Giving ‘Til It Hurts’, R. Bachner-Melman and B. Oakley:
"After all, over the past century thousands of articles and books on altruism have pointed out that caring for others is central to all human social structures. The study of altruism has recently gained momentum as neuroscience has revealed the role of genetics and neurophysiology in our feelings of compassion and empathy. It appears we are hardwired to care for others. And if most of us derive a sense of competence, pleasure and self-worth from being kind, helpful and generous towards others, how could altruism be pathological? Many researchers are so invested in the benefits of altruism that they frown on studies emphasizing its potential pitfalls. Western societies have become so focused on its benefits that its flip side has been virtually ignored."
"pathological altruism can be defined as 'the willingness of a person to irrationally place another’s perceived needs above his or her own in a way that causes self-harm'."
"Empathy involves experiencing the same feelings as the person with whom we are empathizing, somewhat like feeling bad for someone in a pit and climbing down into the pit to comfort. Compassion involves concern, but not necessarily the same feelings as the person to whom we are offering compassion, like inviting the person in a pit up to your level to share a cup of tea and talk more dispassionately about the problem together."
“ 'I was a pleaser from a very young age to my father, mother and other family members and friends, and this took away my freedom to make choices that were right for me,' writes a 44-year-old woman in recovery from anorexia nervosa after over 20 years of illness (D. Friedman, personal communication, September 7, 2009)."
"Often, a poorly defined sense of self leads those who develop eating disorders to constantly adapt themselves to external needs and expectations. The experience of negating themselves and denying their needs in order to serve others therefore becomes all too familiar."
"Sufferers, therapists, researchers and theoreticians have all documented the low priority eating disorders patients allocate to their own rights and wishes and the high priority they give to the needs and expectations of others."
"Hilde Bruch was among the first clinicians to emphasize the extent to which individuals with eating disorders, whom she called “consummate caretakers”, stunt the growth of self-identity by constantly giving to others."
"Eating disorders may be seen in this context as an attempt to deny dependence on everybody and everything, symbolized by them becoming dependent on food-related contexts. Other biological needs, such as the need for rest, sleep, and sex are often also pushed aside. Medical care may be seen as superfluous and basic interpersonal needs for affection, support and help are denied. A regimented, ritualized daily schedule regulated by behavioral and moral rules provides an effective strategy to avoid the satisfaction of genuine needs and to appear self-sufficient."
"Palazzoli emphasized the guilt experienced by children who later develop eating disorders in response to their needs, and described family dynamics that lead them to feel responsible for their parents’ wellbeing. Bachar pointed out that eating disordered patients often recall feeling responsible for their parents and taking on a comforting, organizing role at home."
"All too often the parents of adolescents with eating disorders, particularly anorexia nervosa, ignore and deny their child’s illness as long as possible, and react with incredulity and disbelief when confronted with it. How, they ask, could such an easy, sweet-natured, undemanding and self-disciplined person possibly become ill?"
"A person with an eating disorder equates food with self-indulgence and selfishness."
"In the absence of the ability to give to self and little sense of how much of self is reasonable to relinquish for the sake of others, giving often smacks of martyrdom."
"The motivations and feelings behind the act of giving are central to the distinction between normal and pathological altruism. For people with eating disorders, the simple joy of giving is often tainted by anger and frustration, conscious or unconscious, at sacrificing so much and receiving so little in return. Bruch wrote that women with anorexia nervosa help and serve other people, but disown their anger and aggression. The tendency of women with anorexia nervosa to repress needs and feelings, especially anger, to protect interpersonal relationships, has been supported from a cognitive and sociological perspective by Geller and her colleagues."
"Treatment is an unfamiliar and challenging experience for eating disorder patients, since it provides the opportunity to focus on their needs instead of those of others."