To further confound the patient's situation, cycles of restriction and binge eating disrupt normal sensations of hunger and fullness (Apple & Agras, 1997, p. 44). Some patients constantly feel hungry; others describe feeling full all the time. Still others seem to feel satisfied only when they binge. The initial phase of the binge, patients report, is often pleasurable. Free from dietary restraint at last, they are relaxed, happy, and their selective focus on food tunes out other troubling thoughts. Patients claim that bingeing helps ameliorate stress, boredom, depression, anxiety, and anger. Some patients say they use bingeing to reduce the vague feelings of uneasiness associated with transitional periods such as coming home from work or schooL getting ready for bed, or beginning a study session.