Back in 2002, when I first started learning about eating disorders, it was rare for the media to mention genetics. Now it is rare for it not to be mentioned. But how much further are we on this? The idea of a genetic predisposition to eating disorders still causes a range of reactions: from relief to ridicule.
Most parents, I’ve found, are relieved to learn that 50-83% of the risk of developing an eating disorder seems to be genetic. This odd and frightening thing that has happened to their dear child’s mind can seem more understandable if looked at as programmed in. That fits with what we’re seeing: an inexplicable change in personality and demeanor and a set of fixed ideas that make little sense and seem to come from nowhere.
But the next question, naturally, is whether this means there was no way to prevent it and no way to recover. After all, if it was in the brain all the time, how can it be fixed? If this is in the family, then are other loved ones doomed to be struck down as well?
This misunderstanding is common, but there are reassuring answers.
Genetics Is Not Destiny
First of all, genetics is not destiny. Environment matters: from prenatal hormones to adolescent stress. From the time we are conceived, our genes are interacting with the environment and creating a unique individual. Genes affect the environment, too: how we develop has an influence on those around us and the things that happen to us. As far as we know, no one is born to be anorexic or bulimic.
More to the point, just because an illness has a biological basis, it doesn’t mean it can’t be successfully treated. There may not be a pill, but changing the environment includes nutrition and retraining the mind. Early intervention and assertive treatment can work very well in getting a patient back to normal development. Complete recovery is not only possible, but should always be the goal.
If it isn’t the answer to what causes an eating disorder, then why care about genetics? For two good reasons. One is to help us all stop blaming patients for their illness. The other is to help us discover new targets for treatment.
Pinning Down The Genetics of Eating Disorders
Actually, there’s a third reason. Pinning down the genetics, Dr. Cynthia Bulik tells us, helps us figure out the environmental influences as well. If we learn that eating disorder predisposition involves genes involved with anxiety, for example, we may better understand how to intervene and when. If mechanisms of food seeking or autoimmune issues seem to be related, that could guide researchers to the literature of related fields for additional insight.
Eating involves a great many physical, emotional, and cognitive factors. There are likely to be many pathways and drivers to this illness, and as Dr. Thomas Insel at the National Institute of Mental Health reminds us, we may need entirely new categories for what we now think of as a set of related illness – or a single name for a problem with different manifestations.
I find the information about genetics to be encouraging and not depressing. I find this information helpful and optimistic for the goal we all share: better outcomes and better lives!