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. 
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 WebMD.com, 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 www.helpguide.org 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.
