That is the question.

No one really knows with certainty what causes anorexia. There are studies that identify those in the higher risk brackets, but the actual causes are still unknown. It is more than probable that a series of factors are the key to the causes.

People with anorexia may feel that they would be happier, more successful, better people, if they were thin.

They tend to be perfectionists and they want everything in life to be perfect. Anorexic conduct revolves around control. There is enormous will power behind not eating.

People with this food disorder are usually very active in sports, and engage in many activities.

Anorexics are usually very intelligent people and very good students.

They blame themselves if things go wrong, if their school grades are low or if the other things in their lives are not perfect. I have also seen them assume blame for things that in reality have nothing to do with them.

One thing has always struck me and I think highlights the difficulties of suffering from anorexia. This is the love-hate relationship with food.

If you take for example someone with an addiction, the addiction is a reflection of “x” problems. The physical problems begin to be solved by not taking the addiction substance or behavior.

With anorexia, the problems are similar, but the physical solution is not to stop taking food, but to actually take.

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A friend just asked me what was the difference between anorexia and bulimia?

People suffering from bulimia ingest large quantities of food, but shortly afterwards they self provoke vomiting, or take diuretics or laxatives to avoid gaining weight.

People who suffer from anorexia stop eating, avoid food with high calories and exercise consistently.

People with bulimia usually do not lose as much weight as those with anorexia.

There are also cases of people suffering from both eating disorders, anorexia and bulimia at the same time.

The long term physical effects can also be different.

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Someone with an eating disorder is obviously focusing on food.

As that person focuses on food, including calories and weight, she is blocking out or cushioning painful feelings and emotions.

Nobody hurts themselves on purpose. Any conduct that appears to be self hurtful is, from the point of view of that person, the best option she can visualize at that time. The conduct will be the result of what she sees as the best solution. The problem is with the solution that person chooses.

Some people use food as a way of comforting themselves (a sort of security blanket, if you like).

In short eating disorders manifest themselves as problems with food, but that is the tip of the iceberg. The relationship with food is a symptom that camouflages other problems.

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