The Mindset of Eating Disorders

Eating disorders can be a mystery to outsiders. It's difficult to empathize with throwing up, starving, or bingeing until it hurts. But there's a reason for every eating disorder. The Savvy Psychologist reveals 4 psychological drivers behind anorexia, bulimia, orthorexia, and other forms of disordered eating.

Ellen Hendriksen, PhD
5-minute read
Episode #240
Woman tied to scale with measuring tape.

Factor #3: Perfectionistic Striving

Many people with eating disorders are high achievers. They’re hardworking, hold high standards, and are diligent and thorough. But aiming high can cross the line into relentless pushing and harsh self-criticism when unreachable standards inevitably aren’t met.

Other individuals with eating disorders can’t point to a history of achievement. But dieting, restricting, purging, exercising, or weight loss can be an area in which they excel. Hitting their exact caloric budget, purging every bite, or powering through on the elliptical until the readout says exactly 2,000 calories is a way to be excellent at something.

The newest way to be perfectionistic around eating is orthorexia, a little-known but burgeoning eating disorder which is essentially clean eating on steroids. Foods that aren’t pure, clean, or healthy enough—in other words, perfect—get cut out or rigidly controlled.

All in all, a common refrain among those with eating disorders is feeling not good enough—not capable, not competent, not worthy, not lovable. What’s more, many perfectionists believe they can remedy these perceived fatal flaws only if particular goals are met. This is called conditional goal setting, and in the case of eating disorders it may make happiness (or mere adequacy) contingent upon weight, caloric intake, or the elusive feeling that they had a “good” day or don’t “feel fat.”

Despite the name, perfectionism isn’t about being perfect; it’s about never being good enough, so striving through anorexia, bulimia, binge eating, orthorexia, or a combination thereof creates a much-needed sense of compensation.

A common refrain among those with eating disorders is feeling not good enough—not capable, not competent, not worthy, not lovable.

Factor #4: Short Term Fulfillment 

A study in the journal Psychological Medicine looked at thousands of people with eating disorders and found that 27% of them also had a history of self-injury. Among individuals with bulimia, 33% had a history of self-injury. 

Why is there such overlap? One hypothesis is that both eating disorder behaviors and self-injury act as a form of emotion regulation. 

For example, have you ever had an ugly cry and then felt calmer? Or vomited when you were ill and then felt sweet relief? It’s the same principle: a big physical release, whether from crying, cutting, vomiting, bingeing to the point of pain, or exercising to the point of exhaustion can usher in a feeling of calm or even short-term euphoria.

In addition, with anorexia, many individuals with the disorder report a feeling of clarity and increased energy when they’re starving and it’s hypothesized that the feeling has addictive qualities. For example, a study in the journal PNAS found that anorexia and ecstasy activate some of the same brain receptors, except in the case of anorexia, the drug is deprivation itself.

In the short term, eating disorder behaviors “work” to regulate emotion—vomiting, bingeing, and fasting are each, in their own way, forms of coping. They instill a sense of control, achievement, compensation, or distraction from core fears of worthlessness, helplessness, or defectiveness. The rub? They’re not sustainable or healthy forms of coping for the long term.

Ultimately, the goal is to trade unhealthy methods of coping for healthier ones, like practicing self-compassion, challenging the harsh voice in our head, or labeling self-criticism as mere thoughts rather than gospel truth. But until we all get to that point, building empathy and understanding of what drives eating disorders is a great place to start. 

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Medical Disclaimer
All content here is for informational purposes only. This content does not replace the professional judgment of your own mental health provider. Please consult a licensed mental health professional for all individual questions and issues.

About the Author

Ellen Hendriksen, PhD

Dr. Ellen Hendriksen is a clinical psychologist at Boston University's Center for Anxiety and Related Disorders (CARD). She earned her Ph.D. at UCLA and completed her training at Harvard Medical School. Her scientifically-based, zero-judgment approach is regularly featured in Psychology Today, Scientific American, The Huffington Post, and many other media outlets. 

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