title: Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research.
abstract: BACKGROUND
  Eating disorders are severe psychiatric disorders with a complex etiology involving transactions among sociocultural, psychological, and biological influences. Most research and reviews, however, focus on only one level of analysis. To address this gap, we provide a qualitative review and summary using an integrative biopsychosocial approach.
  
  
  METHODS
  We selected variables for which there were available data using integrative methodologies (e.g., twin studies, gene-environment interactions) and/or data at the biological and behavioral level (e.g., neuroimaging). Factors that met these inclusion criteria were idealization of thinness, negative emotionality, perfectionism, negative urgency, inhibitory control, cognitive inflexibility, serotonin, dopamine, ovarian hormones. Literature searches were conducted using PubMed. Variables were classified as risk factors or correlates of eating disorder diagnoses and disordered eating symptoms using Kraemer et al.'s (1997) criteria.
  
  
  RESULTS
  Sociocultural idealization of thinness variables (media exposure, pressures for thinness, thin-ideal internalization, thinness expectancies) and personality traits (negative emotionality, perfectionism, negative urgency) attained 'risk status' for eating disorders and/or disordered eating symptoms. Other factors were identified as correlates of eating pathology or were not classified given limited data. Effect sizes for risk factors and correlates were generally small-to-moderate in magnitude.
  
  
  CONCLUSIONS
  Multiple biopsychosocial influences are implicated in eating disorders and/or disordered eating symptoms and several can now be considered established risk factors. Data suggest that psychological and environmental factors interact with and influence the expression of genetic risk to cause eating pathology. Additional studies that examine risk variables across multiple levels of analysis and that consider specific transactional processes amongst variables are needed to further elucidate the intersection of sociocultural, psychological, and biological influences on eating disorders.
authors.affiliation: Department of Psychology, University of Nevada, Las Vegas, NV, USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Culbert
authors.affiliation: Department of Psychology, Ohio University, Athens, OH, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Racine
authors.affiliation: Department of Psychology, Michigan State University, East Lansing, MI, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Klump
mesh_terms: D001068:Feeding and Eating Disorders / Q000209:etiology / Q000235:genetics / Q000503:physiopathology; D006801:Humans
keywords: Eating disorder; biopsychosocial; disordered eating; etiology; risk