Family drama
Now, although Hornbacher's parents were certainly not perfect, one should hesitate to judge them, because she isn't doing that in this book. Hornbacher was very young when her disorders began. At that time, any amount of family fighting or arguing can be a very frightening thing for a child. The family dysfunction was secretly becoming a critical issue to young Marya, but without a way to explain that to anyone, her loneliness mixed with that family drama, and that led her to become mentally desperate.
Eating disorders
By nine, Marya was bulimic, and by fifteen, she was anorexic. These problems are certainly frightening, because although they manifest in the body, which often sustains extreme medical damage, by the way (Marya herself nearly died at only 18 years of age). There were emotional problems that she could not conquer, and without a strong community to come alongside her, she suffered her parents dysfunction alone, the only witness to their fighting. Left untreated, these emotional needs manifested in her diet, and she became obsessed with not eating.
The strange nature of psychosomatic issues
Medicine is often fairly scientific in its approach, which is certainly the correct way to practice medicine, but that does mean that there are limitations in how companies can help people. Besides, who is to say whether the problem resides in her body's behavioral programming (psychical), or in her unmet emotional needs (mental). There is this strange connection between body and mind in Marya's eating disorders. Because she is suffering a problem that is both psychic (in the mind) and somatic (in the body), her path to health needs to be holistic and integrated—she has to strive for wholeness as a person in order to conquer her disorder.
