Psychology

"The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a huge body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders, but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed."

"The findings of this study raise questions about the concept of comorbidity as applied to eating disorders and suggest the likely utility for both research and clinical practice of considering eating-disordered symptoms in their characterological context (e.g., references 12, 34). The data from this study suggest that individuals who develop eating disorders who are constricted in most areas of their lives—e.g., who are passive and unassertive, emotionally constricted, and interpersonally avoidant—are likely to express this pattern with anorexic, rather than bulimic behavior. Clinically, these patients tend to be just as constricted in their sexual lives as they are with food, denying themselves pleasure, avoiding sexual relationships, feeling too ashamed or guilty to indicate to their partners what feels good, and so forth. Conversely, individuals with eating disorders whose ability to regulate their impulses and affects is tenuous—as expressed in spiraling emotions, tantrums, clinging to others for soothing, self-mutilation, and other impulsive acts—are likely to lose control over their eating in binges and to use self-destructive compensatory measures such as vomiting that momentarily help them regulate their affects. From this point of view, the question of whether bulimic symptoms should be regarded as impulsive behavior may be misplaced. The answer is probably that it depends on the personality configuration within which bulimic symptoms are contextualized. In low-functioning, emotionally dysregulated, type II bulimic patients, binge eating and purging may be functional equivalents of substance abuse, self-mutilation, and promiscuity. For these patients, bulimic symptoms may represent desperate efforts to regulate intense negative affects that call for immediate, and often maladaptive, responses. In contrast, high-functioning, perfectionistic, type I bulimic patients do not struggle with affects of the same intensity, and they have more adaptive coping strategies at their disposal for dealing with their distress. For these patients, binge eating is not equivalent to impulsive behaviors such as drinking or self-mutilation."

"Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to review the oro-facial manifestations in patients with eating disorders. The address the focused question was "What is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases were searched from 1948 to March 2012 using the following terms in various combinations: "Anorexia nervosa", "bulimia nervosa", "eating disorders", "dental", "oral health status". Letters to the editor, unpublished data and articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling are common manifestations in patients with eating disorders as compared to medically healthy controls. The association of dental caries and periodontal disease in patients with eating disorders remains debatable. Temporomandibular disorders have also been reported to be more prevalent in patients with eating disorders as compared to healthy controls. A critical oral-dental examination during routine dental check-ups may reveal valuable information regarding the presence or absence of eating disorders in routine dental patients. This may be important information, updating the medical history, supporting the role of the physician."

"Bound in captivity to an unfortunate situation one cannot escape, the common psychological reaction is to identify with the interests of the captor, find hope and justification in negative circumstances: the workaholic, Stockholm Syndrome and the Voltaire's character Pangloss with his argument, faced with the best of 18th century misery that this is "the best of all possible worlds", converges. Workers become the most sincere defenders of their own austerity cuts, a necessary and temporary prick like all those others before, whilst bankers and traders use the cover of crisis to accumulate more capital and increase their share of the collective wealth."

"The powerful, if they carry oppression beyond a certain point, necessarily end by making themselves adored by their slaves. For the thought of being under absolute compulsion, the plaything of another, is unendurable for a human being. Hence, if every way of escape from the constraint is taken from him, there is nothing left for him to do but to persuade himself that he does the things he is forced to do willingly, that is to say, to substitute devotion for obedience. ... It is by this twist that slavery debases the soul: this devotion is in fact based on a lie, since the reasons for it cannot bear investigation. ... Moreover, the master is deceived too by the fallacy of devotion."

"It was the hostages' fault. They did everything I told them to. If they hadn't, I might not be here now. Why didn't any of them attack me? They made it hard to kill. They made us go on living together day after day, like goats, in that filth. There was nothing to do but get to know each other."

"First people would experience something terrifying that just comes at them out of the blue. They are certain they are going to die. Then they experience a type of infantilisation - where, like a child, they are unable to eat, speak or go to the toilet without permission... The hostages experience a powerful, primitive positive feeling towards their captor. They are in denial that this is the person who put them in that situation. In their mind, they think this is the person who is going to let them live."

"Whereas Marx identified the essential condition of capitalism as one of enforced servitude (wage slavery), the Frankfurt School alluded to something even more insidious: a willingness in people to inscribe themselves within the very system that oppresses them; to defer to the widespread mythology of those who have 'made it': the rags-to-riches millionaire, the lottery winner, the pop/sports idols and so on. Contemporary subjectivity is thus one of perverse collaboration. ... Late capitalism is a kind of Stockholm syndrome writ large: a skewed and rather desperate faith in our own socio-economic betrayal."

"Stockholm Syndrome is a subtle thing. It doesn’t just mean people sympathize with their captors — it means that they internalize their values, to the point that their identities are remade."

"I find it very natural that you would adapt yourself to identify with your kidnapper. Especially if you spend a great deal of time with that person. It's about empathy, communication. Looking for normality within the framework of a crime is not a syndrome. It is a survival strategy."

"I learned that the psychiatrists I interviewed had left out something: victims might identify with aggressors as the doctors claimed, but things weren't all one way."

"The prevalent sensation of oneself as a separate ego enclosed in a bag of skin is a hallucination which accords neither with Western science nor with the experimental philosophy-religions of the East — in particular the central and germinal Vedanta philosophy of Hinduism. This hallucination underlies the misuse of technology for the violent subjugation of man's natural environment and, consequently, its eventual destruction. We are therefore in urgent need of a sense of our own existence which is in accord with the physical facts and which overcomes our feeling of alienation from the universe... Just as no thing or organism exists on its own, it does not act on its own.... Parts exist only for purposes of figuring and describing, and as we figure the world out we become confused if we do not remember this all the time."

"If the reverse learning mechanism we have postulated exists, one might wonder what effects its failure might have. A complete failure might lead to such grave disturbances—a state of almost perpetual obsession or spurious, hallucinatory associations—that it would probably be severely selected against. A partial failure should produce unwanted responses to random noise, perhaps as hallucinations, delusions, and obsessions, and produce a state not unlike some schizophrenias."

"For our ancestors, dreams, hallucinations, revelations, and cock-and-bull stories were inextricably mixed with facts."

"All at once, and without further warning, my reason forsook me altogether, and I started from Dr. Moffitt's house to go to my boarding place. The sidewalks were to me one mass of living, moving, howling, and ferocious animals. Bears, lions, tigers, wolves, jaguars, leopards, pumas—all wild beasts of all climes—were frothing at the mouth around me and striving to get to me. Recollect that while all this was hallucination it was just as real as if it had been an undeniable and awful reality. Above and all around me I heard screams and threatening voices. At every step I fell over or against some furious animal. When I finally reached the door leading to my room and just as I was about to enter, a human corpse sprang into the doorway."

"The simplest migraine hallucinations, as we have said, are phosphenes—simple, almost structureless, moving lights in the visual field. Phosphenes virtually identical to these are readily elicited by direct electrical stimulation of the visual cortex, either in the primary area (Brodmann area 17) or the surrounding visual association cortex."

"Question: How did you get fat? Answer: One bite at a time!"

"If you want to do or achieve something, then it stands to reason that you should identify exactly what you must do in exchange. This is a level of understanding accepted by your conscious and your unconscious minds - it's the process of consequence. If you eat too much, the consequence is that you get fat and unhealthy; if you eat less and move more, the consequence is that you get slimmer and healthier."

"Overeating and making your body fat is a clear case of self-harming. Every time you overeat or drink high-calorie junk, especially when you don't need food for energy (i.e. when you are already satisfied) you are deliberately harming yourself."

"Don't tell me you can't imagine yourself not eating chocolate, cakes, crisps, cheese, or whatever else you put in your mouth when you are not hungry, because I don't buy it."

"The ugly truth is that millions of Americans are hooked on foods that stimulate the body's internal pleasure system. They give us that feeling of reward that calls us back for more: it's a biological response and the food makers know this. They actually have what they call 'the bliss point': they know just how much sugar salt and fat will set off the pleasure centres in your brain, the same areas that light up in an MRI if they give you cocaine. ... We need to talk freely and without judgement about these fearsome fearsome issues - about food, about fat, and about body image. We need to have a no-holds-barred conversation... to help us all find ways to tackle one of the biggest problems that's standing between us and a healthier America."

"Sometimes a nutritionist is sought to provide a diet as an answer to the problems with bingeing. However, a diet is not the answer to an eating disorder. Many eating-disordered people are experts themselves on diets and food intake. They know what is healthy. They know the caloric intake of every morsel they put in their mouths. Some are professionals in the area of nutrition. This underscores that eating disturbances are not due to lack of information about a good diet, but have to do with psychological factors that keep people from putting this information to use. Often, a nutritionist and therapist work concurrently. The nutritionist sets the stage for healthy eating, and the therapist examines what gets in the way when someone can't keep to her food plan. The goal overall is that of allowing someone to eat when hungry, in moderation, and to understand what motivates problematic eating so that better choices can be made."

"Because the symptoms of bingeing, vomiting, exercising, or starving can be so disruptive and frightening, it is easy to pay attention only to those behaviors. To do so, however, misses the point. The overt symptoms are just the tip of the iceberg. Beneath the surface lies a much larger piece of the picture - a complicated world of feelings and experiences that are very much part of the eating disorder. Both the visible and invisible parts need to be acknowledged in order to understand the disorders of bulimia nervosa, anorexia nervosa, and binge eating."

"The goal of treatment should not be merely to stop the behavior, but to understand how and why the person has used food to attempt to meet developmental and emotional needs."

"If you call your overeating 'comfort eating', start to think of it as 'addictive eating'. Calling it 'comforting' focuses on the perceived benefit only, which is how you justify it. It's more honest to call it 'addictive eating'."

"... when people eat when they are not hungry, it's to get a feeling. Often, it's to get any feeling other than the one they are experiencing, and they seek solace in the sensation food gives them. They become anchored to feeling better when they eat. This is called 'comfort eating'. If you remove the causes of the negative feelings - whether it's a past trauma or anxiety, or a stress of some kind - the need to eat to get rid of that feeling by comfort eating disappears."

"Nutritional counseling. Nutritionists, who are trained to assess imbalances in food intake and develop dietary programs, can help correct nutritional deficits and guide someone with an eating disorder to develop healthy eating habits, perhaps for the first time. Some people with eating disorders have extremely chaotic eating patterns or have not eaten a "meal" in years."

"Unless the reasons underlying disturbed eating are understood and addressed, the eating-disordered person […] will remain vulnerable to maintaining disordered food rituals when faced with difficult times or distressing internal experiences."

"The more I recognise my freedom to choose, the less I feel deprived and the less I need to rebel. When it comes to taking control of addiction, it makes all the difference when people genuinely acknowledge the free choices available to them. This is the key: own your choices and, as a result, you take control."

"Instead of thinking of food as either 'allowed' or 'forbidden', think in terms of choices you make either to enhance your health or impair it."

"In order to achieve your goal of eating less at meals, you will need to be willing to feel unsatisfied - and not 'full' - at the end of your meal. When you make a Plan before you start eating, you decide on a stopping point where you have the opportunity to confront your addictive hunger (see page 106). The last thing you want is a feeling of fullness and satisfaction. That's what got you into this problem in the first place!"

"It can be a very big step to say 'no thanks' when something's offered, or to order salad while your friends have pizza."

"And that's precisely where the magic happens: when we own our problems and recognise that we are the source of the solutions. Especially when it comes to eating, because that can be so completely within our control."

"... ultimately it's up to you and you alone what goes in your mouth."

"Surgery. It is important to note that while surgery is considered the most effective treatment for the morbidly obese patient, studies are just evolving considering the long-term effect of this kind of treatment and whether this treatment is ultimately helpful for the binge-eating patient. In general, at one and a half to two years postsurgery, weight loss stabilises, and a substantial portion of individuals even begin to regain lost weight. What is clear is that a presurgical history of binge-eating disorder is associated with poorer long-term weight outcomes. There are many stories of patients who have reached their ideal weight following surgery, only to quickly regain all of the weight once their goal has been reached. In these cases, bingeing begins again despite severe physical pain, vomiting, and the obvious despair of watching the scale skyrocket again. One patient described losing and gaining over 100 pounds in less than two years. Bariatric surgery thus can initially achieve substantial weight loss, but surgery alone may not alter the underlying eating disorder. If the eating disorder remains, positive results can be significantly compromised. Without a deeper understanding of the psychological role of bingeing, without the possibility of medication to address physiological cravings, and without an ongoing program to develop new means of dealing with feelings and stress, surgery may just be a bandage that only temporarily covers a longer-term and deeper problem."

"If you want a reason to keep overeating, you'll always be able to find one. Alternatively, you could make some different decisions about one thing you have complete choice about: what and how much you eat."

"You must become more aware of just how much you eat - even 'healthy' calories will make you fat if you eat too many of them. You must use your own common sense and intelligence here."

"Accepting your addictive desire to eat means being willing to feel it, without satisfying it, fighting it, avoiding it or doing things to make it go away. ... Simply allow yourself to feel it, because it's your resistance to it that makes it more persistent and more intense. … [I]t's in your best interest to accept your addictive desire to eat, relaxing as much as you can and letting it be there. Remember that the only reason you're feeling the desire is because you ate addictively in the past … And probably the main reason you ate addictively in the past is because you live in a food-addicted culture."

"... make dealing with your addictive eating your main goal. This requires a change in your thinking, ..."

"(Dr Nowzaradan, to camera, explaining): "Lisa knows she is helping to kill James every time she overfeeds him, and that he could die any minute from his weight, but she still won't stop.""

"Steve Miller: "If I have to move mountains to help them, that's exactly what I'm going to do. It's time for this fat family to do things my way. It's got to change.""

"I can't tell you what to eat, I can't tell you what to change, because you have to decide for yourself what you want."

"People think they must prohibit because if they don't, they will eat too much. But that's not inevitable. There is another way. And that is, to give yourself permission: to know that you can eat absolutely anything, without actually doing that. What makes the difference is that instead of trying to obey instructions, instead of thinking in terms of rules and restrictions, is to freely choose to eat less. ... This is related to the way our brains work, which is why it is so important. ... The ways in which we habitually think actually direct and have an effect on the way that our brains function. ... The solution is to embrace freedom completely - to know that you can follow any nutritional advice and still know you haven't lost your freedom at all: you still can eat absolutely anything, and, you don't have to do that to prove it. ... Discover the power in genuine freedom of choice. ... The mindset for healthy eating begins with freedom of choice, a freedom that is rightfully yours."

"I was the one who did my own actions. Right now you have the ability to take your power by taking the responsibility of your own life and your own actions. Blaming means you are giving your power away. Instead, keep your power and use that power to shape your own reality. "I have all the power within me right now in order to change." You have all the power within you to change right now, and only you can do it, which means taking the responsibility of your own life, your own actions. Your actions today determine the future you are heading to. Stop blaming, making excuses, and change. Become the person you want to be. No one is stopping you besides yourself."

"I love food. I'm a junk food junkie. When I start eating those foods I can't stop. I love the way it all tastes. I love the way it makes me feel. It's my comfort, but I know the food is killing me. And it's keeping me from being a part of my kids' lives. I need to change, or I'm gonna die."

"Be aware that a portion size isn't designed to make you 'full up' - it's designed to satisfy and nourish you. There's a big difference between being satisfied, i.e. eating enough, and being full up. When you are full up, the uncomfortable sensation you get is your stomach telling you it is over-distended (stretched). Unfortunately, people get used to this sensation and program themselves, or anchor it, to be the feeling they think they should get after every meal, and they don't stop eating until they get it."

"With bulimia or binge eating, the benefits of therapy cannot solely be measured on the basis of changes in the eating disorder itself. Sometimes quick improvements in the eating patterns are short-lived, prompted by a display of "white-knuckle" willpower or a wish to please the therapist. Developing a trusting relationship, expressing feelings, and increasing one's self-esteem have to be established before a more sustained change in the eating can occur. These less observable changes are crucial as a basis of long-term growth."

"I am keenly aware of my addictive thinking, and I believe it is nothing but this awareness that gives me the ability to stay in control of my eating. This approach, which I'll explain to you in this book, is all I'll ever use or need."

"If you have a compulsive behavior pattern such as smoking, overeating, drinking, TV watching, Internet addiction, or whatever it may be, this is what you can do: When you notice the compulsive need arising in you, stop and take three conscious breaths. This generates awareness. Then for a few minutes be aware of the compulsive urge itself as an energy field inside you. Consciously feel that need to physically or mentally ingest or consume a certain substance or the desire to act out some form of compulsive behavior. Then take a few more conscious breaths. After that you may find that the compulsive urge has disappeared for the time being. or you may find that it still overpowers you, and you cannot help but indulge or act it out again. Don't make it into a problem. Make the addiction part of your awareness practice in the way described above. As awareness grows, addictive patterns will weaken and eventually dissolve. Remember, however, to catch any thoughts that justify the addictive behavior, sometimes with clever arguments, as they arise in you mind. Ask yourself, Who is talking here? And you will realize the addiction is talking. As long as you know that, as long as you are present as the observer of your mind, it is less likely to trick you into doing what it wants. p. 149"

"We all possess, in our unconscious minds, a kind of servant who performs certain automatic functions. When I learn to type or drive a car or learn a foreign language, I have to do it painfully and consciously; then, suddenly, my robot takes over and does it automatically; in fact, he does it far more quickly and efficiently than "I" could. The main trouble with this mechanical valet is that he often takes over functions I would prefer to keep for myself - for example, when I am tired I eat "automatically," […] In fact, this is the reason that so much of our experience seems oddly "unreal"; the robot has taken it over. […] I may live for whole days in a "robotic" state, so that experience flows off me like water off a duck's back."