THE JOYFUL REDUCTION OF UNCERTAINTY

Del Giudice On The Self-Starvation Cycle

[Content note: eating disorders]

Anorexia has a cultural component. I’m usually reluctant to assume anything is cultural – every mediocre social scientist’s first instinct is always to come up with a cultural explanation which is simple, seductive, flattering to all our existing prejudices, and wrong. But after seeing enough ballerinas and cheerleaders who became anorexic after pressure to lose weight for the big competition, even I have to throw up my hands and admit anorexia has a cultural component.

But nobody ever tells you the sequel. That ballerina who’s losing weight for the big competition at age 16? At age 26, she’s long since quit ballet, worried it would exacerbate her anorexia. She’s been in therapy for ten years; for eight of them she’s admitted she has a problem, that her anorexia is destroying her life. Her romantic partners – the ones she was trying to get thin to impress – have long since left her because she looks skeletal and weird. She understands this and would do anything to cure her anorexia and be a normal weight again. But she finds she isn’t hungry. She hasn’t eaten in two days and she isn’t hungry. In fact, the thought of food sickens her. She goes to increasingly expert therapists and dieticians, asking them to help her eat more. They recommend all the usual indulgences: ice cream, french fries, cookies. She tries all of them and finds them inexplicably disgusting. Sometimes with a prodigious effort of will she will manage to finish one cookie, and congratulate herself, but the next day she finds the task of eating dessert as daunting as ever. Finally, after many years of hard work, she is scraping the bottom end of normal weight by keeping to a diet so regimented it would make a Prussian general blush.

And nobody ever tells you about all the people who weren’t ballerinas. The young man who stops eating because it gives him a thrill of virtue and superiority to be able to demonstrate such willpower. The young woman who stops eating in order to show her family how much their neglect hurts her. If they pursue their lack of appetite far enough, they end up the same way as the ballerina – admitting they have a problem, admitting they need to eat more, hiring all sorts of doctors and dieticians to find them a way to eat more, but discovering themselves incapable of doing so.

And this is why I can’t subscribe to a purely cultural narrative of anorexia. How does “ballerinas are told they should be thin in order to be pretty” explain so many former ballerinas who want to gain weight but can’t? And how does it explain the weird, almost neurological stuff like how anorexic people will mis-estimate their ability to fit through doors?

All of this makes much more sense in a biological context; it’s as if the same system that is broken in obese people who cannot lose weight no matter how hard they try, is broken in anorexics who cannot gain weight no matter how hard they try. There are plenty of biological models for what this might mean. But then the question becomes: how do we reconcile the obviously cultural part where it disproportionately happens to ballerinas, to the probably biological part where the hypothalamus changes its weight set point?

I’m grateful to Professor del Giudice and Evolutionary Psychopathologyfor presenting the only reasonable discussion of this I have heard, which I quote here basically in its entirety:

The self-starvation cycle arises in predisposed individuals following an initial phase of food restriction and weight loss. Food restriction may be initially prompted by a variety of motives, from weight concerns and a desire for thinness to health-related or religious ideas (eg spiritual purity, ascetic self-denial). In fact, the cycle may even be started by involuntary weight loss due to physical illness. While fasting and exercise are initially aversive, they gradually become rewarding – even addictive – as the starvation response kicks in. At the same time, restricting behaviors that used to be deliberate become increasingly automatic, habitual, and difficult to interrupt (Dwyer et al, 2001; Guarda et al, 2015; Lock & Kirz, 2013; McGuire & Troisi 1998). The self-starvation cycle plays a crucial role in the onset of anorexia.

Increased physical activity is a key component of the starvation response in many animal species; in general, its function is to prompt exploration and extend the foraging range when food is scarce. This response is so ingrained that animals subjected to food restriction in conditions that allow physical activity often starve themselves to death through strenuous exercise (Fessler, 2002; Guarda et al, 2015; Scheurink et al, 2010). In humans, pride is a powerful additional rewrad of self-starvation – achieving extraordinary levels of thinness and self-control makes many anorexic patients feel special and superior (Allan & Goss, 2012). The starvation response also brings about some psychological changes that further contribute to reinforce the cycle. In particular, starvation dramatically interferes with executive flexibility/shifting, and patterns of behavior become increasingly rigid and inflexible. The balance between local and global processing is also shifted toward local details. This may contribute to common body image distortions in anorexia, as when patients focus obsessively on a specific body part (eg the neck or hips) but preceive themselves as globally overweight (Pender et al, 2014; Westwood et al; 2016).

The self-starvation cycle has been documented across time and cultures, including non-Western ones. In modern Western societies, concerns with fat and thinness are the main reason for weight loss and probably explain the moderate rise of AN incidence around the second half of the 20th century. However, cases of self-starvation with spiritual and religious motivations have been common in Europe at least since the Middle Ages (and include several Catholic saints, most famously St. Catherine of Siena). In some Asian cultures, digestive discomfort is often cited as the initial reason for restricting food intake, but the resulting syndrome has essentially the same symptoms as anorexia in Western countries (Bell, 1984; Brumberg, 1989; Culbert et al, 2015; Keel & Klump, 2003). The DSM-5 criteria for anorexia include fear of gaining weight as a diagnostic requirement; for this reason, most historical and non-Western cases would not be diagnosed as AN within the current system. However, the present emphasis on thinness is likely a contingent sociohistorical fact and does not seem to represent a necessary feature of the disorder. (Keel & Klump, 2003)

My anorexic patients sometimes complain of being forced into this mold. They’ll try to go to therapy for their inability to eat a reasonable amount of food, and their therapist will want to spend the whole time talking about their body image issues. When they complain they don’t really have body image issues, they’ll get accused of repressing it. Eventually they’ll just say “Yeah, whatever, I secretly wanted to be a ballerina” in order to make the therapist shut up and get to the part where maybe treatment happens.

The clear weak part of this theory is the explanation of the “self-starvation cycle”. Aside from a point about animals sometimes having increased activity to go explore for food, it all seems kind of tenuous.

And how come most people who starve never get anorexia? How come sailors who ran out of food halfway across the Pacific, barely made it to some tropical island, and gorged themselves on coconuts didn’t end up anorexic? Donner Party members? Concentration camp survivors? Is there something special about voluntary starvation? Some kind of messed-up learning process?

I am interpreting the point to be something along the lines of “Suppose for some people with some unknown pre-existing vulnerability, starving themselves voluntarily now flips some biological switch which makes them starve themselves involuntarily later”.

Framed like this, it sounds more like a description of anorexia than a theory about it (though see here for an attempt to flesh this out). But it’s a description which captures part of the disease that a lot of other models don’t, and which brings some things into clearer relief, and I am grateful to have it.

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221 Responses to Del Giudice On The Self-Starvation Cycle

  1. LadyJane says:

    I’m usually reluctant to assume anything is cultural – every mediocre social scientist’s first instinct is always to come up with a cultural explanation which is simple, seductive, flattering to all our existing prejudices, and wrong.

    Aside from things like sexual orientation, and mental illnesses with a clear biological basis, I’d say that the majority of personality traits and behavioral traits are a result of social (i.e. cultural and/or interpersonal) environment. I don’t think biological factors have all that much impact on how people’s personalities develop, except in really obvious ways like “too little food and too much exposure to lead as a child will affect your cognitive capacity for the worse.” I don’t doubt that intelligence has some biological component, but even then, I don’t think it’s purely biological in nature, and I think social factors can have a huge impact on things like IQ, and in determining the specific types of intelligence that people end up having aptitudes for.

    I find it likely that self-image disorders like anorexia are probably entirely socially-constructed, or close to it. That said, what we call anorexia might also describe several different conditions: Some could be related to neurologically-based conditions like body dysmorphia, some could be rooted in the self-starvation cycle mentioned here, and some could be caused by other factors, even if the majority of cases were purely a result of psychosocial self-esteem issues.

    • BlindKungFuMaster says:

      Well, science thinks otherwise.

      Shared environment effect on personality traits and IQ are basically zero after adolescence.

        • LadyJane says:

          That article claims that parenting has virtually no effect on life outcomes, which seems a little ridiculous to me. If a child grows up abused and neglected, and learns from a young age that people are emotionally volatile, unreliable, and untrustworthy, that’s going to strongly affect her disposition and her approach to social interaction. The fact that PTSD exists and has a major effect on people’s actions and demeanor is pretty strong evidence of the fact that social environment can have drastic effects on people’s behavior. You don’t even have to use examples that are so extreme. If a child’s parents continually pressure her to go into a specific field like medicine or finance or law, and that child grows up to be a successful doctor/businessman/lawyer, that seems like a pretty good indicator that they affected her life. If the same child had been raised by parents who told her that she shouldn’t worry about her career and working a minimum wage job was fine, it’s doubtful she would’ve had the same level of success.

          Of course, there is technically a very broad sense in which all human behaviors could be said to be 100% heritable, since they’re all based on neurological hardware that was formed according to a genetic blueprint, but that’s a very different meaning of the term than “this person would behave almost exactly the same way if they were raised in a totally different social environment.” This article seems to be pulling a motte-and-bailey trick by conflating the two.

          • Fluffy Buffalo says:

            The discussions of heritability of personality and the influence of parenting usually come with a disclaimer “we’re talking about variations in regular parenting here, not catastrophic abuse, which has obvious, well-documented negative consequences”.

            This discussion has been around for something like two decades – Judith Rich Harris’ “The Nurture Assumption” came out in 1998. You might want to have a look at it before you insist that it’s ridiculous. (Its basic claim may indeed sound ridiculous when you first hear it because it goes against commonly held attitudes, but it’s supported by solid evidence, and I don’t think it has been debunked in any meaningful way.)

          • BlindKungFuMaster says:

            There are precise definitions and empirical results for heritability and the influence of environment on life outcomes. These don’t leave much room for motte-and-bailey or other forms of dissembling.

            Of course you can come up with extreme scenarios where environment is key, but if you average over a big sample of the population in developed countries, it just doesn’t play a role.

          • moscanarius says:

            The fact that PTSD exists and has a major effect on people’s actions and demeanor is pretty strong evidence of the fact that social environment can have drastic effects on people’s behavior.

            Ah, but even things like PTSD may have a genetic component about them. Not every person who experiences the same kind of “trauma” manifests the illness. I’m not a specialist, but I know there has been discussion on this in the literature (see here, for example).

          • nadbor says:

            there is technically a very broad sense in which all human behaviors could be said to be 100% heritable, since they’re all based on neurological hardware that was formed according to a genetic blueprint

            Yes. But this is not what all those studies measuring heritability of this or that mean by ‘heritability’. Heritability is the fraction of the variance of a trait in a population that is explained by genes.

            this person would behave almost exactly the same way if they were raised in a totally different social environment.

            This is more like it but needs some caveats.

            Specifically:

            totally different social environment

            AFAIK every adoption study of heritability was done in a single (developed?) country in a limited window of time. Foster families are also a non-random subset of all families.

            There was no adoption study where one of the identical twins was raised in 1960s Denmark and the other in ancient Greece. Or in Ethiopia. Or in a hippy commune. Or in the royal family. If there were, the measured heritability would probably be lower and impact of shared environment higher.

            But this is a feature of adoption studies, not a bug. They tell us about the factors driving psychological differences between children raised in fairly normal families in a single country in a given period of time. They say nothing about what would happen if you were raised by aliens from Mars.

            would behave almost exactly the same way

            and

            child’s parents continually pressure her to go into a specific field like medicine or finance or law,

            Again AFAIK, adoption studies are mainly concerned with psychological traits, not choices or outcomes. Conscientiousness is a trait, becoming a doctor is an outcome. Your parents can theoretically influence your conscientiousness and thus indirectly your chances of becoming a doctor. Studies show that shared environment has negligible impact on conscientiousness, so that apparently doesn’t happen. But your parents have the *additional* option of telling you to go to med school and paying for it and (given that your genes made you conscientious enough) that just might tip the balance between you becoming a doctor or some other kind of professional.

            So it wouldn’t surprise me if many specific life outcomes showed lower heritability and higher shared environment impact than most psychological traits.

            But when it comes to psychological traits, the jury is in and
            1. they are all significantly heritable
            2. impact of families is smaller than that of genes
            3. there is a significant fraction of variance unexplained by either families or genes
            (Turkheimers laws of behavioural genetics).

            For example the Big 5 personality dimensions are 40-60% heritable with negligible shared environment component. IQ is even more extreme this way.

            You can look all of this up in the wikipedia “Behavioural genetics” and “Heritability of IQ” articles and their links.

          • Mary says:

            If a child grows up abused and neglected, and learns from a young age that people are emotionally volatile, unreliable, and untrustworthy, that’s going to strongly affect her disposition and her approach to social interaction.

            The problem with that theory is that child was born to people who are emotionally volatile, unreliable, and untrustworthy, and abuse and neglect children. That is, that is where her genetics come from too.

          • Kaj Sotala says:

            This discussion has been around for something like two decades – Judith Rich Harris’ “The Nurture Assumption” came out in 1998. You might want to have a look at it before you insist that it’s ridiculous. (Its basic claim may indeed sound ridiculous when you first hear it because it goes against commonly held attitudes, but it’s supported by solid evidence, and I don’t think it has been debunked in any meaningful way.)

            Haven’t dug into it, but I’ve heard claims that The Nurture Assumption cherry-picks its evidence, in e.g. this review:

            No one denies that there is some truth to her argument. Even her detractors like the way she’s blown the lid off dumb studies that can’t tell the difference between parents’ influencing their kids through genes and influencing them through actions. And they applaud her for pointing out that children of divorce are not necessarily ruined for life, notes psychologist Robert Emery of the University of Virginia. But many of the nation’s leading scholars of child development accuse Harris of screwy logic, of misunderstanding behavioral genetics and of ignoring studies that do not fit her thesis. Exhibit A: the work of Harvard’s Kagan. He has shown how different parenting styles can shape a timid, shy child who perceives the world as a threat. Kagan measured babies at 4 months and at school age. The fearful children whose parents (over)protected them were still timid. Those whose parents pushed them to try new things–“get into that sandbox and play with the other kids, dammit!”–lost their shyness. A genetic legacy of timidity was shaped by parental behavior, says Kagan, “and these kids became far less fearful.”

            “Intervention” studies–where a scientist gets a parent to act differently–also undercut Harris. “These show that if you change the behavior of the parents you change the behavior of the kids, with effects outside the home,” says John Gottman of the University of Washington. Programs that teach parents how to deal with little monsters produce effects that last for years. “When parents learn how to talk to and listen to kids with the worst aggression and behavior problems, and to deal with the kids’ emotions,” says Gottman, “the kid becomes less impulsive, less aggressive, and does better in school.” Maybe such effects aren’t picked up in the studies Harris cites because such motivated–dare we say saintly?–parents are so rare. Gottman studies children at the age of 4, and then at 8. Some have parents who learned to be good “emotion coaches.” They’re sensitive, they validate the child’s emotion (“I understand, sweetie”), they help her verbalize what she’s feeling, they patiently involve her in solving the problem (“What should we do?”). Other parents didn’t learn these tough skills. The 8-year-olds of emotionally adept parents can focus their attention better and relate better to other kids. “There is a very strong relationship between parenting style and the social competence of their children,” says Gottman. Since the parents learned to be emotion coaches, and the kids changed over the years, the result cannot be easily dismissed as genetic (emotionally intelligent parents pass on emotional-IQ genes).

            Critics also slam Harris’s interpretation of twins studies. From this research she concludes that “parents do not make siblings any more alike than their genes already made them… [P]arenting has no influence.” But some of the leaders in the field say their measurements cannot support that. “The sample sizes we use are so small that you can’t detect a 10 percent or even a 20 percent effect of the family environment,” says Dr. Kenneth Kendler of the Medical College of Virginia. And as Kagan points out, the vast majority of such studies rely on questionnaires to assess personality, recollections of childhood and descriptions of what goes on in the home. “Questionnaires are totally suspect,” Kagan says. “The correlation between reality and what people say is just 30 or 40 percent.” Such flaws could be why twins studies fail to detect an influence of parents on kids.

            Finally, some researchers take issue with Harris’s logic. This one is tricky, but crucial. Harris says studies of twins and siblings find no effect of “shared environment.” True. But even children who grow up with the same parents do not have an identical environment. The firstborn does not have the same “environment” as her baby brother: she has younger, less experienced parents, and no midget competitors. Also, parents treat children differently, as Harris admits: she monitored Elaine’s homework but not Nomi’s. Children, through their innate temperament, elicit different behaviors from their parents; thus they do not share this environment called “parents.” Parents, then, arguably belong in the category called “unshared environment”–which behavioral genetics suggests accounts for about half the differences among people. And besides, even what seems like an identical parenting style may be received differently by different children. One may conform, the other rebel. That does not mean that parents did not influence what their children became. It means that we are not smart enough to figure out how parents shape their child. Says psychologist Theodore Wachs of Purdue University, “The data do show that the same [parenting] does not have the same effect on kids. But that doesn’t mean there is no effect.”

            In person, Harris backs off a bit from her absolutist stance. “I do think there is something to the possibility that parents determine their child’s peer group, and children do learn things at home which they take to the peer group,” she told NEWSWEEK. She allows that children can retain many of the values and other lessons parents teach despite peer influences. “If the group doesn’t care about plans for the future, then the child can retain those ideas from home,” she says. “And if things like an interior life aren’t discussed by peers, then that wouldn’t be affected by the group either.” Might different children experience the same parenting differently, and be influenced by it? Harris pauses a few seconds. “I can’t eliminate that as a possibility,” she says.

          • L. says:

            @Kaj Sotala

            I am of limited scientific literacy (also know as “scientifically illiterate”) and can’t find the studies they’re referring there, but depending on the quality of the studies, wouldn’t the argument in the first paragraph be vulnerable to argument that the same fearful genes that made timid children, also made fearful, overprotective parents?
            Similarly, wouldn’t the argument in the second paragraph be vulnerable to the argument that the genes responsible for emotional competency were what drove both the adoption of emotionally sensitive parenting by the parents and the social competence of the children?

          • @Kaj Sotala:

            Gottman studies children at the age of 4, and then at 8.

            Judith Harris’s claim is that the family environment has little effect on the adult personality, hence that particular study is irrelevant to its truth. The same seems to be true of a number of the other ones your quote lists.

            Which I think illustrates the danger of rejecting an argument on the basis of reading a critique without having read the original. You have no way of knowing if the critique is honest, competent, relevant.

      • INH5 says:

        And yet adult IQ scores have risen by ~3 points per decade as far back as they’ve been measured (in the US, at least up until 2014), a rate far too fast to be due to genetic factors. Any possible environmental factor(s) would clearly vary between households at any given time, so why doesn’t this show up as a shared environment effect? I have brought this up many times before here and on the subreddit, and no one has yet been able to give me an explanation reconciling this with the results of twin studies that is even remotely plausible, so I continue to default to “there’s just something wrong with twin studies.”

        • Randy M says:

          While possibly insightful, that’s not enough to discount a strong genetic impact on intelligence and personality.

        • baconbits9 says:

          Why is this a rate to fast to be due to genetic factors?

        • Anon. says:

          The Flynn effect is not on g, in other words it’s an increase in test scores without a corresponding increase in general intelligence. It’s also uniform across the distribution, and thus probably not that relevant to cross-sectional variation.

          • INH5 says:

            Neither of these points seem very relevant.

            What’s at question is the validity of twin studies, so whether the Flynn Effect is “real” or “on g,” or whatever does not matter at all. The only thing that matters is whether the Flynn effect exists on IQ tests that are used in twin studies, which as far as I am aware it does.

            As for the rate of increase not correlating significantly with position on the IQ distribution: so what? This doesn’t change the fact that it seems preposterous on its face for any kind of environmental factor that changes dramatically over the course of a few decades to be uniform across all American households at any given time. Certainly none of the commonly proposed explanations of the Flynn Effect work like that.

          • Anon. says:

            Certainly none of the commonly proposed explanations of the Flynn Effect work like that.

            More education, test experience, technology, and “social multiplier” effects are the most common explanations and they all work more or less like that.

          • INH5 says:

            I don’t know what you mean by “social multiplier,” but everything else that you listed clearly doesn’t work like that. Some households have access to more or better education than others. Some households have more test experience, because the children go to schools that do more tests or test training, or the parents use test prep services, or whatever. Technology clearly differs greatly between households, because richer and/or more urban households get the new stuff first, while lower-income and/or more rural households get hand-me-downs from previous tech generations at thrift stores and the like.

          • Nancy Lebovitz says:

            “The Flynn effect is not on g, in other words it’s an increase in test scores without a corresponding increase in general intelligence”

            I thought the big deal about IQ is that it has a strong correlation with g.

          • BlindKungFuMaster says:

            Technology clearly differs greatly between households, because richer and/or more urban households get the new stuff first, while lower-income and/or more rural households get hand-me-downs from previous tech generations at thrift stores and the like.

            If you look at some technology adoption curves in the last 50 years, the bulk (like from 0 to 90%) of the adoption happened usually in less than ten years, which severely limits in-generation variation.

          • INH5 says:

            If you look at some technology adoption curves in the last 50 years, the bulk (like from 0 to 90%) of the adoption happened usually in less than ten years, which severely limits in-generation variation.

            The World Wide Web became open to the general public in 1991. It took until 2012 for more than 80% of US adults to use the internet. The first commercially available handheld cell phone came on the market in 1983. Cell phone ownership rates among US adults didn’t pass the 80% mark until 2008. The first commercially available smartphone…well, it ultimately depends on how you define “smartphone,” but devices that would fit many definitions came on the market as early as 1994. Among US adults, smartphone ownership is about 77% right now. The VHS VCR first came on the market in 1977. Household ownership rates didn’t pass 80% until the late ’90s. Cable TV developed into a form that we would recognize as “basic cable” by 1980. Cable TV subscription rates peaked at around 70% of US households in the early 2000s.

            Nailing down precise dates on this sort of thing is hard because of definitional issues (IE do you just look at DVDs, or include laserdiscs as well in the category of “optical video discs,” or look at home video in general and include VHS too?), but the usual pattern seems to be for it to take about 20-30 years for a major technology to go from cutting edge to ubiquitous.

            Which means that one would expect a typical low-income American household to be 2 or more decades behind a typical high-income American household, technologically speaking, at any given time. If technological changes are the primary driver for the Flynn Effect, or if the other major factors behind the Flynn Effect are correlated with income to a similar degree, then that alone is enough for 6+ IQ points from shared environment. Why wouldn’t that show up?

          • L. says:

            but the usual pattern seems to be for it to take about 20-30 years for a major technology to go from cutting edge to ubiquitous.

            This might be so, but if I’m understanding the argument correctly, this isn’t necessarily what we should be looking at.
            For this argument it isn’t important when the technology first became available to the public, but when the technology became available to children; more specifically, when it became widespread among the children of rich people and when it became widespread among the children of the poor people.
            I have no way to measure that, but in my experience the time it takes for that to happen is a lot shorter than the time it takes for technology to go from cutting-edge to ubiquitous.

          • INH5 says:

            @L.: In-house technologies such as TV and personal computers should become available to children at the exact same time they become available to their parents, unless the parents are unwilling to share for some reason.

            For cell phones, I can’t find any solid data at the moment, but I do know that in movies made as late as the 1990s, a teenager having a cell phone was a sign of them being spoiled brats with rich parents. The characters being glued to their cell phones on posters for the film Clueless was intended as a visual gag back in 1995, for example.

            EDIT: According to Pew, in 2004 43% of teenagers owned a cell phone. We definitely didn’t go from “no teenagers owning a cell phone” to “all teenagers owning a cell phone” overnight.

          • L. says:

            @ INH5
            They become available to children only when they lose their “Serious business™” status, which almost all technologies have at first.
            For most children first personal computers and cellphones were mythical objects you weren’t allowed look at wrong lest they sense it and tell on you to parents.

            Not to be a cunt, but have you read your own sources?
            Yes, in 2004 only 45% of teenagers owned a cell phone, but 4 years latter in 2008, 71% of teenagers had one; that’s a 26 percentage points increase in only 4 years.
            You have a similar figure in the source you gave earlier on smartphones ownership, which shows a whopping 42 percentage points increase in smartphones ownership over 5 years.
            These are numbers very inconsistent with the narrative of slow adoption of technology and poor households lagging behind decades.

          • INH5 says:

            For most children first personal computers and cellphones were mythical objects you weren’t allowed look at wrong lest they sense it and tell on you to parents.

            Do you have a source for that? I was born too late to experience the early years of home computing myself, but plenty of ’80s movies prominently feature kids messing around with home computers and even the proto-internet (Wargames, Weird Science).

            Yes, in 2004 only 45% of teenagers owned a cell phone, but 4 years latter in 2008, 71% of teenagers had one; that’s a 26 percentage points increase in only 4 years.

            2008 is 25 years after the first cell phones hit the market and at least 13 years after rich kids owning cell phones became common enough to be joked about in teen comedy movies.

            You have a similar figure in the source you gave earlier on smartphones ownership, which shows a whopping 42 percentage points increase in smartphones ownership over 5 years.

            You mean this? 2016, the presumed end of that “5 years” is, likewise, roughly two decades after the first commercially released smartphones.

            These are numbers very inconsistent with the narrative of slow adoption of technology and poor households lagging behind decades.

            Taking 20+ years to reach >60% market penetration seems pretty slow to me. Sure, adoption rates are fast when you get to the middle of the S-curve, when prices drop enough to be affordable for middle class households, but the tech in question often spent a long time before that point as an expensive luxury good.

          • L. says:

            @INH5

            Full answer to come latter as I’m currently too distraught and am going to sleep, but something just occurred to me:

            Sure, adoption rates are fast when you get to the middle of the S-curve, when prices drop enough to be affordable for middle class households, but the tech in question often spent a long time before that point as an expensive luxury good.

            If this is so and the numbers from your sources are true, doesn’t that mean that your argument can no longer stand as it is now, but must also include middle-class households among those households who are technologically 2 decades or more behind high-income households?

          • INH5 says:

            If this is so and the numbers from your sources are true, doesn’t that mean that your argument can no longer stand as it is now, but must also include middle-class households among those households who are technologically 2 decades or more behind high-income households?

            Not quite. After you pass the midpoint of the S-curve, the rise in adoption rates start to slow down again, and it takes a little while longer for tech to go from widespread to truly ubiquitous. So middle-class households are behind the curve compared to rich households, but not by as much as poor households are. If you look at internet adoption rates by income, for example (select “Income” in the second graph on this page), adults who make less than $30,000 per year trail adults who make $30-49,000 per year by roughly ten years, and that group in turn tracks adults who make more than $75,000 by roughly ten years.

        • edmundgennings says:

          Some amount of this indicates intelligence is like height. ie within generation variation is almost entirely genetic but intra generational variation is environmental. Also this is more measurement change than underlying values. We have gotten better at taking IQ tests because of unintentional societal teaching to the test. US functionality has not increased that much. People 1 standard deviation beneath the mean a hundred years ago clearly did not have the same problems people 3 standard deviation beneath the mean do today.
          There is plausibly been some increase in what we care about but not two standard deviations.

        • quanta413 says:

          Any possible environmental factor(s) would clearly vary between households at any given time, so why doesn’t this show up as a shared environment effect?

          This assumption is false. Just because you can’t personally think of any environmental factors that hit all households within a small time window (say a few years) doesn’t mean they don’t exist. For example, economic growth may vary slightly across the country, but on a broad scale, almost every place in the U.S. has experienced an increase in living standards over time. They also tend to experience recessions at the same time.

          A shift in the environment may explain little variance across households even if it didn’t occur in all of them at once and yet explain a large amount of the shift across generations. 3 points is also pretty small. The variance in the population about 15. Even if there as an environmental effect causing the 3 point shift and it differed strongly only between but not within households within a short time window, that would contribute 20% of the variance maximum. Give more realistic assumptions about any environmental shift occurring almost uniformly within the country, and it’s just noise in the heritability estimates.

      • Vergence says:

        Why only mention shared environment? Genes leave a lot of variance unexplained, so there’s plenty for the unshared social environment to do.

    • Steve Sailer says:

      My vague impression is that anorexia correlates with class. The higher up the social scale a young woman is, the more susceptible she is to anorexia.

      The most straightforward explanation would be that higher class people tend to be genetically better at self-discipline, and society in 2018 rewards slenderness.

      But I think this correlation has been around longer, even in the past when high class men like William Howard Taft or J.P. Morgan were expected to be what my father called “fat cats.”

      In general, higher class seems to be associated with slenderness. Extremely elongated movie stars like Peter O’Toole, the son of a bookie, and Nicole Kidman typically play higher class characters, and look miscast as working class (e.g., Kidman’s unfortunate casting as a farm worker in “The Human Stain”). O’Toole was about 8 inches taller than T.E. Lawrence, but was famously well cast for Lawrence’s image.

      An example I’ve always found amusing are the English soccer stars David Beckham and Wayne Rooney. Both are of roughly similar class backgrounds and both are usually in fine physical condition. But Rooney has a broad face that looks prole while Beckham has a narrow face that looks aristocratic:

      http://www.unz.com/isteve/facial-width-and-class/

      Interestingly, Beckham seems to have decided that physiognomy is destiny for him, marrying Posh Spice, and pursuing a genteel retirement life as an extremely well-dressed gentleman.

      I find this correlation of elongation and higher class rather puzzling, but I suspect it may offer some broadly applicable clues. I suspect it may be related to Scott’s recent topic of fast versus slow life “strategies,” which also seem to be related to class, with working class people living fast (c.f., Springsteen’s “Glory Days”), and bourgeois people sexually maturing late.

      Perhaps girls who reach puberty late tend to be taller and, especially, longer legged, than girls who mature early? Similarly, taller people seem higher class because they presumably had better nourished childhoods. So perhaps we tend to conflate longer leggedness, whether due to nature or nurture, with higher class?

      Another correlation is that femme fatales in 1940s movies (e.g., Barbara Stanwyck in “Double Indemnity”) were envisioned as long-legged. My guess is that the implication is that the long-legged femme fatale is below average in sexual emotions: she’s a cold-blooded predator who can play a man for a sap. (Lauren Bacall often played a likable variation: she looked like a femme fatale but her characters would ultimately prove to have warm womanly emotions.)

      • Aging Loser says:

        Upper-class people fight with wands and rapiers; lower-class people fight with stout lumpy clubs.

        Upper-class thinking consists in a narrow line of propositions proceeding toward the precise conclusion. Lower-class thinking consists in a bunch of vaguely associated conclusions wadded up into a mass, supported by a handle of insufficient general impressions (this is how I think).

        The appetitive part of the soul is associated with the pelvis and lower abdomen, the spirited part with the chest, the intellectual part with the head. Naturally, lower-class people will be thicker below the neck. And their heads even resemble stomachs, because their appetitive humors have seeped up through their necks into their underjaws and cheeks.

        • BlindKungFuMaster says:

          The appetitive part of the soul is associated with the pelvis and lower abdomen, the spirited part with the chest, the intellectual part with the head. Naturally, lower-class people will be thicker below the neck. And their heads even resemble stomachs, because their appetitive humors have seeped up through their necks into their underjaws and cheeks.

          Can I hire you as a writer for my upcoming phrenology paper?

      • LadyJane says:

        Upper class aesthetic norms are based around differentiating themselves from the lower classes. When most poor people were skinny from malnutrition, the upper classes idolized wider builds to show off the fact that they could afford to eat a lot. Now that poor people are more likely to be obese as a result of exercising less (due to lack of free time) and having less healthy diets (because unhealthy foods are cheaper), it makes sense for upper class people to idolize skinnier builds as a way of showing off that they can afford better food, have more refined taste, devote more time and effort to exercising, take better care of their health in general, have more self-control, and so forth.

        Plus, thin physiques are less well-suited for raw strength, and brute force is something associated with manual laborers, blue-collar workers, violent criminals, and other lower class types. There’s a reason working-class people tend to prefer heavily strength-based sports like football, wrestling, and boxing, while elites tend to prefer sports like tennis and gymnastics that are more about agility, precision, and finesse than pure strength.

        • baconbits9 says:

          Upper class aesthetic norms are based around differentiating themselves from the lower classes. When most poor people were skinny from malnutrition, the upper classes idolized wider builds to show off the fact that they could afford to eat a lot. Now that poor people are more likely to be obese as a result of exercising less (due to lack of free time) and having less healthy diets (because unhealthy foods are cheaper), it makes sense for upper class people to idolize skinnier builds as a way of showing off that they can afford better food, have more refined taste, devote more time and effort to exercising, take better care of their health in general, have more self-control, and so forth.

          Is this actually the order of events? Did Hollywood starlets start getting skinny AFTER the obesity epidemic in the US kicked off or before? My impression is that it is well before.

        • moscanarius says:

          the upper classes idolized wider builds to show off the fact that they could afford to eat a lot.

          The wider builds they liked were not the same as fatness, AFAIK.

          Fatness, like baldness, has not been held in high regard.

        • Bamboozle says:

          On your sports bit at the end, that doesn’t explain why all the private schools in Britain play rugby and the free schools play football.

          Presumably it’s because you only need a ball to kick around anywhere to play football, where as rugby needs a proper pitch, and usually strength training and plenty of food to get bigger.

          Unless you’re from New Zealand where everyone plays rugby regardless.

          Which is to say i think you’re reaching with a lot of this.

        • Cliff says:

          Now that poor people are more likely to be obese as a result of exercising less (due to lack of free time) and having less healthy diets (because unhealthy foods are cheaper)

          Try again. Poor people work less and have more free time. Healthy vegetables are very cheap, processed food is expensive.

          • arlie says:

            Where are you shopping?

          • cryptoshill says:

            Literally anywhere. Processed meals are almost universally a ripoff.

          • Andrew Cady says:

            “Processed food” isn’t the same thing as “processed meals.”

            $1 can get you about 200 calories of raw unprocessed carrots or 5,000 calories of highly-processed bleached flour. (Flour is cheaper than unprocessed vegetables by weight, too. It’s just amazingly cheap.)

            $2 can get you about 50 calories of Roma tomato (those are a cheaper variety) or it can get you 500 calories of tomato paste

            As a general principle, processing the food lowers its weight (removes water etc.), increases its packed shipping density, and makes it more resistant to spoiling. This makes it substantially cheaper because shipping and spoiling are significant factors in food prices, while processing costs are not.

            There is also much less waste since fresh foods are selected carefully even on appearance, while processed foods are just all ground up together including the bruised and broken and rotten-looking.

            Buying anything in prepared “meal” form is expensive. But prepared meals made from processed foods are still going to be cheaper than prepared meals made from fresh food.

      • Randy M says:

        The most straightforward explanation would be that higher class people tend to be genetically better at self-discipline, and society in 2018 rewards slenderness.

        Anorexia as a fail state of high willpower makes a certain amount of sense, but then I would expect it to be an easier condition to recover from.

        • cuke says:

          My non-scientific story about why that is is two-fold:

          1. When you externally suppress responding to your appetite over a stretch of time, the appetite seems to respond by getting confused and not sending clear signals to the brain. So people with AN lose a sense of appetite. Kids I’ve seen raised by parents who are highly controlling or anxious around food may go the other way as well, going towards obesity because they’re eating emotionally rather than responding to their brain signaling physical signs of appetite. So this seems like a circuit amenable to being behaviorally distorted and won’t just self-correct if you stop doing “willpower.” Something about one’s interoceptive capacity needs to be re-learned.

          2. I also think a lot of disordered eating is a behavioral coping mechanism for anxiety, in the way phobias, OCD, ruminating and other kinds of learned problem-solving behaviors are. In that sense, recovery may mean addressing the underlying anxiety, and just stopping the controlling part isn’t going to solve the issue.

          • cuke says:

            Not a huge sample size but there are more studies like this with larger sample sizes (but less concise abstracts):

            “Eighty-three percent of subjects with AN and 71% of those with BN had at least one lifetime diagnosis of an anxiety disorder. By far, the most frequent was social phobia (55% of the anorexics and 59% of the bulimics). When present, the co-morbid anxiety disorder had predated the onset of the ED in 75% of subjects with AN, and 88% of subjects with BN. Our results are consistent with those of studies conducted in other countries, and show that an anxiety disorder frequently exists before an ED. This has to be taken in consideration for successful treatment of patients with AN or BN.” (https://www.sciencedirect.com/science/article/pii/S0924933800002121)

            If it’s common for an anxiety disorder to exist before the ED, and if most people with EDs have anxiety disorders — and I’d add from my experience, many people I treat who have anxiety have subclinical levels of appetite/eating issues — then it would also help explain why just fixing the behavioral manifestation (the disordered eating) wouldn’t resolve all the symptoms. It’s possible some of this is mediated through gut ecology or neurotransmitter function in the gut (which has its own genetic/environment dynamics), I have no idea.

            So if we want to look for genetic predispositions for eating disorders, I would argue for it to be anxiety. Other personality traits (likely also heavily genetic), like conscientiousness/perfectionism/black-and-white thinking, are likely to be contributing factors (or are part of the same predisposition towards anxiety). And then environment/experience may play a role in tipping the behavioral manifestation of the anxiety into disordered eating or a phobia or substance use or some other thing.

    • SamChevre says:

      I’d say that the majority of personality traits and behavioral traits are a result of social (i.e. cultural and/or interpersonal) environment.

      I would disagree fairly strongly. My observation of both my siblings and my children, and other parent’s reports as well, is that infants in the same family have identifiably different personalities from the time they are very young. There’s definitely a reinforcement component–the classic “you get rewarded for what you are good at so you keep doing it”–but that doesn’t seem to be all of it.

      • moscanarius says:

        Seconded. It can be seen even in newborns.

      • Viliam says:

        It is so easy to get completely opposite intuitions on this topic.

        Families share genes, but they usually also share the environment, so you can blame the same traits on either. And siblings differ in genes, but also in birth order and individual experience, so you can blame the differences on either, too.

        And if you want to ask a scientist, the answer will probably depend on whether you talk to a geneticist or a sociologist first.

        (I am not suggesting that both views are equally valid. If you see the mind as a part of the body — residing in the physical brain rather than in the immaterial soul — it goes automatically that the mechanism which can make you shorter or taller, brown-eyed or blue-eyed, can also make you more or less aggressive, introverted or extraverted. I am just saying that it is easy to believe in the opposite and still feel like the evidence supports you.)

    • Roger Sweeny says:

      Robert Plomin’s new Blueprint goes into a lot of this. It is in some ways an updating of Judith Rich Harris’s The Nurture Assumption. Warning: he’s a big twin studies guy who thinks “biological factors” mean a lot; “social (i.e. cultural and/or interpersonal) environment” not so much.

  2. I am interpreting the point to be something along the lines of “Suppose for some people with some unknown pre-existing vulnerability, starving themselves voluntarily now flips some biological switch which makes them starve themselves involuntarily later”.

    The obvious way to test this would be to look at the population of people who voluntarily fast for extended periods, and see if they develop anorexia at a rate higher than the general population. I guess it would probably be confounded by selection effects and/or people fasting for weight loss reasons though.

    This seems like a really important thing to find out ASAP, considering fasting shows promise for addressing quite a few health problems (including longevity and sustainable weight loss). Intuitively I would guess fasting is probably a bad idea for people with existing eating disorders, but it would be a massive bummer if it also triggered them in otherwise healthy people.

    • Murali says:

      Does the fasting that Muslims do during Ramadan count? It’s not genuine starvation except for 12 hrs or so. I know a lot of Muslims who suffer from sever obesity. I think that they tend to gorge themselves before sunrise in order to last through the day and after sunset because they haven’t had anything to eat for 12 hours. This might trigger other sorts of disordered eating patterns that persist past Ramadan.

      Personally, I have, however, found that returning to normal food portions after holiday feasting is really difficult.

      ETA: I imagine that over extended periods of time, the body adjusts to particular patterns of eating especially when those patterns of eating have been in place for extended periods of time. I suspect that some people find it much harder to expand or reduce their regular food intake by significant amounts.

      • I don’t think it counts. At the 12 hour mark, you’re only just beginning to transition into a fasted state – it’s no different to having dinner at 7pm, then breakfast at 7am, which is pretty much the status quo for most people. Maybe the feast-famine pattern has some kind of behavioral effect, but physiologically, it doesn’t resemble actual starvation.

      • Michael Watts says:

        I know a lot of Muslims who suffer from sever[e] obesity.

        If they’re Arabs, this is confounded with the greater susceptibility to obesity and diabetes of populations without much of an agricultural history.

        If they’re Persian / Pakistani, that’s not an issue.

        • Murali says:

          They’re Malay. The Singaporean male Malay population’s BMI seems bimodal. People tend to be either very fit or very fat with much less in between.

        • INH5 says:

          A lot of Arabs live in places like Egypt and Iraq that were home to some of the oldest agricultural civilizations in history.

          • quanta413 says:

            Not familiar with the ancient genetics of the area, but isn’t there an obvious confounding here in that there was an enormous expansion and migration of the Arab population when Islam arose?

            As far as original premise you’re responding to goes, I also don’t see why a few thousand extra years of agriculture should make a population less susceptible to obesity either. It’s not like agriculture even a couple hundred years ago made many people fat.

            It’s hard for me to imagine selection against fattening up easily occurring any time in the past. Like it could theoretically occur now, but it would take a few generations to see any noticeable effects.

          • bullseye says:

            I read about a genetic study that found the English are only about 30% Anglo-Saxon by blood; the other 70% is the people they conquered. This despite the Anglo-Saxons having annihilated the previous culture so completely that archaeologists suspected they killed everyone. I suspect that Arabs outside the Arabian peninsula would have even less than 30% Arab blood, because the civilizations they conquered were older and more densely populated than Britain.

  3. Camouflage Interior says:

    While fasting and exercise are initially aversive, they gradually become rewarding – even addictive – as the starvation response kicks in.

    Huh? How can fasting be addictive? According to conventional wisdom, starvation is unpleasant. And beyond that, fasting entails merely continuing to starve at all times. It doesn’t have the “pressing the lever” quality usually associated with addiction.

    I can see how fasting is rewarding–you meet your goal to not eat for one day or whatever, and then feel satisfied with your achievement of self-control. But as an addiction seems bizarre.

    • Murali says:

      It’s like you’ve never heard of self-mortification before

      • Tenacious D says:

        Now I’m wondering if other forms of mortification (abstinence, uncomfortable clothing or beds, self-flagellation, etc.) are susceptible to this kind of cycle, or does the starvation response provide a unique kind of feedback?

        • flame7926 says:

          I would imagine they are susceptible to similar patterns – I have also noticed with the anorexic people that I know that they engage in multiple regimented and unregimented behaviors that seem almost masochistic. Lack of sleep, braving the cold, excessive exercise, pushing themselves beyond their physical limits in multiple ways.

    • Anonymous says:

      Only the first couple of days are substantially unpleasant. After that, you feel “you could eat” but aren’t all that hungry (because ketosis has kicked in and your metabolism is marshalling all that body fat that’s usually unavailable for burning). Plus, most (western) people eat a ridiculously poisonous diet, so even a few days break from a variety of irritants, allergens and toxins will do wonders for one’s physical comfort.

      • eyeballfrog says:

        “Plus, most (western) people eat a ridiculously poisonous diet, so even a few days break from a variety of irritants, allergens and toxins will do wonders for one’s physical comfort.”

        Could you go into more detail about this? E.g., which commonly eaten products have toxins in them?

        • unagflum says:

          Some examples that most everyone in the west eats:
          – Vegetable/seed oils (corn, soy, peanut, canola, etc.) with too much omega 6 polyunsaturated fatty acids
          – Refined sugar and flour with an extremely high insulin response
          – Massive amounts of fructose

        • Anonymous says:

          Could you go into more detail about this? E.g., which commonly eaten products have toxins in them?

          Just about every plant. Doubly so when eaten raw. Dairy is also a culprit, being a common allergen – especially milk proteins and lactose – and dairy is very commonly used in just about anything (similar to added sugars). And that’s even before the various conserving agents (like, say, E-249 through E-252).

          What @unagflum said as well.

          • eric23 says:

            Are you honestly arguing that humans would be healthier if they never ate plants?

          • Anonymous says:

            @eric23

            Are you honestly arguing that humans would be healthier if they never ate plants?

            A contemporary human, living in the state of abundance, will be much healthier never eating any plants. The ongoing carnivore experiment is giving some very promising results, and I have personally benefited from this in predicted ways since making the leap.

            Plants (via agriculture and cooking) are best understood as a crutch to support large populations in historical times, after we have hunted our preferred prey (giant, fatty animals such as mammoths) to extinction. Entirely necessary for developing civilization, but sacrificing the health of the individual members of society in the process. It could be that we can eventually solve the problem with technology, but first the institutional bias in favor of plant foods needs to be corrected. This will happen eventually as evidence mounts that humans are extremely poorly adapted to plant foods and a carbohydrate-based nutrition; absent very aggressive supplementation, especially with B12, a human is an obligate carnivore.

          • eyeballfrog says:

            This is why a lot of people have given up on dietary recommendations. The fraction of my diet that should be plants seems to range from 0 to 1, and I already knew that.

          • Anonymous says:

            This is why a lot of people have given up on dietary recommendations.

            Yeah, the official recommendations are absolute rubbish.

            The fraction of my diet that should be plants seems to range from 0 to 1, and I already knew that.

            Unless you want permanent nerve damage, that fraction needs to be substantially less than 1, or include B12 supplements. (The other deficiencies caused by a plant-based diet – A, D, K, among others – are less lethal.)

          • Error says:

            I’m a bit curious what you do for meals. Meat is expensive, and preparing it is a hassle. Even if you’re right, I can’t see doing it for (nearly?) every meal.

          • Anonymous says:

            @Error

            I’m a bit curious what you do for meals. Meat is expensive, and preparing it is a hassle. Even if you’re right, I can’t see doing it for (nearly?) every meal.

            A typical inhabitant of my country spends about 1000 local currency units (LCU) on food per month, from a typical net salary of 3000 LCU. I spent around half that. I do this by simply buying the cheap meat, which also often happens to be even more nutritious than more expensive types. The very expensive cuts tend strongly to be the leanest, which doesn’t work – humans can’t process an unlimited amount of protein like cats can; most of the energy intake needs to be fat (or carbs, but I eat only trace carbs).

            Fried or smoked bacon costs about 18-23 LCU per kg.
            Most pork costs below 15 LCU per kg, sometimes under 10 LCU.
            Fatty beef, 80/20 or 70/30, costs around 17 LCU per kg.
            Mackerel and salmon bellies costs about 12-18 LCU per kg.
            Pastured eggs cost about 0.80 LCU per egg.
            Raw pork fat tissue costs about 8 LCU per kg.
            Poultry (chicken, turkey) organs cost around 5-7 LCU per kg.
            Clarified butter costs about 35 LCU per kg.
            Beef tallow costs about 9 LCU per kg.

            I get eggs “free” from the family farm. “Free” because I buy and/or incubate the actual chickens, so it’s more of a case of amortizing hens. I doubt I spend more than about 500-600 LCU on food in a typical month. And I’m hardly optimizing for thrift that hard – I could probably cut that down even more.

            In a typical day, I eat some kind of fish, about four eggs, about half a kilo of fatty meat, and maybe 100g of clarified butter. It’s rare for me to have more than three caloric events (meals) per day. Two is more common.

            I almost never eat out. Meat preparation is very simple IMO – just throw it on the pan, and wait until it changes colour. Eggs are similarly simple.

            What are incomes/prices like at your locality?

          • Anonymous says:

            A typical inhabitant of my country spends about 1000 local currency units (LCU) on food per month, from a typical net salary of 3000 LCU.

            Correction, since I shouldn’t have believed the very first link about the topic I googled up, and gone straight to the central census bureau, like I have done now.

            Typical net income per capita for 2017: ~1600 LCU.
            Typical food expenditure per capita: ~380 LCU.
            Alcohol, tobacco and restaurant meals were excluded, and I don’t see an easy way to add them in, but it would likely increase the total by about 50 LCU.

            The numbers I gave before make sense and were intended for the capital city, not for the country at large. I don’t live in the capital city; the updated numbers suggest that I’m spending only moderately more than the typical person on food.

          • bullseye says:

            Given the huge variety in human diets across different cultures, I find it very hard to believe that there is one correct human diet. Even Neandertals didn’t have an all-meat diet. I figure your diet is fine because our bodies can handle pretty much anything we throw into them. Modern processed foods are a problem mainly because they’re designed to make us overeat.

          • Anonymous says:

            @bullseye

            Given the huge variety in human diets across different cultures, I find it very hard to believe that there is one correct human diet.

            While human diets vary, the overall human digestive tract does not. Features such as canines and non-flat molars, high stomach acidity and the stomach being one-chambered, presence of a gall bladder, absence of a significant cecum, and shortness of the large intestine all suggest a diet heavy in meat and fat. Nothing I know of suggests that plants are a non-optional part of the diet (outside of conditions of scarcity, where any source of calories is good, because the alternative is starvation).

            Even Neandertals didn’t have an all-meat diet.

            I have heard than Neanderthals ate about 20% plant matter. This is a) a far cry from today’s meat consumption (which is more like the opposite), b) likely there because they have figured out thermal food processing. Pre-cooking, the only substantially digestible plant matter are fruits (unavailable most of the year) and some starchy tubers (which are more a starvation food than a staple when raw, especially if you don’t farm them but have to find them).

            BTW, if you want purer examples of contemporary and historical human hypercarnivores, here’s a list.

            I figure your diet is fine because our bodies can handle pretty much anything we throw into them.

            Given the metabolic syndrome and other chronic illness epidemic, this is unlikely. Metabolic syndrome is probably the biggest one, and is caused by eating carbohydrates, and you don’t find substantial amounts of carbohydrates in meat. Hell, before agriculture and cooking, even plants didn’t have as much available carbohydrate as we have bred into them.

            Modern processed foods are a problem mainly because they’re designed to make us overeat.

            Modern processed food does have a habit of using various methods of taste improvement to make even the least palatable substances delicious, and processing vastly improves digestibility. Which has the obvious effect of overeating and absorbing a lot of calories – but not necessarily various micronutrients (or even macronutrients), because the base substances (typically plant-based) are either poor in them to begin with or have low nutrient bioavailability.

    • HeirOfDivineThings says:

      “How can fasting be addictive?”

      A lot of religious experiences are triggered from fasting. Some people even recount getting a fasting high.

    • nonsense_w says:

      I can only speak from experience, but I have always found fasting fairly pleasurable. It’s not the reward really, but I have always found being mildly hungry (that is, ~16-36 hours without food) as pretty enjoyable. Unsurprisingly my weight is fairly low, though probably not anorexic currently. Gaining weight is.. not impossible but pretty unpleasant. I have no idea how people can just eat all the time. Don’t you miss getting hungry?

      This is not a new thing, this has been the case for as long as I can remember (starting around 10? I am currently 40). I have always chalked this up to individual appetite. If something happened that reset my appetite to low levels, it was so long ago that I have no idea what happened.

      Longer fasting (72+ hours) is kind of a different story, IMO. Although I will say it is pretty fun to actually enjoy food, and breaking a fast is pretty much the only time I really do.

      • Thomas says:

        Many of my patients (I’m a cardiac nurse) cannot stand to be the slightest bit hungry for more than a minute. We get the most amazing wailing if someone has to go without food overnight to prep for a test. Family members yell that we are starving poor mom or dad. People wake up at midnight and eat a full meal, and again at 3:00 and want another. Pepsi all night long. Snacks. Graham crackers at odd hours. I notice that these people seem to love very sweet food, and use multiple packets of artificial sweeteners in their coffee.

        These people are usually, but not always diabetic. And it isn’t because their blood sugar is low. We check that.

        • Nancy Lebovitz says:

          High blood sugar + insulin resistance (or maybe insulin resistance alone) can lave people feeling hungry because they aren’t being nourished.

          I think you’re claiming moral superiority when what you’ve got is a fortunate metabolism.

          • Anonymous says:

            I think you’re claiming moral superiority when what you’ve got is a fortunate metabolism.

            Diabetes isn’t “unfortunate metabolism”. It’s a disease caused by eating excessive carbohydrates for years or decades on end.

          • Nancy Lebovitz says:

            Diabetes isn’t necessarily caused by excessive carbs consumption.

            I’ve got diabetes. I never had simple carbs as the primary part of my diet, and I’d been gradually dialing them back because they weren’t leaving me feeling good. Now I eat a lot less of them.

            My idea of simple carbs for the fun of it was two or three 20 oz. real Cokes a week. This was pre-diagnosis– now I don’t have Coke, since I don’t like sugar substitutes. However, this is hardly the sort of consumption I think you’re blaming people for.

            https://www.youtube.com/watch?v=UMhLBPPtlrY

            15 minutes by a doctor who blamed people for type 2 diabetes until, even though he ate carefully and exercised 3 or 4 hours a day, got insulin resistance.

            He now thinks insulin resistance might be caused by eating too much simple carbs, not getting fat or eating too much in general, but he’s working with researchers who don’t agree with him in the hope that they can keep each other honest.

          • Anonymous says:

            @Nancy Lebovitz

            Diabetes isn’t necessarily caused by excessive carbs consumption.

            I’ve got diabetes. I never had simple carbs as the primary part of my diet

            Simple or complex does not matter – notice how I did not differentiate between simple or complex carbs. They’re all metabolized to glucose (with fructose being odd and getting also substantially converted to fat).

            Unless you mean to tell me that you’ve been eating a low-carbohydrate or ketogenic diet all your life, your diabetes (presumably – type 2; correct me if I’m wrong) is the direct consequence of your diet being based around carbohydrates – breads, pastas, potatoes, rice, the whole bottom level of the food pyramid.

            I don’t blame you for, well, being given wrong information all your life. (The discovery of insulin and the subsequent availability of a symptom treatment basically put research into dietary interventions out to dry, and it’s only recently being taken up again.) But it’s not an “unfortunate condition” caused by some unknown forces at random. Diabetes is caused by carbohydrate consumption. The doctor from the video even says that it’s his hypothesis. Since the video is from five years ago, I can only guess whether he came to a firmer belief about this.

            Carbohydrates spike insulin, because high sugar concentrations are toxic, so you need to remove them from the blood. Combined with frequent meals (all in line with official recommendations), that’s almost perpetually elevated insulin. Since insulin is perpetually elevated, the system downregulates responsiveness to insulin. Hence insulin resistance. But you still need insulin to get your cells nourished, so it gets produced more. And that drives even deeper insulin resistance, because the cells are already stuffed and don’t want more. Eventually, the insulin production capacity peaks and even breaks down, and you’ve got full-on type 2 diabetes.

            The good news is that this is easily treatable and reversible. Stop eating carbs, or at least cut them to below 80 grams a day. I suggest getting a copy of Lutz’s Life Without Bread. Or Fung’s Complete Guide to Fasting, if you cannot wean yourself off of carbohydrates. Maybe even take a look at Paleomedicina’s dietary treatment of chronic illnesses.

        • Anonymous says:

          These people are usually, but not always diabetic.

          Pre-diabetes is still diabetes.

    • Camouflage Interior says:

      Somehow I was (baselessly) interpreting it only as addiction to staying in the fasting state once already there. This struck me as strange as an addiction to not doing something. But I suppose you could have for example, a craving to go back to fasting after eating something which would be not all that different from another addiction.

  4. Anonymous says:

    They recommend all the usual indulgences: ice cream, french fries, cookies.

    Has anyone tried meat? Fatty meat.

  5. Ketil says:

    From http://www.healthofchildren.com/A/Anorexia-Nervosa.html:

    Anorexia nervosa was not officially classified as a psychiatric disorder until the third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. It is, however, a growing problem in the early 2000s among adolescent females. Its incidence in the United States has doubled since 1970. The rise in the number of reported cases reflects a genuine increase in the number of persons affected by the disorder and not simply earlier or more accurate diagnosis. Estimates of the incidence of anorexia range between 0.5 percent and 1 percent of Caucasian female adolescents. Over 90 percent of patients diagnosed with the disorder as of 2001 are female. The peak age range for onset of the disorder is 14 to 18 years. In the 1970s and 1980s, anorexia was regarded as a disorder of upper- and middle-class women, but that generalization is as of 2004 also changing. Studies indicate that anorexia is increasingly common among females of all races and social classes in the United States.

    I’m not sure there are any psychiatric condition that is skewed by demographics to a similar extent? I’m sure there are biological factors as well (aren’t there always?), but it’d be interesting to see how shared environment vs shared genetics play into this.

    • Steve Sailer says:

      The first celebrity I can recall dying of anorexia was Karen Carpenter, singer/drummer of 1970s band The Carpenters, in 1983.

      Looking at Wikipedia, she seems to have been from a bourgeois background (her father was the son of Protestant missionaries in China, which is usually a tell for intense WASPness, e.g., Henry Luce) and was a tomboy (loved baseball [including baseball statistics!] and chose to be a drummer).

      “Karen Anne Carpenter was born on March 2, 1950, in New Haven, Connecticut, the daughter of Agnes Reuwer (née Tatum, March 5, 1915 – November 10, 1996) and Harold Bertram Carpenter (November 8, 1908 – October 15, 1988).[2] Harold had been born in Wuzhou, China, where his own parents were missionaries, and was educated at boarding schools in England, before working in the printing business.[3]

      “Carpenter’s elder brother Richard developed an interest in music at an early age, becoming a piano prodigy. Karen’s first words were “bye-bye” and “stop it”, the latter in response to Richard. She enjoyed dancing and by age four was enrolled in tap dancing and ballet classes.[4] When she was young, she enjoyed playing baseball with other children on the street, and was picked before her brother in sandlot games.[5] She studied baseball statistics carefully and became a fan of the New York Yankees.[6] In the early 1970s she would become the pitcher on the Carpenters’ official softball team.[7]”

  6. nestorr says:

    I’ve done a bit of fasting, it seems to me that eating less downregulates hunger, and I actually only get a big appetite if I’ve gorged myself the previous day. It seems a pretty sensitive system, with feedback effects over a few hours/days, so if you spent months starving yourself it could conceivably stick the dial on “starve” or “gorge”. the nitty gritty of how that works in terms of neurobiology I leave to the experts.

  7. Brandon Berg says:

    In chronic overeating, leptin resistance can set in, creating a vicious cycle. Intuitively, it seems possible that the opposite process could happen. I don’t know why some people would be more susceptible than others, but that seems to be the case with a lot of problems.

    • Reziac says:

      Leptin is pretty strongly tied to thyroid. If I were struggling with an anorexic patient, I think the first thing I’d do is a full thyroid workup, with attention to leptin and insulin levels. Note that among its plethora of vague symptoms, hypothyroidism can cause a total loss of appetite with muscle wasting and depression.

  8. Michael Arc says:

    Can this PLEASE be an all Evolutionary Psychopathology blog for the next few months! I feel like you’ve arrived Scott!

    There’s a long way to go though. We need discussion of coordinating strategies within lifestlyes, and of what to do if the sociopath style is firmly entrenched enough at the top to be robust and to impose itself upon all the lower classes. I think that we also need to differentiate between two Hufflepuff styles. The higher class ‘keep your head down, be agreeable and make many weak friendships, move where the wind is blowing and appease’ and the proper low class “work hard but be humble, don’t trust anyone but family or any facts, don’t ahead beyond a year or so, and form a high commitment partnership with a single partner as young as possible and have kids as soon as that is remotely possible, relying on the circumstances to accommodate” strategy. We don’t meet those people, nor see them on blogs, and nobody talks much about them because it seems naive and would cost everyone class points, but they are very numerous.

  9. eigenmoon says:

    It seems to be very common for involuntarily starved people to treat all food like treasure for the rest of their lives, being triggered by every sight of food thrown away. While totally understandable, it might be the other side of the anorexia mechanism.

    If so, the mechanism could be described like this. Once starved (voluntarily, involuntarily – doesn’t matter), a body (System 1, if you want) will assume that the environment is risky and the food might always get scarce. It will disbelieve the mind’s assessment that food will always be aplenty from now on – after all, the body has evolutionary experience worth millions of years, what could the primate’s mind possibly do against that? The body will therefore compel the individual to conserve resources one way or another.

    In this model, the possible way to cure anorexia is to stop trying to convince the body that the food is plentiful and it’s healthy to eat more. The body simply isn’t going to believe that. But if the patient reduces throwing food away and starts to stockpile canned food and water, maybe the body will buy that food is being conserved by means other than eating less, so everything is fine now.

    This method has the obvious problem that anorexic patients probably do lots of throwing food away. I obviously don’t know how big of a problem that is. So if you’re anorexic, just stockpile lots of food and let’s see what happens.

    • Gabe says:

      The part about food stockpiling makes sense to me. I started therapy a few years ago for anxiety and depression and found that I also had some moderate eating-disorder symptoms. Part of the therapy involved making preparations for a natural disaster I was constantly worrying about. So I stockpiled about three months’ worth of canned and dried food. Since that time, I have gained ~35 pounds and am back at a healthy body weight.

      There are a lot of other variables in the mix that I have not mentioned, but in my experience, food stockpiling is correlated with anxiety reduction and weight gain, FWIW.

    • theBearwithThrust says:

      This is definitely an interesting idea.

      Maybe throwing away food somehow convinces the body that those food are not edible, and thus the resources in the environment are increasingly scarce?

  10. OrangeInflation says:

    I lurk exclusively. Here goes, because I’ve been a 1 decade off again on again anorexic. I’m female, I’ve never been a ballerina or in any other profession that requires me to be good looking, and I have lots of experience speaking with other anorexics.

    She understands this and would do anything to cure her anorexia and be a normal weight again. But she finds she isn’t hungry. She hasn’t eaten in two days and she isn’t hungry.

    Anorexics lie, all the time, about everything. About how much we ate, about how much we didn’t eat, about what we ate, about our physical symptoms, about how hungry we are. In my experience the anorexics who say they are disgusted by food or not hungry are either lying OR truly not experiencing physical hunger but rather experiencing a sort of “mental hunger,” a preoccupation with food that causes one to spend most of the time grocery shopping, food hoarding, looking at recipes, and cooking wonderfully for everyone else. Deceit is a HUGE part of this disease.

    I was hungry every day, every moment, and was thus for a decade. I would lie about this usually. This is also why anorexics are really cranky.

    Suppose for some people with some unknown pre-existing vulnerability, starving themselves voluntarily now flips some biological switch which makes them starve themselves involuntarily later”.

    This rings true. I originally went hungry at age 12 for one week because of a stressful situation, and just never stopped. Many anorexics are also extremely conscientious types who are able to delay gratification in finance, sex, etc. Seems to me that a lot of people diet (self starvation) but only anorexics have the willpower to extend this to the extreme.

    The social approval for starvation is a major factor. From age 12 on most women expressed jealousy and approval for my weightloss down to about BMI=16, and in my experience the positive attention from men increases to that BMI as well. Constant social reinforcement of the disease. I have no idea why men seem to like such extremely low levels of bodyfat.

    Increased physical activity is a key component of the starvation response in many animal species; in general, its function is to prompt exploration and extend the foraging range when food is scarce.

    I’ve heard a lot of explanations for this in humans but in my personal experience, the explanation was pretty simple–I had to be constantly active in order to distract myself from the constant hunger. I felt like I could binge on pretty much anything at any time, so constant business was necessary to prevent that. The fear that the moment I stopped I would eat everything in sight and then balloon up kept me on my feet all day.
    But this doesn’t explain why this occurs in animals. Shrug.

    • HeirOfDivineThings says:

      ” I have no idea why men seem to like such extremely low levels of bodyfat. ”

      They don’t. At least, not as much as women think.

      Do men find very skinny women attractive?.

      • dividebyzeroes says:

        Another data point supporting the idea that men don’t actually find the very thin body type attractive in women is the set of revealed preferences reflected in online (ahem) erotica availability. My impression is that videos featuring BBW (Big Beautiful Women, where Big ranges from “a few pounds overweight” to “full-on obese”) are plentiful and popular, whereas the number of films with women who range from underweight to anorexic is orders of magnitude lower.

        • baconbits9 says:

          You also need to account for the subset of men (as AnnaR notes below) that are making the comments. There are two concepts that might be at work here, being noticeably skinny makes you stand out, if 5% of men like very skinny girls and 95% like something else, and 100% of women are something else then going from something else to very skinny will give you a huge boost in attention. An average looking girl with an average body type might get entirely ignored (especially in high school) for extended stretches, but losing 20-30lbs might give them specific attention from a small subset.

          The other is that eating disorders seem to commonly start around adolescence, and that means a lot of the attention from opposite sex is from really inexperienced people. They don’t have a fully formed sense of who they are and what they like, and are probably more susceptible to social pressures (real and imagined) in their actions than they will be later in life. Anecdotally I was young for my grade and developed fairly late (I was one of the 2 shortest boys in my year through 8th grade despite eventually being average height). When kids my age started liking girls I pretended (and I suspect that a lot of them were pretending to an extent as well, emulating older boys as happens). This is not a good situation for girls getting accurate feedback about what boys like.

          • OrangeInflation says:

            Your first paragraph has been more helpful than a thousand “love your body babe” affirmations flung about in recovery circles. Thanks for that rational look. I’m also embarrassed that it wasn’t obvious to me.

          • grendelkhan says:

            Christian Rudder did some digging on this on the old OkCupid data blog. (Rehosted on Jezebel, of all places.)

            tl;dr, better to be one person’s shot of whiskey than everyone’s cup of tea.

          • Rm says:

            Come on, 5 % is great! It means “I almost certainly attract the attention of at least someone in my school who is my age”. Adult women have to get by on much slimmer pickings.

            My friend lives in a village (almost a suburb). Once, there was a rumour of a maniac roaming around targeting young females, and the schoolchildren were warned against coming up to strangers. So many more of the girls started to wear miniskirts and try to get a lift in a passing car. And it was one measly maniac.

            OTOH, when I try to explain to a man how “a ray of sunset crossed her iris at an angle and illuminated it from within, and it was so beautiful”, he looks at me like he can’t get it. Other women are just much better at giving feedback at all.

            Which is a problem for anorexics who get too much feedback for being “potentially slim” and then build from there.

      • AnnaR says:

        Perhaps. Maybe a subset of men do – the ones all the girls are attracted to?
        It’s funny because in more than one girls’ young adult novel the main character (flat chested) envied thr busty dumb blonde cheerleader for her figure…. While in reality, I’ve observed the preference for boyish over Barbie often and it confused me.

        Of course with normal girls, behavior muddles this a lot, and a mediocre girl with a certain something “in her air and manner of walking” will fare better than Angelina Jolie lookalike who is standoffish or socially awkward.

      • John Schilling says:

        Do men find very skinny women attractive?

        From 1975 through 2008, Playboy centerfolds consistently had an average BMI of 18.1, standard deviation 0.87; less than 3.5% came in at 16.5 or below. So, perhaps “skinny” but not fashion-model or ballerina skinny. If OrangeInflation’s classmates were envious of everything down to 16, then either A: they were overshooting the mark out of ignorance, or B: they were not aiming to appeal to typical men, or C: they thought they knew better than the publishers of Playboy what typical men found attractive.

        That the men of modern Western Civilization desire women somewhat slimmer than average should not be surprising, given that “average” has lately been skewed by unlimited access to tasty food and greatly decreased need for physical exertion in daily life. But there seems to be a disturbingly common error of making the leap from “I should be skinnier than average to attract a man”, to “I should be as skinny as possible to attract a man”, if indeed attracting men is the object here.

      • benf says:

        I think the model of physical appearance as a means of procuring sexual attention is highly overrated in comparison with the need to impress people in your immediate social circle, which will tend to be same gender, non-romantic relationships. In short, women are trying to impress women, not men. Same with super-ripped guys: some girls may dig it, but the main point is to impress/intimidate other men.

      • benf says:

        “it may be that male fashion designers are more likely to prefer boyish figures.”

        Almost a laugh-out loud funny line that actually may have a lot of truth to it. If you’re looking for an indicator of what men find sexually attractive in women, an industry dominated by gay men is unlikely to be a useful resource.

        • bullseye says:

          Fashion designers want skinny models because they want the clothes to look the same on the model as on a hanger.

        • idontknow131647093 says:

          Fashion, generally, doesn’t seem to have much heterosexual male involvement. If it did, highwaisted things would never have been a thing, those weird shirts that make every girl look 5 months pregnant would never have been a thing, etc etc. There would be a balance between modesty and sexuality for sure, but dozens of recent trends I have seen girls go through over my fairly short life seemingly were about making women unattractive to men, or at least weird to them.

          I think the most famous one would be humongous sunglasses. No straight guy signed off on that. It makes everyone look the same. It was basically Harrison Bergereoning face cuteness.

          • The Nybbler says:

            The high-fashion glasses industry in general seems to be based on having models with strikingly attractive faces wear the ugliest glasses possible.

            The effect to me is “See, our models are so gorgeous they look good even wearing these hideous abominations”, but I guess for some reason it works for the glasses people.

      • Paul Torek says:

        Reminds me of a comedian who said something like, “I don’t get the fashion industry thing with ultra skinny models. I don’t like women to look like 12 year old boys. I’m a … whaddayacall it … heterosexual.”

        • ChrisA says:

          Evolutionary psychology reasons why men might be attracted to skinny women; they look younger and are less likely to have had children already, so maximising the resources they can put into your children.

    • Partisan says:

      Several of your points here ring true for me. I’m a guy; I’ve had some sort of eating disorder as long as I can remember; I have no idea why.

      Anorexics lie, all the time, about everything. About how much we ate, about how much we didn’t eat, about what we ate, about our physical symptoms, about how hungry we are. In my experience the anorexics who say they are disgusted by food or not hungry are either lying OR truly not experiencing physical hunger but rather experiencing a sort of “mental hunger…”

      This definitely describes me. I dedicate loads of mental energy into planning out what/when/where I’ll eat, have excuses planned out in case someone invites me to lunch or something, and am constantly ready with plausible reasons to decline food on offer.

      Many anorexics are also extremely conscientious types who are able to delay gratification in finance, sex, etc. Seems to me that a lot of people diet (self starvation) but only anorexics have the willpower to extend this to the extreme.

      Also me. I did very well in school, have very healthy finances, and in general have a high degree of self-control.

      The social approval for starvation is a major factor. From age 12 on most women expressed jealousy and approval for my weightloss.

      As a guy I never had this – the opposite, sometimes. However, I was / am often praised for my discipline, especially my rigid exercise schedule, which of course does reinforce my issues.

      I have no idea why men seem to like such extremely low levels of bodyfat.

      Here’s something I’m sure has to be related to my issues, but I have no idea how. I don’t prefer thin women at all.

      My girlfriend has a perfectly normal BMI; I’d like her to gain 15 or 20 pounds and become a bit overweight. When she’s gained 5 pounds on holiday or something I’ve always been very attracted to that.

      Is this a thing? Anorexics being attracted to overweight or obesity?

      I had to be constantly active in order to distract myself from the constant hunger. I felt like I could binge on pretty much anything at any time, so constant business was necessary to prevent that.

      I’ve not thought of this, but I do wonder how much of my educational and professional success is due to focusing on work so I could distract myself from constant hunger.

      (In case anyone’s worried, the severity of my issues seem to have peaked several years ago; and they’ve never been un-manageable.)

      • OrangeInflation says:

        Well, I still extend sympathy. Eating disorders are hell, professional success being the upside I suppose. For me, a healthy financial situation and extreme aversion to debt are the upsides.

        Are you deceitful in any other area? I am not. I am honest, except with respect to the eating disorder.

        This is also why I am skeptical that the proportion of anorexics is so heavily weighted towards female. How many men like you never get a diagnosis? All the reported stats are based on who is diagnosed, I would guess.

        This definitely describes me. I dedicate loads of mental energy into planning out what/when/where I’ll eat, have excuses planned out in case someone invites me to lunch or something, and am constantly ready with plausible reasons to decline food on offer.

        Yep.

        • Partisan says:

          For me, a healthy financial situation and extreme aversion to debt are the upsides.

          I too am very averse to debt. I am reluctant even to use a charge card, and bought my car and flat outright.

          Are you deceitful in any other area? I am not. I am honest, except with respect to the eating disorder.

          Yeah, same here. I go out of my way to be honest in other areas.

          This is also why I am skeptical that the proportion of anorexics is so heavily weighted towards female. How many men like you never get a diagnosis?

          I have to agree. The few times I’ve engaged with others about this, I’ve been steered toward dealing with “body image” issues, which I don’t really have.

          • OrangeInflation says:

            Thanks for sharing all this. Hearing from other people with eating disorders has made me more skeptical of a lot in medicine. The Gell-Mann amnesia effect seems relevant.

          • Partisan says:

            I appreciated your comments quite a lot; thank you for un-lurking for this.

            These notes really have had an effect on me. Your notion about working hard as a means to distract from ever-present hunger is probably going to change how I think every day.

            I said above that I’m really only deceitful on this one topic, and I feel a bit bad that I’m lying a bit in this thread – I’ve changed some of my details and am (of course) using an assumed name. If you’d like, you can send me a note: partisan@partisan.33mail.com .

            Thanks again, really.

          • HeelBearCub says:

            I’m confused about the statement that neither of you have “body image issues”.

            Is the following from the OC true?

            The fear that the moment I stopped I would eat everything in sight and then balloon up kept me on my feet all day.

            That seems like a body image issue to me? It’s not a current body, but a prospective body that is feared.

          • Partisan says:

            When I say I don’t have “body image” issues, I mean that I don’t have a distorted view of my current body. I don’t think I’m fat, or a part of me is fat, or whatever.

            I may be unusual in that I also don’t have a fear of “being fat,” i.e. I don’t have some image in my head of a fat version of myself that scares me.

            Rather, I have some compulsion to prevent myself gaining weight. It’s hard to describe, but it’s like I have an instinct to avoid it. I don’t have a visceral fear of it, but it’s always in mind.

            It’s something like this: When you’re driving, you really want to avoid drifting into oncoming traffic. You’re not actively afraid of that at any one moment, but your brain is constantly having your motor system make steering adjustments to prevent it from happening.

            One complication – it’s evidently not a fear of the number on a scale going up that I have. A while back I started resistance training, and I’m sure that I added muscle weight. This didn’t cause me any distress.

            (Another complication that must be related, but I don’t know how – I mentioned above that I’m not attracted to very thin women, and would welcome it if my (normal BMI) girlfriend gained some weight. This is mostly an attraction to the gaining weight, rather than the being fat, I think. I would probably be attracted by a woman who was gaining weight, even if she was very thin, if that makes sense.)

          • bullseye says:

            I’ve read that hunger influences a man’s taste in women; when he’s hungry he’s more attracted to heavier women. The theory is that when you’re hungry your interested in people who look like they have a good supply. I supposed weight gain is an even better sign of having food than being big to begin with.

          • Partisan says:

            @bullseye, wow! This never crossed my mind, but it’s another thing from this thread I’m going to be thinking about forever.

            I’m tempted to start a spreadsheet with when I’ve last had a meal, and how attractive the proposition seems to me at each time.

    • savannahjay says:

      I second your comment about “mental hunger.” In my own case, it became hard to sort out physical cues for hunger (appetite seemed consistently inactive/”flat”, like I could eat but didn’t need to) but the preoccupation with food was very persistent.

      Related to the physical activity, though, my own experience was somewhat different; movement/exercise feels less like a distraction and more like a separate compulsion to me (it feels like it occupies a different brain-space and doesn’t respond to or modify food-preoccupation), a scrupulous response to a fear that I am inherently lazy. I have heard a variety of explanations for over-exercise from other anorexics: a mechanism to try to restore hunger, an antidote to depressive tendencies, explicit self-punishment, and more.

      Possibly the over-exertion reaction is a biological fact of the starvation response and I have a unique set of influences which make my particular ex-post-facto explanation seem most salient, and everyone else with the disease would have a slightly different experience/explanation because we all like to have explicable cause and effect determinants of our behavior? (Which is not to dismiss your, my, or anyone else’s experience; I mean to say that maybe each brain is capable of translating the basic starvation response behavior into the most reasonable reasoning for each person’s conscious mind, as part of the process of successfully carrying out the behavior in the organism, which is how it might seem like a logical conscious response to us, but occur in animals presumably without conscious reasoning.)

      • OrangeInflation says:

        Your last paragraph is interesting. It does seem like the eating disorder is a bit of a virus, which creates a narrative to perpetuate itself.

      • Rm says:

        I am… probably anorexic and definitely depressed (not too severely), and I loved hiking. It was tied to my job, & being good about my job was why I could call myself a person. I was already seriously underweight then. Then I married, bore a kid, went on a diet to breast-feed, stayed at home for years, lost any internal right to call myself a person, and 4 kg of weight (my weight was and is very stable).

        So I would not say exercise is always the way anorexics get to become thinner, sometimes it’s the way we keep body mass up.

    • Nancy Lebovitz says:

      OrangeInflation, do anorexics feel better when they eat somewhat more than they usually permit themselves, but lie about it?

      • OrangeInflation says:

        Physically I feel better when I eat more, because then I am starving less, and starving makes everything hurt. Mentally I would feel worse. For me, it’s not that I don’t want to eat, it was that I was terrified to eat and gain weight.

      • Partisan says:

        For me the lying is always saying I’ve eaten more than I actually have.

        For example, I’m at some family event, and someone keeps offering me food. I might say “Oh, I just ate,” or “I’ll definitely have some later.”

  11. Berna says:

    In fact, the cycle may even be started by involuntary weight loss due to physical illness.

    I think this may have happened to my neighbor. She’s 90+ years old, and she was already thin, but now she’s been in hospital because of a broken hip and has become even thinner. She would love to gain weight, but she’s just not hungry, she says, and she gets nauseous when she tries to eat anyway. I wish I could do something to help her. 🙁

  12. b_jonas says:

    It’s good to finally read about a psychological disorder on Slate Star Codex where the description of the symptoms doesn’t fit me like a horoscope.

  13. John B says:

    The theory that people start starving for social reasons but then become trapped in it by physiological processes has been around for decades. It is the central analytical point in Rudolph Bell’s “Holy Anorexia” (1985), about those starving saints Scott mentioned. Some of the saints are stunningly well documented and we know that their confessors tried to bully or force them into eating –because, after all, suicide is a mortal sin — and although they were trained as nuns to obey church authority they simply could not. I would have to go back to the book to find the medical sources Bell drew on, but my memory is that they were rich and I found the argument entirely convincing.

  14. Murphy says:

    So, a number of people I know and work with also work with eating disorder patients.

    I have a half-baked hypothesis that’s I’ve been knocking around for a couple years based on a few things that seem like interesting coincidences.

    1: a common claim I’ve heard from clinicians working with near-death eating disorder patients is that some patients start self-harming when their condition becomes very extreme and stop when they’re made to put on a few pounds.

    2: kidney function suffers in such patients because… well, their bodies are eating their own organs and renal failure is one of the ways patients can go. As such uric acid levels can be quite high in ED patients and uric acid levels are sometimes tested for to monitor kidney function.

    3: there’s a rare genetic disorder called Lesch–Nyhan syndrome. Don’t google image search it. kids with the disease spend their short lives trying to eat their own fingers/lips/faces and compulsive self-mutilation a big problem. It’s not psychological. it’s 100% genetic and the syndrome is caused by a broken pathway that causes patients to have sky-high uric acid levels.

    4: patients suffering kidney failure and on dialysis become more inclined towards suicidal behaviour and self harm: https://www.ncbi.nlm.nih.gov/pubmed/24547611

    So, with those things in mind… my half-baked hypothesis is that at least in some people high uric acid levels (or possibly something else caused by the associated kidney problems) it causes something to flip in the human brain to make people more inclined towards self-mutilation and self-harm.

    Restore the kidney function and they stop trying to cut themselves.

  15. Anon. says:

    Are bodybuilders/weightlifters who go through bulk & cut cycles prone to anorexia?

    • Walter says:

      I feel like being a bodybuilder and being an anorexic are mutually exclusive, though I don’t have any personal experience with either one.

      Does that track? It seems like you can’t eat thousands of calories a day to get gains while simultaneously not eating to lose weight.

      • Anon. says:

        I mean yeah, if cutting induces anorexia you’ll stop being a bodybuilder pretty fast.

      • cryptoshill says:

        You physically can’t. Most bodybuilders eat like a monk for six months then eat an amount of calories that would be considered over the top if it was deliberately meant to make fun of fat people for the other six. It’s a very weird thing bodybuilders do, and it requires exactly the kind of discipline and conscientiousness about food and training that is a prerequisite for AN.

        It might be that this same process is evident in bodybuidlers, but they have achieved some sort of mind-over-body mastery of it that it doesn’t persist in the same way. That said, intuitively – ex-bodybuilders should become very fat or die of thinness. Do we have any data to back that up?

    • OrangeInflation says:

      The dieting needed to cut bodyfat to show levels of lean-ness often triggers disordered eating beyond the show. Many bodybuilders struggle with a cycle of binging and restricting. Source: personal experience, and hanging out in that world for a while.

    • HeirOfDivineThings says:

      Weightlifters seem to get reverse anorexia.

    • Thegnskald says:

      As I understand it, although it’s been some time since I’ve looked into it, bulimia tends to be more common in weightlifters, although the presentation is different (instead of purging by vomiting, weightlifters purge by doing a lot of working out). It doesn’t tend to get a lot of attention, however, either because it is seen as a positive thing in our culture, or because it has less nasty health consequences than other eating disorders.

    • Nancy Lebovitz says:

      I’ve heard about wrestlers (who force their weight lower to make weight classes) can develop eating disorders.

      • eccdogg says:

        This is the question I was going to ask. Wrestling (along with MMA and Boxing) can involve some serious weight loss and dieting and I wonder if it ever triggers anorexia.

        Personally I wrestled and sucked weight often. I would generally lose around 20 pounds between the end of football season and the start of wrestling season 210->189.

        I have been around wrestling most of my life (my father was a coach) and I can’t think of a case of anorexia that developed from sucking weight. Maybe it has to do with how wrestlers actually do it. Sure there is calorie restriction, but there is often a focus on dehydration because the key is just to weigh less not actually have less body mass. Also once weight is made wrestlers gorge themselves so they have energy for the match.

        • knockknock says:

          Jockeys often face an obsessive situation to make weight (about 115-120 pounds in North America). That includes long stays in the sauna, spartan diets, laxatives and “flipping” — deliberate vomiting. And remember these are not just kids but often guys well up into their 30s and 40s, when it gets even harder to stay so slim.

          The “flipping” is often referred to as bulimia but I’m not sure it’s really the same since it’s so deliberately aimed at a specific external goal, an exact number on the scale. Maybe if it got out of control …

          Meanwhile, I haven’t heard about jockeys or former jockeys developing anorexia, but like eccdogg with wrestling I wonder if that’s been looked into

          • eccdogg says:

            I found this https://www.ncbi.nlm.nih.gov/pubmed/10527308

            RESULTS:
            No significant differences were found between the number of in-season wrestlers and nonwrestlers classified as “at risk” for bulimia nervosa. Significant differences were revealed, however, between in-season wrestlers and nonwrestlers, and between in-season wrestlers and off-season wrestlers, on the Drive for Thinness subscale. In both cases, significantly more in-season wrestlers scored above the “at risk” cutoff on the subscale.

            CONCLUSIONS:
            These results indicate that although in-season wrestlers are more weight conscious than nonwrestlers, these feelings and attitudes are transient. All subjects classified as “at risk” also participated in an interview which followed the format of the Eating Disorder Examination. Interviews with in-season wrestlers revealed that their concerns with weight were due entirely to the demands of wrestling, and did not meet the severity level required for a diagnosis of bulimia nervosa.

        • johan_larson says:

          Also once weight is made wrestlers gorge themselves so they have energy for the match.

          Wrestling should really adopt BJJ’s practice of weighing the fighters right before the match rather than several hours before. Weight control would still matter, but the really extreme bits, including dehydration, wouldn’t work any more.

  16. kybernetikos says:

    This fits nicely into some personal theories and observations (so maybe I should be suspicious of it on that basis?), but another nice connection is to the marshmallow test.

    One interesting observation about the marshmallow test is that children who eat the marshmallow are doing the right thing if they live in a context where adults are not trustworthy.

    I have come to think that perhaps that – the trustworthiness of the adults in early life might be one of the triggers that might lead to adopting a fast or slow life strategy. There’s been lots of investigation into attachment in early childhood, and it makes complete sense from a storytelling and logic point of view that if you don’t form a strong attachment with some caregivers, then you’re probably living in a world where you need fast strategies.

  17. HeirOfDivineThings says:

    “Suppose for some people with some unknown pre-existing vulnerability, starving themselves voluntarily now flips some biological switch which makes them starve themselves involuntarily later”.

    Sounds a bit like alcoholism. Aren’t some ethnicities more prone to alcoholism than others?

  18. Thegnskald says:

    Has anybody checked gut flora of anorexics?

  19. yildo says:

    Concentration camp survivors?

    Audrey Hepburn was never sent to a concentration camp, but she did develop anorexia during her WW2 experience in the Netherlands.

  20. Hackworth says:

    If persistent Mal de debarquement exists, why not its anorexia equivalent?

  21. Irein says:

    I don’t know if anyone has posted this before, but there’s a beautifully-written article by Hilary Mantel about anorexia and medieval saints here.

    edit: I see Rudolph Bell has been mentioned above. Mantel discusses his work and others’.

  22. Cerastes says:

    Continuing my long history of speculating based on very different species: could it be energy conservation?

    I’ve got a long personal & professional history with pythons and boas, which are famous for consuming HUGE prey items (up to 100% of their body mass), and correspondingly have a digestive system which massively hypertrophies upon prey consumption – the intestines increase in mass 7x (both cell growth and replication), the stomach pH drops to under 1 (even bones and teeth dissolve), the heart grows 40% to keep up (folks are trying to adapt this to treat human heart issues), and they expend so much energy that they raise their body temperature several degrees C (pretty big deal for an ectotherm). Then, once it’s done, everything atrophies into a dormant state until the next meal, to save energy.

    The problem is that if they go off their food too long, the system basically shuts down and stays atrophied, and they seem to lose their appetite – they’ll fast themselves to death “voluntarily”. Correspondingly, the “standard treatment” is force-feeding, which puts something on their stomach and gets the system going again. This is less common is snake species which eat smaller and more frequent meals, and which correspondingly lack this growth/atrophy response.

    Obviously, humans are far inferior to not pythons, but the gut consumes a HUGE amount of energy in humans, just resting as well as during digestion. The celiac trunk and superior mesenteric arteries in humans are HUGE, nearly a centimeter in diameter. We know that the human digestive system does atrophy during starvation, but could that be a part of it? We also know there’s a lot of para/sympathetic neural connections in the gut (cue the somewhat misleading “there are more neurons in your gut than your brain” cliche).

    Maybe it’s a feedback cycle, where during starvation, the body offlines the expensive digestive system, and correspondingly the nerve feedback from it declines, putting the body into a low-hunger starvation state. Perhaps individuals have different “thresholds” or “activation energies” needed to move between these two states, and in some individuals the lack of feedback from the digestive system neurons makes that transition out of the starvation state an unscalable mountain?

    • JohnBuridan says:

      Awesome example. Someone must have done research on this? I wonder how anorexic respond to feeding tubes? Of course, feeding tubes are horribly unpleasant, and doctors are reluctant to do anything that invasive, but it’s would make an interesting study for stubborn anorexia.

      Do feeding tubes work on pythons? Or do we just cram things down the python’s throat? Or do we cram a tube down the throat and inject food?

    • Elementaldex says:

      That is really fascinating. I never knew how much I did not know about giant snakes eating things. Thanks!

  23. JohnBuridan says:

    Anecdotes:

    I have a close friend who specializes in working with people with eating disorders. The impression I have received from him, although these are my words not his, is that anorexia frequently is an overdeveloped “purity” value feedback loop, and that the strategy being employed is to surrender to their desire for purity.

    Another anecdote, I have a cousin with anorexia who deals with it by being vegan. It seems to work and it she manages to eat vegan or at least vegetarian friendly pies on occasion.

    Anecdote 3. A close friend with a supportive and fairly balanced religious upbringing seems to have been predisposed to scrupulosity. As he learned the moral code of traditional Catholic teaching he became almost unable to function in environments where people are not following the same strict moral code. I not talking about drug induced orgies, I mean normal groups in which either swearing or dirty jokes or marijuana is.

    I definitely think the switch exists, and hypothesize that it is tied somehow to neuroticism and purity.

    Does this fit any of your experience?

    • Hefficurious says:

      I’ve been getting to know a young anorexic, and this value feedback loop is a good match. It’s a baffling disease. Here is a sort of poetic model that sticks together for me.

      Perhaps Anorexia is an OCD that works on a value, rather than a fear. I imagine a little row of “values” comparator engines, somewhere in the brain, one assigned to cleanliness, one to kindness, one to keeping fit, etc. These values feed into our decision making brains somewhere at a higher priority than logic, about where “Gross” and “Abhorrent” are evaluated. These engines are the conscience, and they have the ability to torture us with with “I feel guilty”, and reward us with “I am virtuous”, regardless of what the logical mind thinks. Some are tiny and have almost no effect, and some are stronger. Usually they are small inputs among many, balanced by physical desires and logical plans. When you get to be a teenager, your brain opens up to adding new values from outside your family. Learning begins, but in somebody with an OCD tendency and a reason to get really skinny, maybe a nasty feedback loop can develop. Every time the body says “I’m hungry”, the value node says “Nope, eating is not virtuous, I must withstand”, and the OCD says “Why am I withstanding, it must be very important!”. Perhaps starvation chemistry kicks in as well, saying “Whatever I’m thinking about while starving must be super important.” (it should be “Damn it I should have stored more grain for winter!” or “Deserts are not nice places to live”). After this strengthening loop runs for a few months, instead of being a normal little value “Would be nice to lose a little weight, and bad to be gluttonous”, the value node becomes huge, overshadowing all others, with a cartoon clown message of “Angelically virtuous to be thinner than now; unspeakably abomination to be fatter than now”. This cartoon virtue has the ability to cause both pangs of self-abhorrence, and shots of virtuous ecstasy. So, now, the poor person has an internal training system with delivers the equivalent of electric shocks and golden cookies. Is it any wonder the person’s behavior becomes conditioned?

      It’s a fanciful model, but it has in its favor that it doesn’t propose any simple solutions. Doesn’t that makes it more likely to be closer to the truth?
      Values are sticky and hard to change even when surrounded by other people who don’t share them. What if anorexia is an error in the value learning system caused by a feedback loop? Is there a way to unlearn a value?

    • less_so says:

      I have a close friend who specializes in working with people with eating disorders. The impression I have received from him, although these are my words not his, is that anorexia frequently is an overdeveloped “purity” value feedback loop, and that the strategy being employed is to surrender to their desire for purity.

      Anorexic here. Not a doctor. I think this interpretation has a great deal of validity. Which in fact is why:

      Another anecdote, I have a cousin with anorexia who deals with it by being vegan. It seems to work and it she manages to eat vegan or at least vegetarian friendly pies on occasion.

      I did the same thing, after starving myself for about nine years. It appears that I was able to transfer the obsessive purity anxiety into a more healthy means of expression. I am rather open about this with my other vegan friends.

      • JohnBuridan says:

        Oh wow! Thanks for sharing.

        If you don’t mind my asking how strict of a vegan are you and do you experience disgust responses to food still?

        • less_so says:

          Cheers, of course.

          I am a strict vegan. I have gradually established a clear range of foods which are acceptable to eat, and it feels natural and comfortable to obey these rules continuously and without exception.

          I have intense disgust response to all meat products now. I would no sooner eat a meat product than I would feed a child a bottle of poison. One decade ago I would have said the same thing about almost any food. Now there are restaurants I eat at happily and my food intake and weight are quite normal. Except that they are vegan.

          I am somewhat aware that my disgust at animal products has an element of irrationality to it. I just allow myself to live with this for the time being.

  24. juliemadblogger says:

    I can only speak for myself. I often get bashed for saying this but I am speaking from my own experience, and that only. I was a promising music student, a composer, about to graduate. I had had a Jewish upbringing. I didn’t know what a fashion mag was, and I didn’t care, either. I took myself to therapy in 1981 at a community mental health center because I was having eating problems. I didn’t know it was called anorexia because it wasn’t a household word back then. The mental health professionals didn’t know what to do with me. Later, I learned that what I went through was likely typical. I went from one mental health professional to another, hoping to find one that knew about my problem, but they didn’t. Instead they gave me other diagnoses, mainly because they had to to justify the appointments. Instead of getting better, I got worse. It didn’t take long before my medical records no longer reflected the actual reason why I was there. Instead, I had multiple psych diagnoses on record that did not fit me, failed to describe my experience, and did not even mention ED anymore.

    After decades went past I was on a cocktail of drugs and mostly suffering from the effects of the drugs and the way they interacted with each other. I had to take more drugs to treat these effects. I felt embarrassed to bring up the ED. I had been trained well by the assume to assume it was trivial, that it didn’t matter, that these other diagnoses that weren’t even who I was were far more important. “How are your symptoms?” was the usual question. My answer was to list the usual litany of drug side effects. I was an SSDI recipient, a chronic mental patient. They even tried shock treatments on me. I agreed only because I secretly hoped they’d help my ED. They didn’t, and what actually happened was that I ended up severely disabled by the shock for the next 18 months. That was 1996-97. They added another diagnosis then.

    I was lucky because finally I was able to convince someone I actually had an ED, first and foremost. The therapist got me into ED treatment. However, what I saw of ED treatment shocked me. Was this the dark ages? Three decades had passed since the day I went on my first diet, and yet this was hardly state-of-the-art. I was 52 years old. My fellow patients and I knew far more about ED than the staff. The treatment was force-based and cruel. If it was all force-based, how could it possibly work?

    I began to see my life, how everything had happened, in a new way, and realize that a tragedy had occurred. What could I do now?

    I couldn’t erase 35 years of coerced unemployment and lost wages I never needed to endure. I can’t erase the hours and weeks I spent in humiliating day treatment or locked in “hospitals” against my will and lied to, told it was “necessary treatment.” I can’t erase the decades of treatment for depression, bipolar, schiz, and all the other diagnoses I never had, while my eating issues went ignored. I can’t erase the polypharmacy I never needed, that eventually destroyed my kidneys.

    I can tell my story in hopes that others don’t fall into the same trap. I can tell others there IS hope, that you CAN walk away from the system and rebuild your life, even though it’s not too common to do so successfully. I can tell others to hold onto that hope, to never give up. I know for sure that it was the diet that started the cycle, not some underlying mental disorder. I never had one! As soon as I got all the mental health, all the therapy out of my life, got them off my back, ended the addicting, obligatory appointments, ended it all, then almost like a miracle, after all those decades, my eating disorder stopped and never came back.

    It’s amazing that I can go to a grocery store and not feel fearful, that I can cook any meal I want, that I can eat without fear, that I can choose to exercise or not exercise without worry that a therapist is going to approve or not approve, and not only that, I’m extremely healthy, 60 years old, working and enjoying my career.

    I would wish the same blessing for anyone.

  25. srconstantin says:

    We have a lot of complex metabolic responses to dietary restriction that I’ve learned about in the course of reading about dietary restriction & longevity. Some of them are “good for us” — multi-day fasts trigger more removal of “trash” like senescent cells and misfolded proteins, improve our insulin sensitivity, and reduce chronic low-grade inflammation. Some people report euphoria during long fasts. Some people report increased physical energy.

    We evolved to survive periods of food scarcity; we (as in, everything from worms to humans) have a famine response oriented to *preventing fertility* and promoting survival. “Just get through this bad year, and don’t make any new investments.” Preagricultural humans regulated their reproduction not through elaborate chastity norms (as agricultural humans have) but simply by being too thin to be fertile when they couldn’t “afford” another baby. Female fertility starts dropping *long* before survival is in danger. I’m not sure exactly how this relates to anorexia but it seems like it probably has implications. (Speculation: perhaps the signal “ok, famine’s over, let’s get into babymaking mode” is not just driven by food availability and is neurologically mediated? For instance, let’s say you go into Famine Mode, but you’re also anxious; now you get food back but you’re still anxious, so you don’t switch back into growth-and-reproduction mode, and your appetite doesn’t come back and your metabolism is still set for famine survival. Given how hard it is for wild animals to reproduce in captivity, even when safe and fed, it totally sounds plausible that one’s perception of whether one’s environment is “a good place to have babies” affects fertility.)

    Hunger seems to be a tiered system — we have the ordinary peckishness when we’d like a meal, which comes from slightly lower blood sugar, but if we skip the meal and just keep fasting, that hunger *goes away* as we switch to glycogen or maybe fat stores. Keep fasting for longer and I’m not sure what happens is the same for everyone, but possibilities include weakness/fatigue, fainting, nausea, obsession with food, that weird sensation called “protein hunger” which iirc some languages have a different word for than ordinary calorie hunger…my hypothesis has generally been that anorexics are experiencing a signal of being underfed that literally does not feel like “a hearty appetite.” (I imagine we’ve all had this on occasion; I had an easily upset stomach as a young child and frequently complained of feeling too sick to eat when that nausea was actually hunger.)

    • Walliserops says:

      Building off of this idea, aren’t periods of moderate food scarcity in small communities exactly the kind of situation that would reward anorexia-like behavior? Such a community would presumably have enough food to sate any single individual, or even all its members for a limited period of time, but its overall fitness would be decreased by selfish actions. These populations would possibly be selected for the kind of altruism that involves (a) willfully abstaining from eating (especially after a sudden dip in food intake) and (b) increasing physical activity to find new sources of food, which risks harm to the individual but provides a greater potential benefit to the community.

      Skimming some Google searches, I can see other people suggesting altruism/anorexia links as well, but I don’t know if there’s any concrete study about whether anorexic individuals are more altruistic than the norm.

  26. August says:

    I would like to offer a possible way to increase weight. I lost a lot of weight, due, in no small part, to Seth Robert’s Shangri-La diet. He had a flavor/calorie association hypothesis. To lose weight, I took two tablespoons of walnut oil, with my nose clipped, so that I would not taste the flavor. This helped me lose my appetite and I was able to do all the paleo, low carb, calorie counting that I wanted. Then I got into the normal range for weight, and eventually noticed that I needed to eat more. I had to figure that out- the hunger didn’t just come back.

    I would think that someone trying to gain weight might want to focus less on calories, and focus more on flavor. Many dependable flavors (with some calories, but don’t try to stuff yourself) over the course of the day send a signal. And not just a signal that food is coming, but also a signal that the environment might just be conducive to human life. If you think of a long fast under adverse conditions, that our ancestors undoubtedly had to endure in the past- the lack of flavors would be a signal too- to downregulated many things in order to last long enough to survive.
    Focusing first on many flavors throughout the day could lead to an increased appetite, and the ability to increase calorie intake should follow. And there are more flavors than sweets- It’d be great if they could manage little bits of liver in their diet, to help replenish their nutrition.

    • cryptoshill says:

      Intuitively this makes at least some sense without even subscribing to the Shangri-la diet.

      Ever seen how fast hord’ouerves vanish at a party? Sometimes to the point where some of the people at the party don’t even feel like eating dinner?

  27. captbackslap says:

    I briefly had a college roommate whose anorexia started when he was an offensive lineman for his high school football team, and was thus made to gain a lot of weight, concurrently with a close relative’s life-threatening illness. After his last season on the football team ended, he started losing weight and just kept losing it.

  28. romeostevens says:

    Maybe not at all in the same ballpark but I just came off a 4 day fast and desserts seem completely unappealing. Guacamole, olive oil, and steak do. I wonder what would happen if recommendations were switched up to high fat rather than high carb.

  29. Pingback: Rational Feed – deluks917

  30. vV_Vv says:

    But after seeing enough ballerinas and cheerleaders who became anorexic after pressure to lose weight for the big competition, even I have to throw up my hands and admit anorexia has a cultural component.

    Simpler boring hypothesis: there is no cultural component to anorexia. Anorexics are overrepresented in current or former ballerinas, cheerleaders, fashion models, etc., because these professions select for thin people, and anorexics and pre-anorexics are overrepresented in thin people for biological reasons.

  31. idontknow131647093 says:

    And how come most people who starve never get anorexia? How come sailors who ran out of food halfway across the Pacific, barely made it to some tropical island, and gorged themselves on coconuts didn’t end up anorexic? Donner Party members? Concentration camp survivors? Is there something special about voluntary starvation? Some kind of messed-up learning process?

    It might have to do with voluntary activities, but in all those cases there is an extreme shift in environments. There are many documented cases of soldiers abroad (most notably in Vietnam) becoming severely addicted to opioids, but then on returning to the US they have no urges to use at all. Sometimes these things are compartmentalized.

  32. benjdenny says:

    I find the quoted text’s reasoning that Asian cultures stated initial reasons for stopping eating to be about digestion to be less than convincing; are we now suddenly sure that people’s stated reasons for doing things are always or even often their actual reasons? Especially in cultures in which we have admitted we don’t understand the culture around their anorexia in the same argument in which we state we understand the culture around their anorexia enough to know that they are shame-free enough to admit their actual reasons?

  33. pistachi0n says:

    I remember a year and a half ago or so you wrote a post about anorexia and metabolic set point. I found that post interesting–and this post–because I recognize a less extreme degree of this physiology in myself with no psychological origin. In fall 2016 I had a bad stomach bug, I couldn’t keep much down, I lost a bunch of weight, and I also hid that I was sick because I was starting out grad school and didn’t want that to be people’s first impression of me. But in retrospect that probably delayed recovery and I should have just taken a few days to lie in bed and do nothing.

    My anecdata is that eating hasn’t been the same since then–I seldom feel truly hungry, I get full after a few bites. It’s not an extreme reduction of my quality of life but I definitely have to be more aware that I may need food even when I don’t feel hungry, which is very counterintuitive to common health advice to listen to your body and not eat when you’re full. Re distorted body image, it didn’t occur to me that I was losing weight even though my pants kept getting bigger and bigger. I’d feel them slip down my waist and think “weird, my pants are getting so stretched out”. But I wasn’t thinking about how much I weighed or how I looked, at all, until I was weighed at a standard doctors appointment and noticed that I was 20 pounds lighter than the last time I’d weighed myself. “Oh, that’s why my pants don’t fit anymore–my jeans haven’t magically grown, I’ve shrunk!” So although I’ve never ruminated on my body image I definitely hadn’t noticed I’d lost any weight.

    • b_jonas says:

      You were weighed on a standard doctor’s appointment? What country is this, and did you have to pay much for those appointments? I was never weighed by doctors since I was a kid, not even once. Even before the surgical operation with anesthesia, the doctor just asked me my weight. I want to move to such a country. Not for measuring my weight, I can do that just fine at home, but because of the signal that sends about healthcare.

      • gbdub says:

        I am in the US, and I have literally never been to a doctor’s appointment of any kind (even an urgent care visit) where I wasn’t weighed and had my temperature, heart rate, and blood pressure checked.

        • Nornagest says:

          I frequently have, but only since five years ago or so, when I switched to a different clinic that skipped some of the traditional kabuki dance of doctors’ appointments.

          That stuff gets done when I come in for a physical, but I only do that once a year.

      • andrewflicker says:

        I mean, my experience with US doctors is pretty miserable, and I’m pretty down on doctors / the medical process in general… but I’ve still been weighed every time I’ve had a physical, and every time I’ve went to the urgent clinic for stuff like respiratory infections.

      • pistachi0n says:

        This was in the US, and I don’t think I’ve ever been to the doctor for any reason without them getting height, weight, blood pressure, and oral temperature.

    • cuke says:

      I think it’s possible there are longer-term sequela for some people after norovirus or food poisoning than is commonly recognized. I read through research on this after I failed to fully recover from a bout of norovirus. I think the gut ecology can get seriously out of whack and may not come back into whack without some additional support. We don’t know exactly what that support is, but it might include things like probiotics, fermented foods, eating fewer carbs for a stretch, antibiotic treatment for secondary infection in small intestine (SIBO), or other things.

      • pistachi0n says:

        somewhat ironically that’s very adjacent to my area of research in grad school–mechanisms behind long term complications of intestinal parasitic infection

        • cuke says:

          Oh that’s lovely! I’m a poster child for those kind of complications. I hope you guys figure it out. My anecdotes are at your service! There are things I would have so done differently if I’d known the risk for chronic illness I was accumulating.

          I consider some of my risk factors to have been: repeated annual stomach bugs from childhood, lots of foreign travel during my 20s with many bouts of travelers diarrhea, including salmonella infection not treated for awhile. And then at the time of the rotovirus infection, it came on the heels of another infection with an amoeba — that one may have been opportunistic at that point due to immune system weakening. Also, I never had vomiting with the rotovirus but was sick with it for two weeks while the other people in my household had the more typical 24 hours of vomiting and then done — I’d read that that kind of slow burn was a potential risk factor for complications afterwards.

          Afterwards, I developed celiac type gluten intolerance (possible gene expression due to repeated gut infections?), malabsorption problems, systemic inflammation, and positive rheumatoid factor, among other things. Long story and that’s already TMI, but I’m interested in your research! I’m significantly better than I was, but it’s been a 14-year experience so far.

          • pistachi0n says:

            that is interesting! I hope you continue to recover.

            more specifically I’m working on a project studying enteric hormone regulation (CCK, serotonin, gastrin, etc.) and associated physiological changes (GI motility, gastric emptying, intestinal epithelial barrier integrity) following infection with one intestinal parasite in particular that I’m not going to say because I’m paranoid about this comment coming up when people in my field google the right keywords.

          • cuke says:

            Understood. I wish you the best in your work!

  34. Watchman says:

    And how come most people who starve never get anorexia? How come sailors who ran out of food halfway across the Pacific, barely made it to some tropical island, and gorged themselves on coconuts didn’t end up anorexic? Donner Party members? Concentration camp survivors? Is there something special about voluntary starvation? Some kind of messed-up learning process?

    But many survivors of historical traumas did stop eating and fade away. It’s not called an eating disorder, at best being seen as a manifestation of melanchonia, but it was a common enough occurrence to be unsurprising. The person who survived then failed to eat existed; the need to classify them as anorexic didn’t.

    As to modern examples, are you able to make the statement survivors don’t have eating disorders securely? It seems to be an assumption that news’s testing.

    • Nancy Lebovitz says:

      I’ve heard more about survivors doing food hoarding than about them having eating disorders, for what that’s worth.

      I’ve wondered whether eating disorders are involve more than being underfed– they’re triggered by a combination of feeling obliged to eat much less than one wants while being surrounded by food that one has permission to eat.

  35. googolplexbyte says:

    I wonder if fasting after taking LSD increases the likelihood of anorexia.

  36. less_so says:

    I am interpreting the point to be something along the lines of “Suppose for some people with some unknown pre-existing vulnerability, starving themselves voluntarily now flips some biological switch which makes them starve themselves involuntarily later”.

    I know anecdotes are not data. But I am a possibly-former anorexic male and the “pre-existing vulnerability” mentioned in this proposition is most certainly some form of anxiety disorder.

    I have been in countless treatment centers; every AN patient in every one is suffering from anxiety of one or another grand magnitude. They observe that starvation treats the anxiety very well. They continue to starve. And then at some point (a year in? six months?) it is very noticeable that a ‘switch’ is flipped in your mind and something horrible has changed in the way you relate to yourself biologically.

    I strongly suspect that, contrary to what has been suggested upthread, causing people to fast voluntarily will not engender AN unless an existing anxiety disorder is present which the starvation can ameliorate.

    • Scott Alexander says:

      It sounds like you’re saying there might be three things?

      1. Wanting to be a ballerina or whatever, so you fast
      2. Noticing you are less anxious when you fast, so continuing for 6 months
      3. A switch that flips in your brain after 6 months

      Am I understanding you right?

  37. queenshulamit says:

    Bulimia confirmed for “worthless dumbasses trying and failing to be anorexic” (I am talking about myself, I am allowed to say this.)

    • OrangeInflation says:

      On again off again anorexic (see my thread above) here. It’s been my experience that most anorexics have a point at which they start bingeing, some are just able to push the bodyweight lower before the body fights back in that way. At an extremely low weight I did find myself bingeing, and then restricting for long periods. As my weight increased that urge passed. Just one of the many places where I feel common wisdom on eating disorders get this wrong– anyone with a bodyweight that’s not completely emaciated feels like an anorexic failure. The behaviors needed to maintain my weight get more and more insane the lower my weight goes, and after a while I had to accept that there’s just no reality in which I am <X lbs and not miserable and insane. I am sorry you are suffering, it's hell.

  38. Izaak says:

    Congratulations! This post overtook your other medical blog posts so far to become the one that disturbed me the most. I had to go get something to eat while reading it in order to avoid worrying about starvation.

  39. MP1996 says:

    Have you read Fasting Girls: The History of Anorexia</i? I think it does a good job of explaining the interplay of cultural and biological in anorexia. I think it talks about addiction to starvation more or less, how starvation can induce euphoria (but I also read it a long time ago).

  40. cheloniophile says:

    I am so glad someone is talking about this. For years I have had no desire to eat. I have always been naturally thin due to genetics, but it really picked up around eight years ago when I was incredibly depressed after a huge romantic failure and mostly stayed in bed all day for months, getting up to eat a sandwich or something in the afternoon more out of a feeling of obligation to keep myself alive than genuine hunger. It has nothing at all to do with body image. I am in great shape and like the way I look apart from trying to gain weight, but food just disgusts me and even when I do eat I get full after a few bites. Hunger doesn’t really feel that unpleasant, just something I naturally ignore like background music. Soylent saved my life by providing an easy way to quaff 400 relatively tasteless calories in a few seconds. Every doctor I mention this to just says “Hmm, sounds like you need to eat more.” Thanks, you don’t say. Exercise helps a bit, but hasn’t fixed whatever part of my brain is broken.

  41. hyperboloid says:

    Scott, you’re obsessed with genetics to a completely irrational degree. I have theory as to why this is, but I’m not going to share it here because it’s speculative and and not very flattering.

    I suspect the obvious answer is that there really is something different about voluntary starvation, and probably all sorts of voluntary behavior. There is a strange kind of fallacy common among people who are strongly convinced of any account of inner life that reduces psychology to physical processes im the brain. What they often do is continue to treat psychology as completely separate from biology and then treat psychology as irrelevant. What’s all this business of thoughts, feelings, and childhood traumas? Neurotransmitters, synapses , ans genes is where it’s at!

    But inner psychological states are physical events in the brain, and there is no reason to doubt they can have profound and lasting effects. It’s hardly surprising that the human brain would have evolved in such away that intentional behaviors, when pursued strongly and consistently enough, would eventually be written in to the firmware as it were and potentially become compulsive.

  42. Alexandre Z says:

    Wait, I’m confused. What about all the literature that shows weight-loss doesn’t last?

    • Nancy Lebovitz says:

      Have an epicycle.

      Weight loss *generally* doesn’t last. Maybe people resist dieting because they instinctively understand it isn’t safe.

      • Anonymous says:

        It doesn’t help that the most common method of weight loss – caloric restriction and exercise – is not all that different from being worked to death in a concentration camp.

        • Nancy Lebovitz says:

          Probably more like being an underfed peasant, but yes.

          I like to think ancient Romans would laugh themselves sick at the idea of free people walking on treadmills and not even grinding grain.

          • bullseye says:

            There was a Roman author who complained about men lifting weights instead of doing useful farm labor. Rich Romans didn’t have to do manual labor, but some of them did; I think it was considered a sign of virtue.

  43. Don_Flamingo says:

    I naturally fall into a pattern of forgetting to eat and eating little total calories over the day (though, not because I only eat tiny meals). Never felt hunger much. It’s not disgust with food. I like food and I like eating it, but it’s all pleasure and no desire.
    Having done loads of IF and then Keto, and then carnivore for some time, whilst working out and being on high dosages of Armodafinil long term has basically eliminated all hunger sensation. Having experimented with food replacements and protein shakes, probably didn’t help with that. I also did have a bout of involuntary starvation in my teens. In an Asian country, I just absolutely hated all the food. Got down to 53kg and I had extreme weakness spell, when waking up one day. Got taken to a doctor, he gave me a bunch of pills, I threw up. I was fine, the next day and slowly regained my weight. Since then, I eat and enjoy eating absolutely everything.
    I do eat, because I know I must. It’s still kinda instinctive, but it’s just not hunger and it’s a very weak instinct.
    But cooking is a chore and eating out is expensive.
    So I often have just one meal per day, without it being some feast.
    And I notice, that I usually feel, that it was good, that I ate.
    Though, I rarely feel, that I need to eat, to feel better.
    My weight is between 64kg and 74kg and I’m 187 cm tall. Between 10% and 14% bodyfat, if my electric scale is to be believed. I’m at the low end at the moment and will take care, to work out and eat more. But I feel fine. I haven’t gotten sick in two years, though I used to get lots of colds, when I was younger (am 26 now).
    I look somewhat young for my age and wonder sometimes, if I’ve accidentally unlocked the longevity benefits of caloric restrictions through sheer lazyness.
    Also, I think, that what people consider normal (and I don’t mean obese) is far from the optimum.
    I doubt, that people should feel much hunger, ever. Sounds unhealthy, really. Like you’ve conditioned your body to expect food three meals a day at specific times, like a trained dog. Don’t think the EEA hunters would have so much food or have it so regularly. A priori, would you expect it to be optimal for a flexivore predator like us, to have his digestion constantly working?
    Or that men could have possibly any benefit from more than 15% bodyfat?

    So if I would have no trouble of joyously eating a whole cake, if someone offered me one, then I don’t have anorexia? Good to know.
    This post reminds me to eat, though.

  44. Kaj Sotala says:

    And this is why I can’t subscribe to a purely cultural narrative of anorexia. How does “ballerinas are told they should be thin in order to be pretty” explain so many former ballerinas who want to gain weight but can’t? And how does it explain the weird, almost neurological stuff like how anorexic people will mis-estimate their ability to fit through doors?

    All of this makes much more sense in a biological context; it’s as if the same system that is broken in obese people who cannot lose weight no matter how hard they try, is broken in anorexics who cannot gain weight no matter how hard they try. There are plenty of biological models for what this might mean. But then the question becomes: how do we reconcile the obviously cultural part where it disproportionately happens to ballerinas, to the probably biological part where the hypothalamus changes its weight set point?

    I’m confused as to why this is confusing? Suppose we explain it as something like “cultural reasons to be thin strongly reinforce a desire to be thin, setting up a circuit in the brain that reinforces behaviors and changes to internal variables which seem to maintain the thin-ness; this circuit remains active even after the initial conscious motivation fades and the person understands it to be dysfunctional.” This would be a bit hand-wavy of an explanation, but still roughly in line with any other dysfunctional behavioral patterns where the person realizes that the patterns are no longer serving their purpose, but can’t help but to engage in them anyway.

    The only difference here is that the pattern is not purely behavioral but also affects biological variables, but placebo and nocebo effects are a known thing, so this wouldn’t be particularly unusual. People claiming to have electromagnetic hypersensitivity sometimes get genuine physical symptoms, despite it all being nocebo.

    • Paul Torek says:

      Exactly. The idea that “almost neurological stuff” somehow conflicts with cultural stuff is, how can I put this nicely, stark raving mad. Essentially all culture is encoded in neural connections. The information stored in books and films pales in comparison.

  45. rahien.din says:

    So, anorexia is a specific type of autoechopraxia. Like a tic.

  46. Manx says:

    Thanks!
    I’m actually treating 2 anorexic patients right now, and found this description very helpful. Even if an anorexic holds on to body-image issues, the physical discomfort associated with eating helps reinforce some of their moral intuitions. I think that explaining to them where the discomfort may come from and that it is not only ‘in their head’ in some sense might be liberating… Will have to see.

  47. Nancy Lebovitz says:

    Here are my general thoughts about eating disorders and such– my background is reading a lot of accounts of eating disorders, but not having an eating disorder myself.

    A lot of eating disorders seem to start with food restriction in childhood. I was surprised to see that it didn’t seem to matter whether the food restriction was chosen by the child or enforced by the parents.

    I think the standard of beauty in this culture involves being thin enough that most women lose quality of life if they try to achieve it.

    A lot of women get compliments on how they look when they are actually unhealthily thin even if they aren’t emaciated. This applies to eating disorders, enough dieting to feel bad, and being ill. There are women who are dying of cancer who feel better because at least they’re thin.

    I thought anorexics starved themselves because they are afraid of abused for being fat, and I believe this does happen, but apparently there’s also a motivation to be dramatically and praiseworthily thin.

    I’ve heard a claim that anorexia is co-morbid with a bunch of other mental disorders. Unfortunately, I don’t remember the list, but it wasn’t just anxiety. The author of Wasted is bipolar.

    As for what men want, it’s a fairly common story from fat women that there are men who want to have sex with them but not be seen with them in public. I’m not saying all men are like this, but it points at status issues about weight that aren’t about sexuality.

    Men get anorexia, and have a lot of trouble getting diagnosed, treatment, or even information.

    I do think there are significant cultural factors, but I can also believe the cultural factors hit people who are vulnerable for other reasons.

    The discussion here is a good reminder that there can be sensory issues involved that may be physical rather than psychological.

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