I am not so sure that culture cannot cause eating disorders. Actually I believe that mental but also other diseases often develop because both a vulnerability and a cultural context come together.

Personally I am convinced that I developed BED because I grew up as a fat kid in a culture that despised my body, for example I was bullied from a very early age, and teachers, doctors, and eventually also my parents constantly harked on how I needed to lose weight. My natural tendency to be bigger than the average person together with being someone who cares a lot about what others think of her (note: not necessarily a bad thing) as well as someone who tends to live extremes (i.e., I either do things close to "perfectly" or not at all) probably predisposed me, but I really doubt that I would have developed my ED if the cultural context had been more friendly.

Two points I wanted to add to my previous comment:

1) I don't blame my parents for my ED - in fact, I think I have the most supportive and loving parents in the world. I do however think that in my case they acted as an additional cultural influence. Understandably they believed what they professionals around them told them to do and tried to control my weight.

2) What speaks for a combination of nature and nurture form most mental disorders is the fact that while an identical twin often have a very high strongly increased risk to develop the same disorders as their twin this likelihood is never as high as 100% (or at least I don't know of a disorder were it is 100%). Of course, there are non-genetic biological factors that also might have an influence, still I think that the evidence makes it likely that at least in some cases and for certain disorders social factors do play a role.

That could be very true- Cindy Bulik (an ED researcher at UNC Chapel Hill) said that genetics loads and gun and environment pulls the trigger. And I do believe how the environment pulled the trigger!

But I don't know that culture *caused* your eating disorder. Without an underlying genetic vulnerability, I don't think you would have developed a full blown ED. That you might not have developed it without the cultural input is entirely possible. You might have still had the loaded gun, but not the trigger. Yet that doesn't necessarily imply a cultural "cause".

I'm not trying to discount your personal experiences AT ALL. Just putting in my perspective.

Thanks for sharing,
Carrie

Well, actually the way I understand it (from my social psych background - and we might use a different language than other fields) it depends on how you construe things. I could say that my personality (which is to some degree genetically determined) and other non-personality related biological factors caused my ED while culture acted as a mediator. But it is equally possible to say that culture is the cause while biological and personality factors acted as mediator. In reality this wouild mean there are several causal factors which have to come together. Of course it's possible that one of the is the primary factor, but I am honestly not sure which one it would be.

As a social psych grad student I tend to assume that social factors play a strong role in determining people's behavior, and that would include certain disordered behaviors. But I might be biased. I do, however, dislike the focus on the individual - mainly because I think it is counterproductive at best and harmful at worst to label certain people as disordered while not looking at "disordered" patterns in society.

(Also, don't worry, I did not have the impression that you were trying to discount my personal experiences. In fact, I very much agree the general tone of your blog. In particular I appreciate that you do not just write about anorexia and bulimia but also about EDNOS in its various forms.)

I love the post - wonderful! - and this discussion.

If everyone in the ED world were having this conversation we would really be doing well. Unfortunately we get stuck in a nature VS nurture smackdown and lose the point. Biology and thoughts interact.

I happen to think society does influence disordered eating and thinking, but that an eating disorder is something of a very different magnitude. Paper cut to guillotine.

Paper cuts suck, but an ED requires a whole different reaction.

Just wanted to say... when I wrote "mediator" earlier on I meant "moderator" (considering that I had several statistics classes dwelling on the difference it is kind of embarrassing that I made that mistake...)

I agree with Laura that getting bogged down in nature vs. nurture is completely counterproductive, as science has repeatedly shown that it's how these interplay that creates the individual.

It is highly unlikely that the genetic bases for ED function like one on/off switch. In a given population, some people will have a very high propensity for developing ED, and some will have a very low, and most will be in-between. Therefor it stands to reason that the more the (cultural) environment is condusive to developing disordered eating, the more likely it is that people who started out with lower propensity will wind up having their "nascent" ED triggered. Thus the phenotype is more likely to be realized in a culture that lauds and encorages disordered eating, than in a culture that supports intuitive eating.
IMO, of course.

It's also possible that the "nature" vs. "nurture" ration is different for different EDs.

Somewhat related to this... I think my family is something of an interesting case. My oldest sister was anorexic when she was about 15. Fortunately she recovered before the ED could take hold. I and my other (also older) sister both showed at least some BED behaviors - although it has been a lot worse in my case. (I am also the only one of us three that still struggles with an ED.) Two of my four female cousins had anorexia, one who actually cycled between anorexia and binge-eating, for the second I don't know details. I CAN imagine that there is some common genetic factor present. Although this would seem counterintuitive for a lot of people since anorexia and BED are usually viewed as polar opposites (I am personally not sure if this is really true, though).

I think the "nature" vs. "nurture" components are different for each person. We can say with anorexia that, on average, about 70% of a person's risk is genetic. That doesn't mean that 70% of the time, the cause is genetic and 30% the cause is cultural; rather, it has to do with the *strentgh* of the risk. And this is probably going to be different in different people.

Also keep in mind that environment can change genes: http://ed-bites.blogspot.com/2008/10/how-nurture-changes-nature.html and it may be that the environmental triggers (such as dieting), as well as the hormones of puberty (gotta love 'em!) can turn on some of the genes that ultimately perpetuate ED behavior.

And your genetic history suggests a very strong risk indeed! The fact is, no one knows the exact underpinnings of either AN or BED, but I would suspect there would be some similarities- an inability to hear hunger and fullness cues, for instance. Anxiety/depression issues. Things like that. And some of the same genes could be different in both AN and BED, although these differences would have opposite effects.

Wow- this is a great discussion.

Actually, I don't find the link between AN and BN and BED that odd: all three have their roots in restriction.

Dieting can lead to self-perpetuating restriction for some, to intermittent bingeing and purging for others, and bingeing in a third group.

(Most people just get hungry and cranky, and drop the diet.)

I think the "nature" vs. "nurture" components are different for each person. We can say with anorexia that, on average, about 70% of a person's risk is genetic. That doesn't mean that 70% of the time, the cause is genetic and 30% the cause is cultural; rather, it has to do with the *strentgh* of the risk. And this is probably going to be different in different people.

Is this inside American culture or are different cultures taken into account? (I know that's a weird question because you just said "cultural" - I think influences are usually social, and cultural influences those social factors). As far as I know, those estimates are usually made based on data from one culture - and they can differ from culture to culture. For example, if I would live in a culture with significant food shortage my genome would determine my weight to a lesser degree than living in a culture where food is rather abundant.

As for my genetic background - I am also wondering if people who develop different eating disorders during their life time have a different genetic make-up than people who "stick to one eating disorder. (While I don't think I could develop anorexia or bulimia, I personally have an issue with very "successful" restrictive dieting - basically I tend to go to either extreme, however, the overeating extreme is more dominant. And as I said, at least one of my cousins cycled between BED and anorexia.)

And since you brought it up - the epigenetics stuff is really interesting. I had a professor during my undergraduate studies who specialized on this, particularly on how DNA packing influences gene expression - and while I have heard/ thought about it in the context of weight I never thought about it in the context of eating disorders, though.

Laura, I don't find the link that strange either. But even a lot of therapists really don't see it at all. Concerning dieting, I have seen ED information websites who promoted commercial weight loss programs as treatment for BED and my last therapist actually asked me if I had tried popular diet XYZ when I brought about some eating/ body image related stuff - and that although I had told her I had cycled between several month-long phases of restricting and somewhat longer phases of bingeing for years. (In her defense I should say that I was in treatment for depression, not for BED, however, it was one of the reasons why I eventually decided that she was probably not the right therapist for me - but that's a totally different rant.)

The uneven levels of training, standards, and coherence in this field are - well - maddening!!!

I suppose I am using "social" and "cultural" interchangably, when they're really not. What I should be using is "environmental." Thank you for pointing that out. I'm guessing this is an American study- it would be interesting to see any differences in other cultures.

And I know several researchers who are looking at factors related to "diagnostic migration," which is one disorder turning into another. But no one really knows.

On a slightly different note, I think the American encouragement of dieting is far more dangerous than any obsession with models.

On a slightly different note, I think the American encouragement of dieting is far more dangerous than any obsession with models.

I completely agree - although in my therapist's case it was the Dutch obsession with dieting (I currently live in Amsterdam). However, I guess that diet obsession has unfortunately become common in many countries.

(Also, I agree that this discussion is really stimulating... thanks for letting me be part of it.)

Also, could you give me some names concerning diagnostic migration? I might get into the mood to look up some articles in the journals my university is subscribed to.

I would search for "diagnostic migration" and "eating disorders" or "anorexia nervosa" in PubMed: http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed

Although I believe David Herzog out of Harvard has done one or two studies. I'm fairly certain there are others.

Happy searching!

Thanks again Carrie! It's interesting to hear the debate on nature and nurture when it comes to eating disorders. And I think that so often, parents want to know what they did wrong. But as you said with genetics loading the gun...we don't know what our genes hold. Someone may be predisposed to cancer because of their genetic makeup, but indulging in high risk behaviors pulls the trigger. Sometimes I feel like people too badly want to know why. I know that I have been asked why I do what I do. And it's such a hard question to answer...because truthfully, I have no idea. Maybe I was predisposed to it, or maybe growing up as a dancer did it, or maybe it was the media. To be perfectly honest, I think that the best thing for the media to do is learn HOW to cover eating disorders. Showing pictures doesn't help. Explaining what other people did...doesn't help. However, warning people about the dangers AND giving resources and suggesting communities such as these...those help. And way too often the media makes eating disorders seem hopeless when that is entirely not the case. I think that I have one of the best therapists in the world...and for the first time in a LONG time...I actually feel hopeful. Once again, you've said out loud what I have been thinking about for a while.

A colleague just forwarded me an article in Newsweek that discussed the impact of the Pro-Ana community within Facebook; talk about Eating Disorders in a modern context. However, I found it encouraging when I went onto Facebook and saw all of the groups that were established to ban pro-Ana groups. Ashy brought up good points about the importance to teaching the media about how to cover ED. Many people that follow this blog have been role models as to effective ways of addressing ED in news in a pro-recovery manner.

Thanks for discussing Eating Disorders Not Otherwise Specified or EDNOS. Did you know that more than 50% of people who seek treatment for eating disorders are given EDNOS as a diagnosis? The Center for Eating Disorders at Sheppard Pratt discusses what EDNOS is, why it’s important and who it’s affecting in their most recent blog entry. Be sure to check it out here: http://eatingdisorder.org/blog/2008/12/02/ednos-is-it-an-eating-disorder-or-not/