Psychorexia

I want to be clear from the very beginning, psychorexia is entirely psychosomatic. If you believe that your absent appetite, feelings of nausea, and/or food aversion is a byproduct of your anxiety or depression, then you probably have psychorexia. If you are unable to eat, but you believe the root cause to be something other than anxiety or depression, then you probably do not have psychorexia. Therefore, you should be evaluated by a medical professional to rule out any physical causes.

Psychorexia is not related to change in appetites due to body image issues (e.g. anorexia or bulimia). Additionally, psychorexia is not related to any major eating disorder. Psychorexia is simply a byproduct of one’s anxiety or depression. And it means that your stomach and appetite are highly sensitive and reactive to your psychological and emotional wellbeing. If you have any of the following eating disorders, or you feel your situation more aptly fits the description of one of these disorders, then you do not have psychorexia:

• Anorexia Nervosa: An eating disorder characterized by an intense fear of gaining weight, leading to self-imposed starvation and a distorted body image. Individuals with anorexia often have an excessive focus on body weight, size, and shape. (This is contrasted with people with psychorexia who often want to gain weight, and want to eat, but are physically unable to do so)
• Bulimia Nervosa: This disorder involves a cycle of binge eating, where individuals consume large amounts of food in a short time, followed by compensatory behaviors such as vomiting, excessive exercise, or fasting to prevent weight gain. Like anorexia, bulimia is associated with a distorted body image.
• Binge-Eating Disorder (BED): BED is marked by recurrent episodes of consuming large quantities of food in a short period, during which the person feels a lack of control. Unlike bulimia, individuals with BED do not engage in regular compensatory behaviors such as purging.
• Avoidant/Restrictive Food Intake Disorder (ARFID): Formerly known as selective eating disorder, ARFID involves limited food choices, avoidance of certain textures, smells, or colors, leading to restricted eating. It's not driven by concerns about weight or body image but can result in nutritional deficiencies.
• OCD and contamination: Associated with a form of eating disorder known as "Avoidant/Restrictive Food Intake Disorder (ARFID)" coupled with obsessive-compulsive features. In this case, the individual avoids eating due to an intense fear of contamination, a common theme in obsessive-compulsive disorder (OCD). The fear may be related to concerns about impurities in food, leading to restrictive eating patterns, nutritional deficiencies, and significant distress. It's a complex presentation that involves both elements of ARFID and OCD.
• Orthorexia Nervosa: While not officially recognized in all diagnostic manuals, orthorexia involves an obsession with eating only healthy or "pure" foods, to the detriment of overall well-being.
• Rumination Disorder: Characterized by the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. This behavior is not due to a medical condition but rather a lack of interest in eating.
• Night Eating Syndrome: This involves recurrent episodes of night eating, often waking up during the night to eat, with a significant amount of total daily food intake occurring after the evening meal. It can be associated with insomnia.
• Purging Disorder: This disorder involves recurrent purging behaviors (vomiting, excessive exercise, or fasting) without regular binge eating episodes. It shares similarities with bulimia but lacks the binge-eating component.

Anxiety-induced appetite loss is a multifaceted phenomenon with its roots deeply embedded in the intricate interplay between the nervous and endocrine systems. This physiological response is primarily orchestrated by the activation of the body's "fight or flight" stress response, governed by the sympathetic nervous system.

When an individual experiences anxiety, the amygdala, a crucial component of the brain's limbic system, perceives a threat and triggers the release of stress hormones, most notably cortisol and adrenaline. This activation sets in motion a cascade of events designed to prepare the body for rapid and heightened responsiveness.

Cortisol, commonly referred to as the "stress hormone," plays a pivotal role in mobilizing energy resources for immediate use. It stimulates the liver to convert stored glycogen into glucose, facilitating a surge in blood sugar levels. This elevation in blood glucose serves as a rapid energy source, aiding in the body's ability to cope with the perceived threat.

Simultaneously, adrenaline, also known as epinephrine, is released into the bloodstream. Adrenaline intensifies the "fight or flight" response by increasing heart rate, dilating airways, and redistributing blood flow to vital organs like the brain and muscles. Importantly, it acts on the hypothalamus, suppressing appetite through a complex interplay with neuropeptides.

The hypothalamus, a key regulator of hunger and satiety, is influenced by these stress hormones. Corticotropin-releasing hormone (CRH), released by the hypothalamus during stress, inhibits the release of appetite-stimulating neuropeptides such as ghrelin. Additionally, stress-induced cortisol release impacts the hypothalamic-pituitary-adrenal (HPA) axis, which further contributes to the suppression of appetite-stimulating signals.

Furthermore, anxiety-induced activation of the autonomic nervous system diverts blood flow away from non-essential functions, including digestion. The sympathetic nervous system dominance inhibits the activity of the parasympathetic nervous system, responsible for rest and digest functions, including stimulating appetite and digestive processes.

In summary, anxiety triggers a complex neuroendocrine response that involves the amygdala, hypothalamus, and stress hormones like cortisol and adrenaline. This orchestrated physiological reaction suppresses appetite through the inhibition of appetite-stimulating neuropeptides and the redirection of resources away from digestive processes, ultimately preparing the body to confront or evade perceived threats.

Anxiety-induced nausea is intricately tied to the physiological response orchestrated by the central nervous system when confronted with stress. The amygdala, a key component of the limbic system, initiates the stress response upon perceiving a threat. This activation triggers the release of stress hormones, notably cortisol and adrenaline. The ensuing sympathetic nervous system dominance leads to a series of physiological changes, including increased heart rate and altered gastrointestinal function.

Within the gastrointestinal tract, the sympathetic nervous system's influence is substantial. Splanchnic nerves release neurotransmitters like norepinephrine, affecting the smooth muscle and slowing down gastrointestinal motility. Concurrently, stress hormones impact gastric function, with cortisol influencing the secretion of gastric acid in the stomach. Elevated levels of gastric acid contribute to the sensation of nausea and discomfort. The inhibition of the parasympathetic nervous system, responsible for promoting digestion, further exacerbates these effects, leading to disruptions in normal gastrointestinal processes.

Emotional distress during anxiety also plays a role through the release of neurotransmitters such as serotonin and substance P in the gastrointestinal tract. These neurotransmitters modulate visceral sensation and contribute to the overall perception of nausea. In essence, anxiety-induced nausea is a consequence of the intricate interplay between the central nervous system, stress hormones, and the autonomic nervous system, resulting in disruptions to gastrointestinal motility, increased gastric acid secretion, and altered visceral sensations.

Depression-induced appetite loss involves a complex interplay of biological factors that impact the brain and its communication with the rest of the body. Two key neurotransmitters, serotonin and dopamine, are central to this process. Serotonin, often associated with mood regulation, also influences appetite. In depression, there's a decrease in serotonin levels, disrupting the normal functioning of appetite control centers in the brain, particularly the hypothalamus. This disturbance can result in a reduced interest in food and a decrease in overall appetite.

Dopamine, another neurotransmitter, is involved in the brain's reward system and motivation. In depression, alterations in dopamine levels affect the brain circuits responsible for pleasure and motivation, contributing to a lack of interest in activities, including eating. The combination of imbalances in both serotonin and dopamine systems contributes to the observed appetite loss in individuals experiencing depression.

Additionally, the stress response system, governed by the hypothalamic-pituitary-adrenal (HPA) axis, is frequently dysregulated in depression. This leads to an increase in the stress hormone cortisol. Elevated cortisol levels can affect the hypothalamus, a brain region that plays a crucial role in appetite regulation. The disruption in this hormonal balance contributes to a decrease in appetite as part of the body's response to stress.

Moreover, the autonomic nervous system, responsible for regulating involuntary bodily functions, is involved. Depression often results in increased activity of the sympathetic nervous system, which inhibits the parasympathetic nervous system responsible for activities like digestion. This imbalance further reduces the body's inclination to eat, as the digestive processes associated with the parasympathetic system are suppressed. In summary, depression-induced appetite loss is a result of disruptions in neurotransmitter systems (serotonin and dopamine), dysregulation of the stress response (HPA axis and cortisol), and alterations in the autonomic nervous system, collectively affecting the complex network that regulates appetite in the human body.

It is important to note that many people suffering with anxiety may also suffer from depression, and vice versa.

The following representation is a simplification and may not entirely encapsulate the complexity of the situation. However, it is plausible that an individual may be experiencing symptoms indicative of depression, leading to:

• A diminished interest in food or eating
• Complete loss of appetite
• Reduced desire or willpower to engage in eating
• Limited inclination or motivation to undertake cooking activities

Alongside the manifestations of depression, the presence of anxiety could contribute to:

• A sensation of tightness, tension, or trembling in the stomach
• A perception of warmth or flushing in the abdominal region
• Experiencing nausea during attempts to consume food
• A reluctance to partake in eating due to the unpleasant and discomforting nature of the process, involving nausea and the need to force down each bite

As we noted above, for the “appetite losers” (AL), the mechanism for loss of appetite due to stress/anxiety appears to be related to fight-or-flight. Stress activates the sympathetic nervous system, leading to the release of stress hormones like adrenaline and noradrenaline. These hormones suppress appetite by diverting blood flow away from the digestive system and towards the muscles and brain. Furthermore, they may experience gastrointestinal effects from the stress causing a tightening of the stomach or nausea, making the act of eating very unappealing. Biologically this appears to make sense.

But then why, by the very same token, does that same stress or anxiety cause other people to gain their appetite? It seems that the majority of people, when highly stressed or anxious, will actually eat more, or binge eat. Let's call these individuals the “appetite gainers” (AG). Biologically, stress will lead the body to create more cortisol, which then stimulates the release of glucose, triggering a drop in blood sugar levels, ultimately resulting in a craving for carbohydrates. This could further be amplified by the release of ghrelin due to stress, further increasing appetite.

If the AG are stressed/anxious, why does fight-or-flight not get activated and cause a suppression of appetite? If the AL are anxious, why doesn't the same cortisol raise their appetite? Why does ghrelin not get produced for the AL? Why does the very same activation of stress lead to two totally different physical outcomes? Is this all just psychosomatic?

One study shows the ratio of appetite loss to appetite gain in people who were depressed (not anxious): [1]

Patterns of appetite change were examined in a varied sample of depressed patients. In 66% appetite was decreased, in 20% it showed no change, and in 14% it was increased. In both directions, greater appetite change tended to be associated with greater severity of illness, suggesting the possibility of two distinct groups.

I’ve not been able to find an adequate answer to this paradoxical puzzle. There is not yet a definitive answer within the scientific community. But it does seem a group of German scientists may have stumbled upon some intriguing clues that could be the first footsteps on the path to unravel the mystery: [1] [2]

The team, consisting of researchers from several German university hospitals, examined the brain function of affected participants at rest and recorded their psychological symptoms. This allowed them to compare whether individual symptoms of depression are more predictable. To do this, they focused on the functional connectivity (also called connection strength; it describes the strength of communication between different brain regions) of the nucleus accumbens, one of the central regions in processing rewards and controlling goal-directed behavior, with other brain regions.

When patients with depression experienced a loss of appetite during a depressive episode, the strength of the connection between the reward system and other regions that play an essential role in value-based decisions and memory processes was reduced. If, on the other hand, there was an increase in appetite, the researchers observed a weaker connection between the reward system and the part of the brain where taste stimuli and bodily signals are processed. "These changes in the reward system were so prominent in severe depression that we were able to predict whether someone would suffer from an increase or loss of appetite based on the individual profiles of the reward system," Kroemer said, describing the study results. "In contrast, it was not possible to tell whether someone had depression in general or not. So, it's not just a change that matters, but especially the nature of the behavioral change."

Another study commented on the fact that its a mystery why this relationship between depression and how it affects appetite loss or appetite gain has not been previously researched or questioned: [1]

Appetite and weight changes are common but variable diagnostic markers in major depressive disorder: some depressed individuals manifest increased appetite, while others lose their appetite. Many of the brain regions implicated in appetitive responses to food have also been implicated in depression. It is thus remarkable that there exists no published research comparing the neural responses to food stimuli of depressed patients with increased versus decreased appetites.

However, they were able to pinpoint the areas in the brain where appetite gain or appetite loss is triggered by depression:

Depression-related increases in appetite are associated with hyperactivation of putative mesocorticolimbic reward circuitry, while depression-related appetite loss is associated with hypoactivation of insular regions that support monitoring the body’s physiological state. Importantly, the interactions among these regions also contribute to individual differences in the depression-related appetite changes.

But why those cerebral areas are triggered for some and not others is still a mystery. And could be a product of the complex interplay between both nature and nurture. [1] [2] All we can say for sure is appetite loss caused by anxiety or depression is psychosomatic and idiosyncratic. In the end, it doesn’t really matter why some people lose their appetite when anxious or depressed. What matters is being able to alleviate or cure those symptoms and return to healthy eating, with a hardy appetite, and devoid of nausea. Treatments are discussed below.

Beware the anxious thought loop. Anxiety creeps in, causing a loss of appetite and the onset of nausea. Soon enough, the mere sight of food or the prospect of a meal triggers anxiety, creating a self-perpetuating cycle. Intrusive thoughts flood your mind: "Can I manage to eat this?", "I hope I don't feel nauseous," "I pray my friends won't notice my lack of appetite," "Will this make me sick?" The worrisome stream continues with questions like, "Will this ever end?" In the past, appetite loss and nausea was the result of some stressor in life, suggesting a return to normal eating once the stress subsided. However, the anxious thought loop causes a loss of appetite whenever you're near food or even just thinking about it—anticipating the struggle to eat or fearing the onset of nausea.

To break free from the anxious thought loop, consider embracing Vipassana meditation and cultivating awareness of your sensations. Thoughts always lead to other thoughts, creating a vicious spiral. By directing your focus to your breath or bodily experiences, such as your belly or throat, you can confront these sensations with equanimity. Gradually, with time and practice, their intensity tends to diminish. However, attempting to flee or avoid the thoughts and sensations only serves to increase their severity.

Chronic anxiety can have a significant impact on the gastrointestinal (GI) system due to the prolonged release of stress hormones such as cortisol and adrenaline. These hormones can have a direct effect on the digestive system, causing changes in digestion and increasing stomach acid production. Prolonged expsore to these stress hormones and aciditidy can create long-lasting GI issues, such as: [1]

• Functional dyspespia - a specific subtype of dyspepsia characterized by chronic or recurrent upper abdominal discomfort or pain that cannot be attributed to any identifiable structural or biochemical abnormality. In other words, functional dyspepsia is diagnosed when there is no evidence of an underlying cause for the symptoms. The symptoms include pain or discomfort in the upper abdomen, bloating, fullness, early satiety, and nausea.
• GERD (Gastroesophageal Reflux Disease - a digestive condition that causes acid reflux, which is when stomach acid enters the esophagus and leads to sensations like heartburn and trouble swallowing.
• IBS (Irritable Bowel Syndrome) - a common disorder that affects the stomach and intestines, also called the gastrointestinal tract. Symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both
• Stomach ulcers - also known as gastric ulcers or peptic ulcers, are open sores that develop on the inner lining of the stomach, the small intestine, or the esophagus. These ulcers typically result from an imbalance between digestive fluids in the stomach and the protective mechanisms that line the stomach and intestines.

It is advisable to consider consulting a gastrointestinal (GI) specialist if you have been experiencing chronic anxiety over an extended period. Seeking such evaluation can help to identify and address any potential underlying physical conditions that may exacerbate symptoms such as difficulty eating, loss of appetite, or nausea.

Hope and Help for Your Nerves by Dr. Claire Weekes outlines a practical and effective approach to overcoming anxiety through four key steps: Facing, Accepting, Floating, and Letting Time Pass. Here's a detailed explanation of each step:

1. Facing: This step involves confronting the situations or bodily sensations (stomach trembling, nausea, etc) that trigger your anxiety. Instead of avoiding them, you deliberately expose yourself to them. By facing your fears, you begin to realize that they are not as threatening as they seem. This step is crucial because avoidance can reinforce anxiety by preventing you from learning that you can cope with the situation.
2. Accepting: Acceptance is about acknowledging your anxious feelings without trying to fight or control them. Instead of struggling against your anxiety, you embrace it as a natural response to stress. By accepting your anxiety, you remove the added layer of distress caused by resistance and struggle. This step helps you shift your focus from trying to eliminate anxiety to learning to live with it in a more manageable way.
3. Floating: Floating involves adopting a detached and observant attitude towards your anxiety symptoms. Instead of reacting with fear or panic, you allow the sensations to happen without resistance. Imagine yourself floating on the surface of the water, allowing the waves of anxiety to pass beneath you without pulling you under. By practicing this detached observation, you can prevent yourself from becoming overwhelmed by your symptoms.
4. Letting Time Pass: This step emphasizes the importance of giving yourself time to recover from anxiety episodes. Instead of expecting immediate relief, you allow yourself the space and patience to gradually calm down. Recognize that anxiety is temporary and that it will eventually subside on its own. By letting time pass, you avoid the urge to rush the process and trust in your body's natural ability to regulate itself.

Overall, the approach outlined in the book emphasizes the importance of facing anxiety and the manifesting sensations in the body, accepting it without resistance, adopting a detached attitude towards symptoms, and allowing time for recovery. By following these steps, individuals can develop a healthier relationship with anxiety and learn to manage it more effectively.

Fear is the Root Cause

Whether [mental] breakdown be mild or severe, the basic cause is fear. Conflict, problems, sorrow, guilt, or disgrace may start a breakdown, but it is not long before fear takes command. Even great sorrow at the loss of a loved one is mixed with fear, the fear of facing the future alone. Guilt opens the door to fear. Anxiety, worry, dread are only variants of fear in different guises.

Fear of the Sensations Themselves Causes more Fear

The nervous illness described in this chapter was not complicated by a particular problem. It was caused by no more than fear of the very feelings that fear itself had aroused, and as such is the commonest and most straightforward form of nervous illness we know. If yours is this type of illness, it is a step toward cure to see your various symptoms as part of a single pattern coming from a single cause, fear. These symptoms are not peculiar to you, but are well known to many like you.

Face the Bodily Sensations

Begin with the nervous feeling in your stomach, the so-called churning. This may feel like an uneasy fluttering or may bore steadily like a hot poker passing from your stomach to your back. Do not tensely flinch from it. Go with it. Relax and analyze it. Take a few minutes to do this before reading on.
Now that you have faced and examined it, is it so terrible? If you had arthritis in your wrist, you would be prepared to work with the arthritic pain without becoming too upset. Why regard this churning as something so different from ordinary pain that it can frighten you? Stop regarding it as some monster trying to possess you. Understand that it is but the working of oversensitized adrenalin-releasing nerves and that by constantly shrinking from it you have stimulated an excessive outflow of adrenalin that has further excited your nerves to produce continual churning. By your anxiety you are producing the very feelings you dislike so much.
While you examine and analyze this churning a strange thing may happen: you may find your attention wandering from yourself. This “thing,” which seemed so terrible while you stayed tense and flinched from it, may fail to hold your attention for long when you see it for what it is—no more than a strange physical feeling of no great medical significance, and causing no real harm.

Accept the Sensations, and Don't Rush the Process

So, be prepared to accept and live with it for the time being. Accept it as something that will be with you for some time yet—in fact while you recover—but something that will eventually leave you if you are prepared to let time pass and not anxiously watch the churning during its passing.
But do not make the mistake of thinking that it will go as soon as you cease to fear it. Your nerves are still sensitized and will take time to heal, just as a broken leg takes time. However, as you improve and are no longer afraid of the churning, and do not try to cure it by controlling it, and are prepared to accept it and work with it present, you will gradually become more interested in other things and will gradually forget to notice whether it is there or not. This is the way to recover. By true acceptance you break the fear-adrenalin-fear cycle or, in other words, the churning-adrenalin- churning cycle.

Be Kind to Yourself

True acceptance means letting your stomach churn, letting your hands sweat and tremble, letting your heart thump without being too disconcerted by them. It does not matter if at first you cannot do this calmly —whocould? It may be impossible to be calm at this stage. And you may find that one minute you can accept, the next you can’t. Don’t be upset by this—it is normal in the circumstances. All I ask for as acceptance at this stage is that you are prepared to try to live and work with your symptoms while they are present, without paying them too much respect. Don’t be bluffed by physical feelings!

The Negative Sensations are Always Exaggerated

After examining these “terrible feelings,” I want you to remain seated and concentrate on each in turn and try to make it worse. You will find you cannot. The power of the adrenalin-releasing nerves is limited. You may succeed in slightly intensifying its effect with concentration, but only slightly. And yet, all the time, without realizing it, you have been shrinking from facing these symptoms squarely because you were afraid that by so doing you would somehow make them worse. It was as if you gave them a fearful, sideways glance.
Let me reassure you. You cannot increase your symptoms by facing them or even trying to intensify them. In fact, you may find that when you try consciously to make them worse, they improve. The very act of concentrating on them in this way means that, for the time being at least, you look at them with some interest rather than fear, and even this brief respite from tension may have a calming effect. In other words, you are no longer withdrawing from your symptoms. Symptoms can be intensified only by further fear and its resulting tension, never by facing and accepting. Are you beginning to suspect that your symptoms may have had you bluffed? They most certainly have.

Floating is remaining Detached and Equanimous

To float is just as important as to accept, and it works similar magic. I could say let “float” and not “fight” be your slogan, because it amounts to that. Just as a person, floating on smooth water, lets himself be carried this way, that way by the gentle movement of the water, so should the nervously ill let his body “go with” the feelings his nervous reactions bring instead of trying to withdraw from them or force his way through them.

Regarding Nausea

Eating may be a problem. You have probably lost weight and feel nauseated at the sight of food. Do not make the mistake of thinking that because you feel nauseated and are under stress, your food is doing you little good and that therefore you need not eat much. Even when eaten in these conditions food will nourish you, although it may take longer than normal to digest. Malnutrition and anemia can bring symptoms like yours, so you must eat enough.
If you have eaten poorly for weeks, your stomach may be unable at first to hold a normal-sized meal. If so, take small meals frequently. Drink egg flips and plenty of milk. Also, take a daily dose of vitamins, but only theamount prescribed by a doctor. Too many vitamins can be as dangerous as too few.

On Fear of Vomiting

Many nervously ill people are haunted by fear of vomiting in public, but I have not yet met one who has actually done this. Many have gagged gently to themselves or have hurriedly left the hall to gag in the lane outside, but vomit food—no. This is remarkable when we realize that short of putting his finger down his throat, a nervous person could hardly stimulate his stomach, abdominal, and throat muscles more than he does by his tense, anxious control of them. It is not as easy for a healthy stomach to vomit food as one imagines.
If the nervously ill person were to let go and give up the struggle to try not to vomit, his muscles would gradually relax and vomiting would be even less likely. If he does not vomit while tensely on guard, he certainlywill not do so when he relaxes and lowers that guard, and how much more comfortable he will be.

The Goal

Calm acceptance, despite delayed recovery, is your goal.

Recovery Takes Time

Having faced and accepted the disturbing sensations of nervous illness, your next question will be, “How long before I am myself again?” Now, it is almost certain that, despite your new approach to your illness, your symptoms will continue to return for some time—perhaps, at first, as acutely as before you read this book. You will understand this when you appreciate that your adrenalin-releasing nerves will continue to be fatigued and sensitized for some time longer, in spite of the new approach.

Never Run from Feelings or Sensations

Let the feelings come. Running away won’t prevent them. But if I accept them, they will gradually calm down.

Setbacks Happen

You may sometimes go in search of the old sensations to try yourself out, thinking it too good to be true that you are free of the wretched things. Go ahead. You can come to no harm if you go toward them and don’t withdraw from them. What cured you in the past (facing, accepting, and letting time pass) will continue to do so, in spite of any setback. So accept any setback, however long it may last, and let more time pass.

Depression

Depression is born from emotional fatigue. If depression strikes suddenly as a strong physical feeling, it can be a shattering experience, and it is hard to believe that the world is still a good place to live in and that recovery is worthwhile and possible. The sufferer rarely understands that this is but another expression of his extreme fatigue. Our moods are so much a part of us that it is difficult to regard them dispassionately. When the world seems black it is not easy to say, “It is I who am out of sorts, not the world.”

Nervous Illness can create Obsessions

Obsession is one of the most alarming manifestations of nervous illness and more than any other symptom convinces the sufferer that he must be on the way to madness. And yet it can start very simply in a fatigued person. Most of us have a mild obsession or two; for instance, the woman who, on going out, must return and check the faucets or gas jets, although she knows perfectly well she turned them all off before leaving. Obsession that comes with nervous illness is more demanding than this and is characterized by repeated compulsive thought or action which is always distasteful, even fearful, to its victim.

Indecision and Unresolved Problems

If some distressing problem has brought you to a state of great emotional and mental fatigue, you have probably realized that you now have little hope of making lasting decisions about your problem without help. You will certainly try to force yourself to do so, at great expense of nervous energy, but you will probably be unable to hold any decision for long and will make new, even momentous, decisions every little while. One moment you will think you have everything straightened out and feel happy about it. And then you find, perhaps only a few moments later, some new aspects of the problem that send you immediately off into indecision again.
You seem to be propelled into always thinking the same thoughts. In this condition it is essential that you seek help. You must have someone with whom to discuss your troubles and help you find a satisfactory way of looking at them. Only then will your sensitized body begin to find peace, your tired mind find rest.

The Road to Recovery

Recovery, then, from nervous illness caused by some apparently insoluble problem lies, first, in understanding and losing fear of the bodily symptoms that accompany the stress of long anxious brooding and, second, in learning how to compromise by finding, if not a perfect solution, as least a satisfactory way of looking at the problem. It lies in then practicing glimpsing this new point of view until it is established as the final point of view. Glimpsing may be difficult at first, but it is a most important part of treatment.