FIVE

Thinking Our Way into the Toxic Triangle

PRESSURES TO BE thin, caring, and empathic toward others, and to cope quietly and internally with stress, lead some women to develop ways of thinking about themselves and the world that can further set them on the path to the toxic triangle. These thinking styles, or ways of processing information, keep women focused on controlling their bodies and minds as a way of coping, instead of acting to change societal norms and the pressures they face as a result of them.

Overthinking

When something distressing happens, like getting a pay cut on the job, it’s natural to think about it. We turn it over in our minds, analyzing the situation. Should we file a grievance? Change jobs? Many of us decide there isn’t anything we can do, and move on; some decide to take some action to make the situation better. For example, we might come to the conclusion that since everyone else has gotten a pay cut, there is little we can do about it, and since we don’t want to change jobs right now, we’ll just have to live with less money. Or we might decide to immediately apply to a new job because in fact the pay cut is outrageously unjustified.

But some of us have a hard time doing either. We roll potential decisions over in our minds, again, and again, and again. We question the motives of the people involved—how could our boss be so mean? We look for a deeper meaning in the situation—is there something about me that means I can’t find a stable job? We worry about the future—what if I can’t live within this lower salary, or can’t find a better-paying job? We connect this situation to ones that have happened in the past—my last two jobs were with companies that had to downsize, it’s just not fair!

I have labeled this process of going over and over a situation and the feelings it provokes, rehashing things that have happened before, worrying about the future, being unable to make decisions in the present, as overthinking. In my book Women Who Think Too Much, I described dozens of women who get stuck overthinking. They can’t let go of past events, constantly rework or “relive” them, trying to understand their meaning and implication for their lives. Fretting about things that haven’t happened yet, they anticipate the worst and consequently become immobilized when they try to make decisions.

Jenna, a twenty-six-year-old junior marketing executive for a major firm on the East Coast, is a rabid overthinker whose bouts can cover vast territory—her work, her family, her love life—but the most common focus is her body, and how much she eats and drinks. Let’s listen to some of the thoughts that go through her head.

I can’t believe I lost control so completely last night at that reception for our office! I’d been doing so well on the promises I made to myself to eat healthily and not drink. I should have been able to keep control, even though the food was spectacular and the wine was free. Instead, I ate like a pig—I must have consumed a thousand calories! And I’m not even sure how many glasses of wine I had! I know it was enough to make me feel lousy today!

I’m just a weakling. I always seem to lose control no matter how hard I try. I can’t keep my promises to myself in other areas of my life, either. I’m not exercising like I should. I’m not keeping in touch with old friends like I said I would. What’s wrong with me? Why can’t I do even these simple things?

I’m never going to find a guy if I can’t get a grip on myself. No wonder I can’t keep a relationship going for very long. What guy would want a woman who can’t control herself around food and wine? I saw that guy, Sam, from the accounting department sneering at me last night. He probably thought I was disgusting standing by the table just shoveling the food in and guzzling the wine down.

Oh, I hope my boss, Karen, didn’t notice me last night. I’m having a hard enough time impressing her on the job—I don’t need her to think I’m a drunk. What if she saw me? Should I say something to her, apologize or something? But then she might take my defensiveness as a sign that I really do have a drinking problem. And what if she didn’t see me? I don’t want to say anything if she didn’t see me! Okay, who was there standing near the table last night that I can trust? Is there someone I can ask if Karen was anywhere near while I was chowing down at the food table?

Jenna might have had reason for concern if she actually had been standing by the table gorging herself on food and gulping down alcohol—but that’s not what she did. She took a reasonable plate of food and a glass of wine and stood there talking with coworkers as she ate and drank. Thanks to overthinking, this plate of food and glass of wine turned into an orgy of eating and drinking. Now Jenna—again thanks to overthinking—is making matters worse by anxiously talking with coworkers about her exaggerated memory of her own behavior.

Overthinking doesn’t just make us have unwise conversations with our coworkers. In twenty years of research, I have found that overthinking can also lead to significant mental health problems.1 The first is depression. My students and I have conducted several studies in which we have tracked overthinkers and nonoverthinkers for a period of a year or two. We have found that overthinkers are significantly more likely to develop moderate symptoms of depression, and even to be diagnosed with a depressive disorder, than are non-overthinkers.

Overthinking leads to depression in several ways. First, when you overthink, you are looking for trouble—you dredge up problems and bad memories from the past, you focus on obstacles in your current situation, you worry about the future. These negative thoughts tear you down, make you feel hopeless, helpless, and depressed.

Second, overthinking gets in the way of doing what you can to take control of your problems and feel better. Although women often enter into bouts of overthinking because they are trying to understand problems they’d like to solve, overthinking actually interferes with good problem solving. It’s harder to generate good solutions to problems when you are overthinking. I showed this in an experiment I conducted with Sonja Lyubomirsky, now a professor of psychology at University of California, Riverside.2

Sonja and I invited two groups of moderately depressed people to participate. In one group, we encouraged them to begin overthinking (by directing their attention to the kinds of thoughts that overthinkers get stuck on). In the other group, we encouraged them not to overthink, by giving them pleasantly distracting scenes on which to focus (such as a fan slowly turning on a warm day, or a bird gliding overhead). We then gave everyone in the study a difficult interpersonal problem, such as a friend who is avoiding you, and asked them how they would solve it. The participants in the overthinking group generated solutions that were significantly less effective than those in the pleasant distractions group. For example, the overthinkers’ “solutions” included “I guess I’d just avoid my friend too.” In contrast, the people in the distraction group came up with solutions such as “I’d gently ask my friend if I’d done anything to offend her.” When you are over-thinking, you may feel you’re gaining great insights into your problems, but you’re actually working at a disadvantage in terms of problem solving. As a result, problems don’t go away, they just get worse, which can make you depressed.

Third, overthinking annoys other people. With psychologist Christopher Davis, who is now at Carleton College in Ottawa, Ontario, I did a study in which we tracked, for two years, over-thinkers and non-overthinkers after they had endured the death of a close family member (usually an elderly parent or spouse).3 The overthinkers reached out to others for social support more than the non-overthinkers, which makes sense. Because overthinkers had so much on their minds, they wanted to share their thoughts and concerns with trusted friends and family members. But over time, the overthinkers reported that people pulled away from them, and even became hostile. In essence, the overthinkers were violating social rules about how long one should actively grieve a loss—they were thinking and talking about their loss and their feelings way beyond the time when their family members and friends felt they should have moved on. As a consequence, friends and family members became increasingly frustrated with the overthinkers, telling them to “get over it” or “get a grip.” Now, this response may not be fair. Nevertheless, the end result was that the overthinkers lost social support at a time when they still needed it badly, and were much more likely than non-overthinkers to have serious symptoms of depression over the two years we followed them.

Some overthinkers try to escape the roar of their thoughts by binge eating or binge drinking. In a questionnaire study I did with 735 adults randomly chosen from the San Francisco Bay community, I found that overthinkers were significantly more likely than non-overthinkers to binge eat and drink when they were upset. A good example is Marina, a thirty-four-year-old freelance computer consultant, with deep brown eyes and long blond hair.

Marina’s overthinking bouts usually began with a disagreement with her husband, Perry. Their marriage was actually fairly solid and happy, but he could become quite unreasonable when he was in a bad mood and would say things that just sent Marina’s thoughts flying. She could go from disagreement to wanting to file for divorce in just an hour of overthinking!

One night Perry came home from a business trip, and after a brief hello to Marina and their son, Jason, said, “You two need to stop burning so many lights at night—our electric bill is through the roof!”

Marina fumed about this remark for hours, particularly as she lay in bed that night. “How could he be so hostile and focus on such a trivial thing when we hadn’t seen him for days? What kind of jerk is he?! Why do I put up with this?”

But her thoughts were not only (justifiably) angry thoughts at her husband. They also spread and grew as her overthinking fueled them: “Sometimes I think I should just leave him. At least then I wouldn’t have to put up with his rudeness. And Jason wouldn’t have to be the target of his hostility either. But I can’t leave him, I wouldn’t have enough money for Jason and me to live comfortably. And I’m not sure I could live without him, or at least without some husband. I don’t want to be a single parent. Why does he think he can get away with treating me like this? I don’t think he cares what I think anymore. He doesn’t seem to be attracted to me much—he hardly ever initiates sex. What should I do? What can I do?”

At about 1 A.M., Marina got out of bed and wandered down to the kitchen, overwhelmed by her thoughts and wanting some relief from her anxiety and sadness. She looked in the refrigerator and saw the lasagna she had made for that night’s dinner. She took it out. Just a bite, she told herself. She shaved off a small wedge and ate it with her fingers. It felt so good—so comforting. “I shouldn’t do this,” she said to herself, “this is stupid.” But she shaved off another small wedge and ate it. Then another, and another. Pretty soon, she’d eaten two large pieces of lasagna. But she felt so good, better than she had for hours. Her thoughts about Perry had dulled and all she could think about now was being thirsty. “I’ll have a small glass of wine, that will help me go to sleep.” So she poured herself a glass of wine, and proceeded to eat more lasagna, one sliver at a time.

That first glass of wine was gone and she still didn’t feel sleepy. In fact, her angry thoughts about Perry were coming back full force, loosened by the wine. “I can’t believe I’ve put up with him for all these years. Why don’t I just tell him off when he’s rude to me or Jason? It’s because I can’t stand conflict. No, it’s because I can’t think fast enough to come back with a retort. I’ve always been that way—slow on my feet. That’s why I can’t seem to make the big money writing software—I can’t pitch my ideas convincingly to clients. If they challenge me at all, I crumble and can’t come back forcefully. I’m never going to get any interesting projects!”

By 2 A.M., Marina had eaten most of the lasagna and nearly three glasses of wine, at which time her thoughts turned to self-ridicule: “Oh my god, I can’t believe I ate all that! How did that happen! I am so full I want to throw up! I’m pathetic, I’m just totally pathetic!” She went to bed in the guest bedroom so as not to wake Perry and proceeded to lie awake for another hour beating up on herself mentally until she finally fell asleep.

Both women and men who are overthinkers are also prone to binge eating and drinking, as well as to depression. But many studies have found that women are more likely than men to fall into the trap of overthinking. When a man faces a distressing situation—say Marina had said something rude to Perry and not vice versa—he tends either to blow it off or confront the situation immediately. Perry might tell himself that Marina must be premenstrual and so forget her remark, or he might come back at her saying, “Boy, you’re grumpy, what’s wrong with you?” Women are more likely to take the same situation to heart, think about it and analyze it, and go over and over what they should have said or done.

HOW WE GROW OVERTHINKERS

Women aren’t just born overthinkers, they are channeled into it by gender roles. In chapter 3, I described the pressures girls and women are under to cope quietly with distress, not impose it on others, but rather manage it within their own bodies and minds. Especially when it comes to anger, women are not allowed to confront or burden others; they are taught from a young age to keep it to themselves and deal with it internally.

I have found in my research that these same social pressures significantly contribute to the development of overthinking in girls and women. For example, women who were most uncomfortable with expressing anger toward others were also most likely to be overthinkers. If you feel unjustified in being angry, or if you feel that you will face the disapproval of others in expressing your anger, you will, like most women, hold it in, letting it stew and grow, and sometimes even seeing it morph into self-hate and despair. Similarly, if you feel no one is interested in helping you deal with situations that make you sad, you’ll keep the situation locked inside yourself, going over and over it, trying to figure out some way you can escape.

The social pressure on women to be caregivers to everyone also can contribute to overthinking. I have found that women who are most concerned about keeping everyone happy and about being liked and approved of are highly likely to be overthinkers.4 Being excessively concerned about relationships leads you to overthink because ambiguity and uncertainty are both rife in relationships, and thus are available to be analyzed to death—an offhand remark by a spouse, an upcoming evaluation from a boss, a coworker who is acting aloof. Women have been taught that it is their responsibility to make these situations right, so they spend endless hours replaying exchanges with others, anticipating what others might say, and worrying about the meaning of changes in a relationship. All of this is potent fuel for overthinking.

All-or-Nothing Thinking

Overthinking is even more dangerous to your mental and physical health if you are also prone to engaging in all-or-nothing thinking.5 Without a middle ground, or a gray area, women who engage in this thinking swing from one extreme to the other, their mood and behavior swinging with them.

Jill, whose story we’ve been following in this book, was well practiced at all-or-nothing thinking. On days when things went well at work, she loved her job and felt extremely competent. A forceful and effective communicator, she pitched new ideas to her clients and could also produce sales materials that were elegantly and creatively written. She could coax extraordinary levels of productivity out of her staff. “I love what I do, and I’m really good at it!” she’d say to herself.

On days that things at work didn’t go well, however, Jill’s thoughts took a 180-degree turn. If a client seemed bored by her sales pitch, or, heaven forbid, she lost an account, she’d go into a tailspin. She’d repeat in her head again and again the day’s events and the client’s remarks. The most negative, extreme perspective would regularly pop into her mind: “I’m an idiot. I can’t put a sentence together. How could I ever have thought that sales plan would work?” She imagined losing her job, being kicked out of her office without notice, walking past her staff as they laughed and sneered. “What if I can’t find another job?” she’d wail to herself. “Then I’d have to move back in with my parents and I’d rather die than do that!”

It’s easy to see how exaggerated negative thoughts can lead to depression. If you thought you were a complete failure and everyone was against you, you’d feel sad, hopeless, unmotivated. Symptoms of depression occur more often in people who are prone to all-or-nothing thinking, particularly when they are stressed out or disappointed. Like Jill, it’s difficult to “go with the flow,” to recognize that some days are good and some are bad. For some people, there is no averaging out the days to maintain a balanced sense of life. Instead, they let their moods be influenced excessively by whatever happens, feeling either really good or really bad. And since any day offers something to be frustrated or disappointed with, all-or-nothing thinkers spend more of their days feeling really bad than feeling really good.

All-or-nothing thinking can also lead to symptoms of eating and alcohol problems. Several studies have found that women with significant symptoms of eating disorders are prone to setting rigid rules and absolute standards for themselves.6 Just being a “normal” weight and shape isn’t enough—they have to be as skinny as the models in the magazines or the actresses on TV. It doesn’t matter if their body is incapable of being transformed into a semblance of those images because their bone structure or body shape will never allow them to be tall and ultra-thin. They have to achieve the skinniest body they possibly can, and they can never be skinny enough.

So they diet. Some women are very successful at dieting. They can deny or ignore symptoms of hunger, even in the face of extreme deprivation and great temptation. These women seem oblivious to their body’s signals that it is starving. All they know is that they aren’t thin enough yet, so they need to lose more weight. Or, at the very least, not gain any more weight. Women who have these absolute, all-or-nothing attitudes are at special risk for developing symptoms of anorexia nervosa—self-starvation.

Most of us, however, can’t deny our body’s screams for nourishment. Try as we might, we eat when we are hungry, and we are hungry a lot of the time when we are on a rigid and extreme diet. We may eat a bit, just a little bit, to try to stave off the hunger, only to discover that it’s not enough and that we must go back for more. Here’s where the all-or-nothing thinking kicks in and sabotages us. We think “I’ve blown my diet, I might as well blow it all the way.” So we eat a lot of the most caloric, fattiest, satisfying foods we can get our hands on. In the scientific literature, this is called the abstinence violation effect—we’ve violated our diet (our abstinence from food) and our all-or-nothing thinking leads us to eat far more than we need to quell our hunger and need for nourishment. Let’s return to Jill, whose all-or-nothing thinking often led her to binges such as the one I just described.

The day she lost an important account, Jill went home from work upset and worried. She kept waiting for the phone to ring, and for her boss to tell her he wanted her in his office early the next morning to discuss her failure and incompetence.

She tried to make herself a light, healthy dinner—some soup and a salad—from a menu she had cut out of an article from a women’s magazine on losing five pounds in a week. But when she finished eating the allotted portion, she still felt hungry and needy. She decided to have an oatmeal cookie for dessert to make herself feel better, reasoning that at least the oatmeal had some redeeming nutritional value. It tasted really good—until she made the mistake of looking at the label on the package and discovered that just one cookie was 200 calories. She had just gone over the daily quota for calories on this diet by 20 percent!

Now she really felt like a failure. “I can’t sell, I can’t handle clients, and I can’t stay on a simple diet! This is just impossible, the whole thing is impossible. I’ll never lose any weight, so why bother?” Jill proceeded to eat the four cookies still left in the package.

The abstinence violation effect also happens with alcohol.7 All-or-nothing thinking leads women to set up rigid rules about how much they can drink and when. Jill’s rules were “I won’t drink at all on the weekdays, and I’ll never have more than two glasses of wine on weekend nights.” If she was good, everything was fine—she felt virtuous and clean and strong. But if she violated the rules, even just a little, she judged herself out of control for lapsing into heavier drinking, as she did the night she lost the account. After Jill ate the five oatmeal cookies, she felt as though all her efforts at self-control were hopeless. The dieting rules had been broken, so why not break the drinking rules, too? Jill opened a magnum of wine and sat down with another box of cookies to drown her thoughts about the horrible day and the consequences that were sure to follow.

The abstinence violation effect doesn’t just happen as a result of stress or a traumatic event; it can sneak up in even the most benign circumstances. The only condition needed for the abstinence effect is a rigid set of rules and an all-or-nothing attitude toward them. If you violate the rules and judge yourself harshly, then abandoning all efforts at control is the logical outcome—as Julie, a fifty-year-old homemaker who wanted to reduce her drinking because she had high blood pressure, knows all too well.

Julie read somewhere that alcohol can increase your blood pressure, and she certainly felt her pulse get quicker when she was drinking. She was terrified of hypertension, since her father had died of a heart attack at the age of sixty-five. Julie didn’t have other risks for cardiac disease—she was of normal weight and had low cholesterol. Nonetheless, she decided she had to quit drinking altogether in order to lower her risk of heart disease.

This was difficult, since Julie’s husband was a food critic for a major metropolitan newspaper and she accompanied him to nice restaurants several nights a week. The meals and wine were paid for by the newspaper so they could afford to eat and drink well. Julie had always loved having a drink with her meals, and hadn’t ever had a drinking problem. Her physician had not told her to cut out drinking completely, but Julie nonetheless decided she couldn’t let a drop pass her lips.

She kept to this absolute rule for about a month. Then one night when she and her husband were at one of the best restaurants in town, the wine steward recognized them and sent a bottle of extremely expensive fine wine to their table. Julie knew that they would never have ordered such a pricey wine at the paper’s expense, or, for that matter, on their own money. She just had to try it. So she allowed the wine steward to pour her a glass. The wine was every bit as good as its reputation. Julie felt a surge of pleasure that she hadn’t felt since she’d put herself completely on the wagon.

But her thoughts raced as she sipped. “I’m blowing the rule. This is bad. I’m not supposed to have any wine.” These thoughts were met by defiant counter-thoughts: “Who says I can’t drink? My doctor never said that. This tastes so good. I would be crazy to pass up this chance.” Julie’s heart rate increased a bit due to the alcohol and her raging thoughts and she became even more anxious. She just wanted to blank out this anxiety, so she drank more wine and tried to put her attention completely on her husband and the food.

As she ate and talked with her husband, however, she kept lifting the glass to her lips. She was trying so hard to concentrate on anything but the wine and her beating heart and to block out the thoughts in her mind that she didn’t notice she had finished the glass of wine. The steward came by to pour another glass and she started to wave him off. But she found herself thinking, “Oh hell, just drink the damn wine,” and gladly accepted another glass.

Julie probably didn’t need to worry so much about drinking a little wine at dinner. But her all-or-nothing thinking, as seen in the absolute rule she set for herself, led to the abstinence violation effect—she ended up drinking more than she might have otherwise because, having violated her abstinence, she decided she might as well blow the rule all the way.

All-or-nothing thinking undergirds the toxic triangle by setting up the perfect conditions for all three components simultaneously. When you set absolute rules for yourself that are highly likely to be violated, and then you do in fact violate them, you feel bad about yourself and sink into depression. Then you may eat or drink to escape from that feeling. And if the rules are specifically about how much you can eat or drink, then once they are violated, your all-or-nothing thinking leads not only to depression but also to bingeing on food or alcohol.

Conditions of Self-Esteem

The absolute rules of all-or-nothing thinking can often expand to take the form of “If I do X, then I’ll be a good person.” Psychologist Jennifer Crocker of the University of Michigan has called these contingencies conditions of self-esteem.8 You set up conditions you (or the world) must meet before you can consider yourself worthy of self-love. As long as you are meeting your conditions, you feel good about yourself. When you aren’t meeting them, however, you can feel very bad about yourself.

We all set up conditions for self-esteem—it may be tied to your success at work, or the quality of your family life. Most religions do the same in the form of codes of conduct that should be followed in order to be a good or moral person.

For some of us, however, the conditions we set for our self-esteem are extreme and unattainable. Because of women’s roles as caregivers to others, as well as our great empathy for others, many women set up the condition “If everyone loves me, then I’m a good person.” They then sacrifice their own needs in order to make this the case. They choose not to confront others in high-conflict situations for fear of being disliked or disapproved of, they go along with unreasonable demands in order to keep others happy, and they overthink interpersonal situations, worrying what other people think and about relationships that aren’t going “perfectly.”

Not surprisingly, conditions of self-esteem that involve keeping everyone (except perhaps yourself) happy are a setup for disaster. In our research, we found that people who agreed with statements such as “For me to be happy, I need others to be happy” were more likely to be depressed, anxious, and to binge eat when upset. Women were significantly more likely than men to endorse such relationship-oriented conditions of self-esteem.

Societal pressures to be thin offer yet another condition of self-esteem for women who wish to be thin and attractive. If they can achieve this condition, they feel they are in control, strong, and superior. If they can’t achieve it, they are a failure, bad, or unlovable. Jennifer Crocker has found that women who set up appearance-related conditions of self-esteem are more vulnerable to depression and to symptoms of eating disorders.9 They become depressed when they fail to meet their standards for loving themselves, while the symptoms of eating disorders arise when they either starve themselves to meet their conditions of self-esteem or fall into the abstinence violation effect when they fail to do so.

Silvie, a twenty-two-year-old mother of young twin boys, lived in constant fear of slipping from her standard of being extremely thin. The first thing you noticed about Silvie was her arms. They were like sticks. Her bones stuck out and there seemed to be no flesh. The rest of her body was nearly devoid of fat, and her clothes often hung on her.

The first thing Silvie did every morning was weigh herself. Her goal was to remain at 105 pounds, well under the “healthy” weight for her 5-foot, 6-inch frame. If she went over 105 by even a pound, she would cut back on her eating until she got back to 105. If she went under 105, she felt as if she had some “wiggle room” in her diet and could eat a bit more that day, although subconsciously she was gleeful about weighing even less than 105.

Silvie was aware of every morsel that went into her mouth. She didn’t really count calories, but she knew exactly how much she ate in a typical day, and if she exceeded her usual amount, she would become moderately panicked. She would go back over what she had eaten at every meal and snack, analyzing any situation that had led her to eat more than she was “allowed.” She would then vow to avoid that situation in the future. As long as she kept rigid control over her weight, Silvie felt good about herself. She loved being so thin, although she was annoyed when people expressed concern about her weight.

Occasionally, because of bloating when she was premenstrual, or because she actually ate more than usual, Silvie’s weight would increase by a few pounds. If she stepped on the scale in the morning and it read 108, or even 110, her heart sank. She felt ugly and fat. Her mind raced as she tried to determine the source of her added weight. If it was due to the meal she had the night before, she would chastise herself for “pigging out.” If she couldn’t determine why she had gained weight, she began to worry that she wouldn’t be able to control her weight in the future. Regardless of the reason, she felt horrible about herself. She ate as little as she could the rest of the day, and prayed that her weight would be back to normal by the next morning.

Silvie’s standards for her weight, and for her behavior more generally, were extreme, but many women have a similar mindset. On “skinny days” we feel good about ourselves. On “heavy days” we don’t.

The combination of appearance-related conditions of self-esteem and all-or-nothing thinking sets up women for at least two components of the toxic triangle. Psychologist Kathleen Vohs of Case Western Reserve University in Ohio and her colleagues found that women who had both rigid, perfectionist beliefs and felt they weren’t meeting the personal standards for their weight set by those beliefs were especially likely to have symptoms of depression and bulimia.10

Basing your self-worth on appearance may also lead to heavy drinking. In studies of high school and college students, Jennifer Crocker found that students with appearance-related conditions of self-esteem drank more heavily in their first year of college than students who didn’t.11 Crocker speculates that this may be because students who were concerned with their appearance were more likely to join groups that focused on appearance and social status, such as sororities, which in turn exposed them to more peer pressure to drink.

Crocker also finds that basing self-worth on any type of external condition dependent on the opinions of others puts women at risk for depression and maladaptive ways of coping with stress.12 When your opinion of yourself depends on meeting external standards, you are at the mercy of others’ judgments and attitudes toward you. Other people are, as we know, not always generous, so there is always room to worry about what others think, making your self-esteem highly unstable, which in turn sets you up for depression and unhealthy behaviors such as binge eating or drinking.

Unfortunately, women are more likely than men to have external conditions of self-esteem, particularly those related to appearance or how well they are liked by others. Again, this is probably because we women have spent our lives being encouraged to care what others think of us and to look good by society’s standards. These external conditions of self-esteem, however, are yet another factor that influences the toxic triangle.

Some Good News!

The same brain that overthinks and sets us up with unreasonable expectations for ourselves can also be trained to defeat these self-destructive tendencies, even in those women who have a biological vulnerability to fall into the toxic triangle. Research shows a variety of strategies that can help women overcome unhealthy attitudes and regain control over their lives. We can implement these strategies for ourselves, and they are the focus of chapter 6.