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Eating Disorders are Not a Choice

Eating Disorders are Not a Choice

By Sally Stocker

Mar 7, 2017

Updated Nov 17, 2023

5 min read


What is an eating disorder?

Eating disorders are ways in which a person relates to food. They are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. More than 70 million people worldwide suffer from an eating disorder. Every 62 minutes someone with an eating disorder loses the fight. Eating disorders don’t discriminate by age, gender, or race. Eating disorders have the highest mortality rate of any mental illness. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery. In the United States alone, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life. Of those millions of people, more than ten percent will die prematurely from complications related to their eating disorder. [1] Put more simply, a person with an eating disorder will most likely cause health risks to nearly every organ in the body.

What causes eating disorders?

Genetics. Genetic factors are definitely at play. Dr. Cynthia Bulik, a leading researcher on anorexia nervosa has identified the interaction of genes versus environment in the development of anorexia nervosa. Even more surprising, eating disorders do run in families and first-degree relatives are eleven times more likely to also suffer from an eating disorder than those who do not have a first-degree relative with an eating disorder. [2] This doesn’t mean that your child’s sibling will develop an eating disorder – just that they are more likely to do so.

Brain Chemistry. The organization and the reorganization of the brain is a factor as well. In a person without anorexia nervosa, they will generally feel irritable when they are hungry and feel better when they eat. In a person with anorexia nervosa, the wiring is kind of backward. The person can feel better when they are hungry and feel worse and anxious when they eat. [3] This isn’t always the case, but it helps explain the wiring.

Keeping in mind that every eating disorder takes a slightly different form, my daughter’s explanation of the feelings behind her eating disorder shed a little more light on this:

As far as I understand it, anorexia is not a predetermined state of the brain. Instead, you sort of wire yourself into these thought patterns that only become dominant after a period of time, but they aren’t there to begin with. As my eating disorder developed, I didn’t start off skipping meals and feeling great immediately thereafter. It progressed in small steps until I got something close to a high from skipping a meal. Even then, it wasn’t really a high from skipping the meal itself, but in anticipation of seeing my body change. A lower number on the scale or seeing my clothes hang differently on my body was the real motivator in my behaviors. And I did all of this in spite of how my body was feeling; I think I tricked myself into believing that these behaviors were good for me, because as all of this was going on, it didn’t feel good on my body at all. I was dizzy all the time, I couldn’t digest food properly when I did eat, and I felt short of breath after exerting myself physically. That speaks to the power of the mind in these situations, though. The feeling of intense satisfaction after seeing my body change was enough to fight past what my body was trying to tell me: “You need food.”

Environment/Social-cultural Influences. Environmental factors also play a significant role. There are all sorts of things out in the world, such as dieting, the media, or fashion that can trigger an underlying predisposition for an eating disorder. The best way to think about it is this: “Genetics loads the gun and the environment pulls the trigger.” [4]

It is also very important to note that families or the person suffering are not the cause of eating disorders. Eating disorders are not a choice. They are not a fad, phase, or type of lifestyle. The person suffering needs professional help just as if that person had broken a leg. The only significant difference is that you can’t visually see an eating disorder (at least at the beginning).

Types of eating disorders

Anorexia Nervosa: In this cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. The body is forced to slow down all of its processes to conserve energy, resulting in:

  • Abnormally slow heart rate and low blood pressure. These changes indicate a change in the heart muscle. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
  • Severe dehydration, which can result in kidney failure
  • Fainting, fatigue, and overall weakness
  • Reduction of bone density, causing dry, brittle bones
  • Muscle loss and weakness
  • Dry hair and skin; hair loss is common
  • Growth of a downy layer of hair – lanugo – all over the body, including the face, in an effort to keep the body warm

Bulimia Nervosa: The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Health consequences include:

  • Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death
  • Electrolyte imbalance is caused by dehydration and loss of potassium, sodium, and chloride from the body as a result of purging behaviors
  • Potential for gastric rupture during periods of bingeing
  • Inflammation and possible rupture of the esophagus from frequent vomiting
  • Tooth decay and staining from stomach acids released during frequent vomiting
  • Chronic irregular bowel movements and constipation as a result of laxative abuse
  • Peptic ulcers and pancreatitis

Binge Eating Disorder: This disorder often results in many of the same health risks associated with clinical obesity, including:

  • High blood pressure
  • High cholesterol levels
  • Heart disease as a result of elevated triglyceride levels.
  • Type II diabetes
  • Gallbladder disease

Other Specified Feeding or Eating Disorder (OSFED): These eating disorders cannot be clearly defined. The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school, or relationships. Examples include:

  • Atypical anorexia nervosa (weight is not below normal)
  • Bulimia nervosa (with less frequent behaviors)
  • Binge-eating disorder (with less frequent occurrences)
  • Purging disorder (purging without binge eating)
  • Night eating syndrome (excessive nighttime food consumption)

Now, back to the story.

The next few weeks, in addition to learning all I could about eating disorders, I researched eating disorder treatment facilities. We needed a place with positive outcomes on treatment and appropriate for my 15-year-old daughter. We hoped we could find a facility that would also accept our insurance.

We were lucky. Many families wait months and months for admission to a facility. My daughter was admitted within two weeks to a facility close to home and they were able to work with our insurance. On the day we took her to the facility, it was a bright, sunny day in contrast to our worried and sad feelings. Once there, my daughter was taken away almost immediately. She was weighed, measured, and assessed. We (her parents and step-parents) were taken into another room, sat with the care manager, filled out the forms, paid our portion of the bill, and then toured the facility. They had allowed my daughter to take a few things to her room. (Everything packed needed to be searched.) I looked at the twin bed with my child’s baby blanket on it and I burst into tears.

It took a full five months for something in her head to click. I spoke to her on the phone weekly and we had family therapy sessions over the phone. That five months consisted of intensive therapy, including bi-weekly one-on-one therapy, family therapy, group therapy, meals, snacks, medical assessments, neurotherapy, dietary assessments, animal therapy, and art therapy, among others.

She progressed quickly once the click in her head happened. Finally, after eight months of full- and part-time residential care, my daughter was finally able to come home. There have been a few setbacks, and her care team assured us these are expected and completely normal. One year after her residential care ended, she returned to give a recovery talk to the girls currently admitted.

She is now at college and while I still worry about her (that never goes away – eating disorder or not), I know she is thriving and happy. A sharp contrast from the girl who stayed in her bedroom, avoided dinners (“I had a big lunch”), self-harmed, and fought with us every chance she got.

What should you do if you suspect someone close to you (or yourself) of having an eating disorder?

Get help. Begin educating yourself. Find a primary care provider or a therapist who can help you create a care team consisting of a psychologist or therapist, a nutritionist, and a physician, all of which have a history of treating eating disorders.

In addition, there are many support groups on Facebook and many other online resources. Many of these websites have a toll free, confidential helpline.

[1] National Eating Disorders Association. General Information about Eating Disorders, Accessed 24 February 2017.

[2] Bulik, Cynthia M. The Complex Dance of Genes and Environment in Eating Disorders, Accessed 24 February 2017.

[3] Kaye, Walter, MD. Brain Imaging and Eating Disorders. Vimeo, Accessed 24 February 2017.

[4] Bulik, Cynthia M. Genes Loads the Gun, Environment Pulls the Trigger, Mental Fitness, Accessed 24 February 2017.