Of course, eating disorder 101 is "it's not about the food." Oh, it seems like it is about the food, and one really good way to irritate a patient in the midst of an eating disorder is often to tell them that, in reality, their eating disorder is not about the food.
So, that leaves us with the present reasons for the ED, what needs the ED meets. And even those are numerous, so today I am going to focus on just one: Eating disorders as a form of communication.
In comes the eating disorder. They can use their body to communicate how they feel. So, as their body size decreases or increases, they might be trying to say something that they cannot find the words for. (Note, this is different than that accusation of eating disorders being "attention-seeking." Yes, they are hoping someone will notice and help, but this is not the same as simply seeking attention.) On some level, they don't want to be noticed; they don't want anyone to recognize they have an ED. But on the other hand, they really want someone to notice, to help. So, they are torn.
I recently had a client come in and flat out admit this was the reason for her behaviors. I was impressed with her level of insight as it made it very clear what we needed to work on in that moment. However, for most, I think they are not even necessarily aware that they are using their body to communicate. I often ask patients what they are wanting someone to hear, and with whom they are trying to communicate. If you are family or friend, you could do a similar thing and ask your loved on what they want you to hear. You may learn a lot.
I also want to point out, I think this whole concept also applies very strongly to self-harm, particularly when wounds are visible to others. Again, this is VERY different from the easy answer of "attention-seeking." This is a deeper understanding of the person's internal battles.