Eating Disorders: Exploring the Genetic Connection

Are eating disorders genetic? This fundamental question has sparked considerable interest among researchers and health experts seeking to unravel the complexities of these mental health conditions. The prevalence of these disorders has increased significantly over the years, raising questions about the underlying factors contributing to these complex mental health conditions. Among the various elements believed to influence it, genetics has emerged as a prominent area of investigation.

Understanding Eating Disorders

Before delving into the genetic aspect of eating disorders, it is essential to grasp the nature of these conditions.
These are a group of psychiatric illnesses that involve an unhealthy relationship with food and range from restricted eating to binge eating. They present with distinct behavioral, neurobiological, and psychological patterns that may or may not involve a body image problem.
Individuals suffering from these disorders tend to do poorly in social situations and are in emotional turmoil when it comes to nutrition.
The following are the most commonly diagnosed and researched eating disorders:

Anorexia nervosa

It is the type of eating disorder that involves deliberate starvation and has two distinct clinical presentations:

• Restricted Type
  In this type, the patient tends to go on prolonged periods of fasting and fails to maintain an adequate stream of nutrition.
• Binge-Purge Type
  The pattern consists of periods of overeating followed by periods of restriction. Most patients suffering from this type tend to be visibly underweight and malnourished. Anorexia is more common in post-puberty females and can be potentially fatal if not treated timely, and the latest research categorizes over-exercising as a symptom of anorexia nervosa, especially in young males with athletic pursuits. ¹1. Eichstadt M, Luzier J, Cho D, Weisenmuller C. Eating Disorders in Male Athletes. Sports Health. 2020;12(4):327-333. doi:10.1177/1941738120928991

Bulimia Nervosa

In Bulimia Nervosa, the patients may appear to be of normal weight or even on the healthier side. The lifestyle of BN patients consists of periods of gluttony without apparent control of their eating habits, followed by periods of “dieting,” in which they adhere to an extremely restrictive regimen in an attempt to lose weight. These patients are difficult to diagnose and have all the classic symptoms of overeating, including acid reflux, dental erosion on the inner side of the teeth, and frequent complaints of brain fog. The condition is rarely fatal.

Binge Eating Disorder

People with binge eating disorders are overweight, and such individuals engage in unrestricted gluttony with no attempts at dietary restriction. They can present with a plethora of associated symptoms, such as acid reflux, increased blood cholesterol, and diabetes.

The Current Prevalence of Eating Disorders

In the more developed countries, an estimated 5% of the populace suffers from one of the many EDs.²Mayhew AJ, Pigeyre M, Couturier J, Meyre D. An evolutionary genetic perspective of eating disorders. Neuroendocrinology. 2018 Oct 24;106(3):292-306. While it’s generally perceived that these disorders in males are much less prevalent than those in females, the current stats show that the rate at which men fall prey to eating disorders is faster.³Mitchison, D., Mond, J. Epidemiology of eating disorders, eating disordered behavior, and body image disturbance in males: a narrative review. J Eat Disord 3, 20 (2015). https://doi.org/10.1186/s40337-015-0058-y Currently, 1.5% of women and 0.3% of men globally are a victim of one of the many eating disorders. ⁴Keski-Rahkonen A. (2021). Epidemiology of binge eating disorder: prevalence, course, comorbidity, and risk factors. Current opinion in psychiatry, 34(6), 525–531. https://doi.org/10.1097/YCO.0000000000000750
It is important to highlight these disorders and address them because they have both mental and physical implications. The situation is worsened by the increase in social media consumption by the younger population. ⁵Padín PF, González-Rodríguez R, Verde-Diego C, Vázquez-Pérez R. Social media and eating disorder psychopathology: A systematic review. Cyberpsychology [Internet]. 2021Aug.24 [cited 2023Jul.24];15(3):Article 6. Available from: https://cyberpsychology.eu/article/view/14052
The older population, especially women beyond 50 years of age, is also being diagnosed with multiple eating disorders. This finding is consistent with the fact that most of them develop during the most vulnerable phases of our lives, which include major transitions. Limiting them to only the younger population would be a gross underestimation that can severely depress the magnitude of the problem. ⁶Samuels, K.L., Maine, M.M. & Tantillo, M. Disordered Eating, Eating Disorders, and Body Image in Midlife and Older Women. Curr Psychiatry Rep 21, 70 (2019). https://doi.org/10.1007/s11920-019-1057-5

The Role of Genes in Eating Disorders

The exact factors responsible are yet to be revealed; however, the role of genetics in eating disorders is fairly well-proven. A recent study revealed that more than 50% of the patients who present with clinical symptoms of these disorders have a genetic basis. This finding is consistent with the fact that most common molecular derangements leading to anxiety eating disorders can be traced to the genes probably present on chromosomes 1, 4, and 10. The serotonin and opioid-dependent pathways of the brain have been found to present with multiple aberrations in eating disorders. ⁷Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E. Academy for eating disorders position paper: EDs are serious mental illnesses. International Journal of Eating Disorders. 2009 Mar;42(2):97-103.
However, the research on the elements predisposing to these disorders is far from complete. Hereditary alone cannot explain the variations and prevalence of these mental illnesses. Following are some of the other factors that can contribute to the manifestation of these disorders:

Social Media

The advent of picture-based social media has increased the prevalence of eating disorders in the younger population, and it has been shown that such adolescents may also have body-image issues. Negative perception by teenagers of their bodies is because of the internalization of the reactions they receive online.
The keenness of the younger population to use filters, photo-editing, and enhancing apps to appeal to their online community proves the relationship between social media and eating disorders. ⁸Lonergan AR, Bussey K, Fardouly J, Griffiths S, Murray SB, Hay P, Mond J, Trompeter N, Mitchison D. Protect me from my selfie: Examining the association between photo‐based social media behaviors and self‐reported eating disorders in adolescence. International Journal of Eating Disorders. 2020 May;53(5):755-66.
A recent study established a positive correlation between Facebook usage and disordered eating in the participants. Since disordered eating is a risk factor for eating disorders and most social media users suffer from body image problems, it can safely be concluded that social media and eating disorders have a potent link to one another. ⁹Mabe AG, Forney KJ, Keel PK. Do you “like” my photo? Facebook use maintains eating disorder risk. International Journal of Eating Disorders. 2014 Jul;47(5):516-23.
Another factor to consider here is the continuous anxiety that most social media consumers suffer from. Adolescents who use social media networking sites regularly tend to internalize the body image that they are shown online. They are also more likely to discuss bodies amongst themselves than individuals who don’t have social media accounts. ¹⁰De Vries DA, Peter J, De Graaf H, Nikken P. Adolescents’ social network site use, peer appearance-related feedback, and body dissatisfaction: Testing a mediation model. Journal of youth and adolescence. 2016 Jan;45:211-24. This trend has led to an increase in these disorders in children.

Parent-Child Relationship

Besides genetics, another way parents contribute to eating disorders is through their own actions and thoughts about their own bodies, and if the parents lack a healthy relationship with food, it is quite probable that their children will suffer from the same.
Research has revealed that children from troubled homes or those who did not share a rather dependable relationship with their parents were at a greater risk of developing an eating disorder than the group with healthy parent-child relationships. ¹¹Watson HJ, O’Brien A, Sadeh-Sharvit S. Children of parents with eating disorders. Current Psychiatry Reports. 2018 Nov;20:1-1.

Occupation

If your income depends on the way your body looks, then there is a greater chance that you might have an upset relationship with food. The most common occupations that have a high incidence of eating disorders are modeling and weight-sensitive sports.
EDs in athletes stem from vigorous training and a mindset that they need to be better than their competition. This is why athletes and fitness enthusiasts are at very great risk for them since most of them already exhibit disordered eating, and the latter can deteriorate with time. Female athletes may also suffer from a loss of a normal menstrual cycle because of long periods of malnourishment. ¹²Ravi S, Ihalainen JK, Taipale-Mikkonen RS, Kujala UM, Waller B, Mierlahti L, Lehto J, Valtonen M. Self-Reported restrictive eating, eating disorders, menstrual dysfunction, and injuries in athletes competing at different levels and sports. Nutrients. 2021 Sep 19;13(9):3275.
In the same way, fashion models are under constant pressure to look lean, and the judgments about their bodies act as an emotional stressor. ¹³Collison J, Barnier E. Eating disorders, body dysmorphic disorder, and body image pathology in female Australian models. Clinical Psychologist. 2020 Jul 1;24(2):155-65.

Existing Mental Disease

Having a mental illness increases the risk of having an eating disorder, and recent studies have proven the comorbidity between OCD and eating disorders. OCD patients are prone to developing restrictive eating disorders, especially when they are practicing calorie counting and food monitoring. Such individuals may also prefer to hoard and binge on foods as they seem to have little to no control over their feelings. They tend to repeat their eating patterns over and over and require immediate professional help if they are to nourish themselves. ¹⁴Vanzhula IA, Kinkel-Ram SS, Levinson CA. Perfectionism and difficulty controlling thoughts bridge eating disorder and obsessive-compulsive disorder symptoms: a network analysis. Journal of Affective Disorders. 2021 Mar 15;283:302-9.
Anxiety eating disorders are another group of mental illnesses in which anxiety is both the cause and effect of EDs. Besides, anxiety and eating disorders are directly related to one another. A study showed that a hike in anxiety during the COVID-19 pandemic led to a rise in reported EDs. ¹⁵Scharmer C, Martinez K, Gorrell S, Reilly EE, Donahue JM, Anderson DA. Eating disorder pathology and compulsive exercise during the COVID‐19 public health emergency: Examining risk associated with COVID‐19 anxiety and intolerance of uncertainty. International Journal of Eating Disorders. 2020 Dec;53(12):2049-54.

Latest Treatment Modalities for Eating Disorders

With research showing the various facets of the illness, the therapies for eating disorders have changed considerably with time. However, the following are the most common modalities:

Therapy

Cognitive behavioral therapy (CBT) is currently the gold standard therapy for EDs. Through CBT, professionals can help improve the understanding and attitude of the patients toward food. This can assist them in building sound eating habits and addressing body image problems.

Drugs

Already having a mental illness is a risk factor for EDs; therefore, the drugs commonly used to treat EDs are anti-anxiety drugs and anti-depressants. ¹⁶Davis LE, Attia E. Recent advances in therapies for eating disorders. F1000Research. 2019;8.

Conclusion

In conclusion, the question of whether eating disorders are genetic continues to be a subject of in-depth research and exploration. While genetics indeed appears to play a role in the susceptibility to these disorders, it is crucial to recognize the complex interplay between genetic factors and environmental influences. Understanding the genetic basis of these disorders may pave the way for more personalized and effective prevention and treatment strategies in the future. If you or any one of your loved ones are showing symptoms, please make haste in seeking professional help.

Refrences

• 1
  1. Eichstadt M, Luzier J, Cho D, Weisenmuller C. Eating Disorders in Male Athletes. Sports Health. 2020;12(4):327-333. doi:10.1177/1941738120928991
• 2
  Mayhew AJ, Pigeyre M, Couturier J, Meyre D. An evolutionary genetic perspective of eating disorders. Neuroendocrinology. 2018 Oct 24;106(3):292-306.
• 3
  Mitchison, D., Mond, J. Epidemiology of eating disorders, eating disordered behavior, and body image disturbance in males: a narrative review. J Eat Disord 3, 20 (2015). https://doi.org/10.1186/s40337-015-0058-y
• 4
  Keski-Rahkonen A. (2021). Epidemiology of binge eating disorder: prevalence, course, comorbidity, and risk factors. Current opinion in psychiatry, 34(6), 525–531. https://doi.org/10.1097/YCO.0000000000000750
• 5
  Padín PF, González-Rodríguez R, Verde-Diego C, Vázquez-Pérez R. Social media and eating disorder psychopathology: A systematic review. Cyberpsychology [Internet]. 2021Aug.24 [cited 2023Jul.24];15(3):Article 6. Available from: https://cyberpsychology.eu/article/view/14052
• 6
  Samuels, K.L., Maine, M.M. & Tantillo, M. Disordered Eating, Eating Disorders, and Body Image in Midlife and Older Women. Curr Psychiatry Rep 21, 70 (2019). https://doi.org/10.1007/s11920-019-1057-5
• 7
  Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E. Academy for eating disorders position paper: EDs are serious mental illnesses. International Journal of Eating Disorders. 2009 Mar;42(2):97-103.
• 8
  Lonergan AR, Bussey K, Fardouly J, Griffiths S, Murray SB, Hay P, Mond J, Trompeter N, Mitchison D. Protect me from my selfie: Examining the association between photo‐based social media behaviors and self‐reported eating disorders in adolescence. International Journal of Eating Disorders. 2020 May;53(5):755-66.
• 9
  Mabe AG, Forney KJ, Keel PK. Do you “like” my photo? Facebook use maintains eating disorder risk. International Journal of Eating Disorders. 2014 Jul;47(5):516-23.
• 10
  De Vries DA, Peter J, De Graaf H, Nikken P. Adolescents’ social network site use, peer appearance-related feedback, and body dissatisfaction: Testing a mediation model. Journal of youth and adolescence. 2016 Jan;45:211-24.
• 11
  Watson HJ, O’Brien A, Sadeh-Sharvit S. Children of parents with eating disorders. Current Psychiatry Reports. 2018 Nov;20:1-1.
• 12
  Ravi S, Ihalainen JK, Taipale-Mikkonen RS, Kujala UM, Waller B, Mierlahti L, Lehto J, Valtonen M. Self-Reported restrictive eating, eating disorders, menstrual dysfunction, and injuries in athletes competing at different levels and sports. Nutrients. 2021 Sep 19;13(9):3275.
• 13
  Collison J, Barnier E. Eating disorders, body dysmorphic disorder, and body image pathology in female Australian models. Clinical Psychologist. 2020 Jul 1;24(2):155-65.
• 14
  Vanzhula IA, Kinkel-Ram SS, Levinson CA. Perfectionism and difficulty controlling thoughts bridge eating disorder and obsessive-compulsive disorder symptoms: a network analysis. Journal of Affective Disorders. 2021 Mar 15;283:302-9.
• 15
  Scharmer C, Martinez K, Gorrell S, Reilly EE, Donahue JM, Anderson DA. Eating disorder pathology and compulsive exercise during the COVID‐19 public health emergency: Examining risk associated with COVID‐19 anxiety and intolerance of uncertainty. International Journal of Eating Disorders. 2020 Dec;53(12):2049-54.
• 16
  Davis LE, Attia E. Recent advances in therapies for eating disorders. F1000Research. 2019;8.