I love it when a seemingly little insight can yield so much understanding. In this case, the insight isn't from therapy or thinking, but instead from research (and a cleverly worded press release).

Why Anorexic Patients Cling to Their Eating Disorder

This has been a topic of much conversation and consternation in therapy for me. My one therapist, Dr. G, would always ask me what I was getting out of the eating disorder because "there had to be something since I kept on starving myself." It's true that my eating disorder had an adaptive function, but in those moments when I could recognize how ill I was, I usually wanted to rid myself of the eating disorder, not cling to it. But Dr. G and I discussed things like control and mothers and feelings and some of it was useful and some of it was simply a time suck.

Many times, I didn't really have an explanation for my behaviors. I didn't necessarily understand them myself, and when an understanding did dawn on me it rarely resulted in real, lasting behavioral change. A lot of times, the ED behaviors were just a part of my routine. I woke up, I did X. At "lunchtime", I did Y. After work/school, I did Z. I ate the same breakfast every day for almost two years because choosing a different cereal was overwhelming and I had planned my meals around this one particular type of cereal so I kept on eating it.

The recent paper from the American Journal of Psychiatry titled Neural Correlates of Impaired Cognitive-Behavioral Flexibility in Anorexia Nervosa, found that my experience with a need for routine and inflexibility was common to many AN patients. In fact, the researchers hypothesized that anorexics "clung" to their disorder because they had difficulties in developing new behavioral patterns.

“In this study, we confirmed that anorexic patients cling to familiar behavioral responses more frequently than healthy subjects, thus suppressing alternative behavior," explained Dr. Hans-Christoph Friederich, head of the working group for eating disorders. The analysis of the MRI images also showed that in patients with anorexia compared with healthy subjects, a certain network pathway between the cortex and the diencephalon is less activated. This network pathway plays a decisive role in initiating and controlling actions under rapidly changing environmental demands.

The results of the study contribute decisively to a better understanding of anorexia. In particular, they make it clear that neurobiological factors are involved and sustain the clinical symptoms. Since psychological and neurobiological factors can influence each other, this may lead to new therapy approaches for anorexia.

"We have developed a treatment program for anorexia patients that specifically targets the flexible modification of behavioral responses,“ says Dr. Friederich. In this way, the researchers hope to improve the success of psychotherapeutic treatment. The MRI examination of the brain could contribute to measure the success of treatment.

(I inserted the links in the above quotes)