Cause vs. trigger

This is a sad story, all-around:

Mom says Pittsburgh pupil bulled into anorexia

Clearly, someone needed to take the school district to task over this. Administrators and teachers routinely overlook bullying- I know this very well. Some officials deliberately turn a blind eye, while others simply have no clue. Bullying is hurtful and harmful, regardless of whether it results in an eating disorder or not.

However...the bullying didn't cause this poor girl's anorexia. It might have triggered it, yes, in the sense that the bullying caused her to throw her lunch away, which led to the energy imbalance, which led to anorexia. But it didn't cause her anorexia. Science shows us that genetics form the biggest risk factor for eating disorders, although many environmental factors can play a role in triggering the disorder. This type of bullying is sadly common, and if every case resulted in anorexia, we would have many more cases of eating disorders than we presently do.

Will this girl benefit from some good therapy to help her deal with the bullying? Absolutely! It caused real distress, even outside the eating disorder. What we don't know is whether she might have developed AN if she hadn't been bullied, or if administration officials had stepped in. Maybe she would have, maybe she wouldn't. We just don't know.

Schools should refuse to tolerate bullying because it's harmful and wrong, not just because someone developed an eating disorder. I'm not naive enough to think that bullying will ever stop, but we can stop accepting it as a normal phase of growing up. And that's a good thing even if it has no effect on the number of cases of eating disorders.

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chartreuse said...

I wonder, if the girl had developed PTSD instead of AN, and the headline was "Pittsburgh pupil bullied into PTSD" would you have objected? The argument is really the same. Not everyone who is bullied develops PTSD, and whether you develop PTSD depends largely on whether you are predisposed to have a severe anxiety disorder.

I 100% agree that AN will only occur in those predisposed to develop it. But I am not so sure that this is so different from other psychiatric illness.

Carrie Arnold said...

You raise a really good point, and I had to think about it a bit before I responded. I don't know that the PTSD part would have caused me to react in the same way, even though the bullying wouldn't have caused PTSD any more than anorexia. Because PTSD tends to revolve around a specific event or events, its easy to think of it that way (as being "caused" by an event). I think, again, this is the difference between cause and trigger, and how it's both important and difficult to distinguish between them.

Anonymous said...

Hi Carrie - as a fellow biology lover and recovering ED sufferer, I really appreciate your blog and I follow it regularly. I'm really interested in your ideas about the differences between causes and triggers and I feel like I may be missing something. In my mind, both environmental and genetic factors are contributing causes. What distinguishes the genetic factors such that they alone are privileged as the "cause"?

Carrie Arnold said...

You're right in terms of genetic and environmental factors both contributing to EDs, and I don't know precisely how to draw the line between "cause" and "trigger." Perhaps some of the biology-as-cause is my prejudices as a biochemist coming in.

But I think some of it is that you need a particular genetic background to nurture an eating disorder. We don't yet know exactly what those genes are or what they do, but relatives of people with EDs are twelve times more likely to develop an eating disorder.

That being said, I'm sure there are people with an ED genetic background who don't have eating disorders. So, as you pointed out, genetics isn't the whole story. But I do think it's a significant part.

Both environment and genetics are necessary but not sufficient to cause an eating disorder.

Unknown said...

Here's how I conceptualize the difference. Each of us probably has a wired-in predisposition to a number of things, some heavily loaded and some lightly. Someone who is heavily loaded may only need a miniscule outside trigger - something otherwise benign. A chance remark, just having a mirror in the house, for example. Other people may need the onslaught of years of abuse and toxic surroundings to set off the same condition.

This matters because if we are going to go around whacking at the "causes" and "triggers" we make two mistakes. One is that we can't predict what will trigger who. The other is that these toxic environments deserve to be fought FOR THEIR OWN SAKE, not because some people are triggered to an ED by them. I don't want ANY child to be bullied or victimized - they need not get an eating disorder or another mental illness for me to have the responsibility to work against victimization.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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