Psychological Factors


Emotion Repression

Studies pointed out that eating disorders patients are, for most of the times, always under a high stress level [1]. As they are not good at expressing their emotions overtly, they may suppress their own, or even other’s, negative mood internally. When emotions are suppressed for long or overloaded, it may result in physical and psychological disorders. For example, studies found that when we are stressful, hormonal level will change and simultaneously, there will be an increase in our immunity against diseases to enable us to cope with our stresses. However, this effect may not last long, when our stresses continue to increase to an unbearable level, our immunities against diseases will drop drastically and thus we would be more vulnerable to catch minor illnesses.

Studies showed that negative mood is very often one of the risk factors of eating disorders [2]. According to Hawkins and Clement’s (1987) [3], people rely on eating as a mean to comfort themselves or divert their negative emotions. This emotional-focused coping strategy may help comfort our emotions shortly. However, many eating disorders patients mistakenly regard it as a long-term problem-solving strategy, which eventually turns into a mean to avoid the problems and would easily lead to vicious cycles. They usually rely on self-destructing means, like starving or fasting, to alleviate their negative mood, however, it may eventually create even more negative feelings because of their fear of fat and severe dissatisfactions on their body image [4]. It eventually leads to a vicious cycle according to Nagata et al. (2000) [5].


Distorted Self-image

Many patients believe body figures and appearances stand for everything, and thus they have spent a lot of time in these aspects. They may strive for socially acceptable outlook and body figure in order to get the recognition from others and boost one’s self-esteem. Some patients seem to be very tough in front of the others, but actually they have a low self-evaluation and self-esteem. That is why they need to use their appearance and body figure to enhance their self-esteem and to get recognition from others. However, for most of the times, their self-image and self-evaluation are always disturbed.
Patients who are obsessive in thinking about weight and food may strictly force themselves to meet their self-defined standard, which is usually hard to achieve.


Personality Traits

People with some particular personality traits are at high risk of getting eating disorders. The most common trait is perfectionism [6]. Patients are very strict to themselves and stubborn on certain things. They usually adopt dichotomous thinking mode, believe that if they cannot achieve their standard, they are total failures and are for most of the times denying their abilities. As a result, it is particularly difficult for them to get a sense of satisfaction when compared to others. When their lives are out of their control and expectations or they fail to meet with their standards, they will shift to an area which is easier to control, such as weight. That is why they become self-critical on their body and is particularly sensitive to numbers such in relation to pounds and inches. According to Bruch (1973), they will soon get into the vicious cycles which lead to body dissatisfaction and no matter how many pounds they have already lost, they are still not satisfied [7]. This kind of personality trait may lengthen the treatment period.

Besides, people with high level of mood swings and neauthesis [8], low self esteem [9] and negative self-evaluation [10] are also at high risk of getting eating disorders. Those people are highly sensitive to the changes surrounding them. Some of them are extremely attached to somebody or familiar environment; when changes occur, they become stressful and cannot afford losing the dependent object. As a result, they will use weight control or binging as a mean of ventilating the feelings of loss and emptiness. These kinds of behaviors are to shift attention, make oneself numb and relieve emotions.


Other Mental Health Problems

Eating disorders have high co-morbidity with certain mental illnesses, especially mood disorders (depression and anxiety [11]). It is difficult to say whether eating disorders are caused by mood disorders or that eating disorders cause mood disorders. However, it explains why SSRIs (common drugs prescribed for patients with mood disorders) can sometimes be effective in controlling binging problem under the guidance and supervision of a qualified doctor. As a matter of fact, the occurrence of eating problems may be caused by many stressors and confusions in life. Whether to eat or not is only the presenting problem on surface, however, it is the underlying frustration and distress which makes people depressed and having eating problems. Eating then unconsciously turns into a bad habit or a vicious cycle to express these sufferings in life. Patients may not easily recognize the relationship between their problem and eating pattern. Counseling, one of the main tasks, is to help patients recognize their underlying problems, which may be the cause of their behavioral problem.

Another common co-morbidity is obsessive-compulsive disorders [12]. Patients usually force themselves into certain repetitive behaviors, common ones are those which are related to weight control, in order to have a sense of security. Patients who are comorbid with obsessive-compulsive disorders may repeat something related to eating and weight control, such as compulsive eating, washing hands, brushing teeth and counting calories. These kinds of behaviors are usually driven by the extremely anxious mood. To eliminate this kind of obsessive thought, they may use repeated behaviors to relieve their stresses and anxieties.


[1] “Schmidt, U., Tiller, J., Blanchard, M., Andrews, B., & Treasure, J. (1997). Is there a specific trauma precipitating anorexia nervosa? Psychological Medicine, 27, 523-530.” and “Soukup, V. M., Beiler, M. E., & Terrell, F. (1990). Stress, coping style, and problem solving ability among eating-disordered inpatients. Journal of Clinical Psychology, 46, 592-599.”

[2]Stice, E. (2002). Risk and maintenance factors for eating pathology: A Meta-analytic Review.Psychological Bulletin, 128(5), 825-848.

[3]Hawkins, R. C., II, & Clement, P. F. (1984). Binge eating: Measurement problems and a conceptual model. In R. C. Hawkins, W. J. Fremouw, & P. F. Clement (Eds.), The binge purge syndrome: Diagnosis, treatment, and research. New York: Springer.

[4]Williamson, D. A. (1990). Assessment of eating disorders: Obesity, bulimia, and anorexia nervosa. New York: Pergamon Press.

[5]Nagata, T., Matsuyama, M, Kiriike, N., Iketani, T. (2000). Stress coping strategy in Japanese patients with eating disorders: Relationship with bulimic and impulsive behavior. The Journal of Nervous and Mental Diseases, 188(5), 280-286.

[6]Fassino, S., Piero, A., Daga, G., Leombruni, P., Mortara, P., & Rovera, G.. (2002). Attentional biases and frontal functioning in anorexia nervosa. International Journal of Eating Disorders, 31,274-283.

[7]Bruch, H. (1973). Eating disorders: Obesity, anorexia nervosa, and the person within. New York: Basic Books.

[8]Martin, G., Wertheim, E., Prior, M., Smart, D., Sanson, A., Oberlkaid, F. (2000). A longitudinal study of the role of childhood temperament in the later development of eating concerns.International Journal of Eating Disorders, 26, 150-162.

[9]Gual, P., Perez-Gasper, M., Martinez-Gonzelea, M., Lahortiga, F., de Irala-Estevez, J., Cervera-Enguix, S. (2002). Self-esteem, personality, and eating disorders: baseline assessment of a prospective population-based cohort. International Journal of Eating Disorders, 31, 261-273.

[10]Halmi, K., Sunday, S., Strober, M., Kaplan, A., Woodside, A., Fichter, M., Treasure, J., Berrettini, W., & Kaye., W. (2000). Perfectionism in anorexia nervosa: Variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry, 157, 1799-1805.

[11]Braun, D. L., Sunday, S. R., & Halmi, K. A. (1994). Psychiatric comobidity in patients with eating disorders. Psychological Medicine, 24, 859-867.

[12]Kasvikis, Y. G., Tsakiris, F., Marks, I. M., Basogulu, M., & Noshirvani, H. V. (1986). Past history of anorexia nervosa in women with obsessive-compulsive disorders. International Journal of Eating Disorders, 5, 1069-1075.