What’s at the Root of Anorexia Nervosa?

What’s at the Root of Anorexia Nervosa?

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With a blend of contributing factors such as past experiences and personality, anorexia is more complicated than you might think.

Anorexia nervosa is an eating disorder involving weight loss, food restriction, and sometimes compulsive exercise.

Body image distress and fear of weight gain often drive these behaviors, but the condition goes deeper than that.

Biological and environmental factors can:

  • make you more likely to develop anorexia
  • trigger behaviors related to anorexia
  • get in the way of healing and recovery

In addition, the following factors can contribute to anorexia:

  • genetics
  • brain chemistry
  • family behaviors
  • other mental health conditions
  • past trauma
  • social attitudes about weight

Learning about the risk factors and causes of anorexia can help people at many stages of recovery gain a better understanding of their condition. It can often be a validating process.

Whether you’re still figuring out if you have an eating disorder or you’re far along on your path to recovery, learning about the roots of anorexia could be a step toward healing.

Environmental and social factors play a large role in who develops anorexia.

Eating disorders are often connected to having a history of trauma, especially childhood sexual trauma.

Research suggests that people with eating disorders are also more likely to have experienced:

  • physical abuse
  • emotional abuse
  • teasing and bullying
  • parental divorce
  • loss of a family member

Some other environmental risk factors of anorexia are:

  • bullying, especially about weight
  • childhood adversity or trauma
  • isolation and loneliness
  • being in environments with high pressure to have a smaller body (like modeling and ballet)
  • history of family or generational trauma
  • living in a culture that promotes small bodies as ideal

One study in women with anorexia found that 13.7% met criteria for post-traumatic stress disorder (PTSD). Most of the women with PTSD reported that their first traumatic event happened before they’d developed anorexia.

The most common traumatic events were connected to sexual trauma.

Other research suggests that childhood bullying can predict eating disorder symptoms in both kids who bully and kids who experience bullying.

Sometimes anorexia can be triggered when a person who has other anorexia risk factors spends a lot of time in situations where the pressure to have a small body is very strong.

Certain personality traits are more common in people with anorexia.

Anorexia has been linked to:

  • body dissatisfaction and frequent thoughts about an “ideal” appearance
  • perfectionism
  • anxiety disorders such as social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder (OCD)
  • history of dieting or other weight-control methods
  • autistic features
  • rigid ideas, beliefs, or plans

Some research estimates that anywhere from 8 to 37% of people with an eating disorder could be autistic.

One study found the chances of autism were more than 15 times greater in people with anorexia than in those without.

Researchers also looked at the link between eating disorder symptoms and cognitive inflexibility. Cognitive flexibility is the ability to think about something in a new way, such as finding a new way to solve a problem.

People with cognitive inflexibility may have a harder time adapting to unexpected conditions. They might stay more focused or get stuck on one issue longer.

The study found that eating disorder symptoms and social anxiety were both tied to cognitive inflexibility. And when researchers took social anxiety out of the picture, the link between eating disorder symptoms and cognitive inflexibility stayed strong.

Perfectionism could also play a major role in anorexia, both before and after recovery. Researchers suggest that perfectionism in people with anorexia could be related to self-doubt.

For decades, people believed social, cultural, and family behaviors were the main cause of anorexia. But anorexia can run in families, and twin studies suggest genetics play an important role.

Genetic risk factors of anorexia include:

  • having a family member with an eating disorder
  • having a family member with a mental health condition
  • living with type 1 diabetes

Your chance of developing anorexia is much higher if a close family member has it. If you have a parent, sibling, or child with anorexia, your risk of developing it could be 10 times greater than that of someone who doesn’t have a relative with the condition.

Living with type 1 diabetes is also a key risk factor for anorexia. Research suggests rates of eating disorders are higher in people with type 1 diabetes.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies restricting insulin as a purging behavior. If someone is restricting both food and insulin, they could meet the criteria for anorexia nervosa with purging behaviors.

Eating disorders can impact anyone of any age, gender, socioeconomic status, or race. But some people may have more risk factors that increase their chances of having anorexia.

Women are about 2 to 3 times more likely to develop anorexia than men. But rates of anorexia in men may be underreported due to stigma.

Teens and young women in their early 20s seem to have a higher risk of anorexia than other age groups.

Another risk factor is having a mental health issue, such as:

  • OCD
  • anxiety
  • depression
  • a mood disorder

Many people with anorexia are also on the autism spectrum.

Social and cultural pressures to have a small body can also be risk factors for eating disorders. For example, anorexia is more common in Western culture and in people recently exposed to Western culture.

Low self-esteem is another known risk factor for anorexia.

A healthcare professional can diagnose anorexia. To get a diagnosis, you might talk to:

  • a pediatrician
  • a family practitioner
  • a psychiatrist

This might involve a physical exam and a mental health evaluation. If you want to learn more about anorexia symptoms first, here’s one good place to start.

The DSM-5 has these guidelines for diagnosing anorexia nervosa:

  • weight loss that impacts your health and well-being
  • strong fear of gaining weight
  • body image distortion
  • view of body weight and shape that affects your self-esteem
  • lack of recognition that the weight loss is taking a toll on your health

Anorexia can impact people of any body size.

People with atypical anorexia might be considered average or overweight according to the BMI. But the weight loss they’ve experienced can cause the same health impacts as it would in someone with a smaller body who has anorexia.

So what causes anorexia? It’s caused by a complex interaction of your environment and genetics. Social situations and personality could play especially big roles in whether someone has anorexia.

If you think you have anorexia, you’re not alone. Treatment centers, counseling, family therapy, and other methods can help you build a good relationship with food and your body.

Understanding Atypical Anorexia Nervosa

Most people are familiar with anorexia nervosa, an eating disorder in which a person avoids eating and other caloric intake in an attempt to lose weight, even though they may be severely emaciated already.

Normally, when asked about the symptoms of anorexia nervosa, the common reply will describe a person who is thin, ill and malnourished. However, recent studies are revealing that there’s another kind of anorexia nervosa.

Atypical anorexia nervosa mostly involves adolescents who have lost a significant amount of weight but are not thought to be medically underweight.

Although it’s not well-known atypical anorexia nervosa is indeed an eating disorder, teenagers who’ve developed the disorder often do not show outward signs of serious medical complications related to anorexia nervosa and other eating disorders. Because of this, medical tests like blood work should be performed to ensure physical complications are addressed as well as emotional and psychological ones.

Atypical anorexia nervosa (AAN) is also known as a subtype of Other Specified Feeding or Eating Disorder (OSFED). These subtypes of other major eating disorders are listed in the DSM-V. These OSFED disorders include AAN, low-frequency bulimia nervosa, limited binge eating disorder, purging disorder and night eating syndrome, among others.

What Is Body Dissatisfaction And How Does It Lead To Eating Disorders?

In the 1970s, anorexia nervosa entered the public spotlight and became more widespread, creating new challenges for mental health counselors. 1 Since then, the overall cycle of body dissatisfaction and eating disorders has worsened&mdashespecially in today&rsquos selfie-obsessed, celebrity-centric culture. For many of those struggling with an eating disorder, body image is often the root of the problem.

Body image is defined as the manner in which people perceive themselves physically, and the thoughts and feelings that result from those perceptions. According to the National Eating Disorders Collaboration, there are four primary elements of body image: 2

  • Perceptual body image: How you see yourself.
  • Affective body image: The way you feel about your body.
  • Cognitive body image: The way you think about your body.
  • Behavioral body image: Behaviors you engage in as a result of your body image.

Body dissatisfaction develops when people have negative thoughts about their own body image. Intense body dissatisfaction can damage individuals&rsquo psychological and physical well-being. And when people begin to define their own self-worth based on their negative body image, a number of mental health issues can arise, including eating disorders.

The Role of Mental Health Counselors

Getting help for eating disorders can enable people to change their negative beliefs and behaviors. Professionals who devote their careers to treating patients with eating disorders and the issues that stem from negative body image often hold psychology or counseling degrees and are licensed in their field. If you&rsquore interested in this career path, an online master&rsquos degree program in clinical mental health counseling can prepare you to seek that licensure.

Mental health counselors can help those struggling with body dissatisfaction (and resulting eating disorders) by encouraging them to focus on their positive qualities, talents, and skills. Other helpful practices include setting positive, health-focused goals, and avoiding making&mdashor exposing themselves to&mdashnegative comments about their bodies and appearance.

A positive body image is an important part of physical and emotional health, and with help, individuals can often change the way they see themselves. Clinical mental health counselors working toward this goal with patients know that a positive body image can improve things like: &dagger

  • Self-esteem, which is a measure of how highly people value themselves. High or low self-esteem often permeates many facets of people&rsquos lives, from their personal relationships to their professional world.
  • Self-acceptance, which means people are less impacted by outside influences&mdashlike unrealistic body images promoted by the media&mdashand instead feel comfortable with the way they look.
  • Behaviors and overall outlook around food and nutrition, and the benefits of living a healthy lifestyle.

If you&rsquore interested in a career that allows you to help people who are struggling with eating disorders, earning a Council for Accreditation of Counseling and Related Educational Programs (CACREP)-accredited MS in Clinical Mental Health Counseling, like the one offered by Walden University, can help prepare you for this challenging but rewarding work.

Walden University&rsquos MS in Clinical Mental Health Counseling program is accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP), a specialized accrediting body recognized by the Council for Higher Education Accreditation (CHEA), which is a requirement for licensure in many states.

Materials and Methods


Sixty-nine women aged from 18 to 30 participated in this study of which 20 were diagnosed with AN and another 20 with BN according to DSM-IV criteria and a standardized diagnostic interview (see below). Twenty-nine female age-matched individuals formed a control-group. Individual body mass index (BMI) was calculated based on self-reported height and weight. The majority of patients were recruited from an in-patient unit and an outpatient setting of the Department of Psychosomatic Medicine, LWL University Hospital, Ruhr University Bochum. Controls were recruited from the local university. All participants received a small fee of 20 Euros for taking part in the study. The study was approved by the Ethics Committee of the Medical Faculty of the Ruhr-University Bochum, Germany (approval number 15-5298). The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All participants gave written informed consent. The demographic data of the three groups are summarized in Table ​ Table1 1 .

Table 1

AN (n = 20)BN (n = 20)Control group (n = 29)p-value
Age (years)22.90 (3.78)23.45 (2.72)23.93 (2.34)No significant differences
Mean (SD)Range 18�Range 18�Range 20�
BMI (kg/m 2 )15.27 (2.46)22.43 (5.33)22.17 (2.92)AN significantly differs from BN and controls: p < 0.001
Mean (SD)
Sexual orientation90% heterosexual75% heterosexual93.10% heterosexual
5% bisexual15% bisexual3.45% homosexual
5% unspecified5% homosexual
5% unspecified3.45% unspecified
Relationship status75% single75% single68.97% in a relationship
20% in a relationship20% in a relationship20.96% single
5% married5% other6.90% married
3.45% other


After giving informed consent, participants were screened for mental illnesses according to Mini-DIPS (Margraf, 1994) in order to gather information about psychiatric comorbid conditions in patients and to rule out psychiatric conditions in controls. Control cases indicating any past or present psychiatric disorders were excluded (Table ​ (Table2 2 ).

Table 2

Screening for psychiatric comorbid conditions according to Mini-DIPS.

AN (n = 20)BN (n = 20)Control group (n = 29)
Anxiety disorders10110
Obsessive-compulsive disorder320
Affective disorders9130
Somatoform disorders210
Eating disorders20200
Psychoactive substance use110
Psychotic disorders000

Subsequently, each participant received an individual anonymized participant code for the internet platform 𠇎Survey Creator” 1 , German version, and was asked to fill out several questionnaires including demographic data, the Eating Disorders Examination Questionnaire (EDEQ), the Arizona Life History Battery (ALHB), the Mate Value Inventory (MVI), the Female Intrasexual Competitiveness Scales for mates and status, respectively (ISCM and ISCS) and the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). All questionnaires were provided in German.

Participants were encouraged to fill out the questionnaires honestly and accurately. It was made clear that participating in this study would not influence further treatment of the patients.


Mini-DIPS, Short Diagnostic Interview for Mental Disorders (Mini-DIPS, Diagnostisches Kurz-Interview bei Psychischen Störungen Margraf, 1994)

The Mini-DIPS is a brief version of the German DIPS (Diagnostic interview for mental disorders) (Margraf et al., 1994). It is based on DSM-IV and ICD-10 criteria and facilitates a rapid assessment of the main psychiatric illnesses such as anxiety disorders and affective disorders. Eating disorders are included as well. As mentioned previously, the Mini-DIPS was used to confirm the respective diagnosis of eating disorders, to assess psychiatric comorbid conditions in patients and to rule out mental illnesses in controls.

Eating Disorders Examination Questionnaire (EDEQ Fairburn and Beglin, 2008)

The EDEQ represents a self-report version of the Eating Disorders Examination interview (Cooper et al., 1989) and is utilized to record typical behavioral features and attitudes related to eating disorders. The questionnaire consists of 28 items revealing 4 subscales (Restraint, Shape Concern, Weight Concern, and Eating Concern) and a global score. High scores indicate higher degrees of disordered eating behavior. In the present paper, we used a German translation of the EDEQ constructed by Hilbert and Tuschen-Caffier (2006). It has been shown that the EDEQ has adequate internal consistency and test–retest reliability (Berg et al., 2012). Regarding validity, a recent study including a sample of 935 women with eating disorders found that the global score was quite efficient to discriminate between individuals with an eating disorder from those without an eating disorder (Aardoom et al., 2012), though the four subscales of the EDEQ were not supported by explorative factor analyses. As the mentioned study was the first to examine the validity of the EDEQ within such a large sample of individuals with eating disorders, we merely used the global score in our analysis. Higher scores indicate more disordered eating behavior.

Arizona Life History Battery (ALHB Figueredo, 2007)

The ALHB is a battery composed of different original sources measuring cognitive and behavioral features that indicate an individual’s life history strategy. The component scales are “Mini-K Short Form,” “Insight, Planning, and Control,” “Mother/Father Relationship Quality,” �mily Social Contact and Support,” 𠇏riends Social Contact and Support,” 𠇎xperiences in Close Relationships,” “General Altruism” and “Religiosity.” The subscale “Religiosity” was not included in the scoring of the ALHB due to differences in religiosity/secularism between Germany and the United States (Keller et al., 2013).

The majority of the component scales makes use of a 7-point Likert scale to specify how much the participants agree or disagree with each item. All items of the battery combined form the K-Factor, thus showing how much an individual corresponds to a slow (K-selected) LH strategy on the fast-slow (r-K) continuum. The internal consistency and measurement model structure of the ALHB have been reported to be adequate (Olderbak et al., 2014). Higher ALHB scores indicate a slower life history strategy.

Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A Gioia et al., 2002)

As previous studies have demonstrated that the effect of life history strategies on psychosocial traits is at least partially mediated through executive functions (Figueredo et al., 2012 Wenner et al., 2013), we included the BRIEF-A self-report form to assess executive functioning of the participants. The BRIEF-A consists of 75 items that had to be scored in a range from 0 (“never”) to 6 (𠇊lmost always”) on a 7-point Likert scale. Two summary index scales [Behavioral Regulation Index (BRI) and Metacognition Index (MI)] and a global score (Global Executive Composite, GEC) were computed. The Behavioral Regulation Index (BRI) is a composition of 4 subscales (Inhibit, Shift, Emotional Control, and Self-Monitor), whereas the Metacognition Index (MI) is a composition of 5 subscales (Initiate, Working Memory, Plan/Organize, Task Monitor, and Organization of Materials). All subscales, the BRI, the MI and the global score were measured by building sum scores of the appropriate items with higher scores indicating lower executive functions. Ciszewski et al. (2014) found adequate reliability and validity of the BRIEF-A in a clinical sample with eating disorders (Ciszewski et al., 2014). Higher BRIEF-A scores suggest poorer executive functioning.

Female Intrasexual Competitiveness Scales (Faer et al., 2005)

The Intrasexual Competition for Mates Scale (ISCM) was used to measure intrasexual competition for mates and the Intrasexual Competition for Status Scale (ISCS) to measure intrasexual competition for status. Both are self-report questionnaires involving items that had to be rated according to the level of agreement in a range from 0 (“strongly disagree”) to 5 (“strongly agree”) and third-person vignettes about the fictional character Mary, whose behavior should be evaluated in a range from 0 (𠇌ompletely inappropriate”) to 5 (𠇌ompletely appropriate”). Items 3, 4, and 5 of the ISCS were scored inversely. High scores correspond to a high level of competitiveness in the measured domain. Internal consistency reliability was shown to be acceptable for both ISCM and ISCS (Faer et al., 2005). Higher values on the competition scales indicate greater competitiveness for mates or status.

Mate Value Inventory (MVI Kirsner et al., 2003)

Participants completed the MVI-7 reporting self-perceived mate value. The form includes 17 items containing features which are desirable that had to be rated on a 7-point Likert scale from “extremely low on this characteristic” to “extremely high on this characteristic.”

The MVI has been shown to converge, among other factors, upon one common life history factor (Gladden et al., 2008 Abed et al., 2012), thus representing an indicator of life history strategy. High scores of the MVI indicate good confidence in oneself as a highly valuable potential mate.

The complete ALHB can be downloaded from Professor Figueredo’s homepage 2 . The other questionnaires can be obtained from the senior authors upon request by email.

Statistical Analyses

Data analyses were performed using UniMult 2 3 . We used the conventional level of statistical significance by setting it at p < 0.05, but provided more exact probability values for any future meta-analytic purposes. Semipartial correlation coefficients are reported in the text, presenting both the magnitudes and direction of effects, with their statistical significance indicated by an asterisk after each corresponding parameter estimate non-significant results are listed on the table but not reported in the main text as per APA guidelines.

Specifically, we applied a sequential canonical cascade model to these data based on previous work in similar domains (Gorsuch and Figueredo, 1991 Figueredo et al., 2016). The sequential canonical cascade model uses a pre-defined hierarchical organization of factors, whereby multiple dependent variables are fed into a sequential series of hierarchical regressions to predict the impact of each successive criterion variable, each of which taps into a specific aspect of life history relevant behaviors or attitudes, upon each of the subsequent ones. Accordingly, each prior criterion variable entered the equation as the first predictor for the next, such that each successive dependent variable is predicted from an initial set of pre-ordered predictor variables. This procedure allows to estimate the effect of each predictor (X) on each of the successive dependent variables (Y), while controlling for any indirect effects of the predictors through the prior dependent variables (for further details, see Figueredo et al., 2016). In summary, the sequential canonical cascade model is a statistical tool for identifying the magnitude of direct effects of independent variables on multiple correlated dependent variables. It is thus better suited for dimensional variables rather than categorical variables (such as diagnoses).

Following the implications of LHT on mating behavior, we hypothesized that a hierarchical order of factors made the most sense in the following sequence: (1) the overall score on the ALHB (2) the global score of the executive functioning scale (BRIEF-A) (3) own mate self-reported value (MVI) (4) intrasexual competition for mates (ISCM) (5) intrasexual competition for status (ISCS) (6) disordered eating behavior (EDEQ). Specifically, the ranking regarding competition is based on one of the tenets of evolutionary theory, which gives primacy to the reproductive motivations over the social. Thus, intrasexual competition for mates is seen as more fundamental than intrasexual competition for status, and the latter is often seen as instrumental to obtaining the former, as higher status is believed to confer priority of access to a greater number and/or quality of sexual partners. This is often said of males but also probably applies to female dominance hierarchies.

What is Anorexia?

Anorexia is a type of eating disorder, typified by a strive for thinness or control.
Those who suffer from anorexia experience a distorted body image, perceiving themselves as much larger than their actual body.
Anorexia is seen in males and females as well as across the lifespan, but Anorexia is most commonly found in young women.

Signs and symptoms of anorexia can include:

  • Having unusual self-deprecating thoughts about your body or specific parts of your body
  • Obsessing over what you eat, either by counting calories or becoming consumed with research into health and nutrition
  • Focus on your body shape and weight
  • Skipping meals or minimising food intake
  • Excessive and intense exercise
  • Food rituals, such as arranging food in a particular way on the plate
  • Losing weight or being underweight
  • Signs of malnourishment, including hair growth on the side of the face, discolouration of the skin and thinning hair on the scalp
  • Avoidance of favourite foods or specific food groups
  • Depression and/or a loss of interest in activities and hobbies
  • Binging or purging (e.g. self-induced vomiting)

Anorexia therapy can help you identify and overcome the root cause of the condition

It’s important to know that you are not to blame for developing Anorexia.

Anorexia can develop if you are genetically susceptible in combination with experiencing particular life events and a perception of societal pressure.
Risk factors to developing Anorexia can include:

  • A history of being criticised for your body shape, weight, or eating habits
  • Poor body image and significant attempts at dieting
  • Highly perfectionistic personality trait
  • A family history of eating disorders
  • Childhood trauma or abuse

Why should you seek Anorexia Therapy?

Anorexia can cause severe physiological complications over longer periods of time, such as:

  • Muscle and bone complications, including poor bone density or osteoporosis
  • Fertility issues
  • Heart and blood vessel complications
  • Brain and nerve complications
  • Kidney or bowel complications
  • A weakened immune system
  • Risk of organ failure and death
  • Teeth damage and erosion

The sooner you seek support, the quicker you can begin your recovery. Recovery allows you to feel free in your mind, enjoy the moment, and connect deeply with others. We know the process of recovery can be challenging, so our psychologists try to make the process as comfortable as possible.

At Peaceful Mind Psychology, we provide:

  • Individual treatment sessions
  • Group therapy sessions
  • Carer and family information sessions
  • Carer and family individual support and therapy sessions

Start your recovery journey today

Anorexia can make you feel very isolated from others, but you are not alone. Beginning treatment is as simple as making a phone call and setting your first appointment. There is no need for a referral for you to seek treatment from our psychologists.

Eating disorders are our special interest at Peaceful Mind Psychology, and we’ve helped many people who struggle with Anorexia. We believe in recovery and work hard to help you achieve your goals.

If you or a loved one are struggling with anorexia, the first step in the recovery journey is to seek professional help. Our highly skilled, warm and empathic team are available and ready to ready to play a role in the recovery process.

Peaceful Mind Psychology has clinics in Armadale, Prahran and Hawthorn, you’re able to call and speak to our friendly receptionist to make an appointment on 1300 766 870 or complete our contact form online.

If you have a specific member of our team in mind, please feel free request the psychologist you would like to work with or alternatively, we will match you with a psychologist that suits your unique needs and personality.


The Butterfly Foundation has an abundance of fantastic resources online which can assist your recovery journey alongside receiving expert, professional treatment.

If you are experiencing an acute crisis please do not hesitate to call one of the following

Anorexia Nervosa

Anorexia nervosa is a serious psychological disease, which is characterized by weight loss. The roots of this disease lie in the emotional state of a person. Thus, a patient requires the help of a psychologists, not a nutritionist. The case of Judy Jones, a 14-year old girl who has lost 30 pounds during the last year, is an example of the effect of emotional misbalance on the physical state of a person. The goal of a therapist is to identify the core reasons for the development of this disease and find out what methods and approaches will help stabilize the mental state of a patient and, as a result, treat anorexia nervosa.

As a mental disease, anorexia nervosa can be treated using various psychological therapy methods, but it should be taken into account that every separate case of this disease is unique and has a different background. In the case of a teenager girl, a therapist should use cognitive behavioral therapy. This approach, jointly with the experiential therapy and structural family therapy, identifies family relationships as a possible reason for developing anorexia nervosa, but it also uses a deeper analysis (The Center for Eating Disorders, 2016). For example, the structural family therapy states that the main issue is the problems within the family, and the goal of a therapist who applies to this method is to restore good relationships among the members of a family. Structural family therapy also considers a family and the relationships between children and parents as a possible reason for a mental problem. Cognitive behavioral therapy is the only method among the suggested list which analyzes the problem not only as a conflict in a family, but as the interconnection of personal emotions and relationships (Grilo & Mitchell, 2010). Hence, this therapeutic method considers a mental problem not only as a conflict within the family, but also as a conflict caused by personal emotions as a response to family matters. In other words, there might not be any significant factors which can lead to the development of conflicts in the family, but the emotions experienced by a family member towards certain aspects of life in general may become an issue.

Judy Jones is a teenager, and this fact should be taken into account when one decides which therapeutic approach to apply. At this age people experience rapid shifts in their emotional wellbeing. Hence, their behaviors and relationships are very unpredictable. A necessity to identify oneself as a social being may lead to a severe depression, dissatisfaction with own appearance, and even the development of such disease as anorexia (Grilo & Mitchell, 2010). According to this fact, if one applies any other suggested therapy, it may not provide any positive result, since it targets mostly interfamily relationships, while they might be more than satisfactory within this household. On the other hand, the relationship between Judy and her parents may have been ruined, but the reason is not misunderstanding or an inability to find common language with parents, but Judy&rsquos changes in behavior caused by other factors, such as school life, fashion, trends, stereotypes or relationships with non-family members. Hence, even if the relationships within the family are destructive, they may not be caused by poor parental care, but the emotions that a child experiences due to the age-related changes. The goal of a therapist in such case is to identify the individual&rsquos emotions together with family relationships that could have led to the development of anorexia nervosa.

Cognitive behavioral therapy is considered one of the most effective ways of treating mental problems among children and adolescences. The research conducted by Robert D. Friedberg in the article called &ldquoA Cognitive-Behavioral Approach to Family Therapy&rdquo proves that this method analyzes four main aspects which cause a mental problem – cognitions, emotions, actions and relationships (Friedberg, 2006). All these aspects are interconnected and depend on each other, and, if one of them changes, it bring corresponding alterations to the other parts of the system. The researcher posits that every household tries to maintain the family environment and satisfy the core family needs. Such needs as wellbeing, harmony and good relationships belong to this category. When these needs are not satisfied, a conflict in a family may arise. One should understand that family is a system, and every system strives to solve problems and stabilize its previous condition, which has been defined as satisfactory. Every family has certain expectations, standards and attributions, which apply to each of its members. However, the chosen methods may not always be adequate, because they do not direct such core reasons for changes as emotions (Friedberg, 2006). Hence, when cognitive process blocks the used sense of satisfaction, the family faces a problem, which is presented as a certain behavioral pattern.

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In the case of Judy, the shifts in emotions that she experiences lead to the changes in her behavior, which are not standard for her family. As a result, the relationships within the family also change, and the family needs to restore them back to the previous level. Hence, Judy starts experiencing more problems, because now she is also expected to correspond to the required family standards, which she is unable to satisfy at this particular period of her life. All these factors put a huge pressure on the mental wellbeing of a teenager and may become the reason for such serious psychological diseases as anorexia nervosa. As a result, the abnormal weight loss is not an accident or a physical phenomenon, but a problem that has arisen because of the mental misbalance of a teenager. The research of Robert D. Friedberg shows that such cases should be treated using the specific structure (Friedberg, 2006). First, a therapist should work solely with the patient. At this stage, the goal is to define the mental state and experiences of the patient as well as establish the normal condition before the disease. One should understand how the emotional changes are reflected in a person&rsquos behavior. Second, it is necessary to help the patient understand that the present health state is abnormal. As a rule, people who suffer from anorexia nervosa do not realize that they have a problem or that their condition is harmful to their mental and physical wellbeing. Thus, at the next stage, the therapist should establish contact with the patient and make him/her admit that he/she requires medical help in order to make positive changes to oneself. Only when the previous stages are successfully completed, the problem should be discussed on a family level, and other members can participate in the treatment process. In any other case, the influence of family members may not have any positive result and can only worsen the situation.

As a conclusion, it might be stated that such obvious physical disorders as anorexia nervosa often have psychological background. Treating this disease using certain nutrition or a diet will not have any durable and constant result, because only symptoms, but not the roots of the problem, are addressed in such a way. Only the help of a professional therapist as well as a correctly chosen therapeutic approach can guarantee that the problem will be solved and the patient&rsquos health as well as wellbeing will return to the previous state.


Ideally, to treat the unspecified eating disorder, follow the treatment for the eating disorder that most closely resembles the unspecified TCA itself. On the other hand, it will always be advisable to treat dysfunctional thoughts related to food, weight and body shape, through cognitive behavioral therapy.

Behavior therapy, on the other hand, is also widely used in this type of disorder, through tabular economy, positive reinforcement, differential reinforcement, etc.

Bibliographical references:

Ackard D, Fulkerson J, Neumark-Sztainer D. (2007). Prevalence and utility of diagnostic criteria for DSM-IV eating disorder in youth. International Journal of Eating Disorders 40 (5): 409-17.

APA (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid. Panamericana.

Muñoz, R. and Martínez, A. (2007). Orthorexia and vigor: new eating disorders? Eating Disorders, 5: 457-482.

Our Expertise

If you, are someone you know is suffering from anorexia feel reassured that you do not have to deal with this alone, The Mental Health Company can offer the appropriate therapy to manage and eventually overcome the condition. Anorexia nervosa is a serious eating disorder that if left untreated can have grave consequences and seriously threaten the health of the individual affected. Our experienced Psychologists will help you get back to a healthy weight and change how to think about yourself. Our treatments will help to identify the root cause of your eating disorder and how to deal with difficult situation and emotions. All of our Psychologists are fully qualified and hold a current membership of the Psychological Society of Ireland.

Public Misconceptions about Eating Disorders

Public perceptions and understandings of eating disorders like anorexia nervosa are shrouded in myth. Dr. Paul Rhodes, an associate professor at the University of Sydney, explains it thusly: “At best they think maybe its because of media influence, skinny girls in magazines, or that it is a persons’ attempt to get control in difficult circumstances. This kind of simplistic view protects them from thinking about the pain and suffering involved, the deep distress caused by an illness that has its roots in genetics, personality, society, you name it.”

In other words, the reality behind anorexia for many people is complex and difficult for many of us who are not familiar with the disorder to both understand and accept. This can make seeking treatment challenging, particularly for adolescents who are afraid of facing judgment from their peers and family. However, according to Dr. Rhodes, “We know that up to 60 percent can recover through family-based treatment.” The effort put in by parents over a 12-month period can sometimes make all the difference in their child’s recovery. When caught early, usually within the first three years, the chances of remission become very good.

Understanding Anorexia

Recently I watched a YouTube clip of Phil McGraw (Dr. Phil) counseling a 79-pound woman with anorexia, and it was a sad sight indeed. My sadness was felt both for the plight of the woman and for the plight of all people who get only shallow psychological knowledge from so-called experts and the media. Unresolved inner conflict is a primary cause of anorexia nervosa.

In this video clip from 2012, Dr. Phil succeeds only at shaming the woman for her anorexia. The woman already lives with considerable inner shame, and the unwitting Dr. Phil is only piling it on.

Anorexia can be treated and cured when its psychological origins are uncovered. Yet prominent websites on the subject—such as , the Mayo Clinic , and MedlinePlus , the website of the National Institutes of Health—provide only scanty and shallow psychological information. The National Institutes of Health, which favors a medical approach to understanding and treating eating disorders, claims that , “Family conflicts are no longer thought to contribute to this [anorexia] or other eating disorders.” I disagree with this statement, and I provide evidence in this article that family conflict, along with inner conflict, does indeed contribute to these disorders. When anorexics understand their inner conflict and how they act out that conflict with others, they have a decent chance of escaping their painful condition.

A statement at provides some psychological insight into the causes of anorexia:

Believe it or not, anorexia isn’t really about food and weight—at least not at its core. Eating disorders are much more complicated than that. The food and weight-related issues are symptoms of something deeper: things like depression, loneliness, insecurity, pressure to be perfect, or feeling out of control. Things that no amount of dieting or weight loss can cure. . . .

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless. Through their harshly critical lens, if they’re not perfect, they’re a total failure.

This is all true, and there is more. Let’s explore the psyche to understand better one of the indicators mentioned above—the feelings of helplessness. I explain these painful feelings in terms of inner conflict.

Anorexia is one symptom among many that is caused by an individual’s entanglement in feelings of helplessness. This painful emotion is usually experienced in conjunction with a lessening of one’s capacity for emotional and behavioral self-regulation. Why does the individual have such feelings in the first place? Many of us are unable to completely shake off the feelings of helplessness that we’re born with. We all strive and struggle through childhood and adolescence to come into our own sense of power and autonomy. Yet helpless feelings persist. Even everyday normal people experience it when they’re worried if not tormented by a fear of not being able to take care of themselves financially or otherwise. This is the fear that they’ll somehow be rendered helpless as they make the journey through life.

Feelings of helplessness are often associated with emotional issues related to control and domination. We can feel our helplessness most acutely when it seems that we’re at the mercy of others or are required to submit to others or to some imposing situation. In our unconscious mind, we can start to identify with ourselves through this feeling of helplessness. The feeling can begin to define us to ourselves. We don’t know who we are without it, even though it’s often quite distressful and painful. Consequently, we can be said to be emotionally attached to the feeling of helplessness. We hate to acknowledge this attachment, however, because it undermines our egotism and self-image. Common sense tells us that only a fool or a hopeless neurotic could be attached to feeling helpless. And hence we defend psychologically, on an inner level, against realization of this attachment. We deny the existence of this attachment. Yet the attachment, lingering from childhood, can become an emotional default position that greatly limits our powers of self-regulation and sense of autonomy.

The following examples can help us to understand emotional attachments as they relate to eating disorders. The examples also provide clues as to how the underlying inner conflicts can be resolved. The first example looks at a boy with anorexia, and the second discusses the plight of a girl with bulimia. The examples are taken from my book, Secret Attachments: Exposing the Roots of Addictions and Compulsions.

A gaunt nineteen-year-old anorexic, living at home with his divorced mother, was managing to torture himself with the word should. He agreed with his mother and others that he should be doing better and eating properly. The boy’s refusal of food represented “a refusal of mother” and was a passive-aggressive defense to cover up his attachment to feeling controlled by his dominating mother. His anorexia had caused serious health problems, and he had been admitted to hospital several times. The mother was emotionally insecure, and she required her son to behave according to her demands and needs. Unconsciously, she did not want the boy (who looked no more than sixteen) to grow up. On the surface, the boy went along with her control and domination. He was emotionally captivated by her intense though neurotic preoccupation with him. Still, his unconscious dynamics required that he cover up (or defend against realization of) his attachment to feeling controlled by her. As part of this dynamic, he tormented himself with thoughts that he should try harder to please his mother and be a nicer boy for her sake.

But that sentiment was in vain. He was compelled to act out a self-damaging defense against his attachment to feeling controlled and dominated. His defense (and resulting self-damage) was based on an unconscious formulation that produces an illusion of power: “Mother doesn’t control me. On the contrary, I refuse to eat her food. I refuse to comply with her demands. I even control her feelings and get her upset. True, she doesn’t like me behaving like this, but at least I have some sense of power. It is my behavior that is controlling her.”

This claim to power was, of course, an illusion. But it “worked” to some degree as a defense, even though it produces guilt, shame, low self-esteem, and self-defeat. In fact, the defense produced a great deal of guilt, shame, and low self-esteem, amounting to a considerable degree of suffering. The boy’s emotional entanglement in helplessness made him more passive, which meant that on an inner level he was less able to keep his inner critic at bay. In absorbing the inner critic’s attacks for allegedly being a bad or naughty boy, he felt considerable shame and guilt. Unconsciously he counteracted these inner accusations concerning his “naughtiness” with defensive claims that he wanted to be a good boy and knew he should be a good boy. (A girl and her mother could be involved in the same unhealthy dynamic.)

Inner conflicts are also associated with bulimia, which is characterized by binge eating and purging. One of my clients with a history of alcohol and drug abuse was concerned that her father would think less of her if he were to find out she was also bulimic. He was a successful businessman, and she was convinced he would see her as incompetent and a failure in her life. On the surface, she desperately wanted approval from him. But anyone who is desperate for approval is unconsciously attached to feeling disapproval. This woman had an emotional attachment to the feeling of being seen as a disappointment or in a negative light. By imagining her father thinking less of her, she produced negative emotions (such as anxiety or anger) through her inner conflict which involved wanting approval but expecting (or being attached to) disapproval. After psychotherapy, which addressed this conflict as well as conflicts involving deprivation and control, her bulimia became inactive.

A variety of inner conflicts are associated with eating disorders, and this article provides only a very small sampling. People in need of treatment have every right to expect and demand more insightful psychotherapy than what mental-health professionals are now providing.

UPDATE 11/20/13

Below is an excerpt from The Human Spark: The Science of Human Development (Basic Books, New York, 2013), by Jerome Kagan, a Harvard University professor of psychology. His comment provides more evidence, as I see it, that an unconscious emotional attachment to helplessness (inner passivity) is at the root of the disorder:

Most anorexics are perfectionists with a strong need to be in control of all aspects of their lives because they want to avoid unpredictable and unwanted events. An inability to tolerate uncertainty over the immediate future is a characteristic common to many family 2 disorders. These individuals continually think about the possibility of unwanted surprises occurring during the next moments, days, or weeks and try to do something to prevent them. Because the slightest mistake or failure is an unwanted surprise, they are often incapable of deciding on an action, even one as innocent as purchasing a ballpoint pen, if they haven any doubt about the correctness of their choice. They resemble bronze statues with a half-raised arm frozen in indecision.