**6.6 Risk factors in etiology**

Several risk factors that include body dissatisfaction, dieting, being involved in body-related activities/sports/professions (dancing, ballet, athletics, modelling, acting, etc.), personality traits, family dynamics, and stress/trauma are stated as contributing to the etiology of anorexia [75]. Personality traits such as perfectionism, an obsessive-compulsive personality, and deficits in emotion regulation are prevalent in AN [76, 77]. These personality dimensions can be considered as both the predisposing and maintaining factors. Besides family dynamics, as we reviewed in the psychoanalytic model, are also important. Insecure attachment styles through stressful early childhood experiences and food-/body-related communications [78, 79] are the prominent factors related to the family. There is also some evidence of decreased family functioning in families of AN patients; however this might be a

result of having an anorexic family member, as EDs affect families and caregivers [45]. Finally a wide range of traumatic experiences are prevalent in patients with AN. These include childhood neglect, every form of childhood abuse, witnessing violence, rape, loss of significant others, accidents, as well as interpersonal stress like bullying, humiliation, and body-related teasing [80]. The abovementioned factors may have neurodevelopmental effects on the HPA pathway and serotonergic system, which play a role in the brain's response to stress [81].
