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Genetics and Biology

While genetic and biological predispositions in Anorexia, Bulimia and Compulsive Overeating are important to explore, for each individual there may be a wide variety of reasons for developing an Eating Disorder.

A great deal of research in recent years has indicated that there may be genetic factors that contribute to the onset of an Eating Disorder. This is not to say that emotional, behavioral and environmental reasons do not play significant roles, but that for some, there may be a genetic predisposition to the development of Anorexia, Bulimia or Compulsive Overeating.

One study by doctors at the Maudsley Hospital in London suggested that people with Anorexia were twice as likely to have variations in the gene for serotonin receptors, part of which helps to determine appetite. Because of an overproduction of serotonin, it is possible that those with Anorexia are in a continual state of feeling acute stress -- as in the fight or flight response -- creating an overwhelming and constant sense of anxiety. (Genetic clues to eating disorders; BBC News)

Another study by Dr. Walter Kaye, of the University of Pittsburgh, examined a number of recovered Bulimia patients. They were monitored for persistent behavior disturbances and levels of serotonin, dopamine and norepinephrine. His team found that, compared to people with no history of Bulimia, the recovered individuals still had abnormal serotonin levels, with overall more negative moods, and obsessions with perfectionism and exactness. The levels of the other brain chemicals, dopamine and norephinephrine, were normal in comparison. (Brain Chemicals May Cause Bulimia; BBC News)

What is Serotonin?

Serotonin (ser-oh-TOH-nin) is a neurotransmitter, a group of chemical messengers, that carry out communication in the brain and body. The messengers travel from one neuron (or nerve cell) to others that act as receivers, where they attach to a specific area called a receptor site. This union, like a key fitting into a lock, triggers signals that either allow or prevent a message to be passed on to other cells. Since the discovery of serotonin in the 1950s, researches are finding evidence that one of its roles is to mediate emotions and judgement. (Serotonin and Judgement; Society for Neuroscience)

Serotonin is involved in many behaviors such as hunger, sleep, sexual response, impulse control, aggressive behavior and anger, depression, anxiety and perception. Abnormally low levels of serotonin might be found in someone who is suicidal, who is particularly agressive towards others, or a person who is extremely depressed. High levels of serotonin may be found in a person who is in a constant state of anxiety, has a tendency to be over-exacting in completing tasks, who suffers insomnia, or who has a tendency to feel overly stimulated by their surroundings (overwhelmed).

So how might this translate for someone with an Eating Disorder?

Low levels of serotonin, which could contribute to a person's sense of depression, are in theory, increased during episodes of binging, making the person actually feel better. As theorized, binging on sweets, starches or carbohydrates would increase serotonin and produce a sense of well-being.

The exact opposite would be true in conjunction with self-starvation or restriction. If too much serotonin is present, this may create a sense of perpetual anxiety, and in theory, by reducing the intake of calories to starvation level, the result would be a calming or sense of regaining control.

In other words, those with low or high levels of serotonin may feel "driven" towards eating or not eating as they consciously or subconsciously realize it actually makes them feel better emotionally, because of a physical response in their brain.

It is very important to note that the act of restricting, and binging (with or without purging) can also lead to a disruption in serotonin levels, thus contributing to an already existing problem, or creating a completely new one to deal with. This can lead to depression and anxiety, which are known side effects of malnutrition and vitamin deficiencies, both for undereaters and overeaters.

In addition to Depression and Anxiety, abnormal serotonin levels have been found in people with other mental illness, such as Obsessive Compulsive Disorder, Bipolar Disorder, Borderline Personality Disorder, and Attention Deficit/Hyperactivity Disorder (ADHD), all of which can, for some, co-exist with an Eating Disorder. Studies also suggest that there are genetic predispositions to serotonin disruptions, that appear to run in some families.

NOT the Only Factor

While all of the genetic studies and biological predispositions may be important to understand, it is essential to realize that there are people who live with too much or too little serotonin who do not develop an Eating Disorder. It is also important to note that there are people who develop an Eating Disorder who have no corresponding predisposition. While there may be genes that play a role in the level of serotonin within our brains (for some people), the emphasis on emotional, behavioral and environmental factors cannot and should not be dismissed. For some, low or high levels of serotonin may make a person predisposed to relying on food as a way to control how they feel, but that doesn't elimate all of the non-biological possibilities.

One way to look at this is to examine a child with Attention Deficit Disorder (ADD), that has a parent with ADD. The family environment may be very chaotic, in part due to the way they are hard-wired, but also because of an inability to cope effectively with the ADD. These behavioral patterns, as well as a sense of instability in the environment, are as much a contribution to the way the child learns to cope, as is the genetic influence of ADD. One doctor we spoke with said, "I find that a really high percentage of the [eating disorders] clients I work with have parents with some kind of undiagnosed anxiety or compulsive behavior type. They may learn how to have these behaviors themselves simply by living in such an environment. Only when they grow up and leave the home do they even have the opportunity to see that what they learned may be dysfunctional."

As stressed above there are many thing that may play a role in the onset of an Eating Disorder; Family environments, the way a person was taught to [and how they] cope with their emotions, how they were taught to [and how they] communicate, their general sense of self-esteem, and possible issues of physical, emotional or sexual abuse. Another factor may be a history of addiction to drugs or alcohol in a family, and the effect it may play both genetically and environmentally. The problems each person faces, the way they cope, the reasons for continuing to hurt or punish themselves, and the way the feel are all critical issues that cannot be tossed aside.

Keep in mind, low levels of serotonin have been discovered in some alcoholics as well, but not everyone with a low level of serotonin would become an alcoholic, stressing the point that there are other contributing factors.

Though serotonin may play a role in feeling depressed or overly anxious, it is NOT the only reason people suffer from depression or anxiety, nor the only reason they may develop an Eating Disorder. It may, for some, be an important piece to the puzzle, but isn't by itself a complete picture.

"Although no one can yet say for certain, new science is offering tantalizing clues. Doctors now compare anorexia to alcoholism and depression, potentially fatal diseases that may be set off by environmental factors such as stress or trauma, but have their roots in a complex combination of genes and brain chemistry. In other words, many kids are affected by pressure-cooker school environments and a culture of thinness promoted by magazines and music videos, but most of them don't secretly scrape their dinner into the garbage. The environment "pulls the trigger," says Cynthia Bulik, director of the eating-disorder program at the University of North Carolina at Chapel Hill. But it's a child's latent vulnerabilities that 'load the gun.'" (Newsweek, December 2005, Fighting Anorexia: No One to Blame)

What Do We Do With This Information?

Keeping the big picture in mind it may be useful to be aware of how serotonin levels effect each particular person when it comes to their course of treatment. Medications such as SSRIs (selective serotonin reuptake inhibitors) can help to control levels of serotonin and assist patients in responding more positively to therapy and treatment... but there is no "magic pill." Each individual will ultimately respond best when they can find a therapist and treatment team that can address all issues.

Each Eating Disorder sufferer is an individual. Some may respond to medication, some may not, and some may not wish to take it at all. Some may endure "the serotonin roller coaster ride" while trying to find the healthy middle-ground in which the medication becomes effective. It is important for those in recovery, along with their doctors and therapists, to keep all of this in mind, communicate about what is going on, and to remain patient through the process.

Also read our section on other associated mental health conditions that may sometimes co-exist with an Eating Disorder.

Link: Fighting Anorexia: No One to Blame

Link: Anorexics Can Blame Their Parents

Link: Brave New World: The Role of Genetics in the Prevention and Treatment of Eating Disorders

Link: Anorexia found in rural Africa

Link: Chemical malfunction plays role in bulimia, researchers say

Link: Genetic clues to eating disorders

Link: Brain Chemicals May Cause Bulimia

Link: Research on Obsessive Compulsive Disorder and the role of Serotonin

Link: Center for Overcoming Problem Eating and Eating Disorders Clinic

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