Podcast Transcript

Episode 69: Treating Trauma and Eating Disorders: Clinical Insights with Dr. Laura McLain, PsyD, BC-TMH

[Bouncy theme music plays.]

Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley, and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Have you ever asked yourself why so many people who struggle with eating disorders also seem to have a history of trauma? Have you ever wondered how these two experiences, so different on the surface, can be so deeply connected beneath it all? In today’s episode, we’re unpacking the powerful link between trauma and eating disorders. We’ll explore how trauma reshapes the nervous system, rewires our stress responses, and can change the way we relate to food, our bodies, and the people around us.  But trauma isn’t just about what happened to us.  It’s about how it happened, when it happened, and how our minds and our bodies made sense of it all. Whether it came through abuse, neglect, or emotional absence, trauma can leave lasting imprints that show up in unexpected ways. And because every person’s biology, genetics, family history, and support systems are different, trauma doesn’t follow a script. It affects each of us differently, but healing is possible. And today we’re talking about how. Our guest today is Dr. Laura McLain, PsyD, BCTMH. She’s the Director of Training for The Renfrew Center. She oversees the training initiatives of the organization and is a member of the conference and research committees.  She supports the clinical leadership throughout the organization in being trauma-informed supervisors and providing evidence-based care to clients.  Dr. McLain has over a decade of experience treating eating disorders with a special interest in trauma, college students, clients in midlife, co-occurring substance use, understanding and applying research to clinical practice, and ARFID. In addition to her role at Renfrew, she works in private practice, providing clinical supervision and serving individuals suffering with eating disorders, substance use and trauma.  Dr. McLain is an active member of the American Psychological Association, the International Association of Eating Disorder Professionals. She’s a member of the Psychology Inter-Jurisdictional Compact and is a board certified tele-mental health provider. Dr. McLain joins us to shed light on why trauma is such a common risk factor in the development of eating disorders and how symptoms like restricting, binging, or purging can sometimes serve as ways to cope with overwhelming emotions or stress. We’ll also dive into the importance of trauma-informed care, an approach that prioritizes safety, empathy, and support. Thanks for being with us today.

Welcome back. You’re listening to All Bodies, All Foods. I’m Sam and I’m here with Ashley, my co-host. We have a great show for you today. This is a hot topic, trauma and eating disorders.  We’re here with Dr. Laura McLain. Welcome to the show.

Laura: Thank you for having me. I’m excited to be here. 

Sam: We are excited to have you. You are the Director of Training for all of Renfrew.

Laura: I am.

Sam: Yes. I would love to hear a little more about that, about your role and also what brought you to the field of mental health and eating disorders. 

Laura: Yeah.  So at least in terms of the director of training role, so it’s a newer role to me, but entering in, it’s kind of cool because I get to wear a lot of different hats.  So I’m really ultimately responsible for the internal trainings for our organization. In terms of staff training needs, how are we effectively treating folks with eating disorders, how do we again kind of flex those clinical muscles.  We’re getting patient feedback as well in terms of things that might be helpful to modify within our program, so it’s great in that capacity.  In addition to that, I get to be part of our research department.  I get to have some kind of consultation touch points with various clinical leadership  in the organization. And then we have external facing trainings as well. So I might present at conferences or do some of our webinars or CE events that are existing. And then I am also fortunate enough to serve on our conference committee.  So we get to help develop the conference, Sam and I do.

Sam: Yes, I’m on that committee as well. That’s a fun process, trying to figure out, you know, who, who will present and what are the hot topics this year that people want to learn about.  So, Laura, you do, you do all the training for the therapists at Renfrew, even other providers too, right, dietitians. And so we’re so lucky to have you because you know so much about trauma programming at Renfrew. You’ve helped train the clinicians to actually implement the trauma programming. So I can’t wait to really get into it and learn how you treat both at the same time, because we get this question. You know, this question is so common. How do you treat both an eating disorder and trauma simultaneously? So we’re going to learn all about that today.

Ashley: So, Laura, curious for you, could we start at the basics and learn what exactly when we hear the word trauma, what does that mean?  How do we define it? It’s used a lot in our culture. It’s used a lot in our work. And kind of what Sam was saying, it is pretty common to get clients or even clinicians that are like, what do you treat first, the trauma or the eating disorder? How do you, or do you treat them together?  All that jazz. So can we start at the basics?  How do you define trauma? 

Laura: Yes.  So again, it’s something we absolutely hear a lot. I think there’s lots of definitions, but ones that I kind of settled on doing this work, right? And looking at the literature and those types of things. I take it from, you think of like kind of the three E’s of trauma, right? So you have this event that takes place.  Then how I experienced that event might be different than how the two of you experienced the same event, right? Based on our own histories and the context in which we’re living.  And then the effect of that experience is really what informs whether or not something was traumatic. So  it lends to this really diversification in terms of how we’re actually experiencing the world around us and our emotional reactions to that, which is why it’s really hard and trauma is so individualized.  So then we need to really shift into this place of what was traumatic to you and then we can figure out how to actually address that. And that’s one of the big questions that we ask for our folks that are coming into treatment. And you might have these really acute events that take place, right? It’s really significant event.  Most often folks have a lot of kind of chronic or smaller events that take place. And it’s just an overwhelming experience to the nervous system, which we’ll talk about in a little bit, as well.  And Pat Ogden has talked about, you know, any experience that’s stressful enough to leave us feeling helpless, disempowered, frightened, overwhelmed can be considered trauma. I’ve heard it described as anything less than nurturing, especially for thinking about folks younger in those developmental years. It could be attachment injury, right? It really expands across a variety of experiences. And again, how that impacts us as a person.

Sam: The three E’s, I love this. Would you, let’s break it down again, just so everyone is clear. It’s the event. So it’s like what happened. The experience, and then the effect, how it impacted you.

Laura: And that is physical, social, psychological, system regulation, right? Any of those things is the experience of an event.

Sam: We had, it reminds me, because we had a trauma therapist on the program not too long ago and, Kate Funk, she actually talked about how sometimes trauma can even be what didn’t happen to you. Maybe what should have happened that didn’t.

Ashley: That lack of nurturing. 

Laura: And you’ll see that a lot with folks with developmental trauma, like complex trauma histories that we see. And so there’s a lot of like relational ruptures or again, missed opportunities for nurturing. Again, if we’re thinking about how we develop and grow as humans, we need that nurturing, especially in our infancy and our young childhood years, and some of our folks miss out on that,  whether it be, you know, toxic family dynamics, whether it be other traumatic events,  displacement, poverty, right? Some of these things that just are outside of their control, it lends to this prime environment that is less than nurturing. 

Ashley: I was just going to ask,  do you think,  so I feel like the definition of trauma has shifted  over the years  and that it’s,  it really is moving from like this one  singular event  where we used to talk about, you know,  war or a tornado or something like that to, to, it really can be this collection of micro events or like you were saying, this loss of nurturing.  Do you feel like that’s pretty commonly understood now in our field?

Laura:  In the field, more so, not from what I’ve seen in terms of how we collectively talk about it. So  I think about folks in my own life that don’t really understand what I do for a living, but it’s nice.  But they were like, well, “I don’t understand why that was traumatic for someone. Like nothing really bad happened.”  Right? And like, have family members or people in our community that have been to war.  And that might’ve been very traumatizing for them versus somebody else might’ve had this relational rupture and maybe been in a toxic relationship that could still be traumatic, but those events are very different. And I can pretend to still categorize them as different, which is what I like about the shift in the field is that it’s really bringing it into the person. And we can understand why it was traumatic and what’s happening mind, spirit. Then we have the opportunity to help them figure out how to heal from that and move forward.

Sam: I loved how you used the example that there could be an event, the same exact event that happens to you, that happens to me, that happens to Ashley. Same event, it’s going to impact us all differently and in a unique way. Oftentimes I remind clients too that it’s not just about the event and maybe like our biological differences, but it has to do with when the event happened,  where in our developmental trajectory did it happen? Because it makes a big difference whether it happens to you as a kid or whether it happens to you as an adult.  And also, do you have intergenerational trauma? Do you already have these vulnerabilities in your body from the fact that maybe you have ancestors who experienced trauma? So this event’s going to impact you differently based on your history.

Laura: And the availability of support and what sort of that support-

Sam: Yes.

Laura: Is a huge mediating factor. As I was thinking about the podcasts and coming in and I think some of the biggest ones that come up for people are like I was in high school during 9-11.I was in California, but I remember very vividly my mom turning on the television before I went to school and it was on the TVs at school all day.

Sam: Yes.

Laura: In real time. Yeah. And then the COVID-19 pandemic is probably the most real, like the most recent one for folks in terms of there are folks that were absolutely overwhelmed by COVID and are still dealing with that. Right Then there are others who are a little bit more kind of like, okay, this was what happened and we’re moving on and are relatively fine and everything else in between.

Sam: Right. Right. That’s such a good point. It’s like we all experienced COVID,  but depending on your circumstances, know, whether or not-

Ashley: Or your age.

Sam: Or your age, right. Whether or not you had support. Whether or not you had access to food. Whether or not you already are coming in with co-occurring issues. If you’re already depressed, already anxious, or already have health issues, there are so many factors that impact us on an individual level.

Laura: And that’s what I like about understanding trauma is really the context in which these things unfold. And then how do we hopefully, again, heal from that, but then put things in place that might help kind of mediate that potentially same response in the future. So how do we build some of that resilience or emotion regulation, whatever word you want to use for it. 

Sam: So is it safe to say that it’s really up to us and up to our clients to make the determination whether or not we feel like we’ve experienced trauma?

Laura: That tends to be how I approach it. More so because I don’t necessarily want to put that on someone if they’re telling me that something wasn’t traumatic and I’m not really seeing any indicators that something has been traumatic in terms of like behaviors, right, kind of these other components that come up.

Sam: Symptoms, right.

Laura: I don’t want to put that on them if that doesn’t feel accurate. It’s a very privileged place to be if we’re honest in terms of me deciding  that something is trauma versus how do I have a conversation with someone about the impact of these events and how would they describe it? I might offer up something like, this is what it feels like. Does that resonate with you or does it feel like something different? But I need to have that relationship with them first where they know they can tell me that it’s not. Versus me just kind of coming in at the start of a relationship and deciding that something is really traumatic.

Sam: Right, right, right. I know for some people it could be really validating to learn that something was a trauma.

Laura: Yeah.

Sam: And to hear those words  and to realize, well, no wonder this impacted me so much. This actually was a traumatic event and maybe I’ve minimized it or maybe there’s been denial or, you know, other things at play that, you know, get in the way of you seeing it clearly. But have you had that experience where… oh yeah?

Laura: And again, my approach tends to be this is what I think it might be. Like, of course this is the response again, I want to be able to check in with them. How does that land and does that actually resonate with them? Cause I’ve done the same thing and like, no.  They’ll tell me it doesn’t resonate and that’s okay. So I want to be very cautious about how I have that conversation, but it’s been incredibly validating for folks. And it’s like, okay, like what do I do with this? Like no one’s ever said that to me before. then have somewhere to go.

Sam: Right. taking such a collaborative approach and trying to tease out, you know, is there trauma here that we need to work with?

Ashley: And I think on that, in that same respect, just going back to the relational or the lack of nurturing trauma,  like I’m thinking of a client that I was having this conversation with  a while ago, and they really had a challenging time  grasping  the lack of nurture that they grew up with was traumatic and not that it didn’t affect them, but I think almost in a way that they maybe felt like  gaslit in growing up that like, you can’t be affected because of this. That’s not traumatic. Does that make sense? What I’m saying? Yeah.

Laura: That’s what I think is still prevalent in our culture.

Ashley: I see.

Laura: Well, that wasn’t traumatic, right? Because X, Y, you don’t have PTSD, therefore somebody was traumatic. Those two things are not mutually exclusive, right? So you can experience trauma and not meet criteria for PTSD. Right? And everything else in between. So it just becomes a really interesting discussion. And it’s more of what does this look like now? How is this impacting you now? Because the things that we have some agency over trying to heal.

Ashley: Yeah.  I really love the event, experience, effects. I like, I wrote that down too. I’m like, I’m taking that with me. That’s my nugget for today. In the first five minutes! Yeah.  Okay, Laura. So, piggybacking off of, we just started to talk about PTSD.  So when folks have experienced  a traumatic event, a collection of traumatic events, we know that, or maybe we see that there may be other mental health diagnoses that travel alongside, which could even be an eating disorder.  But I was curious, what do we look out for? What co-occurring diagnoses do we see?  What do we see pop up with trauma and maybe even eating disorders?

Laura: My big answer is almost anything truthfully, right? How somebody might present because of all of our nervous systems and the ways that we respond to our emotions are just different. I think if I’m thinking about folks that I tend to see, whether it be in my private practice or at Renfrew, the big ones that tend to stand out that I think most of us encounter, at least how patients describe it, is usually some level of anxiety. Yes, we might have folks with some type of PTSD.  Substance use  actually can be co-occurring. And then mood disorders, right? Depression, probably something along those lines. So those, again, as I kind of tend to be the big ones, and again, they’re not all-inclusive. There’s definitely everything else that might present. But if I’m thinking about like, again, the somatic activation in the body that can happen around you might feel like anxiety, right? This excessive worry about something that’s hypervigilance that takes place.  They can’t concentrate, right?  It can present in food in terms of trying new foods that maybe elicit a similar response in the body, right? It tends to get conflated. So again, that’s what we talk about in treatment, which we’ll share a little bit later. With mood disorders, again, you have that kind of lethargy, that low energy. It feels like I’m walking around kind of with a wet blanket. I’m not really excited about much. Maybe I’m not sleeping well.  Sometimes there’s some suicidality, self-harm, you know, behaviors and urges.  And that can look like appetite changes that can compound an eating disorder. It can look like not being able to get out of bed and show up for appointments. It can look like not engaging with my friends who I care deeply about, right? Because I’m not feeling well. With PTSD, and again, this is usually what people think about in terms of trauma. I’m gonna cite those really big acute traumas you often see symptoms of PTSD where you have, again, this hypervigilance,  oftentimes to the internal experiences, again, how my body is functioning, but also this hypervigilance to the world around us, which makes sense because our environment has been traumatizing and activating. They’re kind of on high alert.  They might avoid certain people, places, experiences, right? Those types of things. They might have flashbacks and nightmares. So this can look like potentially folks, again, maybe avoiding certain parts of their body or the physical body itself. So whether that be with clothing choices, I might avoid looking in mirrors.  I might be really aware of who’s in my physical sphere of presence because it feels really uncomfortable and activating.  We might have folks that are binge eating to kind of stuff down emotions, metaphorically, if you will.  Or I might restrict on someone to numb out that kind of anxious hypervigilant feeling that I’m experiencing. So it can present in a variety of ways. With substance use and some of the folks that I work with,  again, it can really be any substance, whether it be alcohol, medication, marijuana, I mean, who knows?  And we’re looking at, the frequency of use and all of our diagnostic criteria, but I also look into, again, the impact on daily functioning.  And what happens if I don’t use whatever substance I tend to gravitate toward? What am I really afraid of? What’s the impact going to be? If I don’t  have that other drink, if I don’t take a little bit too much of my medication.  So with some of our folks that we see, I’ve had folks that are drinking nightly to try and prevent having nightmares.  I’ve had folks that are using marijuana to kind of either stimulate appetite on some level or to even kind of minimize the interceptive or physical sensations in their body when they eat. Right. I’ve had some folks that take too much Xanax before they go to a medical appointment, right?  Something along those lines. It can really be all inclusive. So I think again, for us as providers, supports is really thinking about like, what are we noticing? But again, what questions are we asking when we’re getting some of the information with these folks? 

Ashley: Like what is that behavior that they’re doing?  How is that supporting them really? Like how is that helping them manage and deal with whatever their bigger emotional experiences. 

Sam: Like what’s the function of what’s happening? Yeah.  I think trauma often can get missed.  Do you think that that’s true, Laura?

Laura: Because I think there’s still some bias even in the field of what trauma should be.  And again,  obviously I have to use the DSM and I think it’s good in a lot of ways to be able to provide a diagnosis for a specific treatment and all of those things. And it can definitely overlook things, right? And like, there’s no diagnostic criteria for something that felt traumatic, but I don’t experience PTSD.  So it’s hard in that we have to do  that.  To make sure that we’re providing access to care and resources and interventions that are appropriate.  And sometimes there’s blind spots, even in our..Where are we getting our information from?  How do we bridge some of those gaps with like the lived experience that we see with our patients and our clients  that doesn’t exist in the research journals, right? How do we, again, kind of meet in the middle to do the best for our folks? 

Sam: Yeah.  We, we’re talking a lot about PTSD and then there’s also Complex PTSD. I was wondering if you can say a little bit more about that.

Laura: Yeah. So, Complex PTSD, and again, in some of the folks that I’ve worked with, I have tended to see this in terms of their relationships more often, to be honest. So if we’re thinking like a relational rupture, so again, going back to when we’re younger, this could be lack of nurturing or attunement from our caregivers. So again, when we’re really little, we need that external attunement to tell us that we’re safe, to make sure that we’re fed, to make sure that we’re held when we’re crying, right? All of those things are what we need, right, as young beings.  As we grow  up, we often then kind of fall into different patterns where we might have additional relational ruptures. So that could be, it could be an abusive relationship.  It could be chronic disconnection when we want that connection so badly.  It could be feeling othered in spaces that we’re in. So you see this a lot with marginalization and oppression, right, and all of those different components. And then  we grow up into this whole person that has always felt  disconnected, disengaged, I don’t fit in, I don’t have a support system. And all of those cumulative effects take a toll on our mental health, our spiritual well-being, our nervous system, all of those things combined.  So that tends to be how I’ve experienced it and seen it and had it described.

Sam: Yeah.  Thank you. I think a lot of times when people think about trauma, they think of just like one event, like something traumatic happened, like there was an earthquake or there was, you know, some kind of  major  stressor.  And I think we often forget that trauma can really manifest many different ways throughout our whole developmental trajectory. I mean, starting from when we’re an infant, it can be nonverbal. It can happen before we even have the words to talk about it. And so I’m glad we’re having this conversation because trauma is such a complex topic.

Laura: And I think it’s a lot harder. So I’m thinking about some of the clients that I’ve worked with. They didn’t really have these really big events necessarily that almost feel like they shouldn’t have trauma. And again, I think that’s partly in terms of what’s normalized in our culture.  So  they don’t have this really big event like an earthquake or a natural disaster or some really terrible event that has happened.  And yet they are still chronically dysregulated and chronically disconnected, right? And using their eating disorder and all of these other components.  And it feels like I shouldn’t have trauma, right? I don’t really deserve it because nothing really big happened. So it’s easy for us even as providers to kind of get  sucked into that a little bit that we need to be mindful of, of it’s actually okay. And it makes sense based on what you described to me, why this is still impacting you today. Right? So I think it’s okay to normalize that and to even take some of the labels out of it when we’re doing some of that relational repair. Of course you were feeling disconnected and not nurtured and trying to find something to regulate yourself.  We’re all trying to do that on something. 

Sam: Right, right.  You know, I think it gets even trickier when we’re talking about intergenerational trauma. We have a whole other episode on that actually with Dr. Carolyn Cooker-Ross.  But you know, there’s this fascinating study of the mice and the cherry scent, where, long story short, these mice were exposed to this cherry scent and they were also shocked. So they, of course, developed a fear of this cherry scent.  And what they found was the children of these mice and even the grandchildren ended up developing this fear  through the generations, even though they were never shocked, even though they were never exposed  to  the shock and the cherry scent before. And some of these mice didn’t even meet their parents. They didn’t even learn it from their parents. They never even knew who their mice parents were.  And so I think it gets tricky because we could all be sometimes walking around  with the trauma response of our ancestors and not even know why. And how important it is, we talk about doing genograms and therapy to really try to go back and figure out where is the trauma in the family line. And maybe we’ve inherited some of those survival strategies that we don’t really need anymore, but maybe our grandparents needed them at some point.

Laura: Yeah. Well, I love that you talked about it. And thank you in terms of like the survival strategies. Again, that tends to be how I talk about it. Right? And we don’t always know why we’ve activated, why we’re impacted in a certain way. And I think we’re just curious by nature and trying to find answers, but of course you are. Right? And part of that is kind of like evolutionary in terms of, again, out of survival and protection and making sure that we’re okay.  Part of that is a genetic component. Part of it is our environment.  And those two things combined really kind of inform where we are today. And then our job, right, in doing this work is to help folks really stay in a constant state as much as we can of emotion regulation, being able to tolerate that distress so they can make really informed decisions  and respond to what’s happening versus kind of living in this activation fear-based  kind of place. 

Sam: Right, like walking around with these responses that don’t actually fit the present situation.  Much better suited if you were in the middle of that trauma again, but actually not.  Yeah, not adaptive right now. We’re going to dig into all that and I can’t wait, but let’s start first with trauma and eating disorders. We know from research,  we know from experience that trauma is actually a risk factor for developing an eating disorder. So if you have trauma in your history, research suggests that you’re automatically at elevated risk for not only eating disorders, but disordered eating.  The question really is why? Why is that? I think a lot of people are really curious. Like what’s the connection?

Laura: How much time do you have? 

Sam: Can we wrap this up in five minutes here so we can get to everything else?

Laura: I mean, I think in terms of, again, it run through how  we have come to think about this and describe it. So if we go back to emotion regulation,  right, all of us as humans are trying to regulate our responses to our internal, you know, stimuli that’s happening, whether it be from our physical body  and our external world, right? And then again, trying to make informed decisions that are value driven, right? That feel good to us on some level and make our way in the world. So we come at it from that basic standpoint. If I am already primed on some level, intergenerational trauma, but if I’m already primed on some level to be in a hyperactive state of arousal, like survival mode, and then I have these events that are taking place and I don’t have the tools to respond rather than react. I’m going to find anything to try and help myself survive. And for some of our folks that looks like an eating disorder.

Sam: How so?

Laura:  So if I am living in a chronic state of activation, let’s say I’m very anxious, right? And at some point I accidentally even skip a meal because I’m just uncomfortable. I can’t tolerate eating. Nothing sounds good. Right? And all of a sudden I feel a little bit better momentarily in my brain. It goes, we should probably do that again.  Right? Because I definitely don’t want to be uncomfortable. I don’t like that feeling.  So I’m getting this information that at least temporarily that just makes that disappear. I am much more likely to do that again, because I know at least in that moment it worked.  And this is again, what I find so helpful in this work is actually normalizing, there is a reason you have an eating disorder, right? You don’t just wake up one day and decide to have one.  It actually evolves over a period of time for whatever the starting point was.  And of course, because in my brain, it has told me that in that moment, I’m not uncomfortable. I’m not in danger. I’m safe. Right? And it just does this kind of neurochemical reaction that says, well, if I’m feeling that way, I might as well do the same thing because I know what the response is. 

Sam: It gets negatively reinforced

Laura:  and it becomes predictable. 

Sam: Yes.  So here’s the million dollar question then there might be people listening to thinking, well, then why can’t I just use my eating disorder to cope with my trauma?

Laura: You can. Right, and we know that they do on some level. And so as we’re doing some type of work, again, kind of normalizing why those behaviors come back, at least in higher levels of care in particular,  we tend to see that there’s this reason that they’re coming in, whether it be they’re worried about something or somebody else is concerned. And then at some point they stop serving the same function or it’s starting to really impact their life in a negative way, again, with how I relate to myself, do I show up for work or to school,  how I’m relating or not  in important relationships.  And so at some point it really becomes unmanageable. It’s not really serving the same function. Because again, the context is not the same. I’m not in physical danger, but I have conditioned myself to think that I’m in physical danger because it’s uncomfortable. My alarm bells go off in my amygdala, and then I engage in a behavior that says, I can stop that right now. 

Sam: And it’s not a permanent solution either, because the paradox  of avoidance is that the more we avoid something, whether it’s with an eating disorder symptom or any other kind of strategy, the more we try to avoid it, the harder it gets to actually resolve.  And our confidence gets damaged. We sort of believe that we can’t handle it, that we always have to turn to something. So yes, these strategies work, but they work temporarily.  They end up worsening the problem that you’re trying to cope with in the end. 

Laura: And on top of all of that, we then also start to generalize  those behaviors to other situations, other feelings,  other thoughts and emotions and things that come up where  I’ve seen people, their world is so small. From what they’re willing to eat or not eat, how often they might be purging or binging,  much they’re self-harming, they’re avoiding people, they can’t show up to work, whatever it might be. The world is tiny because they are so afraid of what’s happening internally and externally.

Sam: Right, right.

Ashley:  So Laura, feel like there’s,  we mentioned this at the very beginning, the concept of treating trauma and treating eating disorders. What comes first, the chicken or the egg? What do we do first? Do we do it both at the same time? I’m curious as the Director of Training at Renfrew, can you walk us through kind of the aspects of treatment of both trauma and eating disorders at Renfrew?

Laura: To talk a little bit about the program, what I would say is a collective kind of framework. We have folks coming into treatment. And if we’re thinking about, again, emotion regulation, we need folks to be somewhat nourished,  right? So whether that be eating a little bit more consistently, they’re purging less, maybe binging less, right? All of those [inaudible], we need them to be somewhat nourished because again, our brain is really the keeper of how we regulate ourselves.  So that needs to be functioning more effectively.  They need to have  some level of accessibility as some tools that we’re providing in treatment. Again, when I’m activated, because we will always be activated because we’re people, I need to have some different tools to help me get re-anchored, reach back to homeostasis, or at least be okay-ish. And then if we’re bringing in this kind of trauma programming, which we’ll talk about in a second, they are going to get more activated. So you’re going to kind of see an uptick in eating disorder behaviors, which is normal. We’re going back to those old skills and tools and regulating strategies that were once helpful. So there needs to be some level of stability, if you will. Within Renfrew, and I cannot take full credit for this, I had lovely colleagues that really reimagined our trauma programming, and so what they had done is shifted in terms of how are we a trauma-informed community first. Right, so anybody that comes in to Renfrew as part of some of these trauma informed community groups where they’re learning about their own nervous system and attachment styles and how do they get their needs met? What are our needs, right? And all of those components  and how do we acknowledge that everybody’s experience is different, right? And just kind of normalizing that. And then with folks that come in with an identified trauma history and or PTSD, are invited to participate in the kind of specialized trauma groups that we have. And that’s really our blend with our unified treatment model and cognitive processing therapy. And again, we have our kind of anchor in relational cultural theory as well.  So we have to have a relationship first with them, right? And making sure that there is at least a safe enough environment for them to do this work. They have to have this kind of agency and trust in what they’re doing and what they’re learning. Again, the ability to pull on those different tools that they might be learning. And then they’re talking about how is this trauma impacting me now? How is that showing up? They’re doing an impact statement.  They’re doing some homework assignments and some of the themes are like safety and trust and esteem and power dynamics, right? And all of those components to really understand how do I make sense of what has happened? And then how do I then kind of move and do things a little bit differently? And what you’ll see is that as we do some of that emotional work, and we’re healing in terms of that emotional activation, you tend to actually see the other avoidance strategies, including the eating disorder, at least lessen intensity and frequency. They may never be fully symptomatic, at least with us, but you tend to see a decline in those behaviors. 

Ashley: And so just to re-highlight this or ask about this, so there are specific and intentional trauma groups that anyone really who feels like they’ve experienced a trauma can step into.  And also now a part of just the standard treatment model and curriculum that the clients go through, there’s trauma-informed work that they’re also privy to.

Laura: Yep. And then one of the training initiatives that we had done in prior years and continue to make sure that we’re bringing into like our supervision spaces and those types of things is trauma-informed care. It’s really again shifting an organizational framework and dynamic and doing what happened to you and understanding where behavior is coming from as a survival strategy, rather than kind of, it’s very easy to fall into this kind of over pathologizing place, especially in higher levels of care. So you have this big organizational change and we’re constantly reevaluating that, right, and reinforcing that. And then we’re also building trauma-informed communities amongst our patients and staff, and then have these very separate spaces for those that really need to do some of that trauma work. They can also elect to do that individually if they don’t want to do it in a group context. 

Ashley: Can I ask a follow-up question to that too?  So I’m curious that question of what happened to you. I know you all, who is the author that spoke at the conference a few years ago that was with Oprah?

Sam: Bruce Perry.

Ashley: Bruce Perry, yeah, introduced that concept, what happened to you. Are there folks that ever have a hard time with that question because maybe  something has been suppressed so much or to say what has happened to me, like that feels so…like almost like they’re gaslighting themselves, like they’re not giving themselves permission to have been hurt.  Does that make sense what I’m saying?

Laura: Yeah. Yeah. I mean, I, don’t know that I’ve experienced that more recently, but I’m going to imagine. Absolutely. Again, if we think about kind of culturally what we deem is appropriate for trauma, right, I don’t know that that’s going to land well for everybody.  And again, this is where I really love our relational cultural roots too, because again, it just takes us out of that power dynamic and brings us into being human. And so how I might approach that as somebody is really activated by that, I might kind of take a step back and be like, wow, okay, so something got activated. I’m curious what you’ve heard and what…

Ashley:  I got you. Okay.

Laura: Like what is coming up for you? Is it that I’m not allowed to be traumatized?  Is it that I am weak if I have experienced trauma? Right? Whatever the themes might be. And again, it brings us a lot of information into, again, what’s the narrative that we’re telling ourselves related to this? 

Sam: Right. One of the stories we tell ourselves about what happened to us. You know,  I’m really fascinated by this idea of having an eating disorder program where every single person in the community  learns about their own nervous system and learns about trauma. It’s like the entire community is trauma informed. Can you imagine if we just walked around the world and everyone was trauma informed? How amazing that would be.

Laura: That sounds amazing. Yeah.

Sam: Yeah. So it’s amazing that Renfrew is sort of like this bubble where you walk in and everyone just like gets it. They get eating disorders, they get trauma, they just understand it. And I’m just, I was hoping we can get a little sneak peek into learning about the nervous system. You know, what exactly do the residents learn about the nervous system?  How does the nervous system change if someone experiences trauma? How does a dysregulated nervous system affect our relationship with our body, with food? I was hoping you could say more about that.

Laura: Yeah, I will do my best. It’s one of the things that I get very excited about because I love all things about the brain and in doing this work, I have found that again, the vast majority of the time, I think it takes away some of that shame in terms of what they’re experiencing. Because again, our nervous system is really cool in that it actually does what it’s supposed to based on your experience.  So there is a reason you are responding the way that you do based on all of the things that we’ve already talked about. So I think even just normalizing that, you’re not abnormal. You are actually responding for a reason.  So being able to understand what that reason is, and again, does that match this current context? So I like it in that way and being able to talk about it from a biological level. Just kind of take a little bit of that shame out of like, why do I keep responding the same over and over and over again? They get very frustrated by it.

Sam: Sure. Wasn’t there that saying this is a normal response to an abnormal situation?  Yeah.

Laura: I don’t remember who said that. I wish I did, but yeah, of course you’re responding this way, given the rules and the resources that you do and don’t have. We’re doing the best that we can. We’re highly activated. That is survival. Even emotional survival. So I think kind of a place to start and again, not a neuropsychologist. I wish I was, but we’re thinking about like the peripheral nervous systems that pay attention to the outside world, right, along with kind of our internal experience that’s happening from our organs, right? All of that kind. So like if we’re thinking for our eating disorder folks, what we tend to talk about it the most, I might have a heart flutter, if I’m really anxious about something,  I might have, you know, butterflies in my stomach and I’m doing some type of a challenge or a risk in program, right? So you can think of it from that perspective.  And then you have your central nervous system, which is your spinal cord and also up into your brain.  And so your body essentially sends you all of those signals from your internal experience and the world around you. And it goes all the way up into the brain to hopefully be able to make an informed decision when we’re regulated. So what happens, and Dr. Siegel kind of referred to the brain as like the triune brain. So some of us in the field have probably heard of this. So you have this like reptilian type brain, that’s your brain stem, right, and the cerebellum. And those are really all of the basic functions that you don’t have to think about: breathing, heart rate, all that stuff is all kind of managed back here. And then you go into the internal part of the brain, like kind of in the middle. If you think of it that way, the mammalian brain, this is where our limbic system is our emotion center. So you’ve got your amygdala, your hippocampus are the big ones in there. And those are kind of the relay stations and really paying attention to threats. And the hippocampus is the one that also tells our memory how emotionally evocative something was. So really, really scary traumatizing memories getting coded very quickly, hippocampus into our memory. So of course we remember them more often because I need to survive in the future. And then we have the neocortex, which is all of the cortex up on the outside of the brain. And it’s all the gray matter that we think of when you think of a brain. And in the prefrontal cortex, which is this guy right behind our forehead, that’s all of our planning  organization, our personality, emotion regulation, right? Our ability to talk to our limbic system and make informed decisions.  And so what happens when our amygdala gets activated, this goes offline, because I immediately go into fight flight, freeze mode.  I no longer have the capacity really in real time to make a value informed decision. I am in survival mode. And that can look like somebody running out of a treatment program. It can look like someone leaving a group. It could look like someone reacting out of anger. It could look like someone doing anything under the sun because they are not fully in control of what’s happening. Sometimes they don’t even remember what has happened when that fight, flight and a freeze response. So again, it’s helpful, I think, to kind of talk about what can happen with the nervous system. And there’s another one that I know has come up in recent years, the fawn response, which we hear a lot about. And at least in terms of treatment, I think how we see this a lot is that kind of like people-pleasing behavior, saying yes to us, even if they don’t want to say yes, in terms of making a recommendation. It might be kind of the denial of needs. I don’t have any needs necessarily. So that can present and they look like these great patients that are just going to do whatever they want, but there’s not necessarily choice in what they’re doing. So again, we need to be really mindful about how are we responding to them? How are we inviting them into a collaborative space? And again, are we checking in with them in terms of how would this feel for you to do X, Y, and Z? So again, kind of shifting that narrative a little bit as well.

Sam: Yeah. 

Ashley: This material, oh, it’s so good. 

Sam: And it’s so valuable for everyone in the program  to learn.  And these trauma responses,  fight, flight, freeze, and fawn, it’s so helpful to think of them as  survival strategies at one point that were quite useful. And they do pop up maybe in the wrong context or they pop up frequently and learning to name what it is, that this is actually a fawn behavior that at one point helped me survive,  but I don’t really need it anymore and it’s getting in the way.

Laura: As we’re hopefully helping them get more tolerant of how their body responds, especially, right? And again, the thought patterns that come with that naming their emotions on some level, right? Kind of anticipating what this feels like,  the hope essentially, is that they are able to experience something that might actually be activating, but my whole system doesn’t go into fight or flight. I can be uncomfortable, but then still make an informed decision.  And so that’s where you might hear folks be like, oh, my urges were really high today. I wanted to do all of the things, but I thought about our work and maybe I did a three point check or I asked for help or whatever it was, and I was able to not engage  in whatever that behavior was. And those are like huge moments for them where they’ve been so on autopilot and just based in survival that all of a sudden they’re like, oh my gosh, I didn’t have to actually engage in that. And it wasn’t actually as bad as I thought.  And I hear that a lot in this work, which is just super cool for us in terms of, I can do hard things, right? And it’s incredibly difficult.

Ashley: I just love that everybody that  comes to Renfrew has access to this information,  that it’s not just, you know, just the trauma group and just those few individuals that are in a group, but that this is now incorporated into everything  because I just feel like this material can be a game changer. Like I want it to be taught in like the basic education system, you know, like,  because the more we understand that you mentioned Dr. Siegel, Laura,  he also said, “name something and you will tame it.” The more we understand something, the  easier it is to function really.  And so this material, I just feel like can be so helpful for us.  So, okay, Laura, we’re running out of time.

Laura: I know. I’m chatty.

Ashley:  We all are.  Okay, I’m curious.  So before we sign off, somebody that may be experiencing trauma, have had trauma in the past, experiencing a collective, a collection of traumas, somebody that may be experiencing an eating disorder, disordered eating,  what would be something that you would want them to take away from this episode? 

Laura: Well, I think the first part, would be, again, there’s actually a reason. I think it’s very common that folks feel like there’s just not a reason that they’re doing what they’re doing, but there is a real reason and that it is actually possible to change with the right support. So whether that be outpatient, whether that be higher level of care, right, whoever it might be like, it is possible to make changes, it just takes some hard work.  But that’s probably the biggest. I think it’s so isolated and that they’re misunderstood or misdiagnosed,  but that we actually have some decent resources that have been shown to be helpful. 

Sam: Hard work and support makes such a big difference and that you don’t have to try to do all of this alone.

Ashley: Thank you so much, Laura. This is wonderful. We really appreciate you being on with us today.

Laura: Thank you so much for having me. It’s been fun.

Ashley: Absolutely.

Thank you for listening with us today on All Bodies, All Foods, presented by the Renfrew Center for Eating Disorders. 

Sam: We’re looking forward to you joining us next time as we continue these conversations.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

[Bouncy theme music plays.]