Just because male twins have the higher rates of anorexia than non-twin men doesn't necessarily negate societal causes. Perhaps growing up as a twin affected these men's self-image.

I appreciate Carol Lloyd posting on this topic - but there's a bit of ethnocentric assumption in the idea that mental illness around body image is always going to skew toward skinny.

In places like Mauritania, young girls sometimes stuff themselves sick (or are force fed by their parents) in order to fit a fat aesthetic. When thin is in, anorexia goes with it. When fat is in, the opposite would hold true. The cultural image of perfect beauty is what sets the fat-or-thin marker.

Of course, in the West we so completely can't grok the idea of people actually wanting to be fat that the idea of an eating disorder going in the opposite direction of what we're used to is, well. Pretty foreign.

I would like to propose we all just go back to foot binding as the symbol of female beauty and hense, her value to society.

That would make it simple.

Women everywhere will breathe a sigh of relief (and men too) knowing that the fashion will not change and we can all just consentrate our hatred of all things female on the way a woman's foot looks.

"But it completely muddles my understanding of anorexia nervosa as a cultural disease. In countries where zaftig women get the most mojo, are there still (owing to these biological factors) a certain number of people who want to starve themselves?"

Possibly but not necessarily. The "interaction of genes and environment" paradigm has largely unseated the "nature vs. nurture" one in the life sciences. Few genes are known to be completely deterministic for complex traits or disorders. So even were someone to have all the "anorexia genes," it's still highly possible that s/he would never develop it if certain environmental factors never came into play.

But might you have to re-examine certain feminist assumptions about cultural pathology if more complete evidence contradicts them?

Yes.

It's entirely plausible that a complicated mental illness like anorexia might have multiple causes and risk factors, both genetic and societal.

Many mental disorders are like this. For example, schizophrenia has a strong genetic component, but often requires certain stress triggers to manifest. The same is doubly true for more conventional addictive illnesses, such as alcoholism, where there is both a genetic component and social risk factors (e.g. growing up with an alcoholic relative).

It would be interesting to find out how many persons with anorexia (or persons simply at the dangerous end of the body-dysmorphia scale) have relatives that are similarly affected.

Alcoholism was long regarded as a social disease brought on by a lack of willpower, and only in the past few decades have scientists recognized that there is also a genetic predisposition at play as well. The same could very well be true of anorexia, another disease that we like to regard as a "social ill" rather than a potentially genetically-influenced mental illness.

The anorexia industry is hardcoded to treat it like a mental disorder-slash-social disease. If it's genetic you really can't treat it and that will not do for the thousands of people invested in it right now.

I dont see why anorexia having a genetic basis means you can't treat it.

Depression has a genetic basis, and we treat that. Many mental illnesses are rooted in a combination of predisposed traits and environmental factors, and they are all 'treatable'. If something is environment caused, it is best to approach it through therapy, whereas physologically rooted illnesses are best treated through chemical means (drugs).

Like I said, since many mental illnesses are both physological and environment based, they involve a combo of therapy and drugs (where there are drugs available to treat it).

Just because some people are predisposed to anorexia doesn't mean we should throw up our hands and say there's nothing that can be done for them. The first step is to create an environment where their predisposition is less likely to manifest itself, the second step is recognising that certain people may need extra attention to stop them falling into a destructive pattern.

Anorexia is treatable, if the person who suffers from it WANTS treatment. If they do not, or cannot see that they have a problem, the chances that treatment will work are a lot slimmer.

If it is genetic, and you can identify the gene(s) that causes it, then you can identify people at increased risk for the disease. Then you can focus your preventative treatment on the at-risk population, with diminished focus on the majority of the population not at risk (I'm assuming that group is in the majority). This may sound like singling people out, but when you are dealing with limited resources available for prevention, you can greatly increase the effeciency with which the services are delivered.

Hang on tight folks, genetic technology is going to change healthcare to a magnitude not seen since bleeding the sick was routine. Not only will there be genetically targeted preventative care, but genetically targeted drugs, optimized to be the most effective in particular groups, or even on an individual basis. As a science, genetics is very young, we have only begun to scratch the surface - you ain't seen nothin yet!

"If it's genetic you really can't treat it and that will not do for the thousands of people invested in it right now."

What?! Cystic fibrosis is genetic and we can treat that. Not cure, but vastly improve life expectancy and quality thereof. Same for Down syndrome, sickle cell anemia, and schizophrenia. Not curable, but proper attention can be the difference between life and death.

Yes, I think we have a therapy industry overinvested in its pet hypotheses du jour. I have ample personal experience with psychologists highly resistant to considering information that might undermine their own understanding.

We already know that many mental illnesses don't respond equally to the same treatments in all sufferers. I think it's worth hoping that with expanded knowledge of the disorder's biological mechanisms, then treatment can be more individually tailored to take advantage of how a patient's own body is actually working, in concert with whatever the social/environmental stressors are, and increase the likelihood of recovery.