages = 129–134 | date = February 2018 | pmid = 29047075 | doi = 10.1007/s40596-017-0832-z | s2cid = 13656611}}</ref> The media are accused of distorting reality, in the sense that people portrayed in the media are either naturally thin and thus unrepresentative of normality or unnaturally thin by forcing their bodies to look like the ideal image by putting excessive pressure on themselves to look a certain way. While past findings have described eating disorders as primarily psychological, environmental, and sociocultural, further studies have uncovered evidence that there is a genetic component.<ref name="CT3">{{cite journal |vauthors=DeAngelis T |year=2002 |title=A genetic link to anorexia |url=https://www.apa.org/monitor/mar02/genetic |journal=Monitor on Psychology |volume=33 |issue=3 |page=34}}</ref>

=== Genetics ===
Numerous studies show a [[genetic predisposition]] toward eating disorders.<ref name="RB">{{cite journal |vauthors=Klump KL, Kaye WH, Strober M |title=The evolving genetic foundations of eating disorders |journal=The Psychiatric Clinics of North America |volume=24 |issue=2 |pages=215–25 |date=June 2001 |pmid=11416922 |doi=10.1016/S0193-953X(05)70218-5}}</ref><ref>{{cite journal |vauthors=Mazzeo SE, Bulik CM |title=Environmental and genetic risk factors for eating disorders: what the clinician needs to know |journal=Child and Adolescent Psychiatric Clinics of North America |volume=18 |issue=1 |pages=67–82 |date=January 2009 |pmid=19014858 |pmc=2719561 |doi=10.1016/j.chc.2008.07.003}}</ref> Twin studies have found a slight instances of genetic variance when considering the different criterion of both anorexia nervosa and bulimia nervosa as endophenotypes contributing to the disorders as a whole.<ref name="CT2" /> An individual who is a first degree relative of someone who has had or currently has an eating disorder is seven to twelve times more likely to have an eating disorder themselves.<ref name="CT5">{{cite journal |vauthors=Patel P, Wheatcroft R, Park RJ, Stein A |title=The children of mothers with eating disorders |journal=Clinical Child and Family Psychology Review |volume=5 |issue=1 |pages=1–19 |date=March 2002 |pmid=11993543 |doi=10.1023/A:1014524207660 |s2cid=46639789}}</ref> Twin studies also show that at least a portion of the vulnerability to develop eating disorders can be inherited, and there is evidence to show that there is a genetic locus that shows susceptibility for developing anorexia nervosa.<ref name="CT5" /> About 50% of eating disorder cases are attributable to genetics.<ref>{{cite journal |vauthors=Trace SE, Baker JH, Peñas-Lledó E, Bulik CM |s2cid=33773190 |title=The genetics of eating disorders |journal=Annual Review of Clinical Psychology |volume=9 |pages=589–620 |date=2013 |pmid=23537489 |doi=10.1146/annurev-clinpsy-050212-185546}}</ref> Other cases are due to external reasons or developmental problems.<ref>{{Cite book |title=College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It |vauthors=Kadison R |publisher=Jossey-Bass |year=2004 |isbn=978-0-7879-8114-3 |location=San Francisco |page=[https://archive.org/details/collegeofoverwhe0000kadi/page/132 132] |url=https://archive.org/details/collegeofoverwhe0000kadi/page/132}}</ref> There are also other neurobiological factors at play tied to emotional reactivity and impulsivity that could lead to binging and purging behaviors.<ref>{{Cite book |title=Mental Health Issues & the University Student |vauthors=Iarovici D |publisher=Johns Hopkins University Press |year=2014 |isbn=978-1-4214-1238-2 |location=Baltimore |page=[https://archive.org/details/mentalhealthissu0000iaro/page/104 104] |url=https://archive.org/details/mentalhealthissu0000iaro/page/104}}</ref>

[[Epigenetics]] mechanisms are means by which environmental effects alter gene expression via methods such as [[DNA methylation]]; these are independent of and do not alter the underlying DNA sequence. They are heritable, but also may occur throughout the lifespan, and are potentially reversible. Dysregulation of [[dopaminergic]] [[neurotransmission]] due to epigenetic mechanisms has been implicated in various eating disorders.<ref name="RC">{{cite journal |vauthors=Frieling H, Römer KD, Scholz S, Mittelbach F, Wilhelm J, De Zwaan M, Jacoby GE, Kornhuber J, Hillemacher T, Bleich S |title=Epigenetic dysregulation of dopaminergic genes in eating disorders |journal=The International Journal of Eating Disorders |volume=43 |issue=7 |pages=577–83 |date=November 2010 |pmid=19728374 |doi=10.1002/eat.20745 |doi-access=free}}</ref> Other candidate genes for epigenetic studies in eating disorders include [[leptin]], [[pro-opiomelanocortin]] (POMC) and [[brain-derived neurotrophic factor]] (BDNF).<ref>{{cite journal |vauthors=Campbell IC, Mill J, Uher R, Schmidt U |title=Eating disorders, gene-environment interactions and epigenetics |journal=Neuroscience and Biobehavioral Reviews |volume=35 |issue=3 |pages=784–93 |date=January 2011 |pmid=20888360 |doi=10.1016/j.neubiorev.2010.09.012 |s2cid=24599095}}</ref>

There has found to be a genetic correlation between anorexia nervosa and OCD, suggesting a strong etiology.<ref name="cab">{{cite journal |vauthors=Levinson CA, Brosof LC, Ram SS, Pruitt A, Russell S, Lenze EJ |date=August 2019 |title=Obsessions are strongly related to eating disorder symptoms in anorexia nervosa and atypical anorexia nervosa |journal=Eating Behaviors |volume=34 |pages=101298 |doi=10.1016/j.eatbeh.2019.05.001 |pmc=6708491 |pmid=31176948}}</ref><ref name=":19">{{cite journal | vauthors = Meier M, Kossakowski JJ, Jones PJ, Kay B, Riemann BC, McNally RJ | title = Obsessive-compulsive symptoms in eating disorders: A network investigation | journal = The International Journal of Eating Disorders | volume = 53 | issue = 3 | pages = 362–371 | date = March 2020 | pmid = 31749199 | doi = 10.1002/eat.23196 | s2cid = 208214719}}</ref><ref name=":24">{{cite journal | vauthors = Lee EB, Barney JL, Twohig MP, Lensegrav-Benson T, Quakenbush B | title = Obsessive compulsive disorder and thought action fusion: Relationships with eating disorder outcomes | journal = Eating Behaviors | volume = 37 | pages = 101386 | date = April 2020 | pmid = 32388080 | doi = 10.1016/j.eatbeh.2020.101386 | s2cid = 218585620}}</ref> First and second relatives of probands with OCD have a greater chance of developing anorexia nervosa as genetic relatedness increases.<ref name=":24"/>

=== Psychological ===
Eating disorders are classified as [[Axis I]]<ref>{{cite journal |vauthors=Westen D, Harnden-Fischer J |s2cid=33162558 |title=Personality profiles in eating disorders: rethinking the distinction between axis I and axis II |journal=The American Journal of Psychiatry |volume=158 |issue=4 |pages=547–62 |date=April 2001 |pmid=11282688 |doi=10.1176/appi.ajp.158.4.547}}</ref> disorders in the Diagnostic and Statistical Manual of Mental Health Disorders ([[DSM-IV]]) published by the [[American Psychiatric Association]]. There are various other psychological issues that may factor into eating disorders, some fulfill the criteria for a separate Axis I [[diagnosis]] or a personality disorder which is coded [[Axis II (psychiatry)|Axis II]] and thus are considered [[comorbid]] to the diagnosed eating disorder. Axis II disorders are subtyped into 3 "clusters": A, B and C. The [[causality]] between personality disorders and eating disorders has yet to be fully established.<ref>{{cite journal |vauthors=Rosenvinge JH, Martinussen M, Ostensen E |title=The comorbidity of eating disorders and personality disorders: a meta-analytic review of studies published between 1983 and 1998 |journal=Eating and Weight Disorders |volume=5 |issue=2 |pages=52–61 |date=June 2000 |pmid=10941603 |doi=10.1007/bf03327480 |s2cid=34981309}}</ref> Some people have a previous disorder which may increase their vulnerability to developing an eating disorder.<ref>{{cite journal |vauthors=Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K |s2cid=9926158 |title=Comorbidity of anxiety disorders with anorexia and bulimia nervosa |journal=The American Journal of Psychiatry |volume=161 |issue=12 |pages=2215–21 |date=December 2004 |pmid=15569892 |doi=10.1176/appi.ajp.161.12.2215}}</ref><ref>{{cite journal |vauthors=Thornton C, Russell J |title=Obsessive compulsive comorbidity in the dieting disorders |journal=The International Journal of Eating Disorders |volume=21 |issue=1 |pages=83–7 |date=January 1997 |pmid=8986521 |doi=10.1002/(SICI)1098-108X(199701)21:1<83::AID-EAT10>3.0.CO;2-P}}</ref><ref>{{cite journal |vauthors=Vitousek K, Manke F |title=Personality variables and disorders in anorexia nervosa and bulimia nervosa |journal=Journal of Abnormal Psychology |volume=103 |issue=1 |pages=137–47 |date=February 1994 |pmid=8040475 |doi=10.1037/0021-843X.103.1.137}}</ref> Some develop them afterwards.<ref>{{cite journal |vauthors=Braun DL, Sunday SR, Halmi KA |title=Psychiatric comorbidity in patients with eating disorders |journal=Psychological Medicine |volume=24 |issue=4 |pages=859–67 |date=November 1994 |pmid=7892354 |doi=10.1017/S0033291700028956 |s2cid=34017953}}</ref> The severity and type of eating disorder symptoms have been shown to affect comorbidity.<ref>{{cite journal |vauthors=Spindler A, Milos G |title=Links between eating disorder symptom severity and psychiatric comorbidity |journal=Eating Behaviors |volume=8 |issue=3 |pages=364–73 |date=August 2007 |pmid=17606234 |doi=10.1016/j.eatbeh.2006.11.012}}</ref> There has been controversy over various editions of the DSM diagnostic criteria including the latest edition, DSM-V, published in 2013.<ref>{{cite journal |vauthors=Collier R |title=DSM revision surrounded by controversy |journal=CMAJ |volume=182 |issue=1 |pages=16–7 |date=January 2010 |pmid=19920166 |pmc=2802599 |doi=10.1503/cmaj.109-3108}}</ref><ref>{{cite journal |vauthors=Kutchins H, Kirk SA |title=DSM-III-R: the conflict over new psychiatric diagnoses |journal=Health & Social Work |volume=14 |issue=2 |pages=91–101 |date=May 1989 |pmid=2714710 |doi=10.1093/hsw/14.2.91}}</ref><ref>{{cite news |title=DSM-IV Diagnostic Criteria for Eating Disorders May Be Too Stringent |vauthors=Busko M |work=Medscape |url=http://www.medscape.com/viewarticle/557479 |url-status=live |archive-date=2012-05-13 |archive-url=https://web.archive.org/web/20120513204422/http://www.medscape.com/viewarticle/557479}}</ref><ref>{{cite news |title=The Politics of Disease Definition: A Summer of DSM-V Controversy in Review. Stanford Center for Law and the Biosciences |url=http://lawandbiosciences.wordpress.com/2009/09/10/the-politics-of-disease-definition-a-summer-of-dsm-v-controversy-in-review/ |date=10 September 2009 |vauthors=Murdoch CJ |access-date=11 January 2010 |url-status=dead |archive-date=15 September 2010 |archive-url=https://web.archive.org/web/20100915131628/http://lawandbiosciences.wordpress.com/2009/09/10/the-politics-of-disease-definition-a-summer-of-dsm-v-controversy-in-review/}}</ref><ref>{{cite news |date=29 December 2008 |title=Psychiatry manual's secrecy criticized |work=Los Angeles Times |url=https://www.latimes.com/archives/la-xpm-2008-dec-29-na-mental-disorders29-story.html |url-status=live |archive-url=https://web.archive.org/web/20100123002620/http://articles.latimes.com/2008/dec/29/nation/na-mental-disorders29 |archive-date=23 January 2010}}</ref>

{| class="wikitable"
|+Comorbid Disorders
![[Axis I]]||[[Axis II (psychiatry)|Axis II]]
|-
|[[Major depressive disorder|depression]]<ref>{{cite journal |vauthors=Casper RC |title=Depression and eating disorders |journal=Depression and Anxiety |volume=8 |issue=Suppl 1 |pages=96–104 |year=1998 |pmid=9809221 |doi=10.1002/(SICI)1520-6394(1998)8:1+<96::AID-DA15>3.0.CO;2-4 |s2cid=36772859 |doi-access=free}}</ref>||[[obsessive–compulsive personality disorder]]<ref>{{cite journal |vauthors=Serpell L, Livingstone A, Neiderman M, Lask B |title=Anorexia nervosa: obsessive-compulsive disorder, obsessive-compulsive personality disorder, or neither? |journal=Clinical Psychology Review |volume=22 |issue=5 |pages=647–69 |date=June 2002 |pmid=12113200 |doi=10.1016/S0272-7358(01)00112-X}}</ref>
|-
|[[substance abuse]], alcoholism<ref>{{cite journal |vauthors=Bulik CM, Klump KL, Thornton L, Kaplan AS, Devlin B, Fichter MM, Halmi KA, Strober M, Woodside DB, Crow S, Mitchell JE, Rotondo A, Mauri M, Cassano GB, Keel PK, Berrettini WH, Kaye WH |title=Alcohol use disorder comorbidity in eating disorders: a multicenter study |journal=The Journal of Clinical Psychiatry |volume=65 |issue=7 |pages=1000–6 |date=July 2004 |pmid=15291691 |doi=10.4088/JCP.v65n0718}}</ref>||[[borderline personality disorder]]<ref>{{cite journal |vauthors=Larsson JO, Hellzén M |title=Patterns of personality disorders in women with chronic eating disorders |journal=Eating and Weight Disorders |volume=9 |issue=3 |pages=200–5 |date=September 2004 |pmid=15656014 |doi=10.1007/bf03325067 |s2cid=29679535}}</ref>
|-
|[[anxiety disorders]]<ref>{{cite journal |vauthors=Swinbourne JM, Touyz SW |title=The co-morbidity of eating disorders and anxiety disorders: a review |journal=European Eating Disorders Review |volume=15 |issue=4 |pages=253–74 |date=July 2007 |pmid=17676696 |doi=10.1002/erv.784 |doi-access=free}}</ref>||[[narcissistic personality disorder]]<ref>{{cite journal |vauthors=Ronningstam E |title=Pathological narcissism and narcissistic personality disorder in Axis I disorders |journal=Harvard Review of Psychiatry |volume=3 |issue=6 |pages=326–40 |year=1996 |pmid=9384963 |doi=10.3109/10673229609017201 |s2cid=21472356}}</ref>
|-
|[[obsessive–compulsive disorder]]<ref>{{cite journal |vauthors=Anderluh MB, Tchanturia K, Rabe-Hesketh S, Treasure J |title=Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype |journal=The American Journal of Psychiatry |volume=160 |issue=2 |pages=242–7 |date=February 2003 |pmid=12562569 |doi=10.1176/appi.ajp.160.2.242 |author3-link=Sophia Rabe-Hesketh}}</ref><ref>{{cite journal |vauthors=Pinto A, Mancebo MC, Eisen JL, Pagano ME, Rasmussen SA |title=The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake |journal=The Journal of Clinical Psychiatry |volume=67 |issue=5 |pages=703–11 |date=May 2006 |pmid=16841619 |pmc=3272757 |doi=10.4088/JCP.v67n0503}}</ref>||[[histrionic personality disorder]]<ref>{{cite journal |vauthors=Lucka I, Cebella A |title=[Characteristics of the forming personality in children suffering from anorexia nervosa] |journal=Psychiatria Polska |volume=38 |issue=6 |pages=1011–8 |year=2004 |pmid=15779665}}</ref>
|-
|[[Attention-deficit hyperactivity disorder]]<ref name="ADHD">{{cite journal |vauthors=Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL, Zeitlin S |s2cid=31596462 |title=Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study |journal=Journal of Developmental and Behavioral Pediatrics |volume=28 |issue=4 |pages=302–7 |date=August 2007 |pmid=17700082 |doi=10.1097/DBP.0b013e3180327917}}</ref><ref>{{cite journal |vauthors=Dukarm CP |title=Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication |journal=Journal of Women's Health |volume=14 |issue=4 |pages=345–50 |date=May 2005 |pmid=15916509 |doi=10.1089/jwh.2005.14.345}}</ref><ref>{{cite journal |vauthors=Mikami AY, Hinshaw SP, Arnold LE, Hoza B, Hechtman L, Newcorn JH, Abikoff HB |title=Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD |journal=The International Journal of Eating Disorders |volume=43 |issue=3 |pages=248–59 |date=April 2010 |pmid=19378318 |doi=10.1002/eat.20692}}</ref><ref>{{cite journal |vauthors=Cortese S, Bernardina BD, Mouren MC |s2cid=14578808 |title=Attention-deficit/hyperactivity disorder (ADHD) and binge eating |journal=Nutrition Reviews |volume=65 |issue=9 |pages=404–11 |date=September 2007 |pmid=17958207 |doi=10.1111/j.1753-4887.2007.tb00318.x |doi-access=free}}</ref>||[[avoidant personality disorder]]<ref>{{cite journal |vauthors=Bruce KR, Steiger H, Koerner NM, Israel M, Young SN |title=Bulimia nervosa with co-morbid avoidant personality disorder: behavioural characteristics and serotonergic function |journal=Psychological Medicine |volume=34 |issue=1 |pages=113–24 |date=January 2004 |pmid=14971632 |doi=10.1017/S003329170300864X |s2cid=41886088}}</ref>
|}

==== Cognitive attentional bias ====
[[Attentional bias]] may have an effect on eating disorders. Attentional bias is the preferential attention toward certain types of information in the environment while simultaneously ignoring others. Individuals with eating disorders can be thought to have schemas, knowledge structures, which are dysfunctional as they may bias judgement, thought, behaviour in a manner that is self-destructive or maladaptive.<ref name=":3">{{cite journal |vauthors=Williamson DA, Muller SL, Reas DL, Thaw JM |title=Cognitive bias in eating disorders: implications for theory and treatment |journal=Behavior Modification |volume=23 |issue=4 |pages=556–77 |date=October 1999 |pmid=10533440 |doi=10.1177/0145445599234003 |s2cid=36189809 |url=https://www.researchgate.net/publication/12768068}}</ref> They may have developed a disordered schema which focuses on body size and eating. Thus, this information is given the highest level of importance and overvalued among other cognitive structures. Researchers have found that people who have eating disorders tend to pay more attention to stimuli related to food. For people struggling to recover from an eating disorder or addiction, this tendency to pay attention to certain signals while discounting others can make recovery that much more difficult.<ref name=":3" />

Studies have utilized the Stroop task to assess the probable effect of attentional bias on eating disorders. This may involve separating food and eating words from body shape and weight words. Such studies have found that anorexic subjects were slower to colour name food related words than control subjects.<ref>{{cite journal |vauthors=Faunce GJ |title=Eating disorders and attentional bias: a review |journal=Eating Disorders |volume=10 |issue=2 |pages=125–39 |date=2002-06-01 |pmid=16864253 |doi=10.1080/10640260290081696 |s2cid=33900087}}</ref> Other studies have noted that individuals with eating disorders have significant attentional biases associated with eating and weight stimuli.<ref>{{cite journal |vauthors=Aspen V, Darcy AM, Lock J |title=A review of attention biases in women with eating disorders |journal=Cognition & Emotion |volume=27 |issue=5 |pages=820–38 |date=August 2013 |pmid=23228135 |pmc=3610839 |doi=10.1080/02699931.2012.749777}}</ref>

=== Personality traits ===
There are various childhood [[personality traits]] associated with the development of eating disorders, such as perfectionism and neuroticism.<ref name=":19" /><ref name=":24"/><ref name=":32">{{cite journal | vauthors = Pollack LO, Forbush KT | title = Why do eating disorders and obsessive-compulsive disorder co-occur? | journal = Eating Behaviors | volume = 14 | issue = 2 | pages = 211–215 | date = April 2013 | pmid = 23557823 | pmc = 3618658 | doi = 10.1016/j.eatbeh.2013.01.004}}</ref> These personality traits are found to link eating disorders and OCD.<ref name=":19" /><ref name=":24"/><ref name=":32" /> During adolescence these traits may become intensified due to a variety of physiological and cultural influences such as the hormonal changes associated with puberty, stress related to the approaching demands of maturity and socio-cultural influences and perceived expectations, especially in areas that concern body image. Eating disorders have been associated with a fragile sense of self and with disordered mentalization.<ref>{{cite book | vauthors = Skårderud F, Fonagy P | chapter = Eating Disorders | veditors = Bateman A, Fonagy P | title = Handbook of mentalizing in Mental Health Practice | publisher = American Psychiatric Publishing | location = Washington DC | date = 2012 | pages = 347–383}}</ref> Many personality traits have a genetic component and are highly heritable. Maladaptive levels of certain traits may be acquired as a result of anoxic or traumatic brain injury, neurodegenerative diseases such as [[Parkinson's disease]], [[neurotoxicity]] such as lead exposure, bacterial infection such as [[Lyme disease]] or parasitic infection such as [[Toxoplasma gondii]] as well as hormonal influences. While studies are still continuing via the use of various imaging techniques such as [[fMRI]]; these traits have been shown to originate in various regions of the brain<ref>{{cite journal | vauthors = Gardini S, Cloninger CR, Venneri A | title = Individual differences in personality traits reflect structural variance in specific brain regions | journal = Brain Research Bulletin | volume = 79 | issue = 5 | pages = 265–270 | date = June 2009 | pmid = 19480986 | doi = 10.1016/j.brainresbull.2009.03.005 | s2cid = 25490518}}</ref> such as the [[amygdala]]<ref>{{cite journal | vauthors = Marsh AA, Finger EC, Mitchell DG, Reid ME, Sims C, Kosson DS, Towbin KE, Leibenluft E, Pine DS, Blair RJ | title = Reduced amygdala response to fearful expressions in children and adolescents with callous-unemotional traits and disruptive behavior disorders | journal = The American Journal of Psychiatry | volume = 165 | issue = 6 | pages = 712–720 | date = June 2008 | pmid = 18281412 | doi = 10.1176/appi.ajp.2007.07071145 | s2cid = 6915571}}</ref><ref>{{cite journal | vauthors = Iidaka T, Matsumoto A, Ozaki N, Suzuki T, Iwata N, Yamamoto Y, Okada T, Sadato N | title = Volume of left amygdala subregion predicted temperamental trait of harm avoidance in female young subjects. A voxel-based morphometry study | journal = Brain Research | volume = 1125 | issue = 1 | pages = 85–93 | date = December 2006 | pmid = 17113049 | doi = 10.1016/j.brainres.2006.09.015 | s2cid = 16850998}}</ref> and the [[prefrontal cortex]].<ref>{{cite journal | vauthors = Rubino V, Blasi G, Latorre V, Fazio L, d'Errico I, Mazzola V, Caforio G, Nardini M, Popolizio T, Hariri A, Arciero G, Bertolino A | title = Activity in medial prefrontal cortex during cognitive evaluation of threatening stimuli as a function of personality style | journal = Brain Research Bulletin | volume = 74 | issue = 4 | pages = 250–257 | date = September 2007 | pmid = 17720547 | doi = 10.1016/j.brainresbull.2007.06.019 | s2cid = 18722508}}</ref> Disorders in the prefrontal cortex and the executive functioning system have been shown to affect eating behavior.<ref>{{cite journal | vauthors = Spinella M, Lyke J | title = Executive personality traits and eating behavior | journal = The International Journal of Neuroscience | volume = 114 | issue = 1 | pages = 83–93 | date = January 2004 | pmid = 14660070 | doi = 10.1080/00207450490249356 | s2cid = 11710150}}</ref><ref>{{cite journal | vauthors = Sinai C, Hirvikoski T, Vansvik ED, Nordström AL, Linder J, Nordström P, Jokinen J | title = Thyroid hormones and personality traits in attempted suicide | journal = Psychoneuroendocrinology | volume = 34 | issue = 10 | pages = 1526–1532 | date = November 2009 | pmid = 19525070 | doi = 10.1016/j.psyneuen.2009.05.009 | s2cid = 207457515}}</ref>

=== Celiac disease ===
People with [[gastrointestinal disease|gastrointestinal disorders]] may be more risk of developing disordered eating practices than the general population, principally restrictive eating disturbances.<ref name="SatherleyHoward2015">{{cite journal |vauthors=Satherley R, Howard R, Higgs S |title=Disordered eating practices in gastrointestinal disorders |journal=Appetite |volume=84 |pages=240–50 |date=January 2015 |pmid=25312748 |doi=10.1016/j.appet.2014.10.006 |s2cid=25805182 |type=Review |url=http://pure-oai.bham.ac.uk/ws/files/18572989/Satherley_Disordered_eating_practices_gastrointestinal_disorders_Appetite_2014.pdf |access-date=2019-09-24 |archive-url=https://web.archive.org/web/20190924082720/http://pure-oai.bham.ac.uk/ws/files/18572989/Satherley_Disordered_eating_practices_gastrointestinal_disorders_Appetite_2014.pdf |archive-date=2019-09-24 |url-status=dead}}</ref> An association of [[anorexia nervosa]] with [[celiac disease]] has been found.<ref name="BernOBrien2013">{{cite journal |vauthors=Bern EM, O'Brien RF |title=Is it an eating disorder, gastrointestinal disorder, or both? |journal=Current Opinion in Pediatrics |volume=25 |issue=4 |pages=463–70 |date=August 2013 |pmid=23838835 |doi=10.1097/MOP.0b013e328362d1ad |s2cid=5417088 | type = Review | quote = Several case reports brought attention to the association of anorexia nervosa and celiac disease.(...) Some patients present with the eating disorder prior to diagnosis of celiac disease and others developed anorexia nervosa after the diagnosis of celiac disease. Healthcare professionals should screen for celiac disease with eating disorder symptoms especially with gastrointestinal symptoms, weight loss, or growth failure.(...) Celiac disease patients may present with gastrointestinal symptoms such as diarrhea, steatorrhea, weight loss, vomiting, abdominal pain, anorexia, constipation, bloating, and distension due to malabsorption. Extraintestinal presentations include anemia, osteoporosis, dermatitis herpetiformis, short stature, delayed puberty, fatigue, aphthous stomatitis, elevated transaminases, neurologic problems, or dental enamel hypoplasia.(...) it has become clear that symptomatic and diagnosed celiac disease is the tip of the iceberg; the remaining 90% or more of children are asymptomatic and undiagnosed.}}</ref> The role that gastrointestinal symptoms play in the development of eating disorders seems rather complex. Some authors report that unresolved symptoms prior to gastrointestinal disease diagnosis may create a food aversion in these persons, causing alterations to their eating patterns. Other authors report that greater symptoms throughout their diagnosis led to greater risk. It has been documented that some people with celiac disease, [[irritable bowel syndrome]] or [[inflammatory bowel disease]] who are not conscious about the importance of strictly following their diet, choose to consume their trigger foods to promote weight loss. On the other hand, individuals with good dietary management may develop anxiety, food aversion and eating disorders because of concerns around cross contamination of their foods.<ref name=SatherleyHoward2015 /> Some authors suggest that medical professionals should evaluate the presence of an unrecognized celiac disease in all people with eating disorder, especially if they present any gastrointestinal symptom (such as decreased appetite, abdominal pain, bloating, distension, vomiting, diarrhea or constipation), weight loss, or growth failure; and also routinely ask celiac patients about weight or body shape concerns, dieting or vomiting for weight control, to evaluate the possible presence of eating disorders,<ref name=BernOBrien2013 /> specially in women.<ref name="QuickByrdBredbenner2013">{{cite journal |vauthors=Quick VM, Byrd-Bredbenner C, Neumark-Sztainer D |title=Chronic illness and disordered eating: a discussion of the literature |journal=Advances in Nutrition |volume=4 |issue=3 |pages=277–86 |date=May 2013 |pmid=23674793 |pmc=3650496 |doi=10.3945/an.112.003608 |type=Review}}</ref>

=== Environmental influences ===
==== Child maltreatment ====
[[Child abuse]] which encompasses physical, psychological, and sexual abuse, as well as neglect, has been shown to approximately triple the risk of an eating disorder.<ref name=Cas2016 /> Sexual abuse appears to double the risk of bulimia; however, the association is less clear for anorexia. The risk for individuals developing eating disorders increases if the individual grew up in an invalidating environment where displays of emotions were often punished. Abuse that has also occurred in childhood produces intolerable difficult emotions that cannot be expressed in a healthy manner. Eating disorders come in as an escape coping mechanism, as a means to control and avoid overwhelming negative emotions and feelings. Those who report physical or sexual maltreatment as a child are at an increased risk of developing an eating disorder.<ref name="Cas2016">{{cite journal |vauthors=Caslini M, Bartoli F, Crocamo C, Dakanalis A, Clerici M, Carrà G |title=Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis |journal=Psychosomatic Medicine |volume=78 |issue=1 |pages=79–90 |date=January 2016 |pmid=26461853 |doi=10.1097/psy.0000000000000233 |s2cid=30370150}}</ref>

==== Social isolation ====
[[Social isolation]] has been shown to have a deleterious effect on an individual's physical and emotional well-being. Those that are socially isolated have a higher mortality rate in general as compared to individuals that have established social relationships. This effect on mortality is markedly increased in those with pre-existing medical or psychiatric conditions, and has been especially noted in cases of [[coronary heart disease]]. "The magnitude of risk associated with social isolation is comparable with that of [[cigarette smoking]] and other major [[biomedical]] and [[psychosocial]] [[risk factors]]." (Brummett ''et al.'')

Social isolation can be inherently stressful, depressing and anxiety-provoking. In an attempt to ameliorate these distressful feelings an individual may engage in emotional eating in which food serves as a source of comfort. The loneliness of social isolation and the inherent stressors thus associated have been implicated as triggering factors in binge eating as well.<ref>{{cite journal |vauthors=Troop NA, Bifulco A |title=Childhood social arena and cognitive sets in eating disorders |journal=British Journal of Clinical Psychology |volume=41 |issue=Pt 2 |pages=205–11 |date=June 2002 |pmid=12034006 |doi=10.1348/014466502163976}}</ref><ref>{{cite journal |vauthors=Nonogaki K, Nozue K, Oka Y |title=Social isolation affects the development of obesity and type 2 diabetes in mice |journal=Endocrinology |volume=148 |issue=10 |pages=4658–66 |date=October 2007 |pmid=17640995 |doi=10.1210/en.2007-0296 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Esplen MJ, Garfinkel P, Gallop R |title=Relationship between self-soothing, aloneness, and evocative memory in bulimia nervosa |journal=The International Journal of Eating Disorders |volume=27 |issue=1 |pages=96–100 |date=January 2000 |pmid=10590454 |doi=10.1002/(SICI)1098-108X(200001)27:1<96::AID-EAT11>3.0.CO;2-S |doi-access=free}}</ref><ref>{{cite journal |vauthors=Larson R, Johnson C |title=Bulimia: disturbed patterns of solitude |journal=Addictive Behaviors |volume=10 |issue=3 |pages=281–90 |year=1985 |pmid=3866486 |doi=10.1016/0306-4603(85)90009-7}}</ref>

Waller, Kennerley and Ohanian (2007) argued that both bingeing–vomiting and restriction are emotion suppression strategies, but they are just utilized at different times. For example, restriction is used to pre-empt any emotion activation, while bingeing–vomiting is used after an emotion has been activated.<ref>{{cite journal |vauthors=Fox JR |title=Eating disorders and emotions |journal=Clinical Psychology & Psychotherapy |volume=16 |issue=4 |pages=237–9 |date=July 2009 |pmid=19639648 |doi=10.1002/cpp.625 |doi-access=free}}</ref>

==== Parental influence ====
Parental influence has been shown to be an intrinsic component in the development of eating behaviors of children.<ref name=":20">{{cite journal | vauthors = Savage JS, Fisher JO, Birch LL | title = Parental influence on eating behavior: conception to adolescence | journal = The Journal of Law, Medicine & Ethics | volume = 35 | issue = 1 | pages = 22–34 | date = 2007 | pmid = 17341215 | pmc = 2531152 | doi = 10.1111/j.1748-720X.2007.00111.x}}</ref> This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape, how they talk about their own body, and eating patterns,<ref>{{cite journal | vauthors = Lydecker JA, Riley KE, Grilo CM | title = Associations of parents' self, child, and other "fat talk" with child eating behaviors and weight | journal = The International Journal of Eating Disorders | volume = 51 | issue = 6 | pages = 527–534 | date = June 2018 | pmid = 29542177 | pmc = 6002914 | doi = 10.1002/eat.22858}}</ref> the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child.<ref name=":20" /> It is also influenced by the general psychosocial climate of the home and whether a nurturing stable environment is present. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders. As to the more subtle aspects of parental influence, it has been shown that eating patterns are established in early childhood and that children should be allowed to decide when their appetite is satisfied as early as the age of two. A direct link has been shown between obesity and parental pressure to eat more.<ref>{{Cite web |title=Eating disorder {{!}} Health Psychology |url=https://courses.lumenlearning.com/suny-hvcc-healthpsychology/chapter/eating-disorder/#:~:text=Parental%20influence&text=This%20is%20in%20addition%20to,the%20development%20of%20eating%20disorders. |access-date=2023-12-28 |website=courses.lumenlearning.com}}</ref>

Coercive tactics in regard to diet have not been proven to be efficacious in controlling a child's eating behavior. [[Affection]] and [[attention]] have been shown to affect the degree of a child's finickiness and their acceptance of a more varied diet.<ref>{{cite journal |vauthors=Johnson JG, Cohen P, Kasen S, Brook JS |title=Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood |journal=The American Journal of Psychiatry |volume=159 |issue=3 |pages=394–400 |date=March 2002 |pmid=11870002 |doi=10.1176/appi.ajp.159.3.394}}</ref><ref>{{cite journal |vauthors=Klesges RC, Coates TJ, Brown G, Sturgeon-Tillisch J, Moldenhauer-Klesges LM, Holzer B, Woolfrey J, Vollmer J |title=Parental influences on children's eating behavior and relative weight |journal=Journal of Applied Behavior Analysis |volume=16 |issue=4 |pages=371–8 |year=1983 |pmid=6654769 |pmc=1307898 |doi=10.1901/jaba.1983.16-371}}</ref><ref>{{cite journal |vauthors=Galloway AT, Fiorito L, Lee Y, Birch LL |title=Parental pressure, dietary patterns, and weight status among girls who are "picky eaters" |journal=Journal of the American Dietetic Association |volume=105 |issue=4 |pages=541–8 |date=April 2005 |pmid=15800554 |pmc=2530930 |doi=10.1016/j.jada.2005.01.029}}</ref><ref>{{cite journal |vauthors=Jones C, Harris G, Leung N |title=Parental rearing behaviours and eating disorders: the moderating role of core beliefs |journal=Eating Behaviors |volume=6 |issue=4 |pages=355–64 |date=December 2005 |pmid=16257809 |doi=10.1016/j.eatbeh.2005.05.002}}</ref><ref>{{cite journal |vauthors=Brown R, Ogden J |title=Children's eating attitudes and behaviour: a study of the modelling and control theories of parental influence |journal=Health Education Research |volume=19 |issue=3 |pages=261–71 |date=June 2004 |pmid=15140846 |doi=10.1093/her/cyg040 |doi-access=free}}</ref><ref name=":20" />

Adams and Crane (1980), have shown that parents are influenced by stereotypes that influence their perception of their child's body. The conveyance of these negative stereotypes also affects the child's own body image and satisfaction.<ref>{{Cite journal |vauthors=Adams GR, Crane P |date=1980 |title=An Assessment of Parents' and Teachers' Expectations of Preschool Children's Social Preference for Attractive or Unattractive Children and Adults |journal=Child Development |volume=51 |issue=1 |pages=224–231 |doi=10.2307/1129610|jstor=1129610}}</ref> [[Hilde Bruch]], a pioneer in the field of studying eating disorders, asserts that anorexia nervosa often occurs in girls who are high achievers, obedient, and always trying to please their parents. Their parents have a tendency to be over-controlling and fail to encourage the expression of emotions, inhibiting daughters from accepting their own feelings and desires. Adolescent females in these overbearing families lack the ability to be independent from their families, yet realize the need to, often resulting in rebellion. Controlling their food intake may make them feel better, as it provides them with a sense of control.<ref>Nolen-Hoeksema, Susan. ''Abnormal Psychology, 6e''. McGraw-Hill Education, 2014. p. 359-360.</ref>

Negative parental body-talk, meaning when a parent comments on their own weight, shape or size, is strongly correlated with disordered eating in their children. Children whose parents engage in self-talk about their weight frequently are three times as likely to practice extreme weight control behaviors such as disordered eating, than children who do not overhear negative parental body-talk. Additionally, negative body-talk from mothers is explicitly correlated with disordered eating in adolescent girls.<ref>{{cite journal | vauthors = Neumark-Sztainer D, Bauer KW, Friend S, Hannan PJ, Story M, Berge JM | title = Family weight talk and dieting: how much do they matter for body dissatisfaction and disordered eating behaviors in adolescent girls? | journal = The Journal of Adolescent Health | volume = 47 | issue = 3 | pages = 270–276 | date = September 2010 | pmid = 20708566 | pmc = 2921129 | doi = 10.1016/j.jadohealth.2010.02.001}}</ref><ref>{{cite journal | vauthors = Myntti WW, Parnell L, Valledor V, Chow CM | title = Adolescent-perceived parent-child negative body talk and disordered eating: Evidence for behavior-specific affective mediators | journal = Journal of Adolescence | volume = 96 | issue = 5 | pages = 1126–1136 | date = July 2024 | pmid = 38594877 | doi = 10.1002/jad.12323}}</ref>

==== Peer pressure ====
In various studies such as one conducted by [[William L. McKnight|The McKnight Investigators]], [[peer pressure]] was shown to be a significant contributor to body image concerns and attitudes toward eating among subjects in their teens and early twenties.<ref name = "McKnight_2003">{{Cite journal | vauthors = ((The McKnight Investigators)) |date=2003 |title=Risk Factors for the Onset of Eating Disorders in Adolescent Girls: Results of the McKnight Longitudinal Risk Factor Study |url=https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.160.2.248 |journal=American Journal of Psychiatry |volume=160 |issue=2 |pages=248–254 |doi=10.1176/ajp.160.2.248 |pmid=12562570 |issn=0002-953X}}</ref>

Eleanor Mackey and co-author, Annette M. La Greca of the University of Miami, studied 236 teen girls from public high schools in southeast Florida. "Teen girls' concerns about their own weight, about how they appear to others and their perceptions that their peers want them to be thin are significantly related to weight-control behavior", says psychologist Eleanor Mackey of the Children's National Medical Center in Washington and lead author of the study. "Those are really important."<ref>{{Cite web |title=Study finds teenagers' peers play big role in weight control |url=https://www.heraldtribune.com/story/news/2008/07/30/study-finds-teenagers-peers-play-big-role-in-weight-control/28651148007/ |access-date=2024-03-15 |website=Sarasota Herald-Tribune}}</ref>

According to one study, 40% of 9- and 10-year-old girls are already trying to lose weight.<ref>{{cite journal |vauthors=Schreiber GB, Robins M, Striegel-Moore R, Obarzanek E, Morrison JA, Wright DJ |title=Weight modification efforts reported by black and white preadolescent girls: National Heart, Lung, and Blood Institute Growth and Health Study |journal=Pediatrics |volume=98 |issue=1 |pages=63–70 |date=July 1996 |doi=10.1542/peds.98.1.63 |pmid=8668414 |s2cid=43322352}}</ref> Such dieting is reported to be influenced by peer behavior, with many of those individuals on a diet reporting that their friends also were dieting. The number of friends dieting and the number of friends who pressured them to diet also played a significant role in their own choices.<ref>{{cite journal |vauthors=Page RM, Suwanteerangkul J |title=Dieting among Thai adolescents: having friends who diet and pressure to diet |journal=Eating and Weight Disorders |volume=12 |issue=3 |pages=114–24 |date=September 2007 |pmid=17984635 |doi=10.1007/bf03327638 |s2cid=28567423}}</ref><ref name = "McKnight_2003" /><ref>{{cite journal |vauthors=Paxton SJ, Schutz HK, Wertheim EH, Muir SL |title=Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls |journal=Journal of Abnormal Psychology |volume=108 |issue=2 |pages=255–66 |date=May 1999 |pmid=10369035 |doi=10.1037/0021-843X.108.2.255}}</ref><ref>{{cite journal |vauthors=Rukavina T, Pokrajac-Bulian A |title=Thin-ideal internalization, body dissatisfaction and symptoms of eating disorders in Croatian adolescent girls |journal=Eating and Weight Disorders |volume=11 |issue=1 |pages=31–7 |date=March 2006 |pmid=16801743 |doi=10.1007/bf03327741 |s2cid=10497977}}</ref>

Elite athletes have a significantly higher rate in eating disorders. Female athletes in sports such as gymnastics, ballet, diving, etc. are found to be at the highest risk among all athletes. Women are more likely than men to acquire an eating disorder between the ages of 13 and 25. About 0–15% of those with bulimia and anorexia are men.<ref>{{cite book |vauthors=Nolen-Hoeksema S |year=2014 |title=Abnormal Psychology |location=New York |publisher=McGraw-Hill Education |page=323 |isbn=978-0-07-803538-8 |edition=6th}}</ref>

Other psychological problems that could possibly create an eating disorder such as Anorexia Nervosa are depression, and low self-esteem. Depression is a state of mind where emotions are unstable causing a person's eating habits to change due to sadness and no interest of doing anything. According to PSYCOM "Studies show that a high percentage of people with an eating disorder will experience depression."<ref>{{Cite web |title=Anorexia & Depression: When Eating Disorders Co-Exist with Depression |website=Psycom.net |url=https://www.psycom.net/anorexia-and-depression/ |access-date=2020-06-05}}</ref> Depression is a state of mind where people seem to refuge without being able to get out of it. A big factor of this can affect people with their eating and this can mostly affect teenagers. Teenagers are big candidates for Anorexia for the reason that during the teenage years, many things start changing and they start to think certain ways. According to Life Works an article about eating disorders "People of any age can be affected by pressure from their peers, the media and even their families but it is worse when you're a teenager at school."<ref>{{Cite web |title=Peer Pressure 'Big Factor' in Teen Eating Disorders {{!}} Life Works Rehab Surrey |url=https://www.lifeworkscommunity.com/blog/peer-pressure-big-factor-in-teen-eating-disorders |access-date=2020-06-05 |website=www.lifeworkscommunity.com}}</ref>

==== Cultural pressure ====
===== Western perspective =====
There is a cultural emphasis on thinness which is especially pervasive in western society. A child's perception of external pressure to achieve the ideal body that is represented by the media predicts the child's body image dissatisfaction, body dysmorphic disorder and an eating disorder.<ref>{{cite journal |vauthors=Knauss C, Paxton SJ, Alsaker FD |title=Relationships amongst body dissatisfaction, internalisation of the media body ideal and perceived pressure from media in adolescent girls and boys |journal=Body Image |volume=4 |issue=4 |pages=353–60 |date=December 2007 |pmid=18089281 |doi=10.1016/j.bodyim.2007.06.007}}</ref> "The cultural pressure on men and women to be 'perfect' is an important predisposing factor for the development of eating disorders".<ref>{{cite journal |vauthors=Garner DM, Garfinkel PE |s2cid=15755468 |title=Socio-cultural factors in the development of anorexia nervosa |journal=Psychological Medicine |volume=10 |issue=4 |pages=647–56 |date=November 1980 |pmid=7208724 |doi=10.1017/S0033291700054945}}</ref><ref>{{cite journal |vauthors=Eisenberg ME, Neumark-Sztainer D, Story M, Perry C |title=The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls |journal=Social Science & Medicine |volume=60 |issue=6 |pages=1165–73 |date=March 2005 |pmid=15626514 |doi=10.1016/j.socscimed.2004.06.055}}</ref> Further, when women of all races base their evaluation of their self upon what is considered the culturally ideal body, the incidence of eating disorders increases.<ref>{{cite journal |doi=10.1177/1077727X03255900 |title=Body Image, Appearance Self-Schema, and Media Images |year=2003 |vauthors=Jung J, Lennon SJ |journal=Family and Consumer Sciences Research Journal |volume=32 |pages=27–51}}</ref>

Socioeconomic status (SES) has been viewed as a risk factor for eating disorders, presuming that possessing more resources allows for an individual to actively choose to diet and reduce body weight.<ref>{{cite journal |vauthors=Nevonen L, Norring C |title=Socio-economic variables and eating disorders: a comparison between patients and normal controls |journal=Eating and Weight Disorders |volume=9 |issue=4 |pages=279–84 |date=December 2004 |pmid=15844400 |doi=10.1007/BF03325082 |s2cid=13089418}}</ref> Some studies have also shown a relationship between increasing body dissatisfaction with increasing SES.<ref>{{cite journal |vauthors=Polivy J, Herman CP |s2cid=2913370 |title=Causes of eating disorders |journal=Annual Review of Psychology |volume=53 |pages=187–213 |year=2002 |pmid=11752484 |doi=10.1146/annurev.psych.53.100901.135103}}</ref> However, once high socioeconomic status has been achieved, this relationship weakens and, in some cases, no longer exists.<ref name="Sohl, N. L. 2006">{{cite journal |vauthors=Soh NL, Touyz SW, Surgenor LJ |s2cid=178892 |year=2006 |title=Eating and body image disturbances across cultures: A review |journal=European Eating Disorders Review |volume=14 |issue=1 |pages=54–65 |doi=10.1002/erv.678}}</ref>

The media plays a major role in the way in which people view themselves. Countless magazine ads and commercials depict thin celebrities. Society has taught people that being accepted by others is necessary at all costs.<ref>{{cite book |vauthors=Essick E |chapter=Eating Disorders and Sexuality |chapter-url=https://books.google.com/books?id=ZaM04DMwK3gC&pg=PA276 |pages=[https://archive.org/details/contemporaryyout0000unse/page/276 276–80] |year=2006 |veditors=Steinberg SR, Parmar P, Richard B |title=Contemporary Youth Culture: An International Encyclopedia |publisher=Greenwood |isbn=978-0-313-33729-1 |url=https://archive.org/details/contemporaryyout0000unse/page/276}}</ref> This has led to the belief that in order to fit in one must look a certain way. Televised beauty competitions such as the [[Miss America]] Competition contribute to the idea of what it means to be beautiful because competitors are evaluated on the basis of their opinion.<ref>{{cite web |vauthors=DeMonte A |title=Beauty Pageants |url=http://www.credoreference.com/entry/sharpecw/beauty_pageants |publisher=M.E. Sharpe |access-date=24 September 2013}}{{dead link |date=June 2016|bot=medic}}{{cbignore|bot=medic}}</ref>

In addition to socioeconomic status being considered a cultural risk factor so is the world of sports. Athletes and eating disorders tend to go hand in hand, especially the sports where weight is a competitive factor. Gymnastics, horse back riding, wrestling, body building, and dancing are just a few that fall into this category of weight dependent sports. Eating disorders among individuals that participate in competitive activities, especially women, often lead to having physical and biological changes related to their weight that often mimic prepubescent stages. Oftentimes as women's bodies change they lose their competitive edge which leads them to taking extreme measures to maintain their younger body shape. Men often struggle with binge eating followed by excessive exercise while focusing on building muscle rather than losing fat, but this goal of gaining muscle is just as much an eating disorder as obsessing over thinness. The following statistics taken from Susan Nolen-Hoeksema's book, (''ab)normal psychology'', show the estimated percentage of athletes that struggle with eating disorders based on the category of sport.
* Aesthetic sports (dance, figure skating, gymnastics) – 35%
* Weight dependent sports (judo, wrestling) – 29%
* Endurance sports (cycling, swimming, running) – 20%
* Technical sports (golf, high jumping) – 14%
* Ball game sports (volleyball, soccer) – 12%

Although most of these athletes develop eating disorders to keep their competitive edge, others use exercise as a way to maintain their weight and figure. This is just as serious as regulating food intake for competition. Even though there is mixed evidence showing at what point athletes are challenged with eating disorders, studies show that regardless of competition level all athletes are at higher risk for developing eating disorders that non-athletes, especially those that participate in sports where thinness is a factor.<ref>{{cite book |vauthors=Nolen-Hoeksema S |title=Abnormal Psychology |year=2014 |location=New York |publisher=McGraw-Hill Education |isbn=978-0-07-803538-8 |pages=353–354 |edition=6th}}</ref>

Pressure from society is also seen within the homosexual community. [[Gay men]] are at greater risk of eating disorder symptoms than heterosexual men.<ref name="Boisvert, J. A. 2009">{{cite journal |doi=10.3149/jms.1703.210 |title=Homosexuality as a Risk Factor for Eating Disorder Symptomatology in Men |year=2009 |vauthors=Boisvert JA, Harrell WA |journal=The Journal of Men's Studies |volume=17 |issue=3 |pages=210–25 |s2cid=144871695}}</ref> Within the gay culture, muscularity gives the advantages of both social and sexual desirability and also power.<ref name="Siconolfi, D. 2009">{{cite journal |title=Body Dissatisfaction and Eating Disorders in a Sample of Gay and Bisexual Men |year=2009 |vauthors=Siconolfi D, Halkitis PN, Allomong TW, Burton CL |journal=International Journal of Men's Health |volume=8 |issue=3 |pages=254–264 |doi=10.3149/jmh.0803.254|doi-broken-date=1 November 2024}}</ref> These pressures and ideas that another homosexual male may desire a mate who is thinner or muscular can possibly lead to eating disorders. The higher eating disorder symptom score reported, the more concern about how others perceive them and the more frequent and excessive exercise sessions occur.<ref name="Siconolfi, D. 2009"/> High levels of body dissatisfaction are also linked to external motivation to working out and old age; however, having a thin and muscular body occurs within younger homosexual males than older.<ref name="Boisvert, J. A. 2009"/><ref name="Siconolfi, D. 2009"/>

Most of the cross-cultural studies use definitions from the DSM-IV-TR, which has been criticized as reflecting a Western cultural bias. Thus, assessments and questionnaires may not be constructed to detect some of the cultural differences associated with different disorders. Also, when looking at individuals in areas potentially influenced by Western culture, few studies have attempted to measure how much an individual has adopted the mainstream culture or retained the traditional cultural values of the area. Lastly, the majority of the cross-cultural studies on eating disorders and [[body image disturbance]]s occurred in Western nations and not in the countries or regions being examined.<ref name=":14">{{cite book |vauthors=Mash EJ, Wolfe DA |year=2010 |chapter=Eating Disorders and Related Conditions |chapter-url=https://books.google.com/books?id=hhvjIBUVDeYC&pg=PT415 |title=Abnormal Child Psychology |pages=415–26 |location=Belmont, CA: Wadsworth |publisher=Cengage Learning |isbn=978-0-495-50627-0}}</ref>

While there are many influences to how an individual processes their body image, the media does play a major role. Along with the media, parental influence, peer influence, and [[self-efficacy]] beliefs also play a large role in an individual's view of themselves. The way the media presents images can have a lasting effect on an individual's perception of their body image. Eating disorders are a worldwide issue and while women are more likely to be affected by an eating disorder it still affects both genders (Schwitzer 2012). The media influences eating disorders whether shown in a positive or negative light, it then has a responsibility to use caution when promoting images that projects an ideal that many turn to eating disorders to attain.<ref>{{cite journal |vauthors=Schwitzer AM |doi=10.1002/j.1556-6676.2012.00036.x |title=Diagnosing, Conceptualizing, and Treating Eating Disorders Not Otherwise Specified: A Comprehensive Practice Model |year=2012 |journal=Journal of Counseling & Development |volume=90 |issue=3 |pages=281–9}}</ref>

To try to address unhealthy body image in the fashion world, in 2015, [[France]] passed a law requiring models to be declared healthy by a doctor to participate in fashion shows. It also requires re-touched images to be marked as such in magazines.<ref>Kim Willsher, [https://www.theguardian.com/world/2015/dec/18/models-doctors-note-prove-not-too-thin-france Models in France must provide doctor's note to work] {{webarchive |url=https://web.archive.org/web/20161226221553/https://www.theguardian.com/world/2015/dec/18/models-doctors-note-prove-not-too-thin-france |date=2016-12-26}}, The Guardian, 18 December.</ref>

There is a relationship between "thin ideal" social media content and body dissatisfaction and eating disorders among young adult women, especially in the Western hemisphere.<ref name="auto">{{cite journal |vauthors=Ghaznavi J, Taylor LD |title=Bones, body parts, and sex appeal: An analysis of #thinspiration images on popular social media |journal=Body Image |volume=14 |pages=54–61 |date=June 2015 |pmid=25880783 |doi=10.1016/j.bodyim.2015.03.006}}</ref> New research points to an "internalization" of distorted images online, as well as negative comparisons among young adult women.<ref name="auto1">{{Cite journal |vauthors=Perloff RM |date=2014-05-29 |title=Social Media Effects on Young Women's Body Image Concerns: Theoretical Perspectives and an Agenda for Research |journal=Sex Roles |volume=71 |issue=11–12 |pages=363–377 |doi=10.1007/s11199-014-0384-6 |s2cid=28345078 |issn=0360-0025}}</ref> Most studies have been based in the U.S., the U.K, and Australia, these are places where the thin ideal is strong among women, as well as the strive for the "perfect" body.<ref name="auto1" />

In addition to mere media exposure, there is an online "pro-eating disorder" community. Through personal blogs and Twitter, this community promotes eating disorders as a "lifestyle", and continuously posts pictures of emaciated bodies, and tips on how to stay thin. The hashtag "#proana" (pro-anorexia), is a product of this community,<ref>{{cite journal |vauthors=Arseniev-Koehler A, Lee H, McCormick T, Moreno MA |title=#Proana: Pro-Eating Disorder Socialization on Twitter |journal=The Journal of Adolescent Health |volume=58 |issue=6 |pages=659–64 |date=June 2016 |pmid=27080731 |doi=10.1016/j.jadohealth.2016.02.012 |doi-access=free}}</ref> as well as images promoting weight loss, tagged with the term "thinspiration". According to social comparison theory, young women have a tendency to compare their appearance to others, which can result in a negative view of their own bodies and altering of eating behaviors, that in turn can develop disordered eating behaviors.<ref>{{Cite journal |vauthors=Yu UJ |title=Deconstructing College Students' Perceptions of Thin-Idealized Versus Nonidealized Media Images on Body Dissatisfaction and Advertising Effectiveness |journal=Clothing and Textiles Research Journal |volume=32 |issue=3 |pages=153–169 |doi=10.1177/0887302x14525850 |year=2014 |s2cid=145447562}}</ref>

When body parts are isolated and displayed in the media as objects to be looked at, it is called objectification, and women are affected most by this phenomenon. Objectification increases self-objectification, where women judge their own body parts as a mean of praise and pleasure for others. There is a significant link between self-objectification, body dissatisfaction, and disordered eating, as the beauty ideal is altered through social media.<ref name="auto" />

Although eating disorders are typically under diagnosed in people of color, they still experience eating disorders in great numbers. It is thought that the stress that those of color face in the United States from being multiply marginalized may contribute to their rates of eating disorders. Eating disorders, for these women, may be a response to environmental stressors such as racism, abuse and poverty.<ref>{{cite web |title=People of Color and Eating Disorders |url=https://www.nationaleatingdisorders.org/people-color-and-eating-disorders |website=National Eating Disorders Association |date=18 February 2018}}</ref>

===== African perspective =====
In the majority of many African communities, thinness is generally not seen as an ideal body type and most pressure to attain a slim figure may stem from influence or exposure to Western culture and ideology. Traditional African cultural ideals are reflected in the practice of some health professionals; in Ghana, pharmacists sell appetite stimulants to women who desire to, as Ghanaians stated, "grow fat".<ref>{{cite journal |vauthors=Keel PK, Klump KL |s2cid=7683812 |title=Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology |journal=Psychological Bulletin |volume=129 |issue=5 |pages=747–69 |date=September 2003 |pmid=12956542 |doi=10.1037/0033-2909.129.5.747}}</ref> Girls are told that if they wish to find a partner and birth children they must gain weight. On the contrary, there are certain taboos surrounding a slim body image, specifically in West Africa. Lack of body fat is linked to poverty and [[HIV/AIDS]].<ref name=":2">{{cite journal |vauthors=Coetzee V, Faerber SJ, Greeff JM, Lefevre CE, Re DE, Perrett DI |title=African perceptions of female attractiveness |journal=PLOS ONE |volume=7 |issue=10 |page=e48116 |date=2012-10-29 |pmid=23144734 |pmc=3483252 |doi=10.1371/journal.pone.0048116 |bibcode=2012PLoSO...748116C |doi-access=free}}</ref>

However, the emergence of Western and European influence, specifically with the introduction of such fashion and modelling shows and competitions, is changing certain views among body acceptance, and the prevalence of eating disorders has consequently increased.<ref name=":2" /> This acculturation is also related to how South Africa is concurrently undergoing rapid, intense urbanization. Such modern development is leading to cultural changes, and professionals cite rates of eating disorders in this region will increase with urbanization, specifically with changes in identity, body image, and cultural issues.<ref>{{Cite journal |vauthors=Freeman AC, Szabo CP |date=2005 |title=Eating Disorders in South African Males: A Review of the Clinical Presentation of Hospitalised Patients |journal=South African Journal of Psychology |volume=35 |issue=4 |pages=601–622 |doi=10.1177/008124630503500401 |s2cid=144551239}}</ref> Further, exposure to Western values through private Caucasian schools or caretakers is another possible factor related to acculturation which may be associated with the onset of eating disorders.<ref name=":9">{{cite journal |vauthors=Davis C, Yager J |title=Transcultural aspects of eating disorders: a critical literature review |journal=Culture, Medicine and Psychiatry |volume=16 |issue=3 |pages=377–94 |date=September 1992 |pmid=1395702 |doi=10.1007/BF00052156 |s2cid=40864146}}</ref>

Other factors which are cited to be related to the increasing prevalence of eating disorders in African communities can be related to sexual conflicts, such as psychosexual guilt, first sexual intercourse, and pregnancy. Traumatic events which are related to both family (i.e. parental separation) and eating related issues are also cited as possible effectors.<ref name=":9" /> Religious fasting, particularly around times of stress, and feelings of self-control are also cited as determinants in the onset of eating disorders.<ref>{{cite journal |vauthors=Taylor JY, Caldwell CH, Baser RE, Faison N, Jackson JS |title=Prevalence of eating disorders among Blacks in the National Survey of American Life |journal=The International Journal of Eating Disorders |volume=40 |issue=Suppl |pages=S10-4 |date=November 2007 |pmid=17879287 |pmc=2882704 |doi=10.1002/eat.20451}}</ref>

===== Asian perspective =====
The West plays a role in Asia's economic development via foreign investments, advanced technologies joining financial markets, and the arrival of American and European companies in Asia, especially through outsourcing manufacturing operations.<ref name=Pike2015>{{cite journal |vauthors=Pike KM, Dunne PE |title=The rise of eating disorders in Asia: a review |journal=Journal of Eating Disorders |volume=3 |issue=1 |page=33 |date=2015-09-17 |pmid=26388993 |pmc=4574181 |doi=10.1186/s40337-015-0070-2 |doi-access=free}}</ref> This exposure to Western culture, especially the media, imparts Western body ideals to Asian society, termed Westernization.<ref name=Pike2015 /> In part, Westernization fosters eating disorders among Asian populations.<ref name=Pike2015 /> However, there are also country-specific influences on the occurrence of eating disorders in Asia.<ref name=Pike2015 />

====== China ======
In China as well as other Asian countries, Westernization, migration from rural to urban areas, after-effects of sociocultural events, and disruptions of social and emotional support are implicated in the emergence of eating disorders.<ref name=Pike2015 /> In particular, risk factors for eating disorders include higher socioeconomic status, preference for a thin body ideal, history of child abuse, high anxiety levels, hostile parental relationships, jealousy towards media idols, and above-average scores on the body dissatisfaction and interoceptive awareness sections of the Eating Disorder Inventory.<ref>{{cite journal |vauthors=Chen H, Jackson T |title=Prevalence and sociodemographic correlates of eating disorder endorsements among adolescents and young adults from China |journal=European Eating Disorders Review |volume=16 |issue=5 |pages=375–85 |date=September 2008 |pmid=17960779 |doi=10.1002/erv.837}}</ref> Similarly to the West, researchers have identified the media as a primary source of pressures relating to physical appearance, which may even predict body change behaviors in males and females.<ref name=Pike2015 />

====== Fiji ======
While colonised by the British in 1874, Fiji kept a large degree of linguistic and cultural diversity which characterised the ethnic Fijian population. Though gaining independence in 1970, Fiji has rejected Western, capitalist values which challenged its mutual trusts, bonds, kinships and identity as a nation.<ref>{{cite book |vauthors=Becker AE |title=Body, self, and society : the view from Fiji |date=1995 |publisher=University of Pennsylvania Press |isbn=978-0-8122-1397-3 |location=Philadelphia |page=15}}</ref> Similar to studies conducted on Polynesian groups, ethnic Fijian traditional aesthetic ideals reflected a preference for a robust body shape; thus, the prevailing 'pressure to be slim,' thought to be associated with diet and disordered eating in many Western societies was absent in traditional Fiji.<ref>{{cite journal |vauthors=Pollock N |date=1985 |title=The Concept of Food in a Pacific Society: A Fijian Example |journal=Ecology of Food and Nutrition |volume=17 |issue=3 |pages=195–203 |doi=10.1080/03670244.1985.9990896|bibcode=1985EcoFN..17..195P}}</ref> Additionally, traditional Fijian values would encourage a robust appetite and a widespread vigilance for and social response to weight loss. Individual efforts to reshape the body by dieting or exercise, thus traditionally was discouraged.<ref>{{cite journal |vauthors=Becker AE, Hamburg P |title=Culture, the media, and eating disorders |journal=Harvard Review of Psychiatry |volume=4 |issue=3 |pages=163–7 |date=January 1996 |pmid=9384990 |doi=10.3109/10673229609030540 |s2cid=30169613}}</ref>

However, studies conducted in 1995 and 1998 both demonstrated a link between the introduction of television in the country, and the emergence of eating disorders in young adolescent ethnic Fijian girls.<ref>{{cite journal |vauthors=Becker AE, Gilman SE, Burwell RA |title=Changes in prevalence of overweight and in body image among Fijian women between 1989 and 1998 |journal=Obesity Research |volume=13 |issue=1 |pages=110–7 |date=January 2005 |pmid=15761169 |doi=10.1038/oby.2005.14 |doi-access=free}}</ref> Through the quantitative data collected in these studies there was found to be a significant increase in the prevalence of two key indicators of disordered eating: self-induced vomiting and high Eating Attitudes Test- 26.<ref name="Eating behaviours and attitudes fol">{{cite journal |vauthors=Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P |title=Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls |journal=The British Journal of Psychiatry |volume=180 |issue=6 |pages=509–14 |date=June 2002 |pmid=12042229 |doi=10.1192/bjp.180.6.509 |doi-access=free}}</ref> These results were recorded following prolonged television exposure in the community, and an associated increase in the percentage of households owning television sets. Additionally, qualitative data linked changing attitudes about dieting, weight loss and aesthetic ideas in the peer environment to Western media images. The impact of television was especially profound given the longstanding social and cultural traditions that had previously rejected the notions of dieting, purging and body dissatisfaction in Fiji.<ref name="Eating behaviours and attitudes fol"/> Additional studies in 2011 found that social network media exposure, independent of direct media and other cultural exposures, was also associated with eating pathology.<ref>{{cite journal |vauthors=Becker AE, Fay KE, Agnew-Blais J, Khan AN, Striegel-Moore RH, Gilman SE |title=Social network media exposure and adolescent eating pathology in Fiji |journal=The British Journal of Psychiatry |volume=198 |issue=1 |pages=43–50 |date=January 2011 |pmid=21200076 |pmc=3014464 |doi=10.1192/bjp.bp.110.078675 |doi-access=free}}</ref>

====== Hong Kong ======
From the early- to-mid- 1990s, a variant form of anorexia nervosa was identified in Hong Kong.<ref name=":5">{{cite journal |vauthors=Miller MN, Pumariega AJ |title=Culture and eating disorders: a historical and cross-cultural review |journal=Psychiatry |volume=64 |issue=2 |pages=93–110 |date=May 2001 |pmid=11495364 |doi=10.1521/psyc.64.2.93.18621 |s2cid=21186595}}</ref> This variant form did not share features of anorexia in the West, notably "fat-phobia" and distorted body image.<ref name=":5"/> Patients attributed their restrictive food intake to somatic complaints, such as epigastric bloating, abdominal or stomach pain, or a lack of hunger or appetite.<ref name=Pike2015/> Compared to Western patients, individuals with this variant anorexia demonstrated bulimic symptoms less frequently and tended to have lower pre-morbid body mass index.<ref name=Pike2015/> This form disapproves the assumption that a "fear of fatness or weight gain" is the defining characteristic of individuals with anorexia nervosa.<ref name=":5"/>

====== India ======
In the past, the available evidence did not suggest that unhealthy weight loss methods and eating disordered behaviors are common in India as proven by stagnant rates of clinically diagnosed eating disorders.<ref>{{cite journal |vauthors=Mammen P, Russell S, Russell PS |title=Prevalence of eating disorders and psychiatric comorbidity among children and adolescents |journal=Indian Pediatrics |volume=44 |issue=5 |pages=357–9 |date=May 2007 |pmid=17536137}}</ref> However, it appears that rates of eating disorders in urban areas of India are increasing based on surveys from psychiatrists who were asked whether they perceived eating disorders to be a "serious clinical issue" in India.<ref name=Pike2015 /> One notable Indian psychiatrist and eating disorder specialist Dr Udipi Gauthamadas is on record saying, "Disturbed eating attitudes and behaviours affect about 25 to 40 percent of adolescent girls and around 20 percent of adolescent boys.<ref>{{Cite web |title=At war with the Body |url=https://www.newindianexpress.com/lifestyle/health/2019/jul/28/at-war-with-the-body-2009347.html |access-date=2023-08-05 |website=The New Indian Express|date=28 July 2019}}</ref> While on one hand there is increasing recognition of eating disorders in the country, there is also a persisting belief that this illness is alien to India. This prevents many sufferers from seeking professional help.<ref>{{Cite web | vauthors = Chaudhuri ZR |date=2018-01-05 |title=Over 25% of teenage Indian girls suffer from eating disorders. This art project shows how they feel |url=https://scroll.in/magazine/863540/over-25-of-teenage-indian-girls-suffer-from-eating-disorders-this-art-project-shows-how-they-feel |access-date=2023-08-05 |website=Scroll.in}}</ref>"

23.5% of respondents believed that rates of eating disorders were rising in Bangalore, 26.5% claimed that rates were stagnant, and 42%, the largest percentage, expressed uncertainty. It has been suggested that urbanization and socioeconomic status are associated with increased risk for body weight dissatisfaction.<ref name="Pike2015" /> However, due to the physical size of and diversity within India, trends may vary throughout the country.<ref name="Pike2015" />

==== American perspective ====

===== Black and African American =====

Historically, identifying as African American has been considered a protective factor for body dissatisfaction. Those identifying as African American have been found to have a greater acceptance of larger body image ideals and less internalization of the thin ideal,<ref>{{cite journal |vauthors=Miller KJ, Gleaves DH, Hirsch TG, Green BA, Snow AC, Corbett CC |title=Comparisons of body image dimensions by race/ethnicity and gender in a university population |journal=The International Journal of Eating Disorders |volume=27 |issue=3 |pages=310–6 |date=April 2000 |pmid=10694717 |doi=10.1002/(sici)1098-108x(200004)27:3<310::aid-eat8>3.0.co;2-q |doi-access=free}}</ref><ref>{{cite journal |vauthors=Rand CS, Kuldau JM |title=The epidemiology of obesity and self-defined weight problem in the general population: Gender, race, age, and social class |journal=International Journal of Eating Disorders |date=1990 |volume=9 |issue=3 |pages=329–343 |doi=10.1002/1098-108X(199005)9:3<329::AID-EAT2260090311>3.0.CO;2-B}}</ref><ref>{{cite journal |vauthors=Thompson SH, Corwin SJ, Sargent RG |title=Ideal body size beliefs and weight concerns of fourth-grade children |journal=The International Journal of Eating Disorders |volume=21 |issue=3 |pages=279–84 |date=April 1997 |pmid=9097201 |doi=10.1002/(SICI)1098-108X(199704)21:3<279::AID-EAT8>3.0.CO;2-H}}</ref> and African American women have reported the lowest levels of body dissatisfaction among the five major racial/ethnic groups in the US.<ref>{{cite journal |vauthors=Vander Wal JS, Thomas N |title=Predictors of body image dissatisfaction and disturbed eating attitudes and behaviors in African American and Hispanic girls |journal=Eating Behaviors |volume=5 |issue=4 |pages=291–301 |date=November 2004 |pmid=15488444 |doi=10.1016/j.eatbeh.2004.04.001}}</ref>

However, recent research contradicts these findings, indicating that African American women may exhibit levels of body dissatisfaction comparable to other racial/ethnic minority groups.<ref>{{cite journal |vauthors=Olson KL, Lillis J, Panza E, Wing RR, Quinn DM, Puhl RR |title=Body shape concerns across racial and ethnic groups among adults in the United States: More similarities than differences |journal=Body Image |volume=35 |pages=108–113 |date=December 2020 |pmid=32979632 |pmc=7744334 |doi=10.1016/j.bodyim.2020.08.013}}</ref> In this way, just because those who identify as African American may not internalize the thin ideal as strongly as other racial and ethnic groups, it does not mean that they do not hold other appearance ideals that may promote body shape concerns.<ref>{{cite journal |vauthors=Nagata JM, Murray SB, Bibbins-Domingo K, Garber AK, Mitchison D, Griffiths S |title=Predictors of muscularity-oriented disordered eating behaviors in U.S. young adults: A prospective cohort study |journal=The International Journal of Eating Disorders |volume=52 |issue=12 |pages=1380–1388 |date=December 2019 |pmid=31220361 |pmc=6901753 |doi=10.1002/eat.23094}}</ref> Similarly, recent research shows that African Americans exhibit rates of disordered eating that are similar to<ref>{{cite journal |vauthors=Beccia AL, Jesdale WM, Lapane KL |title=Associations between perceived everyday discrimination, discrimination attributions, and binge eating among Latinas: results from the National Latino and Asian American Study |journal=Annals of Epidemiology |volume=45 |pages=32–39 |date=May 2020 |pmid=32340835 |pmc=7329263 |doi=10.1016/j.annepidem.2020.03.012}}</ref><ref>{{cite journal |vauthors=Grabe S, Hyde JS |title=Ethnicity and body dissatisfaction among women in the United States: a meta-analysis |journal=Psychological Bulletin |volume=132 |issue=4 |pages=622–40 |date=July 2006 |pmid=16822170 |doi=10.1037/0033-2909.132.4.622}}</ref> or even higher<ref name=":15">{{cite journal |vauthors=Marques L, Alegria M, Becker AE, Chen CN, Fang A, Chosak A, Diniz JB |title=Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders |journal=The International Journal of Eating Disorders |volume=44 |issue=5 |pages=412–20 |date=July 2011 |pmid=20665700 |pmc=3011052 |doi=10.1002/eat.20787}}</ref> than their white counterparts.

===== Native American =====

[[Native Americans in the United States|Native American]] women are more likely than white women to both experience a fear of losing control over their eating<ref name=":16">{{cite journal |vauthors=Striegel-Moore RH, Rosselli F, Holtzman N, Dierker L, Becker AE, Swaney G |title=Behavioral symptoms of eating disorders in Native Americans: results from the ADD Health Survey Wave III |journal=The International Journal of Eating Disorders |volume=44 |issue=6 |pages=561–6 |date=September 2011 |pmid=21823140 |doi=10.1002/eat.20894 |doi-access=free |pmc=11624507}}</ref> and to abuse laxatives and diuretics for weight control purposes.<ref name=":17">{{cite journal |vauthors=Franko DL, Becker AE, Thomas JJ, Herzog DB |title=Cross-ethnic differences in eating disorder symptoms and related distress |journal=The International Journal of Eating Disorders |volume=40 |issue=2 |pages=156–64 |date=March 2007 |pmid=17080449 |doi=10.1002/eat.20341}}</ref> They have comparable rates of binge eating and other disordered weight control behaviors in comparison to other racial groups.<ref name=":16" /><ref name=":17" />

===== Latinos =====

Disproportionately high rates of disordered eating and body dissatisfaction have been found in [[Hispanic and Latino Americans|Hispanics]] in comparison to other racial and ethnic groups. Studies have found significantly more laxative use<ref>{{cite journal |vauthors=Monterubio GE, Fitzsimmons-Craft EE, Balantekin KN, Sadeh-Sharvit S, Goel NJ, Laing O, Firebaugh ML, Flatt RE, Cavazos-Rehg P, Taylor CB, Wilfley DE |title=Eating disorder symptomatology, clinical impairment, and comorbid psychopathology in racially and ethnically diverse college women with eating disorders |journal=The International Journal of Eating Disorders |volume=53 |issue=11 |pages=1868–1874 |date=November 2020 |pmid=32918315 |pmc=7669650 |doi=10.1002/eat.23380}}</ref><ref name=":17" /> in those identifying as Hispanic in comparison to non-Hispanic white counterparts. Specifically, those identifying as Hispanic may be at heightened risk of engaging in binge eating and bingeing/purging behaviors.<ref name=":15" />

===Food insecurity===

Food insecurity is defined as inadequate access to sufficient food, both in terms of quantity and quality,<ref>{{cite report |vauthors=Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A |title=Household food security in the United States in 2015 ERR-215 |location=Washington, DC |publisher=US Department of Agriculture. Economic Research Service |date=2016 | series = IDEAS Working Paper Series from RePEc}}</ref> in direct contrast to food security, which is conceptualized as having access to sufficient, safe, and nutritious food to meet dietary needs and preferences.<ref>{{cite journal |vauthors=Lang T, Barling D |title=Food security and food sustainability: reformulating the debate. |journal=The Geographical Journal |date=December 2012 |volume=178 |issue=4 |pages=313–26 |doi=10.1111/j.1475-4959.2012.00480.x |bibcode=2012GeogJ.178..313L |url=https://openaccess.city.ac.uk/id/eprint/12902/7/Lang%20Barling%20FdSec%20Geog%20Journal%2003%2001%2012.pdf}}</ref> Notably, levels of food security exist on a continuum from reliable access to food to disrupted access to food.

Multiple studies have found food insecurity to be associated with eating pathology. A study conducted on individuals visiting a food bank in Texas found higher food insecurity to be correlated with higher levels of binge eating, overall eating disorder pathology, dietary restraint, compensatory behaviors and weight self-stigma.<ref name="pmid28626944">{{cite journal |vauthors=Becker CB, Middlemass K, Taylor B, Johnson C, Gomez F |title=Food insecurity and eating disorder pathology |journal=The International Journal of Eating Disorders |volume=50 |issue=9 |pages=1031–1040 |date=September 2017 |pmid=28626944 |doi=10.1002/eat.22735 |s2cid=205778149 |url=https://digitalcommons.trinity.edu/cgi/viewcontent.cgi?article=1141&context=psych_faculty}}</ref> Findings of a replication study with a larger, more diverse sample mirrored these results,<ref>{{cite journal |vauthors=Becker CB, Middlemass KM, Gomez F, Martinez-Abrego A |title=Eating disorder pathology among individuals living with food insecurity: a replication study. |journal=Clinical Psychological Science |date=September 2019 |volume=7 |issue=5 |pages=1144–58 |doi=10.1177/2167702619851811 |s2cid=196509897 |url=https://digitalcommons.trinity.edu/psych_faculty/199}}</ref> and a study looking at the relationship between food insecurity and bulimia nervosa similarly found greater food insecurity to be associated with elevated levels of eating pathology.<ref name="pmid30920683">{{cite journal |vauthors=Lydecker JA, Grilo CM |title=Food insecurity and bulimia nervosa in the United States |journal=The International Journal of Eating Disorders |volume=52 |issue=6 |pages=735–739 |date=June 2019 |pmid=30920683 |pmc=6555671 |doi=10.1002/eat.23074}}</ref>

=== Trauma ===
One study has found that binge-eating disorder may stem from trauma, with some female patients engaging in these disorders to numb pain experienced through sexual trauma.<ref>{{Cite journal | vauthors = Thompson BW |date=1992 |title="A Way Outa No Way": Eating Problems among African-American, Latina, and White Women |url=https://journals.sagepub.com/doi/abs/10.1177/089124392006004002 |journal=Gender and Society |volume=6 |issue=4 |pages=546–561 |doi=10.1177/089124392006004002 |s2cid=145179769 |issn=0891-2432}}</ref>  There are various forms of trauma that individuals may have experienced, leading them to cope through an eating disorder. When in pain, individuals may attempt to exert control over this aspect of their lives, perceiving it as their only means of managing their life. The brain is a very complex organ that tries its best to help us navigate through the hardships of life.

=== Sexual Orientation and Gender Identity ===
Sexual orientation, gender identity and gender norms influence people with eating disorders. Some eating disorder patients have implied that enforced heterosexuality and heterosexism led many to engage in their condition to align with norms associated with their gender identity. Families may restrict women's food intake to keep them thin, thus increasing their ability to attain a male romantic partner.<ref>{{Cite journal | vauthors = Thompson BW |title="A Way Outa No Way" |date=December 1992 |url=https://journals.sagepub.com/doi/abs/10.1177/089124392006004002 |journal=Gender & Society |volume=6 |issue=4 |pages=546–561 |doi=10.1177/089124392006004002 |s2cid=145179769 |issn=0891-2432}}</ref> Non-heterosexual male adolescents are consistently at higher risk of developing disordered eating than their heterosexual peers for various body image concerns, including worries about weight, shape, muscle tone, and definition. Eating disorders in trans and non-binary adolescents is complicated in that some eating disorder symptoms may affirm gender identity in transitioning patients, complicating treatment. For example, loss of menstruation in birth-assigned females or a slender frame in birth-assigned males may align with their gender identity during transition.<ref>{{cite journal | vauthors = Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, Blashill AJ, Mond JM | title = The enigma of male eating disorders: A critical review and synthesis | journal = Clinical Psychology Review | volume = 57 | pages = 1–11 | date = November 2017 | pmid = 28800416 | doi = 10.1016/j.cpr.2017.08.001}}</ref>