Eurekalert posted an interesting article about "insight deficit" and denial. Although the article is about substance abuse and addiction, I think it could easily pertain to eating disorders.
Much like with other addictions, denial can play a very strong role in keeping an individual in their eating disorder illness. The Society of Neuroscience meeting in Washington, D.C. held their annual meeting this past weekend where researchers discussed this impaired insight as well as other neuroscience topics related to addictions. Rita Goldstein, a psychologist who led the presentation, explained that the insight impairment were in many of the same regions of the brain that addiction symptoms seem to appear. She further said:
It is therefore possible that these core clinical addiction symptoms — craving and compulsion and the chronic relapsing nature of addiction — may be a consequence of compromised insight. Such impaired insight might help explain why drug-addicted patients often have a hard time recognizing, accepting, and/or acknowledging their own signs and symptoms of addiction, as well as the need for treatment. It could also help explain these patients' failure to comply fully with treatment regimens — and their tendency to relapse
Now, I'm sure we can chalk some of the denial thinking into pure starvation and malnourishment, but at the same time, there is evidence of the similarities between addiction and eating disorders in both biological mechanisms and psychobiology. An older article in Psychiatric Times explained it nicely. Also, this abstract by Walter Kaye about the neurobiology of anorexia and bulimia nervosa gives another good explanation of these mechanisms.
Whatever your opinion is about the addiction model and eating disorders, this is good food for thought. It's interesting to think that the "denial" so many of us have had at one point or another may be more than just about refusal to completely admit our illness.