Cause of Eating Disorders Effects of Mental Health on Development of EDs
So this is kind of a chicken and the egg question - in terms of the cause of eating disorders, is it the effects of mental health issues on eating disorders or is it the other way around ... the eating disorders symptoms cause the mental health issues? Unless there's been a firm mental health diagnosis prior to the onset of the eating disorder, then it really is hard to tell which came first.
While it is true some people seem not to have an underlying psychological disorder at the same time they have an eating disorder (as in the two do not co-exist), typically, as time goes on and the eating disorder is untreated or is not treated successfully, signs of underlying mental health conditions usually show themselves. Usually this is depression and anxiety. Sometimes, in extreme cases of nutritional deprivation, signs of paranoia and delusions begin to emerge.
Depression
Sometimes depression will preexist eating disorders, contributing as a cause of eating disorders. Remember, just because someone has depression warning signs doesn't mean they'll develop an eating disorder. And the alternative is also true - just because someone has an eating disorder doesn't necessarily mean they have depression or are depressed.
But often you will find that people who develop eating disorders have a history of feeling down and sad, and feeling like they are not in control of their lives. Obviously we've talked about the low self esteem - this can also be linked to women and depression. So while depression isn't a cause of eating disorders, it can preexist the eating disorder.
You will often find people with eating disorders have trouble sleeping (insomnia) ... or they sleep a lot. Again, these are also common in depression.
Anxiety
Anxiety is a common co-existing mental health issue with eating disorders, but not necessarily a cause of eating disorders. Many people with eating disorders show signs of anxiety, from mild worry and concern (not just related to weight and food) to extreme phobias and social anxiety (fear of being around people). It is not uncommon for people with eating disorders to suffer from anxiety attacks and even panic attacks. See what is anxiety for more information.
OCD, Obsessive Compulsive Disorder, is also found in the eating disorder community, although again, say it with me now, it's not necessarily a cause of eating disorders - common, but not a cause. This is linked to anxiety in there is an anxious feeling that is created if rituals are not performed, obsessions are not focused on and behaviors are not repeated in specific ways. OCD can become debilitating, taking over a persons life to the point that they can't get out of the house because of it. Because eating disorders are tied to an obsessive kind of behavior, the two can co-exist quite nicely (okay, not nicely, but you know what I mean ... they fit together because of their common themes).
Self Injury
Self injury - self harm, cutting - is also common in people with eating disorders, but again, is not a cause of eating disorders. Self injury or cutting is when a person takes a sharp object to the skin and deliberately inflicts harm. It is also referred to as self mutilation. The object could also be a lit cigarette, fire from a lighter ... anything to inflict some sort of harm.
Like self injury, eating disorders are a form of self injury. Both have hallmarks of not being able to deal with life's stresses; both include a sense of self-loathing ... self hatred; and both are used in an effort to avoid feeling emotions.
Personality Disorders - Borderline Personality Disorder ... why I hate that diagnosis
It is not uncommon for people with eating disorders to also get a diagnosis of Borderline Personality Disorder. But just because this may be a coexisting condition, does not mean it is a cause of eating disorders or eating disorders caused this diagnosis.
There is great disagreement in the mental health community about this diagnosis - to the point that some mental health professionals don't believe in the diagnosis. Here's my take on it in its most basic form ... I'll go into more detail on another page - the BPD diagnosis is a catchall diagnosis implying that a person has needs that are not being met. They use socially unacceptable means to get those needs met because over the course of time, those manners of getting needs met were the only way they could successfully get those needs met. Are those behaviors the best way to get those needs met? No. But to the person using those means, they know no different. This results in unstable relationships, emotions and thought-processes that make it difficult to form close bonds with others.
So for instance - the need for attention. We all need attention. As children we need to have love and touch and affection and we need our basic living needs to be met for us. If we don't get the attention we need for whatever reason, we do things like cry, act out, hit our baby brother, etc. Over time, if that way of behaving is successful, we continue to use that means of getting attention. Are those kinds of behaviors necessarily acceptable as we move into our teenage years and beyond? No. But that's what has worked before, and it's what we'll keep using until we learn otherwise. -Okay, so that was a really simplistic example, but I think you get the point ... I will go into more detail in another article.
I believe that those kinds of maladaptive behaviors have developed over time and have become what some mental health professionals label as Borderline Personality Disorder. I don't believe a BPD diagnosis means you can't unlearn those behaviors. And since that flies in the face of personality disorders by definition - that you can't change a personality disorder ... once it's there it's there forever - I don't believe in BPD. But I do believe the behaviors exist in some people, and they are often found in people with eating disorders. But I believe they can be changed / unlearned.
Why does BPD often co-exist with eating disorders? Because eating disorders are a maladaptive way of dealing with things. The behaviors consistent in BPD are also maladaptive. Like I said before with OCD - it's a good fit.
Other Personality Disorders
Personality disorders typically develop in late teenage years or early adulthood. Once a personality disorder has developed, it typically doesn't change very much and is pretty resistant to change in terms of treatment.
Sometimes you'll see histrionic personality disorder co-existing with eating disorders, where emotions are exaggerated ... think drama queen - again, not that this is a cause of eating disorders, but it can also be present. I've already discussed OCD, but there is also Obsessive Compulsive Personality Disorder - the difference being in OCD, rituals (compulsions and obsessions) are more general, where in OCPD they are rigid and highly ritualized. People with OCPD are not open or flexible, they are highly ordered and controlled, and they are highly perfectionistic.
In Conclusion
While these often co-existing mental health conditions are not necessarily the cause of eating disorders, they can play a role in the development of an eating disorder. It just depends on whether the issue was present prior to the onset of an eating disorder or whether it developed after the eating disorder. What is important to take out of this discussion is that often there are mental health issues that co-exist with eating disorders and both need to be treated successfully.
