What Do We Mean By Causation?

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Dr. Mark Warren

Often times while in treatment clients wonder how and why their eating disorder developed. The common question “What caused my eating disorder?” is very complicated because it pulls from so many ideas, understandings, conceptions, and misconceptions about the importance of causation, the implication of causation, and the definition of what causation means.

Before we deal with the notion of causation itself, it is crucial to point out there is no evidence that knowing causation leads to cure, and no current evidence that knowing cause provides an avenue to change the treatment that we do. Having said that, virtually all clients and families want to know why they have an eating disorder. We believe, and research has indicated, that there are biological factors that predispose an individual to the illness and environmental factors then influence the manifestation of the disorder. This mirrors most psychological illnesses. When you have a treatment that is purely biological for an illness it moves someone towards recovery, but usually they do not feel better until they have re-established the quality of life they had before the illness. This often means a re-establishment of social contacts, work, school, and the ability to experience personal growth, change, pleasure and happiness. So we are careful not to say that the lack of these things are the causes of the illness, even though attaining them may be a core part of the recovery process. The experience of cure does not need to flow directly from the notion of causation. We know that nourishment and cessation of behaviors is a prerequisite to getting better, and we also know that after stabilization of symptoms there is still much work to do. Our current understanding is that the work left to do is not due to underlying things that caused the illness, but rather issues that may persist after refeeding, issues of body image, negative self-talk and shame, and the ability to experience oneself as whole and healthy.

Contributions by Sarah Emerman