What causes eating disorders?
There is a common phrase among eating disorder clinicians that says “Genetics loads the gun and environment pulls the trigger.” Meaning, there are personality and brain state trait vulnerabilities that are risk factors for certain persons who, when faced with an environmental stressor (adolescence, leaving home/school, relationship break up or divorce, sexual trauma, loss of a loved one, pregnancy and postpartum, etc), then develop an eating disorder.
What traits make a person susceptible to an eating disorder?
As any parent knows, kids come out of the womb with their own unique temperament. It isn’t good or bad and it isn’t controllable. It simply is. Some kids are “slow to warm up,” some kids are “active.” It is apparent almost from infancy. The research literature on eating disorders has identified certain temperament traits that people with eating disorders often have including: negative emotionality/low self-esteem, perfectionism, inhibition, picky eating, obsessive compulsive, anxiety/fearfulness, mood lability, impulsivity.  Even though these traits may sound awful, actually, these traits can be great assets when channeled in the right direction. I myself struggled with low self-esteem, picky eating, shyness, perfectionism, and anxiety all through my childhood. As a recovered adult, I have learned to channel perfectionism into conscientiousness, shyness into being of service, negative emotionality into passion for recovery and empathy for suffering, and picky eating into acceptance of my preferences, anxiety into a creative and professional drive to grow as a person and clinician. I often work with clients on shifting their “character defects” into “character assets.” Falling in love (with appropriate professional boundaries of course) with my clients has helped me see this more clearly: people who have or are struggling with eating disorders are some of the most sensitive, empathic, creative, highly achieving, loyal, and dependable people I have met. They are also extremely hard on themselves. That is where being witnessed and encouraged by an external source of compassion can be especially helpful in recovery, until it can be grown it internally.
Twin studies of Anorexia and Bulimia suggest that there is a 50-80% genetic contribution to these disorders. Wow! 50-80%!  We did NOT learn that in my graduate school training or Psychologist licensure materials. That is similar to the genetic risk factors associated with Schizophrenia and Bipolar Disorder, for which all clinicians are trained to be on the lookout. How many people suffering with eating disorders as well as their parents would feel relieved of it being at least partially “not their fault” and on the lookout for prevention in knowing there was a genetic risk?
What can we DO about it?
1. Awareness of your own and your child’s temperament
Awareness is the first key. There is a 12-step slogan that is helpful to keep in mind here, called “Awareness, Acceptance, Action.” In other words, first, become aware of your own and/or your child’s temperament. If you or your child are of the more “slow to warm up” temperament, notice this and accept it without judgment. As one article describes:
Temperament is not something your child (or you) chooses, nor is it something that you created. There is not a “right” or “wrong” or “better” or “worse” temperament…some children are naturally more comfortable in new situations and jump right in, whereas others are more cautious and need time and support from caring adults to feel safe in unfamiliar situations…Some children seem to come out of the womb waving hello. Others are more hesitant around people they don’t know, beginning even as young babies. As they grow, these children often prefer to play with just one or two close friends, instead of a large group. Children who are slow to warm up often need time and support from trusted caregivers to feel comfortable interacting in new places or with new people.  This is fabulous article on “slow to warm up” temperament: http://www.zerotothree.org/child-development/challenging-behavior/cautious-slow-to-warm-up.html
2. Acceptance and Action of temperament fits
Once you have noticed with awareness and acceptance both your own and your child’s temperament, practice compassionate acceptance and action to accommodate both of these. For example, if you are more slow-to-warm-up but your child is active, go to places where you feel comfortable and your child can be themselves! This might be a playground or other space that the child can be safely active in and you can be an observer. Staying in the house with your active toddler climbing all over the furniture and throwing things is going to set you both up for frustration. If one or both of you are sensitive to sounds and tastes, incorporate that awareness into your planning, your home environment, your communication with caregivers and teachers. My toddler loves smooth textures. He will pretty much eat anything if it is smooth. If he finds a bump, leaf, or seed in it, he will not eat it. Instead of fighting this continually (which I tried!), I give him lots of smooth, blended food and little taste options of other textures to which he can say “no thank you” and leave on his plate until he “warms up” to try them. His school has optional “performances” for all the children. They can do somersaults, be a fire truck, dance, pretend to be a kitty cat, etc in front of all the teachers and parents every week. For an active child, this is a dream come true. These children leap into performing their first day. For a slow-to-warm-up child it is a nightmarish terror. My child has yet to “perform.” I have had to learn to contain my own anxiety and flashbacks of childhood violin recitals. If and when my child is ready, he will perform. Or not.
Here is a helpful article on Goodness of Fit between parents and children:http://centerforparentingeducation.org/library-of-articles/child-development/unique-child-equation/temperament/understanding-goodness-of-fit/
3. Be a mindful eater yourself and let your child maintain their own mindful eating
Recovering women (and men) need to re-learn to trust our bodies, our hungers, listen and trust our satiety levels. We need to re-learn how to “eat normally” and intuitively. Normal eating includes eating food that you like, giving some thought to food selection that includes nutrition without restricting, and sometimes eating for reasons that include emotional needs or convenience. I tell my clients recovering from eating disorders if food was devoid of emotional eating, we would all be eating pellets at mealtime This is not brave new world. We are never going to eat for ONLY physical reasons and that is ok! Food is pleasurable, food includes memories, food includes preferences, family and cultural experiences. I have always liked chocolate since I was a little girl. I have never liked mushrooms. This was true for me as a toddler and it is true for me as a middle-aged woman. This has remained true all through my eating disorder and 15 years of recovery. I need to respect that. I also need to be aware that sometimes I need to eat lunch early due to my child’s or my work schedule or have a snack in the afternoon in order to have a later dinner with my family. My recovery is flexible and mindful to these facets of eating.
Ellen Satter, a Nutritionist and Family therapist and authority on feeding and eating, who has written many books and articles with practical wisdom, offers the following description of normal eating:
Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.
In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings. 4
Children are natural intuitive eaters. Ellyn Satter offers the following “division of responsibility” suggestion for facilitating maintaining a sense of intuitive eating for children as they grow. “The parent is responsible for what, when, where. The child is responsible for how much and whether. Fundamental to parents’ jobs is trusting children to decide how much and whether to eat... Fundamental to parents’ jobs is trusting children to decide how much and whether to eat. If parents do their jobs with feeding, children do their jobs with eating.”
For a full version of the Division of Responsibility, go to
In summary, when we take away the shame and blame of eating disorders, prevention and recovery from them becomes a wide open place of exploration. It stops being about Who caused this or Why am I so messed up and turns into an interesting journey of appreciation and discovery.
Cassin, S. and von Ranson, K. (2005) Personality and eating disorders: a decade in review. Clin. Pyschol. Rev. 25, 895-916.
Wagner, A. et al. (2006) Personality traits after recovery from eating disorders: do subtypes differ? International Journal of Eating Disorders 39, 276-284.
Rachell, L. and Lilenfeld, L. (2011) Personality and temperament. In Behavioral Neurobiology of Eating Disorders (Current Topics in Behavioral Neurosciences, Vol. 6) pp3-16, Springer
 Bulik, CM et al. (2006) Prevalence, heritability and prospective risk factors for anorexia nervosa. Arch. General Psychiatry 63, 305-312.
 Zerotothree website Authors: Rebecca Parlakian and Claire Lerner, LCSW, ZERO TO THREE, Contributors: Patricia Blackwell, PhD Psychologist, Private Practice ZERO TO THREE Graduate Fellow