Psychiatry & Psychotherapy Podcast - An Inside Look At Eating Disorders: Anorexia, Bulimia, & Orthorexia

Episode Date: July 13, 2019

What is an eating disorder? One of the most important things about anorexia and bulimia is understanding that they are caused by a complex interplay of genetics, epigenetics, early development, and current stressors. They can lead to dangerous outcomes because of how the eating disorder changes both the body and the brain. Many therapists and nutritionists, as you'll hear in my conversation with Sarah Bradley, don't treat from multiple angles, and often lack empathy into this condition. There are three main types of eating disorders we will cover here: Anorexia is the practice of cutting calories to an extreme deficit or refusing to eat. Bulimia involves purging, or vomiting, the food that has been eaten. Orthorexia is a fixation and obsession on eating healthy food (like only eating green vegetables with lemon juice). Statistics: Anorexia traditionally lasts for an average of eight years. Bulimia traditionally lasts for an average of five years. Approximately 46% of anorexia patients fully recover, 33% improve, and 20% remain chronically ill. Approximately 45% of those with bulimia make a full recovery, 27% improve, and 23% continue to suffer. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video. Instagram:dr.davidpuder Twitter:@DavidPuder Facebook: DrDavidPuder Youtube channel

Hello and welcome to the psychiatry and psychotherapy podcast with over 32,000 mental health professionals listening in every episode. Why? Because we need to stick together to survive the mental health field. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. Today we are going to be talking with Sarah Bradley. She is someone who has journeyed with different eating disorders, and she's really experienced a lot from different things. therapists and she's had experiences in psychiatry. And she is, according to her, nine out of ten, 10 being the highest of recovery. She's nine out of her eating disorder in her journey. And so it's a pleasure to have her on today. We are going to be talking about a little bit about your journey,

about how to stop thinking about food, about bad experiences with mental health professionals. and things that mental health professionals should know when treating people with eating disorders. So tell me a little bit, first of all, like, where did it begin for you? I would probably say around age seven or eight, I can just remember being really weird about food, just really overthinking it and just feeling like I shouldn't eat

and having this really intense obsession with exercise at a very early age. I was never focused on my body. I was just felt this overwhelming urge to zone in on my diet and my exercise. Hmm. Okay. And was there any contributing factors from your parents that you can tell? Like, did they talk about food a lot? No, they never.

Did they talk about exercise a lot? No. They never ever did. They never put pressure on, I mean, I was never overweight or underweight. I was always totally run in the mill, normal. My sister as well. My parents never said like, no, you can't eat that. Like, that was never a thing.

I don't, I mean, I wore uniform to school, the same uniform as all my peers going to parochial school. And never looking back on it, and it's hard. I mean, it's like what, 18 years, 18 years past. But reflecting on it, I don't really feel like there were any, you know, social pressures. Okay. And you had mentioned earlier that you had some, like, obsessiveness start as well at that age. Yeah. Yeah.

I had to do, so it was kind of like tied in with the exercise. So I had to do 50 sit-ups right after I ate anything, no matter where it was. And I had to do four sets of 25 sit-ups facing a certain wall as a kid as well. And I had this thing about the number eight. And I think by maybe age 10 or 11, I would only let myself eat between the hours of, I think it was 11 a.m. and like 8 p.m. and I would not eat outside. Like just very obsessional aspects still around numbers, but like tied in with eating. And when did you first, when did any family members or anyone notice at first? Probably around age 10.

Okay. So my mom actually has her master's in psychology and she was a social worker for her career. and my dad actually worked in nutrition at a mental state hospital. So, but, and they noticed some things. They definitely did, and they would bring them to my attention. But I think there was so much other conflict going on in the household. And I was also really good at hiding it. I think that's something kind of notorious with people with eating disorders.

It was actually my teachers. school and my friend's parents that were making a lot of comments and sharing a lot of concern, both with directly to me and bringing it up to my parents. And I think after enough other adults kind of said something to my mom, she kind of realized it was a bigger issue. But yeah, I definitely got a lot of comments from teachers at school. And I had this teacher who would come up me at lunch and just say, like, you have to eat more. She said you lost way too much weight, but she said it in front of all the other kids at school.

And it was so humiliated. She, the next day, came into school. And she had these, like, she wrote out these, like, healthy smoothie recipes. Oh. For me and was like, you should try these. And she would, like, look at my lunch cherry every day at school. and it was just a very odd approach. I was really confused that she was,

especially now as an adult, looking back on it, that she was bringing it up to me. But yeah, from teachers. It sounds frustrating. Oh, yeah. I mean, it was like 11, 10, 10, 11, like fifth, sixth grade. Yeah.

I really, and my peers, actually, the first time I ever heard the word anorexia was one of my friends at school, said, well, Sarah's anorexic. And I literally was like, what's that? Like, I didn't even know what I was doing. Like, I had no perception. I was like, what do you mean?

And she's like, well, you're really skinny and you don't eat. And I was like, oh, that's a thing. And I had, I mean, that was my first, you know. Okay. And did you think about food a lot? At the time, I was thinking about how to not eat a lot. Like how to, I was more obsessed with food, rather than food itself, I was more obsessed with how do I keep the craving, the obsession of wanting to eat away.

And I would, I remember going to bed at night and just feeling if I woke up, because I would go to bed hungry a lot. And if I woke up and I made it through the night without eating something and I woke up feeling like hungry and exhausted, I felt like, euphoric over that. Like, just absolutely, like, I won the battle. Like, I really enjoyed that feeling if I could not eat after, you know, early in the evening and then just make it until, like, lunch the next day. I just love that feeling. You felt, like, victorious?

Oh, yeah. I totally did. Yeah, and so most of what you were doing was, like, you felt good about it. Yeah. And were there any other positive? positive reinforcers that kept you wanting to do it more? I really don't think so. I wasn't, I think sometimes if, especially a child is overweight to begin with,

and they, like, get a lot of compliments about their body or they look good or, especially like with teenagers, that can be definitely like a positive reinforcer. But I wasn't overweight and I was like so young. I think I enjoyed at the time. I think looking back on it, I'm assuming that I probably enjoyed the concern from other people. Because the way I look back at it now is I probably felt like very underappreciated and kind of just cast aside from my entire family.

So I probably, if I had to guess what was feeding it, is I enjoyed that concern from other. people because... Did you get connection through that? I'm sorry if that's a frustrating question. Oh, no, no, no, I'm just trying to think. Like, people's concern, it's kind of like a form of connection, right? Yeah, I don't...

It's such an isolating illness. I don't think so, but I think I just really enjoyed, like, oh, people actually care about me. But I didn't really, you know, latch on to it because I wanted to keep it going. Yeah. Does that make sense? Yeah. Kind of a messed up cycle.

Did it bring you into relationship with people in a deeper way? No. No. No. Okay. No. I remember actually, I think I was like 12 or 13 at this point. And one of my dance teachers, she, like, after class one day, she's like, you just seemed so sad all the time.

And I'm just like, okay. And she, like, tried to give me a hug. And I, like, didn't really, you know, I wasn't very, it wasn't reciprocated. the same emotion back to her. And she's like, see, like, a few years ago, you would have given me this really big tight hug and you're just, you're, she's like, you're just a different person. And I was like, well, I don't know what to do. You know, I mean, I was so young.

I don't, I don't really blame myself for. Yeah, it's, of course you don't blame yourself. But no, I don't, it felt very isolated. Yeah, okay. And when you were in the midst of it, did you just not feel very much? Emotion or connection or you felt? I felt very alone, but I really enjoyed kind of that euphoric feeling of not eating. I just really enjoyed that empty, like, hungry, dizzy feeling.

I just, I loved it. I haven't experienced that in such a long time. Really, that was only specific to my early teenage years. but I remember really enjoying that feeling. Okay. And did you do any other types of behaviors that were, like, restricting, so you restricted them food, you did some exercise. Were there any other types of behaviors as well?

No, it was pretty, yeah. I mean, like, I think I told you before, like, I had, like, certain calculations, like how many times I had to brush my teeth and that would go overboard, like washing my hand. that kind of thing. But no, not really nothing else. Did you have thoughts, I wish it was dead, I wish it wasn't alive when you were an adolescent,

12, 13, 14? No, no, I never felt that when I was that young, no. Okay. But later on, you felt that way? Oh, yeah. Oh, yeah, later on. And throwing up after we eat, when did that start? How old were you? So this is, so to me it's still crazy, very,

probably rare that I was able to kind of come out of it. I actually had a very normal time between probably ages 14 and 18 going on 19. I actually, so my parents got a divorce and that kind of lifted a lot of the stress that I was feeling in my household. And after they divorced, like within the next year, I was totally different. I weighed a lot more. I finally like hit puberty. I was not really matching my peers anymore until that point. And I just got over it. And I stopped all my weird behaviors. It just completely snapped out of it.

I really think that's probably not the case with most people. But for some reason, just the change of environment was enough for me. And actually, I had a really good time in high school. I ate whatever I wanted. I, you know, it was very normal. I would, you know, go to parties and eat pizza with all my friends. I had a very normal teenage girl body, like not super fit, not thin, just very normal, you know. And then I went to college and it kind of reared its head again.

This time a little bit different, though. And the throwing up started, I think at the very end. end of my freshman year of college. I think it was like going into my sophomore year like that summer. So it was 19. Okay. So it didn't start when you were younger. It started. The vomiting, no. I never even tried when I was younger. No. And yeah, what was, and how long did it go on? How many times per day? Oh, God.

Every days per week. So it kind of was an off and on thing for a couple years. Let's see, I did it pretty intensely. at least once a day for the first few months. And I got really thin. I dropped. So here's the thing. If I were talking to a different audience, so I'm talking to you, and this podcast is kind of more catered towards clinicians.

If I were in a different setting with other people, like my peers or other people at eating disorders, I would not use numbers, because that can be really triggering for those kind of, like, it can be really triggering knowing like someone else's weight, how many calories they eat,

you get in this game of comparison. So, but for the sake of this podcast, I'll use numbers so we can get a better, like, ballpark idea. So I was, like, about what I weigh now, which is, like, mid-120s. And I got down to, like, about 105 over, like, two months. And I was probably vomiting at least once a day. And the only thing I kept down was, like, a ton of raw vegetables. I did that for, like, an entire summer.

Wow. And I got back to school. and the dean actually had me come into her office, and she, you know, very nicely, but very clearly, you know, like I remember her exact words, like, if we're looking at another 10 pounds, I just don't think you can be here. Like, you know, and not like, you know,

you have to leave campus forever and never come back to school, but, like, I knew she was insinuating, like, it's, like not safe, and it's like a liability. and I probably needed some type of more serious help than what my university, like, outpatient services, had to offer. Okay. So that was kind of a wake-up call for me, and I really wanted to do well with running,

and that was actually the first year I qualified for the NCAA championships, and I really wanted to excel, like, in school and in my sport. So I was able to, like, stop the purging for, like, a few months. And then I had a lot of really awful stuff happen in my personal life. And I kind of started purging again. And this cycle went on for probably like three years. And at its worst, I would say I was purging five days a week, twice a day. So pretty intensely.

So when did you start seeing therapists or seeing professionals? When I was 19, whenever like, the dean of students, like, you really have to get this together. Like, you know, we don't really... What were some of those early encounters like? Were they helpful? Were they not helpful? I think that the clinicians at my alma mater's health services have been wonderful people,

and I think that they really cared. And I think that they always meant well. I just don't think they had any experience. And they admitted that. They really didn't know. Not that they had like never encountered this before, but like they only have so much knowledge and skill with this. What do you think they would, what do you wish they would have done more of? Well, it's kind of like I went to go see the like the nurse practitioner once and she just, you know, gave me this lecture about like how bad this was.

And I was like, yeah. And then I never went back to see her. like they never had me come back. I went to therapy and the first therapist I saw, what I'm about to say, I feel like it doesn't even sound real, but she said that I was the most difficult person she's ever worked with in her entire career. And, I mean, honestly don't even,

it sounds like I'm making this up, but she said she doesn't know how I have any friends, any family, and a peer of mine had went to go see her, as well and had a similar experience. But you know what? She's a good person. Okay. She just, she, I did, whatever I would see her around.

Therapist? No, no. But she, I really think she meant well. And any time I've seen her since, I like give her a hug. I mean, she really, I think means well. I just don't think she deals with type A female as well. Because I had a friend who had a similar experience. She didn't have an eating disorder.

But I went to another guy. And like, honestly, he was a cool guy. He was like the director of the program, but we never talked about my eating disorder. He had no idea what to say. So there's some frustration there too. I mean, no idea. What would have been things that you would have appreciated or the good therapist that you've had in the future? Like what have they done?

How have they brought it up that's been helpful? I think realizing that it's really not so much about the food or the eating. I think it can be to an extent, but probably trying to pinpoint, like, you know, why do I, you know, resort to this when I'm really stressed out kind of a thing. And they really try to ask, like, what's actually going on, like, in your head? Like, what do you, you know, actually thinking? and some of the clinicians, like the first few clinicians I would see, they would just kind of like, kind of brush off what I was thinking like, well, that's ridiculous.

Like you're, I mean, to Western society, and I hope it don't mean to sound egotistical, I am an attractive girl. And they're like, you have such a nice body and why, you know, that's silly. Like, I'm like, that just made me feel stupid because it's just not about that. So when I hear that, I hear a huge lack of empathy. Oh, yeah, yeah. Into your experience.

Like, they couldn't, like, insert themselves into your experience. What are some other ways that people have had a harder time inserting themselves into someone like yourself's experience or into someone with eating disorder? You know, I think this is a good sort of, this is kind of what we've been talking about the weeks leading up to this, right? But we can come back to your story. Oh, no, we don't have to dig into my story. It's fine. I mean, not that we can. I'm all for it, but like I don't want this to be about me, you know, I just more educational

too. I think for, you know, the therapists or clinicians or people in training who are listening to this, hearing someone's story is important because it's like they might not have heard someone's story and heard someone's story at different places in their journey, you know? And so I think it's really good to have someone who has someone who has a story. has, you know, kind of like gone through the system, had different experiences. Yeah.

And share those. But I'm just curious. Coming back to this theme of like empathy, maybe just let's stick with you for now. What are some other examples of places where you didn't feel heard or understood? Okay. And in this sort of phase. Yeah. I remember there was a dietitian I saw once.

and like she had me do like a 24-hour recall. Like, what did you eat past 24 hours? And I had to eat in like a Pop-Tart. And she was like, well, there are much better choices than a Pop-Tart. And I was just think, and this is when I was like, you know, 20, 25 pounds thinner than I am now. And she was speaking from a point of nutrient density. But I just remember thinking, like, how awful is that to say to someone who's, like, afraid to eat? Like, I just remember thinking, like, that's ridiculous.

I ate a Pop-Tart, you know what I mean? That's like the exact opposite. I know, I know. Like, I should normalize, like, eating. You shouldn't be afraid of, I don't know, but she didn't get that. And she also said, and I didn't even bring up my feelings at all, that she walked into the room and said the first thing she said was she was trying to explain the structure of the, you know, relationship between she and I and like what her office, what her space was going to offer me, which is, that's, that's fine. You know, but the first thing she said was, this is not a place where we talk about your feelings. This is not therapy.

I'm just here to talk to you about food. And like, okay, to an extent I can get that because I actually study nutrition. But as someone who's like working with an eating disorder patient, that's like so rude and harsh. And how could the two not be related for me? How could you think that I'm not intertwining some emotion? Of course you're intertwining emotion. I mean, food. I never saw her again.

Yeah, and of course you're entitled to your frustration and your boundary of not seeing her again, you know? Yeah. And I'm trying to think of, so, yeah, other than the like, oh, you have a perfect body, why would you, you know, that's so silly that you, you know, care about your weight. I would say another thing would be just not. And that's interesting because that's not really how it even started. No.

You know, when you were seven or eight or, you know. Well, no one knew this in college. I never got help for it as a child, which blows my mind that my parents didn't intervene. But, you know, I kind of just got over it magically as a kid, right? So my first experience, like, they had no insight. They never asked me about my history. And the other thing is they just, some clinicians have honestly I feel like you kind of almost have to think about it in a context

maybe similar like speaking to someone with schizophrenia like there are things that they're going to think and worry about and you may not know what they are but like you should know that like this is a very secretive disorder and we just don't people that I know and myself don't we don't We don't really want to share it, but like it's there. And I feel like it's kind of a, like, how could you not think that, like, for instance, like the, I think like anxiety about medications. Like it took me years to go on them and be compliant. And it's like how, I don't know, like it feels like, but then again, maybe that's too harsh of me. Maybe I'm criticizing people too much.

And I never, you know, actually felt like they were being a bad clinician because of that. But like, there are just so many things that goes on in my head that have gone on. And it's like, how could you think that it's just as basic as like, I just don't eat this? Or I'm going to throw it up. Okay. So give me some examples of common things that went on in your mind and maybe common things that go on in other people's minds with eating disorders that are different or you wouldn't know unless you maybe have struggled with it or worked with people with it. Yeah. I would say like if I felt like I ate too much the day before and I had plans to go see someone the next day, I would have to cancel because I felt like they would noticeably see like a huge difference in weight. And that was too embarrassing. Like hearing people chew. Yeah, that was in particular frustrating. Oh my God. It would drive me nuts.

Unlike the sound of people cooking, like dishware, you know, clinging on China or something. And like to this day, so for instance, I always feel horrible about this. I never do anything. I never say anything. So, you know, I'm not, I realize it's me being like neurotic. But for instance, if someone who is morbidly obese or really obese is eating around me and I can hear them eating, even to this day, it really stresses me out. Like, I have to, like, so at work there is a person who I have to sit, like, in close proximity with, who is morbidly obese who eats around me. And that's, they should have the total right to, you know, I shouldn't be, and I, I never do anything, but I have to leave.

You are, it's almost as if you're a little bit frustrated that you do this, but nevertheless, you do it. But, like, I get so panicky because it makes me feel like I'm going to be, I'm going to gain, like, 50 pounds from this somehow. Like I'm going, I get so worried that that's what's going to happen. So at dinner tonight, did you have any sort of thoughts come into your mind? So we went out to a good dinner. No one's obese. But unfortunately, if someone were, it might have really bothered me. Does it bother you less than it does?

It probably bothers me less. Okay. But like at work, I usually have to like get up and leave the office for a little while because I'll be, like, I'll be sitting there, like, shaking my leg and sighing and, like, just cringing and just really stressing out about it. So, yeah, those are some things. And then just being, like, so paranoid about anything, like, any medicine that could possibly make me gain weight, like, even, like, an antibiotic.

Like, literally would Google the crap out of anything, anyone ever prescribed me for anything because it was, like, a drug. Like, this is, like, an external control over me. And I, like, that's not okay. You know what I mean? So that was like another huge thing that I just don't think you would ever think of unless, you know, or you would expect unless you ask. And then I would say probably like really obsessively exercising at really weird times. Like getting up at like three in the morning to like go run 10 miles because I had to like burn.

something off. Or probably like, there were times that I missed Thanksgiving and Christmas because it was just too stressful because all the food, like if there's too many options, that's, that was just way too hard. So once I became an adult, you know, not living with my family, there were several times in college where I didn't see my family on holidays because it was just too stressful. Okay. So coming back to like your story, so you're in college, you have some bad experiences with the dietitian, therapist, like, when was it that you first connected with a therapist and

you had a good experience? Honestly, not to this last year. Not to this last year. And out of all ways possible, it's through Skype. Yeah, I think this is great. Yeah, with a psychiatrist I found on the internet, on Instagram, and I saw like he does like, you know, I was like, well, he probably doesn't do it if I'm in the U.S. Because he lives in India. But yeah, that was the first time I connected with a therapist.

And I tried out probably several over the course of a couple of years. And I'd give each one like maybe four or five. I would really try to stick it out, but I just, I actually felt like it was harder with women than it was with men because I felt like women were always turning it into this body image thing because that's kind of, I think, something that they feel as a woman here in America. So once again, this is really important. And I want to reemphasize this. It's, it's, it's, you're feeling a lack of their empathy because they're, they're very much in their own experience. Yeah. Yeah.

And so this is where like, I think it's clinical. clinicians, like, this is actually really hard to do to exit out of our own experience into someone else's to the extent that, like, I know my own experience is like, I love food. Like, you know? Well, yeah, that's the thing is I think maybe that's like why, like, finding this random man, you know, in a different country who, you know, has never had an eating disorder. And I asked him, like, do you have any experience that eating disorder is? And he was straight up.

He was like, not really. But I feel like because he doesn't know and doesn't have this experience that he's, you know. But he was open. Oh, yeah. He was open to listen. Yeah. And he heard what was actually there. Yeah.

Unlike people with preconceived notions. Yeah. Because I think there's this narrative in our culture that eating disorders because of TV and Instagram and the movies and body image. But I think there's this whole other group of people who have, you know, this sort of genetic slash. We were talking about, you know, there is this sort of mechanism in us in a deep way to be able to survive without food for long periods of time. Yeah. And that stimulates pleasure. Yeah.

And that's sort of the theory that sort of you've come to as like makes the most sense for you, you think, in particular. Yeah, I really think so. just like with the whole like feeling you've worked from it and feeling like I mean it was I mean I was able to do like you know I was succeeding in school incredibly well I was running like 10 miles a day um I was you know until I literally like crashed and burned but um I would say for me I think if we have these genetic markers so actually what's interesting is a lot of the genetic markers. I included it in that Google Doc that are for schizophrenia, a lot of them match with eating disorders, like a lot of them. And so I don't, I think it can be very genetic.

It's just a matter of like which mechanism of the biopsychosocial model, I think, can flip it on, if that makes sense. Yeah, I mean, there's multiple genes for every mental illness. You know, there's not just one gene. Yeah, yeah. That's one thing that most people, when they don't understand how these things develop, it's like, no, like there's a lot of overlap with mental illness in general. But then specifically with you, do you have any family members with eating disorders

that you know of? Any great grandparents that were very slender, died early? No, but so my father was an alcoholic, and he, a lot of people that go on to develop bulimia, and this has been studied, and I don't have the name of the study. but I do remember reading this. A lot of them had parents with substance abuse disorders as parents.

Specifically, bulimia seems to be more related to this. So, yeah, but my dad had a lot of issues of mental illness. Yeah, and sometimes people who are alcoholics, they're alcoholics, but underneath the alcohol is, like, other stuff that they're just, like, covering with coping. I think, yeah, my father probably fit the bill for that. So I've never had an issue with alcohol, but with the eating stuff, yes. Okay.

And then, so there was a one point where you finally felt like you couldn't go on in your sport, in academic sort of world. You said you crashed and burned. Do you want to go into that at all? Yeah. I mean, I think at the time, so this actually kind of crosses more over into what's called. over-training syndrome, which is like something, it's actually kind of hard to do. It's more specific in like sports medicine. But basically I was running really hard and like training like a maniac and I wasn't able to sleep because I wasn't eating really. And I just kept losing weight.

And that's just so stressful for the body. So the part of that theory that was talking about earlier, they adapted to flee famine theory. And that's seen in my, that was seen in migration patterns of early humans. And then also with birds, even today, people don't sleep when they're not eating because they're prioritizing finding the food source. You know, and there's like a neurobiological driver, you know, giving you that kind of like euphoric feeling. So that definitely happened for me. And then I literally couldn't run like nine minute pace. for more than five minutes without feel like I had to sit down. And I was sleeping maybe like,

I couldn't sleep for more than 45 minutes straight. It sounds like almost honestly, it sounds like some type of like hypomanic episode. It was more really because I was not eating and sleeping and it all went away and it never came back since. Eating? Yeah. And because I know you've been on the eating boards and stuff like that.

Yeah. Do a lot of other people have similar issues that you've seen? Yeah, yeah. Insomnia is really rampant among people with eating disorders, specifically people who, they don't even necessarily have to be struggling with anorexia or nervosa, but a lot of them, it doesn't matter if you're overweight, but if you're like in this really severe caloric deficiency, or you're throwing up your food and not keeping whatever down,

sleeping is even people that don't have an eating disorder but they're just like intensely dieting that's pretty common and another thing we touched on was orthorexia so oh yeah you talked about how often people will shift from anorexia to orthorexia oh my gosh yeah and i've talked to the people at our eating disorder program and in the future actually i'm going to have some people want to talk about this because it's such a big issue right now because they think that they've found the cure and it's really just the same narrative in a different costume, in my opinion. It's just you're focusing on this singular attribute that is the distractor.

And I think that you're controlling it. Maybe we should define orthorexia for people who haven't heard it. Ortho, straight, two straight in. Yes. Rexia food, right? So it's like to really order the food that you have. So we were joking around. Clean eating.

Yeah. Whole 30. Like, I'm only going to eat green plants and, you know, vegan, but then also, like, raw, you know. Green juice. Green juices. All day, every day. Or, you know, I'm going to be ketogenic. I'm going to be carnivore.

I'm going to be. So it's basically taking any of the popular diets. Oh, yeah. And it's putting so much energy into that. I have a close friend. And she wrote a memoir. and she's writing a second edition, a second book. And she started out anorexic and then started, she became vegan and then raw vegan.

And then she, you know, she couldn't eat more than one of this food group. And it just made everything worse. And then she ended up just binging on really, you know, hyper-palatable foods, like processed foods with lots of, you know, salt, sugar, and fat. And she started binging and purging. And honestly, this is like the, you know, from one disorder to another, but it seems like a very common theme is the anorexia to the orthorexia. Because it's still like, I'm not going to eat this, but I'm going to control it.

Did you go into that at all? Or did you have that sort of that phase? Okay, no. No. Yeah, but that's something we'll dive into more. And it's really important as well as clinicians. if we're if we know that we're dealing with or you know helping someone who has had anorexia that like pushing them towards like a particular diet can actually not be a good idea no it can it kind of

in some ways looks like recovery like and I mean I don't know what's true and what's not true with the you know day and age of social media but there are people who post like what they eat all day it seems like there's still I think I shared some of those accounts with you they still seem very obsessed with food because that's all they're sharing and it's like clean eating food and instead of being like you know grossly thin you know they're now like they're just focused on being completely shredded but it's like kind of the same thing in my opinion if you're so like they're just completely you know doing bikini body competitions and i mean to an extent like i could see how that may be helpful for someone but it just i think it can very easily become just kind of the same

story but looking a bit different. Yeah. Yeah, no, I think that comes to like this sort of topic that we started discussing as well about obsessions with food not really ending. So it's like how much do we want to think about food during the day? Yeah. And we talked about the study. Oh, yeah, the Minnesota Starvation Study. Yeah, tell me about that study. I love that study. I love it too. I think it's so unethical. No, they were prisoners. I mean, okay, not that, you know, that makes me sound like a jerk. No, we should not, we should not, I mean, there's reasons why we don't do, you know, research on prisoners because it's, it's, it was a few decades ago, though.

Okay, so go, tell me, take me through the study. So they had these full grown men and they put them on a diet of like 2,500, I think to 2,700, so calories a day, maintaining their weight for a period of several months. and then they took it way down after that time period to 1,500 calories a day, which is really low for like a full grown, like adequate size man. That would be like me eating like maybe 900 a day or something like that because I'm smaller and I'm a woman. But basically they became totally obsessed with food. They would like suck on ice, chew sugar-free gum,

just like suck on like mints. just so they could, like, get the taste of something and, like, kind of just send that signal of, like, you know, salivating and, like, appeasing their stomach. They would, like, just look up recipes, talk about food all day. They would, they did become somewhat, like, really restless with their, like, energy, like, exercising. And, you know, they lost a ton of weight. And after the study, when it was over.

they binged on food like crazy. Like some, you know, most of, I think it was like at least half of them binged. Like, I'm talking like 10,000 calories a day. Like they tried to record how much they were eating in this after period. And so this like, but the difference is between this group of men is like there wasn't this like, you know, underlying psychological component to this to an extent anyway. And they don't have this guilt about like wanting to go back to that behavior. but someone with someone who's spent starving themselves and then binges,

if they still have these kind of like undertones of this eating disorder, you know, mindset, then that's when purging kind of enters. But yeah, these guys became totally obsessed with food. Right. And it didn't stop until they gained weight. That's like our culture.

I know. It's like, you know, like how much do we think about food? We think about food so much in our culture, like as a whole. Like, I've read probably about 20 books on food.

Really? Yeah. Yeah. See, and I'm a guy. Well, you're a doctor. I'm a doctor.

And a lot of those were, like, trying to figure out, you know, what the healthy diets were. Honestly, there is no one diet that's healthy. I just think there's never going to be

a specific answer. But I think people want, like, especially people with an eating disorder, want, like, this, continuation of like boom boom boom like have all my ducks in a row like I'm only going to

eat this now it's kind of like you're the dietitian who said I'll only talk about food I won't talk about emotions and emotions are a lot more difficult to talk about oh yeah yeah um food it can be very sort of um you know soothing to think about food especially if you're starving Soothing as my, the analyst who mentors me would talk about food and eating as like an oral hunger. And it relates back to like when we were very young and, you know, breastfeeding. And it's like, you know, we want to be fed. We want, you know. So eating and eating together, I think it's really important.

It's an important way to like connect. But yeah. So it comes back to like this question of like, okay, how do we think less about food? I think that's different for someone who. who's been dieting a long time and had any eating disorder. Have you been able to think less about food? Oh, yeah, yeah. How were you able to do that?

Well, truthfully. Honestly, I mean, I gained like 20 pounds, and that was a lot of it. But for someone like you, you know, I'm assuming you've never had an eating disorder. I could be wrong, but I'm assuming that's a no. But you've read like 20 books on food. I mean, I feel like your reason is a bit more, you know, scientific than like the average Joe out there just like going nuts about food and being a foodie or whatever. But like I think the answer looks different for someone who's had an eating disorder, you know. Yeah.

So I think you, it's like that the study, the Minnesota study that we were talking about, like when they were underweight, they thought about food all the time. Yeah. They read cookbooks for fun. Yeah. They talked about food. Yeah. And then once they got back to their normal weight, all of a sudden... They were fine.

They weren't thinking about food all the time. Yeah. I mean, so for instance, even at my lowest weight, I think I technically never met the BMI standard for like underweight. But I looked really bad. So I think... And at your lowest weight, you thought about food. Oh, yeah. Because it was an unattainable weight that I got to through like horrible methods.

You know what I mean? It's not like I'd always been that way. And that's just, you know, who I was. and just was a slim person, right? But yeah, I thought about food all the time. Like, I would go to the grocery store for, like, hours. Just hours and, like, look at food. I would watch, you know, like, I think I put, like, a link in that Google Doc.

It's, like, deeply buried in there. Like, have you ever heard of a muck bang? Oh, my God. It's like, I don't even know how to explain it. Basically, someone buys, like, a ton of food. I'm talking, like, whole big family. Thanksgiving amount of food, right? Like a ton of food.

And they put it all out and they just, they talk about a story totally unrelated to the food. They just start talking about their life. And it's like a 30, 40 minute video of them binging on food. And that's the thing on YouTube. There's like thousands, millions of hits. That's insane. Like that's so nuts to me. That is a society.

But people with eating disorders are obsessed with those. And I would watch them. Oh. Because you get some type of like. vicarious, like, you know, need met, like watching someone else eat. So, like, I sent you that video of that girl. Yeah. She's, like, salivating.

She's watching someone else eat and she's pleasuring in it. She's watching her sister eat. And she's like. And I think that's because of mere neurons. Oh, yeah. Because when we watch someone do something, like our brain lights up in the same way. Yeah. So if you're craving something, then we want to watch other people doing that act that we crave, you know?

Yeah. But I guess regardless of. do you have been eating sort of or not. Like if you, we live in a society where certain foods are demonized and this, this diet is perfect. But whenever any of us kind of adopts that ideology, I think that kind of comes into play. Like, oh, I can't eat that. But like, I'm going to obsess about it now. You know, I, um, so I used to wrestle in high school. And I had to drop like my, from football to wrestling, like 30 pounds. And he did it in like over a couple, you know, a month, basically. Oh my God. I had wrestlers in college. And so I was, I was, and, and, and, you know,

And just talking about this with you brings me back to those days after way in when we would go to breakfast. I've seen the wrestlers just binge out on food. Like everyone would just be like pre-planned what they want. Like people would like write it out. Like as people waited to get their food, they would be drinking the creamers. Like all the creamers in the restaurant would have gone. All this sort of, you know, but. And one of my friends who was like, he was like, he.

could never make the weight that he needed to like but he would think about that one meal that he got and that's all he could think about i know i i i totally get it yeah um yeah i would sit and playing out my food for hours like for the week like hours you know like i said i go to the grocery store for hours i would do that and i don't do any of those things anymore like none of them i mean it took a really long time for that to happen but okay so tell me the practical things that allowed you to do that, like in your journey. Like, you talked about the one good therapist that you've had in the last year. Yeah.

What are some of the other, like, what are the things that have been most helpful for that recovery? Because I'm sure someone's going to listen to this who's, like, not in recovery yet. Like, what advice would you give that person? Do you think those kind of people listen to this? Oh, for sure. Oh, really? Yeah. Okay.

100%. Oh, okay. I just thought it was a bunch of people, like, sitting there at their DSM, like, even their glasses on, like, I'm going to learn something today. I thought I was the only one that wasn't really like. Oh, no. I'd probably say about, about a half. Oh, okay.

Wow. Yeah. I would estimate about a half. Yeah. I'm not mental health professionals, but they're like, yeah. They're seriously curious. And they're often intellectuals who are curious, who read a lot, who learn a lot, like, they're learners. Okay, yeah.

You know? There you go. I just complimented my audience, which I believe. Well, then you have a section on your page. And when I joined, like,

I wanted to see your resources. It says, like, all the different jobs you could have is a mental, and then it's like, I'm just interested, like, exclamation point. So most of the people who sign up for my resources

are people who are mental health professionals because I think a lot of those are, like, higher end, you know, like practitioner levels type content. But yeah, I would say probably about half, especially like some of the episodes like on Ted Bundy and,

you know, stuff like that. I mean, that's been a little bit more popular in the general culture. Yeah. But yeah, the things that I think enabled me to like get from like, you know, just obsessing about food all day to not, like I said, probably actually finding a therapist that I liked. But at that point, I wasn't actually obsessed with food when I started working with him. I would say the gaining weight part and then just letting myself eat whatever I wanted, like stop giving food this like, you know, majestic, you know, ruling that it was like sacred

or something like that. Did you, um, did you like learn about stuff online that was helpful? Was it like, or just was it like life events that was? No, I just, it happened. I remember like. Like, I stopped, I think the, so I went on Zoloft like a year and a half ago. And I remember like within two weeks, like I stopped obsessing about food as much and I like stopped purging from like 10. Let's say it was probably averaging like 10 purges a week. I got it down to like twice a week within like a month.

And so and then I after that point, I think it, I just stopped obsessing about food and I stopped binging. and then I stopped purging. And that, you know, happened less and less. I didn't gain weight, actually lost weight going on Zoloft. But whenever I stopped trying to, like, control my weight, if that makes sense. I don't know. Yeah. So Zoloft, Certraline, you know, SSRI, Cyan reuptake inhibitor.

So it's causing, you know, it will decrease obsessionality. So it's like the impulse. It decreases. the um the upset you sometimes you give it for people the OCD it decreases the obsessionality it decreases i don't know did it help depression or anxiety for you as well no it really didn't help my depression at all um but it really helped with the purging specifically but i i think that was like honestly i had already gained so i gained quite a bit of weight with binging and purging over the years of college.

And so whenever I started to try to stop the purging and just let myself eat what I wanted, you know, food kind of lost its like sex appeal, if that makes sense. And then whenever the purging and binging stopped and my, you know, weight kind of just settled out, I think that, like, I wish. I wish I could tell you some really great, like, therapeutic techniques, but for me, it was just very biological. And I think, though, if I had to pinpoint, like, one type of, like, more aspect targeted towards, like, psychotherapy would be, like,

so working with the therapist that I've started working with in this last year. So something I would have said to previous therapist, and this kind of like circling back to this lack of empathy thing. Like he was like, well, let's say you woke up tomorrow and you were 10 pounds heavier. What would you do? And I literally said, and this was a few months ago, I was like, I couldn't leave my house. There's no way I could leave my house. And he didn't like, well, that's stupid.

You know, he was like, okay, that's really fair, you know, like, why? You know, he wasn't, he didn't brush it off. Like, that's just like so dumb. Like, who cares, you know? But that's so dumb. who cares. You felt that from other people, but you didn't feel it from... No, because he didn't respond with like some crazy look like...

Yeah. Yeah. Well, you know, just move on with your life. Right, right. So... Move on with your life doesn't work. Like, it's like, I felt like they were making it sound like I was, you know, previous clinicians like I was shallow, you know, that I was like just obsessed with my appearance

and I just wanted to look good. And it's really about like, I guess in working with my... therapist in last year kind of just analyzing why I've you know over the years you know culminated this you know zoning in on my weight and food giving me a sense of worthiness and a feeling of like safety um okay because that's that's what it feels like for me that's always what it's felt like um and I guess just trying to really like reexamine those thoughts because before and all the other, you know, times I've been with a therapist. They were just kind of, like, brushed off.

And I just felt, like, even more embarrassed about them. Like, just even, like, like, I said, like, I felt shallow. Like, oh, my God, like, I'm just, you know, crazy. And I'm just, like, this shallow girl. I'm just this, you know, worried, you know, privileged white girl. And, you know, that's what I felt like. And that's part of, I would, I mean, that's horrible to feel those things. It's a barrage of negative sort of accusations, guilt.

They did not say that, but that's how I kind of took it because it was just kind of like dismissed, you know? Right. Yeah. And then I think that negative sort of self-talk, you know, that would go on with those earlier therapists. You were starting to mention that a little bit how like with earlier therapists, you would have this negative self-talk, these sort of things. wouldn't express them. Yeah, like how I would think I was like just this shallow, white privileged girl who just needs to get it together because like this obviously sounds stupid.

And I, you know, I just, I'm way too obsessed with my image. You know, that's what I, even though deep down, that's not what I was feeling. But I was like, well, maybe that's just, maybe that's what it is because that's kind of the message and the vibe that I was receiving. from their, you know, lack of curiosity when I said these things. Yeah. And I think that leads to kind of the importance of talking as a therapist about what is going on in the here and now with people. You know?

So like, for example, these therapists, they might have noticed like, huh, she is kind of reacting odd or, you know, with drawing a little bit or seems to be experiencing shame or guilt after we're talking about this. I wonder what's going on, you know? Do you see what I'm talking about, the interpersonal? Yeah. It's like what's going on in your head right now. Yeah. Like, so our cameras went out for a second, and you started sharing like what was going on

in your head right now. And I think that's important to talk about it. I'd like to talk about that, actually. About, you know. Yeah, what is this experience like talking about? Oh. Like you're eating disorders. I feel like I just am like talking too much.

Like I feel like I'm just like blabbering on and just, you know, like I'm worried I'm just sharing like a lot of useless information and I'm, you know, not getting to the point quickly enough. And I'm, you know, going off on all these insignificant tangents. Yeah. And talking too much about myself too. I really don't want this to be like, you know, about me because it, I just. feel like that is awful.

Yeah. Well, I mean, okay, so it's hard to think that there might be someone critical on the other side of this, right? Listening, watching. And I would say, from my experience, I think a lot of people are going to find this really helpful. I've been getting a lot of messages, DMs from people asking for, you know, eating disorder content, teaching about eating disorder.

And so I was excited to have you come out and share your journey because very rarely it takes courage to share your journey. It takes courage to put yourself out there. And also, I think it's really important that the person is at a certain level of recovery. You know, like you've been through therapy for years. You've had success in your journey. And I think that's really important because that's hopeful. Because, you know, as we treat people with mental health issues, sometimes we only see them at their

the worst, the worst. Like, the first two years of residency for me, like, was mostly impatient. And so people were suicidal or psychotic. And you never saw them two months later when they're outpatient. Yeah. You never see the fall through the resolution. Yeah. So that's why it's, like, really exciting to get this sort of longitudinal story out there of like, hey, this is my journey. Yeah. This is how I stopped thinking about food all the time. Yeah. And tonight we went out, had a hamburger together with my video guy, John Finn.

And we had a great time. Yeah. Yeah, totally. So any other thoughts on like the here and now or what's on that stuff in particular? Yeah. I mean, I would just say like I don't, I wouldn't categorize myself like, you know, super severe. end of the spectrum. I've never required like some intensive, like, inpatient, like, hospitalization.

At one point, you know, maybe that would have been considerably, like, the next step, some type of, like, partial day treatment or something. But, you know, there are people who have, like, you know, and not that my suffering is any less because there are people who have it worse or more severe, but, like, my experience is just mine. and it's, I think that you can still draw a lot of lessons from it, but every person with an eating disorder is going to have completely, you know, can have, obviously there can be some common themes, but have a completely different, like,

projection. Right. Totally, you know, and you have to, like, dig into that because it's not, it's just not ever going to be like this one size fits all like, oh, this is, it's because of blah, blah, blah, blah, blah. Right. No, I think that's really helpful to put out there. We were talking over dinner how in the system, the mental health system that I work in, we have a really good date treatment program.

And I would say, you know, when you were in college, like you would have totally fit into that group. Yeah. And that probably would have been really helpful for you. Oh, yeah. But you figured out a lot of those things on your own. And maybe, you know, you didn't have those resources available, which is too bad. but there's date treatment programs and then, you know, there are impatient places. So we've had some patients that, like, for whatever reason, we could not get them to gain any weight in a day treatment program.

And so they needed to be at more of like a place where they stay for a month, 60 days. And those can be really expensive and the insurances don't always pay. I know two of my friends have gone through that and it's a lot. Yeah. And, you know, and then there's therapists that are experienced in eating disorders. Yeah. And honestly, a good therapist can do a lot of good. And maybe just meeting twice a week, you know, outpatient.

Yeah. So there's a certain level of acuity where that would be helpful. Yeah. I mean, I found a lot of progress. So I just kind of looked outside the resources that I had within my community and, like, the, you know, what was warranted with like through insurance so I just chose to do out-of-pocket pay for obviously the psychiatrist that I see but with that like I said I have like I could message him right now if I wanted to um you know and then with my primary care doctor um same thing it's like unlimited

access and so actually there was a point when so my so this is like the day and age of technology And I think you'd have to be pretty like kind of like far into the end of like remission or like be like really open to like in wanting to get better. But like so my scale that I've had, it connects to Wi-Fi and so uploads in my medical chart. And so like my so that like my doctor can see it like daily. You know what I mean? Oh wow. So like like looking at resources where I just had more contact with my doctors because I. I really needed more accountability than like just going to the doctor like once every three months.

Like that wasn't enough accountability for me. That's not. Yeah. And I think, um... I think I could go kind of terribly for some people with an eating sort of. So like I said, I think you have to really like be kind of really invested into it. I'm really honest, but... And that brings up an important topic that like you got to a place where you're like,

I want to get better. Yeah. And a lot of people with eating just... disorders, especially inorexia, don't. It's usually not the case. But with bulimia, I mean, perching is so painful. It's not fun. It's so painful. Most people with belies, I mean, I was literally desperate to stop. And that's, that was so desperate. Like, I, I refused Zoloft for like a year. And I was like, oh my God, like anything to stop this, you know. Yeah. And then once you got on it, it seems like it's been like all this anti-psychiatry stuff

in the media because I know you're really into social media and stuff. It was going to like, you know, I literally had to have my doctor talk to me like over and over again because I had read all these horrifying articles about how it's like going to eat my brain and give me Alzheimer's and I am going to gain weight on it and I'll be hooked for life. I mean, that's like what these, you know, and it's that's not been my experience at all. like at all and it's like if i feel like if i hadn't if those kind of you know really like harmful you know not truthful you know pieces of information were out there i feel like i would have gone on zola off a lot sooner yeah yeah and that that's tough that's tough i um i get i'm getting more of that stuff lately as i get more out there um and i you know i didn't really know a lot that stuff existed, honestly.

Yeah. Other than, you know, certain religious organizations that are very anti-psychiatry that I don't even want to name out loud. I just really, the anti-psychiatry stuff, but it really feeds into the fear of people with an eating disorder. Because, you know what I mean? I feel like it's like, this is going to make you worse. This is definitely, because it's a lot of the articles I've read talk about how all of these

drugs are like Obisogenic and everybody, and people gain weight for so many different reasons. And I know some drugs can be, you know, more specific to that. But with Zoloft, I mean, even after reading, I read like, you know, PubMed articles. And there was no change in weight, like no significant finding, right? And then I would, but I would still go read these like shared experiences of people on like these organizational websites. And I was like that over, that was completely able to override anything. hard science that I had read because I was, you know. That's really frustrating.

I know. Yeah. Okay. Well, good things have happened and that's good. We should probably bring this. Yeah. Yeah. I should probably bring this to a lot.

It was really good to have you out. And I'm sure this is going to help a lot of people just hearing this. And that's why we do this. Do you want to have me put your link in the show notes or in my Instagram when I post this. Oh, to the Google Doc? Or to the... So number one...

To tag me or something. We're going to have a nice document that you've created that we'll put up on the website. Okay. For people to... You don't have to do that. You don't have to do that. I think it's really good. So it's super interesting.

You did a deep dive. A lot of things that we didn't even get to talking about, like, different things that people are saying in, you know, these groups about their experience and about providers and bad experiences. and different things like that. So we'll put that out there. The link should be in the show notes. And when I post on Instagram, I'll link to your account as well so people can get to

know you or ask you questions. And yeah, thanks for coming on. Thank you for having me. I still can't believe this is happened. I've like incessantly DM'd you for, just for, I want your opinion on this. This is the truth that I actually respond to DMs. I'm a real person. Okay, we'll leave it there.