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Jam: they don’t starve themselves to be one size smaller. This has nothing to do with it. They have a dysmorphic disorder and when they look in the mirror they do not see their hip bones, ribs and collar bones sticking out – they still see themselves as very fat. Often this occurs in girls who originally were not even obese but perhaps 10 or 15 pounds overweight and someone close to them (family or friend) has commented on this once too often. They begin dieting which quickly turns to starvation. They cannot see themselves as anything but fat. Anorexia is a dreadful disease and takes a lot of medical treatment to control. I say control because often, it cannot be cured. Many patients are able to resume a normal life but often have to resist the urge to begin the cycle again. These patients must be on guard for the rest of their lives, although past middle age, the symptoms and urges often dwindle.