We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
He is talking about the subject of what we term "symptom choice." Of course, we do not generally mean that people set out to select a symptom, but we do mean that, except for those with serious brain disorders, the mind has only a set number of outlets for inner turmoil. Some of them are dysfunctional and some are not.
Many factors: cultural, personality-based, familial, genetic, etc. feed into the symptom "choice" of neurotics. I would say that eating disorders (which I view as a sort of obsessive-compulsive symptom) partake of all of the above. However, toying with an eating disorder because of fashion does not create a serious or persistent eating disorder. It's not like heroin.