The Difference between Thoughts and Voices

Short note: For psychologists, I'm sure this post isn't incredibly enlightening.  It is simply intended to be informative for a general audience.  As I learn more about working with schizophrenia, I thought I'd share my experiences here.

The Difference between Thoughts and Voices

Thoughts:
- You can't hear thoughts
- Thoughts can be about anything
- You've had thoughts your whole life
- Thoughts don't have a gender
- You can try to focus your thoughts on one topic (e.g. when problem solving a task)

Voices:
- You can hear voices
- It is someone else's voice
- There is typically a gender of the voice
- The volume of the voice can be loud or soft
- The voices seem to mostly tell you to do specific things / make commands / be judgmental
- Voices can be suggestive
- Voices can narrate what you're doing
- It feels like you can't control when the voices come or the content of what they're saying
- You didn't always have voices, but they started later in life

Related to this last bullet point, it seems important to connect the onset of the voices with mental illness.  First, not everyone is fully aware or willing to admit mental illness, but talking about the onset of voices is a good way to get your foot in the door.  It also seems useful to draw parallels between when the voices started and stress levels at the time.  This provides further evidence that the voices are part of a mental illness and not "real."  In session discussion should also focus on how much patients believe the content of the voices and how compelled they feel to act on the voice's commands.  I always make it a point to emphasize that one could have a voice without believing it was true or needed to be acted upon.

In short, a therapist can teach patients to that voices are part of mental illness, one does not have to believe what the voice is saying, and they don't need to act on a command from a voice.

P.S. If anyone has questions or even some good additions to add to the list, please feel free to leave a comment.

Recruiting for an Eating Disorder Study

If you ever had an eating disorder, you can participate in research at Mt. Sinai in NYC for up to $750. We're also looking for controls, so if you've never had an eating disorder and are interested, let us know too!

Contact: Sydney.Shope@mssm.edu. Thanks!

Dysregulation of the Anxiety System & Bipolar

As per usual, I'm trying to focus on work now, but get completely derailed with a thought I feel the need (compulsively) to blog about.

I saw that someone somewhere on a remote part of the globe was reading a post I wrote a while ago postulating that fear was the first emotion to appear on the evolutionary scene. I decided to revisit it. Here's the link: http://taradeliberto.blogspot.com/2011/03/first-emotion-fear.html

While rereading the post, I had the thought that bipolar disorder may result from a dysregulation of the anxiety system. Long story short, in depression, we see that prolonged anxiety can lead to chronic sadness (via chronic exposure to cortisol and what I conceptualize as over-use of the hypothalamus-pituitary-adrenal axis). We can also see that exhilaration and anxiety are quite similar emotions. Combining these two thoughts, perhaps bipolar disorder could arise out of the dysregulation of a primary anxiety system - sometimes leading to chronic sadness and other times leading to chronic exhilaration.

Interestingly, bipolar is pretty hereditary, but like most psychiatric disorders, it is thought to be prompted by none other than stress, perhaps indicating that it stems directly from some a dysregulation of the anxiety system.

I realize that this is being done already, but the fact that stress / anxiety can trigger the onset of disorders might be a signal to look at how anxiety relates to the course of the illness (with the consideration that anxiety could be the ultimate primary emotion). In this case, while stress may trigger bipolar disorder, lack of ability to regulate anxiety may maintain the behavior. While research in which I am involved examines reward sensitivity in bipolar, I'm wondering if a layer beneath reward sensitivity is anxiety sensitivity, being that we're conceptualizing anxiety as the ultimate primary emotion in this post.

I also realize that to say anxiety dysregulation may prompt bipolar disorder because stress prompts the onset utilizes circular reasoning. But circular reasoning notwithstanding (lol), I still think this is interesting to consider anxiety sensitivity as it relates to two separate constructs of bipolar - both onset and course of the illness.

Ok, back to work.

Triggers - Avoid or Expose?

I was just thinking about the practice of identifying and avoiding triggers in therapy. Sure, inherently harmful triggers are best avoided... but what about triggers that are what we call "conditioned stimuli?"

[For the non-psychologists out there: some of us are triggered by certain things that are actually harmless, but during the course of our lives, we somehow came to associate them with feeling like crap. For instance, walking by a restaurant you used to frequent with an ex could trigger negative emotions. The restaurant itself is harmless, but you've been conditioned to feel sad when walking by it. As such, the restaurant is now a trigger.]

Some therapists may urge their patients to simply avoid all triggers. Sure, this sounds like a good idea, but is it truly helpful? If the patient is in acute / reactive pain, then throwing some more negative experiences their way probably isn't a good idea. But typically, I think that systematically exposing people to triggers, just like you would to anxiety provoking stimuli, would lead to habituation.

While this may be common practice for treating some disorders, it doesn't seem to be the case for all of them (i.e. eating disorders). For instance, when a particular food may trigger a binge, the general advice simply seems to be to avoid that food. Well, I'm just not so sure.

Sensory Integration and Self-Injury

I spent the last semester working with children who have autism.  During this time, I heard the term "sensory issue" a bunch of times, but had no clue what it really meant.  Even after asking questions about it, I never felt like I really understood it.

I ended up learning the most about sensory integration issues at an unsuspecting event - at a writer's conference in NYC.  There, I so happen to have met Nancy Peske, the co-author of the book, Raising a Sensory Smart Child, and a mother of a child with the conceptually elusive sensory integration issue.  I figured she'd be the perfect person to ask about this stuff.

I ended up learning that some people are prone to either seek out intense stimulation or find even the most mild sensations aversive.  For instance, some children have an extremely high tolerance for what would cause most of us pain.  Conversely, the same child may find light tickling painful or aversive.  Although many people with autism have these types of sensory integration issues, we also see this in people who don't happen to have autism.

Relevant to my past research, we find that children who engage in self-injury are more likely to have a high pain tolerance and engage in repetitive behaviors.  While we previously thought that having a high pain tolerance was caused by repeated episodes of self-injury, I'm wondering if actually there is an underlying sensory integration issue here.  [In fact, we're finding that the traditional tolerance theory is not supported.]

On top of that, we have been conceptualizing repetitive behaviors as a precursor to self-injury; however, now I'm thinking that perhaps they both emerge out of the same sensory integration issue that may have been present from before / soon after birth.

And speaking of birth, in Deliberto & Nock, 2008, we report that in utero complications are seen more in children who engage in self-injury than in controls.  Like repetitive behaviors and in utero complications, these findings are also seen in people who have autism.  Although these data are correlational, the relationship among in utero complications and repetitive behaviors, self-injury, and autism is worth considering in my opinion.

In short, I'd bet that both self-injury and some of the underlying commonalities between this behavior and autism are sensory integration issues relating to touch.


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Why Do People Talk about Cutting Themselves?

I just received the following inquiry: I know some one thats very public about cutting themselves. Is this normal? And why do you think this is?

Here's my answer:

Good question. Although I cannot assume I understand this specific person, I can speak generally about the topic of openly discussing one's own self-injurious behavior.

My first inclination is that the person may be seeking what we call "social reinforcement." There are two types of social reinforcement - positive and negative.

What we call "positive social reinforcement" is what people not in the biz call "getting attention." This would come in the form of sympathy, interest, concern, or even people expressing shock. Particularly if a person feels disconnected / a lack of social support (and want these things), they may be prone to be seeking interaction with other people in this way.

So what we call "negative social reinforcement" does actually not mean punishment. In my experience, people in the public misuse the term "negative reinforcement" quite frequently. Negative reinforcement simply means to remove something aversive or to get out of a responsibility. For instance, an adolescent working on a boring group project might tell her peers that she's a "cutter" so they put less of a workload on her. In this example, if the teen gets out of doing something boring, she is negatively reinforced for telling people she cuts.

This brings us to an interesting point. It is my opinion - which is not shared among people with whom I've worked - that when people are socially reinforced (either negatively or positively) for telling people they self-injure, it isn't necessarily the cutting itself that is affected. What I think is more influenced is the actual disclosure of the behavior. This would mean that if someone is socially reinforced for telling people they cut, the actual act of cutting wouldn't necessarily increase, but the number of times self-injury is discussed would increase. To be crystal clear, I think that social reinforcement may shape the largely impulsive behavior of cutting itself, but not as strongly as the seemingly more deliberate act of discussing the behavior.

It is my opinion that people primarily engage in self-injury for emotion regulation purposes. In other words, to decrease their anxiety or to pull them out of a disoriented state (to learn more, I posted a link about this at the bottom of the page). It doesn't make sense to me that people engage in self-injury just so that they can receive attention for it later. My intuition tells me that the reinforcer of social approval is too far removed from that actual act of cutting to be incredibly potent. To my knowledge though, no research has been conducted to support this. In fact, self-report studies show that people report thinking they engage in self-injury to gain approval, therefore, it is advisable to take this into consideration when considering the thoughts previously expressed.

Perhaps self-injury can start out so that one may gain approval (positive social reinforcement) or even get out of something (negative social reinforcement). It could also be the case that someone starts cutting just for the emotional effects, but then starts telling people about it. I just can't buy into the idea that the only reason someone would cut is for social reinforcement.

Anyhow! I digress. Back to your question. It could be the case that this person is trying to connect with people, shock them, or remove his/herself from responsibility. On the other hand, perhaps he/she is just trying to work through previous shame about the behavior and finds it liberating to talk about it. I really don't know. But these are my best guesses!

Speaking to your question regarding whether or not it is normal: based on no data but my experience, about half of people who cut themselves report telling other people, while the other half don't tell anyone but maybe a mental health professional. While I'm not sure how normative it is for people to talk at length about their self-injury, I have some thoughts about this.

We can't make assumptions that talking about engaging in self-injury is necessarily a maladaptive / bad thing. For instance, perhaps the person will end up getting into the right treatment and get support for stopping the behavior. And as previously mentioned, perhaps the person used to feel much shame about the behavior and is working through it by speaking about cutting. Who knows?

On the other hand, one could make the case that if the person is socially reinforced for disclosing that he/she self-injures, the behavior could be maintained. I'm just not sure exactly why this person may be openly discussing engaging in self-injury.

As you can imagine, it is quite complicated!

Great question though. I've never been asked this.

To read more check this out: http://taradeliberto.blogspot.com/2011/02/why-do-people-cut-themselves.html

For Subscribers

For subscribers, I ended up changing the post about the evolutionary reasons we obsessively check Facebook quite a bit. Check it out here:
http://taradeliberto.blogspot.com/2012/04/keep-them-coming-back-for-more_22.html

The Evolutionary Reason We Obsessively Check Facebook

Today's topic is how we're evolutionarily programmed to obsessively check Facebook.

Let's just say that you log on to Facebook and get a good laugh out of a friend's status. You log on a few more times that day, but nothing is interesting. But of course, before going to bed, you log back on one more time just in case. And lucky you - you get another late night chuckle.

First, in this little story, the funny statuses play the role of the reinforcer. Second, the fact that you never know when someone is going to write something clever makes the reinforcer intermittent - or, in other words, random. Put them together and what do you get? A little term us psychologists call intermittent reinforcement.

So the interesting thing is this: when we are intermittently reinforced, we tend to display obsessive behavior (e.g. gambling). Following the rule that intermittent reinforcement leads to obsessive behavior, in this example, never knowing when you're going to read something funny partially explains why we tend to check Facebook all the time as a species. [We also find humor, human interaction, and gossip particularly rewarding.]

So what may the evolutionary advantages to intermittent reinforcement be? Well, I'm not sure if there are too many evolutionary advantages to obsessively checking Facebook, but there certainly are for the underlying mechanism.

Specifically, I was thinking that animals may have evolved to become sensitive to intermittent reinforcement because if we become more persistent in the face of scarce reinforcement / resources, we may increase our chances of success.

Let's consider the definition of perseverance: steady persistence in a course of action, a purpose, a state, etc., especially in spite of difficulties, obstacles, or discouragement.

In that definition, if "difficulties, obstacles, and discouragement" is conceptualized as a lack of reinforcement, then "persistence in a course of action" can be viewed as the somewhat obsessive behavior seen when intermittent reinforcement is given.

While perseverance (with a positive connotation) is readily associated with success, before today, I never considered perseverance as the behavioral result of an environment that is intermittently reinforcing. I'm guessing that will power comes into play too... but honestly, who really knows?

Now, while being sensitive to intermittent reinforcement may be helpful for us to persevere when times are tough, this tendency likely shaped by evolution won't serve us well in every scenario.

There is definitely a darker side to all of this. For instance, if you're more sensitive to intermittent reinforcement, you might be more inclined to stay in a roller coaster relationship, become a compulsive gambler or get engrossed with more trivial matters to increase your mood (e.g. check Facebook more times than you'd like to admit).

We typically think about engaging in these types of activities as a means to avoid feeling negative emotions like boredom, sadness, etc. It may certainly be the case that we engage in behaviors like obsessively checking Facebook to both avoid life and gain pleasure. At the same time, the obsessive nature of Facebook checking may be attributed to the underlying process may be one of intermittent reinforcement.

On a related note, rather than viewing psychopathology in terms of reward sensitivity, I wonder if sensitivity to specific types of reinforcement (or "schedules" as we call them) matters. Namely, sensitivity to intermittent reinforcement may be at the root. Food for thought.

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[And some food for later thought: perhaps this whole idea of valuing one's own naturally persevering nature somehow relates to asceticism. Together they combine to a pretty intense personality that is sensitive to reward.]

Teaching a Little Guy to Recognize Emotion

Here on this rainy lazy Sunday in NYC, I was drinking my usual morning green tea and thinking about the cases I've seen of alexithymia - or the inability to recognize emotions - in children.  What do we do about alexithymia?  Well, definitely the usual stuff like playing games like emotion charades where we have to guess what emotions / feelings we're acting out, practice problems solving / acting out solutions to various conflicts, etc.  But what else?

Here's a made up case to illustrate my thoughts:

Let's say that I'd been treating a 8 year old boy with alexithymia with the usual techniques until one day his mother asked to talk to me womano-a-womano.  She says that he doesn't understand important feelings she has about a specific family situation and takes the opportunity to tell me about her emotions.  So I go into session and directly discuss what mom might be feeling in these tough family scenarios.  The boy is surprised to learn how she might be feeling and feels a bit badly about his behavior.  Then we discuss what he can do differently in the future that takes his mothers emotions into consideration.  During the next week's session, mother reports that the boy was appropriately attentive to her from the moment they left therapy and throughout the entire week.

Now, even though our hypothetical session - that is a hybrid of multiple sessions with various patients - apparently produced the most effective behavior change outside of session, it was probably the most (mildly) aversive session we ever had.  Compared to past sessions where I have been teaching through games, this was no walk in the park.

During a game like emotional charades, the emotions remain impressionistic by nature. So where do we go from there? Sure this may be a good starting point and we also spend some time discussing issues that are upsetting outside of the session, but what about evoking real emotion in session?

By discussing the feelings that his mom might have, a little light bulb went off in his head.  He first reported feeling sad, but after some pressing, he also reported feeling a little bit guilty about his lack of attentiveness to his mother. After all, we are talking about a very kind child, here.

Notably, those emotions of sadness and guilt were freshly created as a direct result of newly learned content in the session. These emotions were not re-conjured from past events outside of session, nor impressionistic. Something to think about.

Because this session was mildly aversive though, my concern for next week was that he would not want to come back. After all, in his mind, we typically just play games. (Sure, these techniques can produce some change, but it is my opinion that they remain surface.)

Flying in the face of my nagging worry, this little guy was actually quite eager to return to session the following week. I suppose that I'll never be sure as to why. We can only speculate that perhaps it was because of a long standing therapeutic rapport and a learning history that coming to therapy is fun. A second option is that he did not experience the sadness and guilt intensely enough for it to deter him longer term.

But what about the results of Walter Mischel's studies?  We know some children can appreciate something more aversive & meaningful in the long-term, but not a barrel of laughs in the short term. 

Maybe this little guy appreciated learning something new and subsequently having his environment change.  After all, mom did say things were much better at home following that session.

Who knows?

To summarize, there are three ways of dealing with emotion in session:
1) evoking then processing new emotion in session as a result of new information / insight
2) rehashing previously felt emotion
3) creating impressionistic expressions of emotions

Maybe #1 is preferable.  Something to think about.

That "Gut Feeling" is Actually in Your Gut

I'm spending this particularly sunny Saturday in Manhattan doing some literature reviews near an open window overlooking people eating at an outdoor cafe`on 3rd avenue. Unbeknownst to them, I've been watching and wondering about the connection between the food they're eating, their bellies, and their brains. I know I shouldn't get derailed from finishing my work, but I couldn't resist writing this post.

I just came across a review paper called "Gut feelings: the emerging biology of gut-brain communication." Cool stuff. Apparently, there has been talk since about 1850 of a nervous system I've never heard of before: the enteric nervous system (ENS). Technically, it is considered the 3rd branch of the autonomic nervous system, which I'm certainly familiar with, but still! The ENS seems a bit too important for me to have been enveloped in the field seven years before learning about it. It could just be me... but I'm guessing the folks in psychology are not all that knowledgeable of the ENS.

That being said: the ENS, - or the interaction system between the brain and the gut - is referred to as the 'second brain' because it is similar in complexity to the one we have in our heads. It turns out that the second brain may have a pretty big impact on emotions, motivation, and [get this] intuitive decision making. In other words, the gut is quite literally involved in making gut decisions.

Who would've thought? Actually, the guy who coined the phrase "gut feeling" may have.

Consider the fun little notion that maybe we have been able to identify that intuitive decision making comes from the gut all along, without ever having scientific evidence. I love the idea that purely being mindful of your own physiological sensations can be an accurate source of information. How incredible.

Another interesting piece of knowledge this article has to offer is this: disruption of the ENS is associated with inflammatory gastrointestinal disorders, obesity, and eating disorders. To me, this certainly makes a lot of sense!

Specifically relating to over-eating, the paper proposes that the underlying biological mechanism is the mismatch between the big expected reward from eating food, and the relatively small actual reward experienced. The idea is basically that people keep thinking they are going to really enjoy food, are left unsatisfied, and keep coming back for more. While this may certainly be a big part of the picture, I have some other ideas about this... Something to think about for later.

Reference:
Mayer, E. (2011). Gut feelings: the emerging biology of gut-brain communication. Nature Reviews, 12, 453-466.

But The Job Market is Tough

Without structure, money, or the feeling of efficacy that comes with working, unemployed people can understandably slip into a depression.

But what do you do when someone tells you that they just can't get a job because of the job market? One option is to ignore this and try to convince the person that it will all be fine, but my guess is that you might not win yourself a fan. When people validly point out that the job market stinks, it 100% must be acknowledged. We are in hard times here.

But here's the catch: clients sometimes say "but the job market is tough" almost as a reason not to submit applications. There is a "what's the point?" feel to it, which is definitely a signature sentiment of depression.

If the person leaves the session just feeling validated in thinking the job market is tough, they'll probably end up feeling temporary relief after having vented, do nothing to better their situation, and end up more depressed. Be careful not to let "but the job market is tough" become an excuse.

So what is a good alternative mindset?

If the job marketis tough, you need to put that much more effort into applying than you would otherwise, not less.

If you're old, changing fields, have been unemployed for a while, or whatever the case may be, you must try even harder. Accepting that it is going to be tough and moving forward despite rejection seems to be the most functional way to go.

It is a time to go all in.

Best Social Phobia CBT Book

This is a great self-help book for anxiety!

Therapy and Eastern Religion

As I mentioned in the post, Near Death Euphoria and the Link to Suicide, I love www.Reddit.com. On this site, a member asked me about the connection between CBT and Eastern Religions. This was my response:

So, there have been three "waves" of CBT. The first was behavior therapy, the second was cognitive behavior therapy, and the third is mindfulness/meditation related.

The Third Wave CBT approaches are very tied into Eastern religion. The names of the most well known Third Wave approaches are Acceptance and Commitment Therapy (ACT; pronounced "act"), Compassion Focused Therapy, and DBT (which I mention elsewhere on this blog). I am a huge fan of Third Wave approaches.

The cognitive Second Wave approaches work on correcting "irrational" beliefs (e.g. I am a worthless person). For instance, we might examine the evidence for and against the argument that you're worthless. As it turns out, once you think about it, maybe you're not really all that worthless.

But the Eastern-influenced Third Wave CBT treatments emphatically do not aim to correct irrational beliefs!

Third Wave approaches mainly focus on noticing thoughts like "I'm worthless" and trying to change one's relationship to the thought, but not the content of the thought itself.
For instance, a Third Wave approach might simply focus on the fact that "I'm worthless" is coming into the mind and that it isn't a particularly useful thought to attend to. The treatment would aim to pull the person out of their head and into contact with the present. So instead of attending to the thought "I am worthless," a person may be encouraged to shift the attention to the breath, for example.

Third Wave approaches offer a lot more than just this, and are very rich approaches, but I think this represents the general idea.

If you're interested in learning more, I highly suggest reading The Compassionate Mind and The Compassionate Mind Approach to Overcoming Anxiety.

For more posts, check out The Psychology Easel and follow me on Twitter at @TaraDeliberto.

"Suicide is Selfish"

I often hear people say things like "suicide is the most selfish thing you can do" and "suicidal people must not care about their families at all."

Well, I just don't think that is the case.

First of all, many do not have families who are particularly supportive, which may be part of the problem in the first place. In fact, many times people who attempt suicide are surrounded by people who are extremely abusive. Especially if the person is a teenager or has limited resources, they may see no way out.

And even if people who have attempted suicide do have people in their lives that are supportive, the person may be truly in so much psychological pain - e.g. they may be bombarded with flashbacks of a very traumatic event or paralyzed by depression - that it might be nearly impossible to take into consideration the perspective of a loved one.

On top of this, some people may feel so worthless that they think ending their lives will actually be doing their loved ones a favor. What's even more upsetting is that in some situations, the person's perception may be accurate - it isn't always, but it could be.  Stigma against people with mental health is strong and I'm sure some family members might consider a person with mental health issues to be a burden.  Of course, this isn't always the case, but it's certainly a possibility.

Please note that whether or not a person's family actually does believe them to be a burden has no bearing on whether or not a person should kill themselves.  Clearly this question is out of the depth of this blog post.  In this post I am merely illustrating reasons why it is myopic to negatively judge people who have suicidal thoughts.  I've heard stories so horrific, it seems incredible that a person could have any will to live at all.  It is not a therapist's job to judge whether or not a person should kill themselves.  It is our job, however, to do everything possible to teach skills that can make life more bearable.

My advice is simply this: don't be so quick to judge.

Eating Disorder Statistics

Just came across this great resource for eating disorders. Please check out the website for the National Association for Anorexia and Associated Disorders, Inc.

Near Death Euphoria and the Link to Suicide

I was asked by a friend if I ever came across someone who attempted suicide not to escape suffering, but because they knew it would feel good.  Although not suicidal, the person asking the question was curious because he had experienced a near-death situation in which he was injured and felt euphoria.

I thought this was a really thought-provoking question. The link between near-death euphoria and suicide never crossed my mind before.

This was my response:

I have heard of people recounting similar types of experiences, but I had never considered the link between near-death euphoria and the intention to commit suicide.

A brief discussion of Thomas Joiner's theory of suicide is in order. The basic gist is that people may build a tolerance for the negative feelings associated with hurting / killing themselves by engaging in self-injurious or thrill seeking activities. While it is not necessarily intentional, the negative feelings about death may lessen over time.

Let's just say a person regularly sky dives. Then, for whatever reason, they become suicidal. If you're already used to jumping out of planes, the idea is maybe you won't be that scared to jump off of a bridge.

There is another relevant example to this discussion as well. Namely, if a person regularly cuts themselves (without intent to die) when they're upset, they may not be scared to make life-threatening incisions when suicidal urges come up.

While I formerly thought of this concept as similar to "building up the courage" to attempt suicide via repeated episodes of cutting / dare-devil behavior, this question has me thinking differently. Perhaps there is an additional component here that is consistent with Joiner's theory.

When people cut their skin with no intent to die, it is thought that endorphins are released. This would create reduction in the negative feelings that may prompt self-injury, like shame, anxiety, sadness, etc. Perhaps people also feel mild euphoria, or positive feelings, from the endorphins. This might suggest that for some, self-injury has at least two psychological functions - reducing negative feelings and increasing positive feelings - perhaps produced by the same biological mechanism (i.e. endorphin release).

In any event, a link between injuring oneself and feeling good is formed. Maybe this association generalizes to suicide in the sense that injuring yourself is linked with feeling good.

Now, getting more to the point of suicide, endorphins are not only relesaed during self-injury, but during a traumatic / near-death event as well. This is very interesting to me because a link can be formed between feeling good and death, specifically. In the sky diving example used above, an association is formed between feeling good and jumping from a height, but not necessarily death. In the case of a traumatic event, the link is formed between feeling good and specifically being near-death.

While people may not report chasing the feeling of euphoria that comes with being close to death, if they've experienced it, the drive for this positive feeling could theoretically propel future suicidal behavior. Whether or not the person is aware that they are driven to suicide because of past feelings of euphoria when close to death, it could be a biological function maintaining the behavior.

In short, while I had formerly thought of suicide as a behavior maintained by the function of wanting to escape pain, this point raises the question of whether or not people want to commit suicide to actually feel better. Again, while I don't think people would necessarily report wanting to die to feel that euphoria, it could influence their suicidal drive and behavior.

[For people familiar with psychology lingo on this blog, the function may not necessarily just be automatic negative reinforcement, but automatic positive reinforcement as well.]

Truly, a fascinating point. Thank you so much for asking.

For more posts, check out The Psychology Easel and follow me on Twitter at @TaraDeliberto.

CBT Resources

New Harbinger Publications has a wonderful resource for people with a variety of concerns including, but not limited to, bulimia, anorexia, panic, ADHD, sexual disorders, etc. It discusses each problem and what the most effective treatment for the consumer is. Click here.

I absolutely love this. Easy-to-read consumer resources describing the most effective treatments out there are few and far between. I hope you find this helpful! If you have any questions, please let me know.

The Dissertation Meter

My dissertation is currently at 84 pages. And that is just the introduction!

Really excited about my topic - the psychology of dieting. I can't wait to blog about the results in about a year from now. Only 250 pages of writing left!

Is There Anything to be Learned from Freud's Oedipal Complex?

Ever wonder if what happened between Oedpius and his mother could happen in real life? Well, apparently it can. And there is a name for it: genetic sexual attraction.

Genetic sexual attraction occurs when genetic relatives meet for the first time in adulthood and an attraction develops. Although it is a rare occurrence, there has been an increase in the number of reported cases in recent years, typically as a consequence of adoption (according to Wikipedia).

I'm no fan of Freud, but it kind of makes me think.

It should definitely be noted though, that for the vast majority of people, it is thought that living in close domestic proximity as children become desensitized to later attraction. This hypothesized phenomenon is known as the Westermark effect. It only pertains to children being raised together, and does not take into consideration whether or not they are genetically related.

I'm not so much wondering about whether or not there is unconscious attraction between members of domestically-cohesive family units in the way Freud talked about it, but how the concepts of both genetic sexual attraction and the Westermarck effect can relate to normative relationships.

Sure, there have been documented accounts of attraction in types of incestuous relationships, but this certainly isn't the norm. Nor do I think this is due to under-reporting! And no, I'm not so sure that a lack of awareness of unconscious motivations is the reason either.

I think it might go something like this:

The Westermarck effect occurs for most people, but there might be a genetic reason why it doesn't kick in for some. I'm guessing this might be the case for the people in a documentary I watched - two genetic siblings who were raised together, eventually developed a relationship and started a family. [What was your physiological reaction to that little story? That's your Westermarck effect in action.]

So while there are probably genetic components coming into play when we see a lack of Westermarck effect, I'm guessing there might be some environmental components at work as well. I'll spare you the details of my thoughts about this, though! Suffices to say that there is usually a mix of genetics and environment resulting in any behavior - normative or not. [Basically, I'm guessing certain conditions can prompt this behavior. I also think that a lack of development of the Westermarck effect could be observed in people who are attracted to people in roles similar to that of a parent (e.g. the classic example of women without a father figure dating a much older man).]

Ok, so while the Westermarck effect (and any generalization about attraction to people in parental roles) may be the norm, what about the genetic sexual attraction sometimes seen in some people who are adopted?

Well, despite the popular cliche` that opposites attract, I'm not so sure. I've certainly come across research saying that people tend to pair off who are similar across many different areas. As you've probably experienced, bonding can occur when you have similar thoughts to someone else. Sure it would be boring if you were exactly the same, but I'm guessing you're probably more similar to the people you're close with than different.

Basically, if you're genetically similar to someone that you meet in adulthood, you could actually be very similar to them, being that genetics play such an important role in personality formation. An account from an adopted woman about her eventual relationship with her genetic father, described a close bond forming because she was more similar to him than anyone she had ever met.

In short, I don't think that we all have suppressed genetic sexual attraction - probably due to the Westermarck effect developing (and most of the time generalizing to people in similar roles). I'd imagine that people are simply attracted to people who directly or indirectly validate them because of similar attitudes.

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As a side note: the problem of marriages or relationships going stale because more of a sibling relationship can develop, may be an interesting generalization of the Westermarck effect. I wonder if some have a stronger inclination for this effect (perhaps couples with a lack of sex drive). It may also have something to do with early development. Different types of effects could theoretically occur (e.g. quick forming attraction and then the Westermarck effect kicking in). Who knows? Something to think about.

Stop Complimenting Me on How I Look

P.S. Here's another observation: extreme discomfort with compliments over time in people with eating disorders. Eventually, it just doesn't feel good to get those addictive compliments any more. Maybe this is a sign of improvement?

I think a recognition that this whole game is dangerous and shallow might precede this phenomenon. At the beginning of a drug addiction, people might think that it is all fun and games. Eventually, they can reach a point of developing an aversion, after all of the consequences come to fruition. I think it is the same for eating disorders.

The drug is achieving incremental goals of deprivation and social approval. In cases I've seen, it appears that the aversion to social approval piece comes first, followed by a disregard for monitoring food intake - but only in people who have truly recovered.

Eating Disorders - Are They Really about Control?

by Tara Deliberto

The concept that eating disorders are all about control never sat well with me.  Specifically, the explanation that people with eating disorders "can't control anything in their lives, so they control food," seems a bit too... poetic.  I understand the general idea, but it seems only to hit the target. I prefer the bull's eye.

Rather than simply increasing control, they way I perceive it, eating disorders seems to be more about the asceticism component. For those unfamiliar with this term, asceticism is the practice of depriving oneself of worldly pleasures. As it applies here, asceticism would involve depriving oneself of things that taste good. While it may not sound like fun, there is definitely a rush that comes along with achieving a goal in line with your values.

If your value is looking good by societal standards (i.e being thin), then you'll feel good about taking that self-depriving step towards trying to lose a bit more weight - e.g. passing on dessert. There is definitely some psychological reward from having this Spartan mentality. On top of this, if you value achievement and hard work, it seems you'll certainly at an increased risk of deriving a lot of pleasure from controlling food intake.

Ok, so we have identified two fundamental components so far:
1. valuing looking good by societal standards (i.e. thinness)
2. putting in lots of effort to achieve a goal

So, moving on!  If you have these values coupled with an environment that is chaotic and/or not rewarding, I'd imagine you'd be really looking for a way to feel good somehow. Because it might be difficult to feel good with a dearth of positive things in your life, you might start to adapt. Maybe you'll start getting your kicks from deprivation rather than your run-of-the-mill pleasures.

Perhaps you decide you want to start looking good because then you'd be happy. Why not try to lose some weight. Ok, so you limit your food. It sure feels good to be in control and achieve a goal.

Fast forward a few weeks. You lose some weight. People start to notice. "Wow, you look great!" Man, those compliments feel good. [And not only that, maybe all those self-esteem killing negative comments about your appearance disappeared too.]

Wham! Eating disorder.

I'd imagine there is a cycle where psychological reinforcement from depriving oneself and looking good feed off each other. The more you deprive yourself, the more compliments you get etc. Over time, depriving oneself is just linked with feeling good. Especially if that is the primary way you can feel positive, I'd imagine this whole deprivation/compliment reinforcement cycle mess is quite addicting. People look to score small amounts of pleasure by depriving themselves, while chasing the big goal of all those compliments and social approval.

While I'd love to speculate more, I have a research proposal to write tonight!

So, to wrap up: it doesn't seem to suffice to say that eating disorders are about "control."  There are certainly other areas to be addressed in treatment, but areas to be targeted rather than simply "control," might be:
1. Valuing what society deems as attractive
2. Valuing extremely perfectionistic work towards achieving goals in line w/ the above value
3. Getting high off of asceticism
4. Getting high off of compliments
5. Potentially not receiving reinforcement and/or deriving pleasure from other areas

In short, this notion that people can't control anything in their environment so they control food, is too poetic for my taste!

Ok, back to writing my research proposal on disordered eating! That's all for today.

For more posts from The Psychology Easel, visit the homepage.


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P.S. Note to self: Return at a later date to examine which of the components listed above are:
1. necessary-but-not-sufficient
2. necessary-but-can-be-sufficient
3. not-necessary-nor-sufficient-but-can-pop-up.

Quickly, it appears that valuing what society/someone in particular deems attractive is necessary-but-not-sufficient due to the sharp increase in eating disorders as societal ideals changed. Unless, of course, the disorder developed primarily to look unattractive & functions to protect the person from maturity/ sexual abuse. The second component is probably necessary-but-not-sufficient only in anorexia nervosa - where people end up drastically committing to deprivation. With bulimia nervosa / EDNOS, it could exist, but vacillate, or be complicated by a compulsive nature etc.