Okay. I don’t eat herring. But, I am worried about herring. It’s a red herring, actually, that’s bothering me. This is something I’ve needed to get off my chest for a while. Hear me out. Please.

I am worried about the recent and extreme focus on eating disorders (specifically AN) as biologically based illness – AN as a  “brain illness” that needs to be treated first and foremost by nutrition and weight stabilization.

Now, don’t get me wrong. I think that the research coming out on the biology of anorexia is absolutely fascinating. I think it’s an important piece of the puzzle. But, that’s just it; it’s a PIECE of the puzzle. I think that it’s premature to claim that “genetics load gun; environment pulls the trigger.” I don’t think one thing loads the gun. I don’t think that one thing is primary. And I think that each person has a different combination of factors and reasons that affect her/his development of an eating disorder.

If eating disorders are first and foremost biological brain diseases, why so many women? Why the increase in anorexia among gay men, another sector of the culture that so values thinness? Why the social contagion aspect? Why the rise in rates in the late 20th and early 21st centuries? Why the “social contagion” aspect? Why the continually earlier onset? Why the continually later onset? We have SO many unanswered questions, I fear that in latching onto the new research regarding the brain, genetics, etc, we might be latching onto a red herring.

Don’t get me wrong, this is not ABOUT latching onto biology only. There have been many red herrings in the search for a “cause” for eating disorders – the media, the fashion industry, our countries nutritional woes, histories of sexual abuse, trauma, perfectionism, parents, intelligence, overscheduling children, pro-ed sites, and on and on. The idea of anorexia as a brain illness just seems to be the most recent one, and is gaining ground as new research comes out.

And this is not to say that these factors mentioned above aren’t important. Rather, this is to say that they are ALL important. I think it’s simplistic to say, “Here. It’s a biological brain illness. That is what we need to focus on.” I also think it’s simplistic to say, “Here. It’s the media.” Or, “Here. It’s the diet industry.” Or, “Here. It’s trauma.”

Because, in my opinion and my experience, it’s all of these things. So, yes, it is important to acknowledge that eating disorders *can* be biologically based illnesess. AND they can be reinforced by societal/media messages. AND they can be reactions to life experiences. AND they can be a manifestation of family dynamics (which is not the same as “blaming the parent”). AND they can be strengthed by pro-e.d. websites. AND they can be a symptom of a patriarchal society in which women often find themselves in circumstances where they have little or no control in regard to what happens to their bodies. Anorexia and eating disorders can be manifestations of all of these things. Or some of them. Or one or two. Or maybe something else entirely.

My own experience of having an e.d., as well as the experiences I’ve learned from people I’ve worked and recovered with, point to the fact that eating disorders are almost always multi-causal. Instead of thinking them as biological illnesses, or brain illnesses, I think of them as biopsychosocial illnesses. How important each factor is varies, as I see it. Each person is unique. Each eating disorder is unique. So, yes, perhaps for some, the (neuro)biology or the genetic predisposition is the biggest factor. And for others, that may not be the case. I suspect that for me, personally, genetics and my personality type may have predisposed me to have an eating disorder, but the primary cause of my e.d., as far as I can tell, is due to life experiences and trauma. And my e.d. has stuck around regardless of my nutritional state or physical health. I have had periods where I have eaten well and healthily, I have eaten intuitively, I have been at my set point. Yet, my e.d. was there, lying in wait, and it came right back when another traumatic event happened. And sometimes it has come back without that. Sometimes it has been force of habit. Sometimes it has been unexplainable. I think that is because there are many “reasons” for my illness, and so it may strike differently each time. I can say that, since doing trauma work, my recovery has never felt so hopeful, so solid.

I think that, instead of trying to figure out the primary cause for eating disorders, our efforts and energies might be better spent acknowledging an studying the multi-causal factors that underly eating disorders and working to develop treatment methods that can accommodate as many of those causes as a client needs.