Biology and Blame

Pamela Keel, Ph.D. — Fri, 25 Apr 2008 11:20:30 -0700

Over the last decade or more there has been increased attention to the contribution of genetic factors in eating disorders. Strong evidence supports a role for genes in risk for developing anorexia nervosa and bulimia nervosa – with genes accounting for as much risk in developing eating disorders as they do for schizophrenia. There has also been a belief that if researchers promote awareness of these findings, this would decrease stigma associated with eating disorders.

Recent studies have documented that individuals with eating disorders such as anorexia nervosa are viewed as being more to blame for their condition than are individuals with schizophrenia. Further, the general public seems more aware of the role of biological factors in the development of schizophrenia compared to anorexia. Essentially, the argument has been that if everyone was more aware of genetic factors in the development of eating disorders, they would not blame patients for having eating disorders because people cannot control their genetic make-up. While the findings regarding genetic contributions are solid, and the potential benefit of increasing awareness of these results laudable, I wonder about the implicit assumption hidden in this approach.

Do we think that people are somehow more to blame for non-biological contributions to mental disorders? For example, one’s culture contributes to one’s risk for developing eating disorders. Are we saying that somehow an individual is more responsible for the culture in which she was born? What about gender? Is a girl to blame for being born female? Ultimately, questions regarding causes should be separated from questions concerning culpability because one has very little to do with the other.

I suspect that a specific challenge arises for eating disorders because an individual with anorexia nervosa deliberately refuses to eat enough food to sustain a healthy weight – thus, giving the impression that she could simply choose to start eating if she wanted. However, this represents a complete misunderstanding of the nature of the illness. An individual with anorexia nervosa may choose not to eat, but she never made the choice to have a disorder in which she would feel compelled to starve herself. Blaming her or anyone with an eating disorder is not supported by any data regarding causes of eating disorders, and it harms the very people who need help.

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Biology and Blame