Frequently Asked Questions (click on questions to display answer)

Why are my panic attacks so clearly triggered by specific situations sometimes, and at other times, seem to occur “out-of-the-blue?”


Good question. These seemingly random, spontaneous, unexpected panic attacks are actually referred to in the literature as “out-of-the-blue” panic attacks. Although you feel as if they occur “out-of-the-blue,” we speculate that there is actually something happening on an unconscious level, i.e., outside of your conscious awareness, perhaps an old fear or an irrational “what if” thought, that signals to your body the need for the “fight-or-flight” response.

Imagine, for example, that you hear someone yell “fire” and your body immediately and appropriately gets ready to fight or flee…but there is no fire…it was a false alarm. Your body was overreacting to something that wasn’t real.




No matter what diet I’m on, I always go off of it. Why can’t I stick to a diet until I lose the weight I want to lose?


A few years ago, Bob Schwartz wrote a book entitled Diets Don’t Work. I always thought the book should have been titled Diet Maintenance Doesn’t Work…because what’s wrong with diets is exactly what you are asking about…staying on them! The very fact that we talk about being ON a diet implies (and predicts) that at some point we will go OFF the diet. Most dieters have the mentality that they can’t wait until the diet is over so they can return to normal eating. This kind of “black and white thinking” is the main obstacle to being able to maintain almost any diet for the “required” length of time it takes to reach the desired weight loss.

Some additional thoughts: diets are monotonous, depriving, and lack excitement. Human beings hate monotony, rebel against feeing deprived, and crave novelty and excitement. Who wouldn’t “die for” a pizza, after weeks of chicken, salad and vegetables…or protein shakes and bars…or cabbage soup? No matter the diet, it begs to be broken. And once we give in to the pizza, what happens? You know this all too well…the burgers, the fries, the pasta, the ice cream…and “I’ll go back ON my diet on Monday.”

There is really only one way to lose weight and keep it off, and it requires a major paradigm shift in the way we think and feel about food, weight, dieting and body image. I work with patients who want to get off the dieting-bandwagon, and who really want to make this paradigm shift. You will need to commit to slow weight loss, mindful eating, and incorporating your favorite foods even while you are dieting. Otherwise, the monotony, the deprivation and the lack of excitement will inevitably sabotage the diet. Once you have lost the desired weight, hopefully you will continue to approach food with the same mindset you had while dieting, but with more freedom and flexibility. You will continue to eat mindfully, continue to treat yourself, continue to exercise and enjoy your body in motion, always keeping in mind my 3 favorite words: BALANCE, VARIETY, and MODERATION.




I am 27 years old and have had an eating disorder since I was 15. My anorexia morphed into bulimia and for the past 5 years I have been struggling with binge-eating disorder. I have been in and out of residential treatment, and have seen several therapists on an outpatient basis. I am beyond frustrated and feeling very hopeless. My question is: does anyone ever really recover from an eating disorder?


Thank you for your question and I am so sorry to hear about your unsuccessful treatment attempts. The answer to your question is a resounding ‘yes,’ but there are so many factors that need to be considered. I just want to assure you that full recovery is indeed possible. I have seen hundreds of patients in full recovery, and I can at least give you a glimpse of what these (former) patients are like today. They are free from obsessing about food, weight, calories, dieting, and body image. They find “all foods in the world acceptable,” with BALANCE, VARIETY, and MODERATION as an ongoing and useful guide. Foods are no longer labelled as “good or bad, safe or unsafe, fattening or non-fattening, dietary or non-dietary.”

Recovered individuals are comfortable around food, whether at a party, in a restaurant, on a cruise ship, or in a foreign country. Many have discovered that they love cooking and enjoy entertaining friends and family…with no fear of eating all the leftovers once everyone has gone home! They are also comfortable in their own skin, and have given up the need to constantly be comparing their body to everyone else’s. Being recovered means truly making peace with your own body, focusing less on what you perceive as your imperfections, and instead, being mindful and grateful for what your body does for you every day of your life. Trust me, with work and commitment and faith in yourself, you can and will recover. I would love to hear from you.





© 2020 by Dr. Paula Levine