Eating disorders can be triggered by lack of support following traumatic events such as bereavement, relationship problems, abuse and sexual assault, according to research published in the May issue of the Journal of Clinical Nursing. Even changing school or moving home can prove too much for some young people and lead to conditions such as anorexia or bulimia.
Researchers from the University of Minnesota, USA, spoke to 26 women and one man aged from 17 to 64 receiving treatment from a specialist outpatient clinic. They had suffered from eating disorders for an average of 20 years.
"The aim of our study was to find out if there was any link between transitional events in family life and the onset of eating disorders" says lead author Dr Jerica M Berge, Assistant Professor in the Department of Family Medicine and Community Health at the University. "Eating disorders are an important public health issue and knowing what causes them can help us to develop more effective treatment and support."
The patients had a median age of 27 years and had been receiving treatment for between ten months and 18 years. Nine had anorexia nervosa, three had bulimia nervosa, one had both and the other 14 had eating disorders that did not meet the diagnostic criteria for any one specific condition.
Six key themes covered the transitional events that preceded eating disorders:
School transition. Some talked about the problems they had adapting to the more independent world of junior high school and others talked about leaving home to go to college and how they missed friends and family.
Starting college was very hard for one woman. "Nobody knew who I was…I was incredibly lonely with no support and I just stopped eating." Another struggled to cope without regular support. "You don't receive the daily love that you are used to growing up, you are left to provide that for yourself and I just wasn't able to do it."
Relationship changes. Breaking up with a partner affected some participants and others talked about their parents splitting up and moving on.
When her father got a new girlfriend when she was seven, one woman lost the close relationship they had enjoyed. "Overnight she became the most important thing in his life…his girlfriend would be really mean to me and my dad wouldn't defend me." Another woman described how her dad left for "the perfect Barbie," adding "I was so mad at my dad for choosing her over us…I think that is when my eating disorder really began."
Death of a family member. The death of a family member or close friend often proved traumatic, with people saying that they didn't not know how to deal with their grief and that they received little support.
One woman's sister died when she was five, but no-one talked about this "major event" in her life. "I started to eat -- to compensate for feelings of anxiety." Another lost her mother to an eating disorder when she was 11. She found herself living in a single-parent household where she was given "so much freedom with not much emotional support… I lost control."
Home and job transition. Some were affected by their family relocating or losing their job and described how they felt lonely, unsupported and lacked close relationships during these transitions.
A new job left one woman with little time for friends and she struggled to relate to her workmates who were all much older than her. "I felt really alone and had no-one to talk to or hang out with." Moving house at 16 was really hard for another woman. "I just felt lost and my eating problems began."
Illness/hospitalisation. A number had been ill and some said that their weight loss made them feel good and prompted positive comments from others.
Having viral meningitis scared one woman -- she realised she had no control over her illness, but could control her eating. "I guess I was thinking that if I could be this small, people would kind of take care of things for me." Being diagnosed with hypo-glycaemia and being told she needed to eat frequently was the start of another woman's problems. "I started to think constantly about food…since then I've had a real struggle with bingeing."
Abuse/sexual assault/incest. Some talked about abusive events and how they felt let down or deserted by the very friends and family they needed to support them. Two said they ate more to become unattractive or bigger and intimidating.
Being sexually abused by her brother triggered one woman's eating disorder. "I think in a way I developed the eating disorder just to get away from it…Just to kill the pain because I couldn't tell anyone." Another woman started eating to try and stop the abuse and violence from her partner. "I thought if I gained weight that he would leave me alone or I could fight him back."
Dr Berge says the study confirms that eating disorders can be triggered by a number of life changes and that lack of support was a common theme. "We hope that our findings will be of interest to parents as well as health professionals as they underline the need for greater awareness and support at times of change and stress."
- Jerica M Berge, Katie Loth, Carrie Hanson, Jillian Croll-Lampert, Dianne Neumark-Sztainer. Family life cycle transitions and the onset of eating disorders: a retrospective grounded theory approach. Journal of Clinical Nursing, 2012; 21 (9-10): 1355 DOI: 10.1111/j.1365-2702.2011.03762.x
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