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The exact causes of anorexia nervosa are unclear, but most specialists believe it's likely to be the result of a combination of factors.
Many people who develop anorexia share certain personality and behavioural traits that may make them more likely to develop the condition. These include:
It's also been suggested some people with anorexia have an overwhelming fear (phobia) of being fat.
Puberty seems to be an important environmental factor contributing to anorexia. It may be the combination of hormonal changes and feelings of stress, anxiety and low self-esteem during puberty that triggers anorexia.
Western culture and society may also play a part. Girls – and, to a lesser extent, boys – are exposed to a wide range of media messages that constantly reinforce the idea that being thin is beautiful.
Magazines and newspapers also focus on celebrities' minor physical imperfections, such as gaining a few pounds or having cellulite.
Other environmental factors that may contribute towards anorexia include:
Anorexia often starts off as a form of dieting that gradually gets out of control.
It's been suggested changes in brain function or hormone levels may also have a role in anorexia, although it's not clear if these lead to anorexia or if they develop later as a result of malnutrition.
These changes may affect the part of the brain that controls appetite, or may lead to feelings of anxiety and guilt when eating that improve when meals are missed or after excessive exercise.
The risk of someone developing anorexia is also thought to be greater in people with a family history of eating disorders, depression, or substance misuse, which suggests genes could play a role.