I believe that any compulsive behavior, defined as that which is repetitive, unhealthy, unwanted, mindless, etc - is avoidance of Self. People learn to avoid themselves because the Self is made of and informed by emotion, and most have learned for some reason or another that there was no room for the emotions. Trauma, childhood neglect or abuse, growing up with someone whose emotions were out of control - these are just some of the reasons people learn to sweep their feelings and opinions under the rug. People learn overt and not-so-conscious ways of controlling themselves and interpersonal relationships only to find that painful patterns keep coming back and they are out of control of their harmful behaviors despite so much effort.
Without addressing underlying social learning about emotion, teaching new ways of coping with feelings, and changing the way people think about themselves and others, there can be no real healing from eating disorders. Whether it is body hate, counting calories, denying the self nutrition - its all the same. These obsessions take us away from healthy relationships with our Selves, with food, with out bodies and with others.
Yup, therapy for eating disorders tends to be a bit difficult and long term. It takes more time to feel understood and to be understood when emotions and vulnerability are repressed. I will take my time. Yup, sometimes people give up - quitting therapy by rejecting the therapist is a good strategy to avoiding emotion and vulnerability. I will be here if and when you come back. Yup, I can handle it. We can make change together if you are committed and ready to bravely look at and accept not your thighs, but your cries, whether they are of anger, for help or in grief. Lets do this.