Without such learning all she learns are the tricks involved in being cute and manipulative to get what she wants. These are poor and insubstantial tools to rely on when building an adult life.

Somewhere inside, over time, she may gradually realize this. But, having no sense of boundaries, she will only become bewildered and anxious. She will use her eating disorder as a way to numb her feelings of anxiety. She will use her manipulating skills to get what she wants from whomever she can use.

As time goes by there will be less people who will allow themselves to be manipulated. The quality of her circle of associates will decline. She will find herself in bad company. This becomes all the more reason for her to rely on food for comfort. The people around her are less reliable all the time. And finally, they tolerate her presence only because they can manipulate her.

Then she is truly in a total victim position. Her manipulative skills backfire. There are people in this world who are better at manipulating and using than she. She has found them. She has become their target and then their prey. Reliable food or food rituals, including starvation, become her most valuable relationship.

Early in her development she learned through massive boundary invasions (which perhaps seemed so ordinary and unimportant at the time) that she was helpless to assert herself. She learned that she had no private or sacred space to cherish and respect. She also could not acknowledge -- often even to herself -- that she was being thwarted, invaded, controlled, manipulated and forced to deny large aspects of her natural self. She had no recourse except to comply. She complied and developed an eating disorder.

Now that she's older and her manipulation skills are failing her, she only has her eating disorder to rely on. This may be the most crucial time in this person's life. If her pain and despair are terrible enough and she is certain she can not bear this way of living anymore she still has choices. One is to continue down the road of self-destruction. The other is to reach out and get help.

It's a very tough position for her. She would have to recognize that she has had enough. She's never known what enough was. She would have to recognize that she can't bear any more pain. She's never known what a limit was. She'd have to be honest and reach out for genuine help. She has only known about manipulating others.

She's got to feel a lot of anguish and pain before she stretches beyond her life pattern into what might be a real healing and recovery path for herself. She's reaching for something she can't even imagine. No wonder it's so difficult for a person with an eating disorder to decide to get help and allow themselves to begin to trust someone with knowledge of their real personhood. She doesn't know that people exist who do respect and honor boundaries. She doesn't know that there are people who can and will honor and cherish her most private and sacred inner spaces. She doesn't know yet, that someday that trustworthy, respectful, steadfast and competent caretaker she needs so badly can be herself.

next: Bulimia, Anorexia and Compulsive Overeating: When Family and Friends Don't Get It