And for adult women, the triggers are often common midlife anxieties like divorce, empty nest syndrome or the loss of a parent.
For this reason, the treatment program at Renfrew involves not just developing healthy eating habits under the supervision of medical staff and a nutritionist but also therapy -- one-on-one sessions with professionals, couples therapy with spouses, or dealing with body issues through art.
Harootunian's breakthrough occurred in a group session called "Psycho Drama" in which a therapist asked other women to play various characters in Harootunian's life. During this session, Harootunian revealed that her relationship to her father was also rocky.
Like her husband, Harootunian's father, a traveling salesman, was often absent from her life. That she didn't have a closer relationship with her dad was deeply hurtful to her as a child.
"I just don't know why Daddy doesn't talk to me. I try so hard in school. And I just don't know why I am not good enough for him," she said during therapy.
Harootunian didn't have the opportunity to fully reconcile with him before his death.
"When my father died, a part of me died," Harootunian told the therapist. "But I know that he's sending me messages to keep doing this, to stay strong, for one reason or another. I feel like I'm on a mission to do this for me, and for him."
The therapist showed Harootunian how she had been using her eating disorder to numb all those years of pain. Confronting her eating disorder through role playing, Harootunian declared, "I want you out of my life!"
It was a cathartic experience for her. When asked by ABC News medical editor Dr. Tim Johnson what she learned during that session, Harootunian said, "That I was at a point where I really wanted to take care of myself. That I was evolving. That I meant something."
Following this revelation, Harootunian approached her treatment program with renewed vigor. Back at home, her husband also made changes -- cutting back on his work hours and caring for the kids while Harootunian was at Renfrew.
Finally, 58 days after she was admitted, at a cost of about $1,000 a day, Harootunian was well enough to go home.
"She ultimately left eating over 4,000 calories, and we started her out at about 1,200," Ice said. "She gained about 25 pounds in the program, and left at almost 90 percent [of her ideal body weight]."
For several weeks after her release, Harootunian continued to check in daily with the Renfrew staff at its outpatient facility, where she took part in therapy sessions. Slowly, her life regained a sense of normalcy.
"I don't get stressed out about a lot of things. I am not as much of a perfectionist," Harootunian said.
Still, she worries about any possible effects her anorexia might have had on her young children.
"I hope that seeing me as a different person will give them insight to stay healthy and stay well," she said.
"Just to see her back, feeling good about herself -- it's energizing and it's positive, and it's extremely attractive in every way to me," her husband said.
Last June, nearly a year after her release, "20/20" caught up with Harootunian again on the Jersey shore. Sporting a new turquoise swimsuit, she reveled in the surf with her kids and proudly showed off her new figure.
She had gained 40 pounds, and weighed a very healthy 120. Although people can never be completely cured of anorexia, Harootunian has not had any relapses and no longer needs the Renfrew support groups.
"It's just letting go of that eating disorder, that's the hardest step," she said. "And you know, a journey of a thousand miles takes one small step."