ABSTRACT
We do not know the exact cause of eating disorders. As in other psychiatric problems there is not just one cause; rather there is a combination of interacting factors. One way to clarify thinking about what starts an eating disorder and what keeps it going is to divide the risk factors into three broad categories – predisposing, precipitating and perpetuating. Predisposing factors are present before the onset of the problem and increase the vulnerability to develop an eating disorder. These include genetic factors, birth trauma, childhood temperament and personality factors, and aspects of upbringing or childhood environment (e.g. childhood abuse or neglect or high parental expectations). Precipitating factors occur around or just before onset such as stressful events or going on a diet. Perpetuating factors are mechanisms (both internal and external) that cause the problem to persist. These are also known as maintaining factors. In this chapter we discuss maintaining factors in particular in relation to anorexia nervosa, although many of the considerations that follow are also relevant to bulimia nervosa and other eating disorders.
