You're not way off. I can only speak for myself, but for me the eating disorder was a way of life. I've always felt inadequate, like I couldn't cope with anything and wasn't good at anything, like I couldn't live and didn't have any goal, and my life was thus... well, pretty much empty. Anorexia filled that void and gave me a clear objective and a set of rules to follow, to succeed at following. So... yeah, it's about filling the void, for some people. And personally, I believe in the vast majority of cases it's definitely not about 'beauty'.
(Ack, sorry for w/e bad English)
Way back when I was in college and anorexia was still a relatively new disorder (at that point it seemed restricted to only white, upper middle class, females, usually somewhere in age between 13-25) I had to read a lot of case studies on it, for a paper I was writing. Over and over again, the girls who were suffering or in recovery spoke of the same thing; control. They felt powerless in so many areas of life, but this was the one thing that they had control over completely. That's why most of them freaked out completely when they were hospitalized and had feeding tubes. Because that one area, the only area where they had that control, was taken away from them. It didn't matter that they were going to die if they kept playing their games, that never factored into their thinking, all that they cared about was that someone was going to make them take food into their bodies, and they didn't want that.
Back then, there were a lot of people who made fun of anorexia. One of the girls in my class, who came from a poor background, single mother who had to work two jobs just so the family could eat, couldn't even deal with the idea of anorexia. All she could do was see rich, spoiled, white girls refusing to eat. I had grown up just a shade below the background most of the victims had, and even I had trouble seeing how people could just refuse to eat, could make a game out of eating. Most of the case studies were loaded with little rules these girls made up about how to eat. "If I don't step on any cracks in the sidewalk, I can eat a spoonful of cottage cheese tomorrow," or, "If I ride my bike five miles in X amount of time, I can have a popsicle or a hoodsie cup. But, if I go for the hoodsie cup, I have to throw it up later." It was just...bizare.
Further looking into the case studies though, showed that a lot of these girls had lives more complicated than most folks not in their situation would understand. Often they had presure on them to succeed and even do better at things that their parents were good at. One study was the daughter of a ballet dancer who really hated dancing, but had been pretty much forced to take dancing lessons since the age of two, because her parents couldn't even fathom their daughter not loving ballet as well. A lot of them were involved in activities, not because they particularly liked them, but because their families, or the schools they attended thought they would be "good for them."
I know that now, more people suffer from anorexia, that it isn't just a young upper middle to upper class white girl disese, so I don't know how much it's changed or how it's being defined now, but I would imagine, it still comes down to control in a lot of cases. "You can make me do this, you can make me do that, you can force me to go here or there, but you cannot tell me what to eat and when I can eat it."
Yes, a lot of the girls saw themselves as fat, there was a self image disorder too. But, a lot of teenage girls, even back then, thought they were fat, even if they were wearing size 1 jeans. But in the case of anorexia, the combination of the poor self image and the feeling of their own lives being out of their control seemed to be the combination to watch out for.
It just sucks that the world is so screwed up that people end up feeling that poorly about themselves, be it that they're too heavy, too thin, too ugly, too whatever. It sucks that the world makes people feel inadequte. I don't think it helps though, that the media pushes a certain type of person at us, as an example of "true beauty," and she's almost always very skinny, blonde, with "bee stung" lips, huge knockers, and skinny little noses. There are so many beautiful people out there, who don't match that stereotype, who seriously believe they are ugly or unattractive, or unimportant, because they don't have that Olsen Twin look to them. It's sad.
My mom and i would watch the lifetime stories about girls who had anorexia,after watching all of that I couldn't help but think "omg thats horrible how can anyone go without eating a burger or pasta or any food at all!?" I had a slight eating problem when i was younger due to medication, where i barely ate at all. I'm not saying i had anorexica because I wanted to eat but the pills made me too depressed to WANT to eat anything.I'm off them luckily but it still felt horrible because i'd end up eating only once a day because of it and it just felt terrible.
I hate how when girls feel confident about themselves finally they get called stuck up, or vain, just because they say "I'm beautiful the way i am" and the next minute some sized 2 blonde bitch is calling that sized 12 girl a conceeded fat ass. I really hate what the world has become, it really sickens me and I hate how alot of sims 2 CC maers are putting anorexics as models and calling them "sexy!" or sometimes i'd see, like that evi poster "big anorexics". It really sickens me =/.