Risk & Protective Factors
The elements that contribute to the development of an eating disorder are complex, and involve a range of biological, psychological and sociocultural factors. An individual’s susceptibility to developing an eating disorder is best understood as a complex interaction between these factors, and the presence of risk factors will vary from person to person.
Awareness of the risk factors can support opportunistic screening and sensitivity of the professional to the complexities of a person’s experience.
Compelling evidence from family and twin studies indicates that a strong genetic component influences the development of eating disorders, in particular anorexia nervosa (1).
There are biological and genetic, psychological and behavioural, and socio-cultural factors which may increase the vulnerability to developing an eating disorder.
Biological and genetic factors
• families with a history of eating disorders and other mental health conditions
• high body weight in childhood
• early start of menarche (<12yrs)
• transition stages with major physical and social changes such as adolescence, pregnancy, postpartum, and menopause
• higher parental body weight
• genetic predisposition towards specific traits such as perfectionism (see psychological factors)
Psychological and behavioural factors
• dieting
• perfectionistic traits
• heightened sensitivity or inability to cope with negative evaluations
• stress
• obsessive-compulsive traits or disorder
• neurodiverse individuals
• depression or depressive features
• anxiety, including social anxiety and avoidance of social interaction
• substance misuse
• overvaluing body image in defining self-worth
• dissatisfaction with body weight and shape
• low self-esteem or feelings of inadequacy
• harm avoidance or traits such as excessive worrying, anxiety, fear, doubt and pessimism
• individuals who have experienced trauma, abuse, neglect or post-traumatic stress disorder (PTSD)
Socio-cultural factors
• adopting and aspiring to cultural ideals of thinness, muscularity and leanness
• pressure to achieve and succeed
• peer pressure
• teasing or bullying, especially when focused on weight or body shape
• troubled family or personal relationships
• family dieting
High-risk groups and presentations
Based on the known risk factors for eating disorders, high-risk groups and presentations have been identified and require specific attention by health professionals that may work with people from these identified groups.
High-risk groups
• Females, especially during biological and social transition periods (e.g., onset of puberty, change in relationship status, pregnancy and postpartum, menopause, change in social role)
• Children and adolescents; although eating disorders can develop at any age, risk is highest between 13 and 17 years of age (2)
• Competitive occupations, sports, performing arts and activities that emphasise thin body shape/weight requirements (e.g., modelling, gymnastics, horse riding, dancing, athletics, wrestling, boxing)
• LGBTQIA+ communities.
High-risk presentations
These are people who:
• are seeking to lose weight
• are experiencing weight loss, intentional or unintentional
• are following a diet that limits energy intake, requires calorie counting or eliminates a food or food group
• are on restrictive diets due to food intolerances or allergies (e.g., coeliac disease, irritable bowel syndrome)
• are experiencing comorbid conditions which cause weight loss or gain/focus on body, weight, shape and eating (e.g., type 1 and type 2 diabetes), polycystic ovary syndrome, coeliac disease)
• are experiencing mental health conditions including anxiety and depression
• are experiencing neurodevelopmental conditions (e.g., autism spectrum disorder)
• are experiencing low self-esteem
• are experiencing substance misuse
• have a history of trauma
• have current or historical experience of food insecurity
• have perfectionist or compulsive personality traits.
Protective factors
Research has shown that there are protective factors that may reduce the likelihood of developing an eating disorder. As with risk factors, protective factors tend to be grouped. These groups include:
Individual protective factors
• High self-esteem
• Positive body image
• Critical processing of media images (i.e. media literacy)
• Emotional well-being
• School achievement
• Being self-directed and assertive
• Good social skills with success at performing multiple social roles
• Problem solving and coping skills
Family protective factors
• Belonging to a family that does not over-emphasise weight and physical attractiveness
• Eating regular meals with the family
Socio-cultural protective factors
• Belonging to a culture that accepts a range of body shapes and sizes
• Involvement with sport or industry where there is no emphasis on physical attractiveness or thinness
• Peer or social support structures and relationships where weight and physical appearance are not of high concern
Body acceptance
Body acceptance occurs when a person is able to accept, appreciate and respect their body, and this acceptance can make a person less susceptible to developing an eating disorder. Furthermore, body acceptance improves self-esteem, self-acceptance, and healthy outlook and behaviours.
For more information, go to the NEDC Body Image page.
A healthy relationship with food and eating
A healthy relationship with food and eating includes:
• eating a variety of different foods from all food groups
• eating an appropriate quantity of food to meet individual health and development requirements
• eating with others or alone with equal ease
• eating with flexibility, spontaneity and for enjoyment
• listening to our body’s cues; eating when you are hungry and stopping when you are full. For some people who experience difficulties with perception of the body’s internal state (such as level of hunger or satiety), a focus on regularity of eating may be more helpful than a focus on hunger and satiety.
• eating that does not interfere with everyday life
• not attaching unhelpful labels to food, such as ‘good’ or ‘bad’, ‘healthy’ or ‘unhealthy’, ‘clean’ or ‘junk’.
For more information, go to the NEDC Disordered Eating and Dieting page.
Media literacy
For many, social media provides an accessible and powerful toolkit for finding information, building relationships and promoting a sense of identity and belonging. For others, online communities can be an unsafe space, and being aware of the risks can help people take the appropriate precautions to ensure safe use. It is important to develop the ability to critically access, analyse, evaluate, and safely create media.
For more information about media literacy programs, go to the NEDC Media Literacy page.
References
1. Bulik CM, Blake L, Austin J. Genetics of eating disorders: what the clinician needs to know. The Psychiatric clinics of North America. 2019;42(1):59-73.
2. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. Full guideline. NICE; 2017.
3. Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. 1999;318(7186):765-8.