Podcast Transcript

Renfrew Conference Mini-Series Episode 7: Exploring the Dissociative Spectrum in Eating Disorders: A Conversation with Dr. Sarah Chipps

[Bouncy theme music plays.]

INTRO

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.

INTRODUCTION TO THE EPISODE

Ashley: This episode is sure to pique your curiosity and have you running to get more education. In this talk, we discuss Dissociation Here and Now with Dr. Sarah Chips, the founder and director of Well Williamsburg and Sanctuary. Dr. Chips explained the spectrum of dissociation, including dissociative identity disorder, and how a diagnosis on this spectrum can interplay with an eating disorder diagnosis. Sam and I were both lucky enough to attend her talk with Greta Gleissner, LCSW, on the first morning of the conference. And we hope you enjoy this very small snippet of such a vast topic.

EPISODE

Ashley: Hey everyone, welcome back to All Bodies. All Foods., Ashley and Sam are here and now we have Dr. Sarah Chips, she’s the founder and director of Well Williamsburg and Sanctuary. She’s a licensed psychologist, certified eating disorder specialist supervisor, and the current chapter president for iaedp New York. Previously, she was clinical director at Mont Nido’s residential program in Irvington, New York. Dr. Chipps specializes in the treatment of eating disorders and trauma, including complex dissociative disorders and her own recovery from an eating disorder and substance dependence influences her professional work. Thank you so much for being with us today, Sarah.

Sarah: Thank you so much for having me.

Ashley: Yeah! So, Sarah, Sam and I both attended your workshop yesterday and I looked over at it. Sam a couple of times and we were both just, you know, taking as many notes as we can. And I should mention the title of your workshop was Dissociation Here and Now. It was so fascinating. It was so informative. I’m really thankful that you came and presented at the conference. And I’m just curious if you could give us an overview of dissociation, dissociative identity disorder. I know that’s a big ask.

Sarah: Yeah, let me see if I can say this in kind of layman’s terms. So, dissociation is something that we all do. Zoning out, checking out, we all have had the experience of thinking that we’re, I think that we have all had the experience. Maybe, there are some outliers out there of like thinking that we have read a page in a book and then having to go back and reread it because our mind was somewhere else, right? These are like very normal experiences and there’s, these are not considered disorders, but they are, they could be classified as dissociation. Now when our, our minds and bodies have these dissociation skills baked into them, they are there for a reason. And, and so when a trauma happens, dissociation can be a really helpful way to put a pause on processing when there’s something happens too quickly or is too intense for the nervous system and the mind to process in the moment. And so, dissociation can remove somebody, psychically from something that they can’t get away from by running away or by fighting something off. And so, it can be lifesaving for people and really help people to just put a pause on processing and then hopefully come back to that later. And so, when there’s a trauma, sometimes part of PTSD can be derealization, the world doesn’t feel real or depersonalization, I don’t feel real. And then as we move along the dissociative spectrum, we can get to experiences like dissociative amnesia, where you might not remember what happened during a period. And then you can get into the complex dissociative disorders, which happen when people have had experiences of trauma that are repeated over a long period of time and usually relational. And so, there’s the first along the spectrum would be other specified dissociative disorders, or at least according to the DSM. Other specified dissociative disorders are OSDD. And this is when people can develop parts of self that can function in different ways or in different capacities. And it’s helpful for one part of self to do specific jobs and have a specific viewpoint and maybe know things that are different than other parts of self. And so, a dissociative barrier can be created within the person. And then the furthest along the dissociative spectrum is dissociative identity disorder. And in people with dissociative identity disorder, there are more than one apparently normal part of self. So, in, oh, and I should say like, these are all like terms and ideas and definitions that are kind of ever-changing. And, you know, as I’ve heard a lot at this conference, like what we know now about psychology and what we know now about how to treat people is going to be like different in 10 years or so. I’m kind of just describing like the general consensus out there right now about these disorders and there’s always conversation happening. And so, folks with DID generally have two or more parts of self that deal with the here and now, their most up-to-date life, right. And then they’ll have parts of self that were created for and by experiences of trauma, usually before the age of seven. So, these traumas have to have happened, the dissociation starts before the age of seven, when the identity is still developing. And when parts of self are still becoming cohesive and coming together in the child.

Ashley: Thank you.

Sarah: Is that clear?

Ashley: Yeah, I think that was extremely helpful. Thank you.

Sam: I think there are a lot of misconceptions about dissociative identity disorder. The media has not been helpful in portraying dissociative identity disorder. I think back, one of the first movies I saw about psychology was Sybil. And you actually brought that up in the workshop. And you also brought up different myths that are out there about DID and you challenged those myths. Would you be able to talk about what do you think are some of the biggest myths when it comes to DID?

Sarah: Yeah. I think that the biggest myth, and one that is the most detrimental to folks living with these experiences, is that it’s very rare. You know, in the presentation yesterday, I brought in statistics from other disorders. And if you look at anorexia nervosa, not atypical, but anorexia nervosa, as it’s defined in the DSM, it’s about 0.4% of the population. DID is about 1.5% of the population, which is the same about as people with bipolar disorder or schizophrenia or even people with red hair. So, if you think about it do we consider having red hair as an extremely rare experience? It’s not typical, right? It is a little bit of an outlier, but it’s not this outrageous thing that you’re never going to see. And so, people, clinicians, treating professionals are missing these diagnoses because they don’t think that they’re going to see them or they don’t even think that they’re real, which is another really a terrible myth that’s out there. And people who are living with these experiences don’t get that normalized and then don’t have language for it, for their experience. And so, they’re trying to understand their experience based on how they hear everybody else talk about or what the general culture or the majority says is your internal experience. And like Greta said yesterday, she thought, oh, that’s my internal monologue. And it wasn’t until decades later that she realized it was a dialogue between multiple parts, just because nobody had given her that language, right.

Sam: You mentioned the myth that DID isn’t real. And I remember in your workshop, you talked a little bit about some brain studies. I was wondering if you can say more about that here.

Sarah: Yeah, so there’s some really interesting brain studies being done at Harvard and McLean. Lauren Lebois, I think I said her name correctly, Lauren Lebois does amazing work and is also an amazing speaker. So, I think you can get some of her stuff on YouTube. But she’s looking at how the ventral medial prefrontal cortex and the amygdala work together to mediate a PTSD experience. So, in people with classic PTSD, they can see that the ventral medial prefrontal cortex, it communicates to the amygdala, ‘hey, you’ve got to fight or flight right now’. In people with dissociative subtypes, it tells the amygdala, ‘don’t do don’t do anything, just chill and pretend like you’re dead’, essentially, right. Like, it’s better for you right now not to fight or not to run away. This is the safer thing is to freeze, right? And to dissociate. And in people with complex PTSD, when the person is, so they put people through like fMRIs, I think. And they say, okay, and they do this with people who can control their switches. They have them in an apparently normal part they can see. In the apparently normal part that the ventral medial prefrontal cortex is, uh, not activating the amygdala. So, there’s no, like Greta was saying that she has a part of self that is, uh, there’s no fear, there’s no anxiety. That’s, and that’s the part that mostly interacts with the world or one of the parts that mostly interacts with the world. When that person’s in their emotional parts, the ventral media prefrontal cortex is like slamming on the gas on the amygdala. And so, it’s like being in a taxicab where the driver’s using both feet to drive, right, the gas and the brake at the same time. And so, there’s this kind of er, er, er, and I just think about like how jolting that can have an experience that can be right, but to be switching between these two states of being very calm and then also having a lot of fear and a lot of emotion at times. And so those brain imaging studies at Harvard and McLean with Lauren Lebois and Melissa Kaufman are really great. And if anybody’s interested, they should take a look at that.

Ashley: Sarah, I’m curious from a clinical perspective, I mean, obviously, you all, you and Greta delivered a fantastic workshop yesterday.

Sarah: Thank you.

Ashely: Sam and I are both clinicians. And like I mentioned earlier, we were avidly taking notes. But I’m curious, what’s a big takeaway that you wish clinicians would hear from you all when you’re giving this talk? What do you want us to know about dissociation?

Sarah: I think the most important thing is it’s treatable. There is hope and there is, uh, there are ways to, uh, help people to move through these disorders and you can do it as a clinician. There’s not enough clinicians out there trained in dissociative disorders. So often I hear people say, or call me and be like, I have somebody with DID, I think in my office, and I don’t know how to treat them. And will you see them? And I’m full. And everybody who treats dissociative disorders is full. And so we need people to like, feel like, yeah, you can learn this. And it’s not scary. And people, they’re not dangerous, right. This is one of the other myths, they’re going to harm the client or that the client is going to harm them or that this is like beyond their wheelhouse and you can learn it and there are resources out there for learning how to help people. And the most important thing is that you be a real human being and show up with your heart and soul. And if you want to help this person, you can, you have to dedicate some time and some energy to it, but you can do it.

Ashley: That’s awesome.

Sam: That’s such a hopeful message. Thank you.

Ashley: Yeah. I had another question.

Sam: I have a question. During the workshop, you gave some really interesting ideas for us as clinicians how to help clients separate past and present. And I think that seems like a big piece of working with the DID. Would you be able to just walk us through a way that we can, anyone really can work on separating the past and the present.

Sarah: Yes. Okay. So, there’s a workbook that I plugged super hard yesterday because I think it’s so foundational and so fantastic. And it’s called the Finding Solid Ground Workbook and it’s by Brand, Lannis and Schelke. I think I’m Schelke something. So, in this book, they talk about a couple of ways that I presented yesterday. And one is just sitting down and writing down, what is the date, how old are you, where are you, and maybe describing around you what are some things around you. That’s to anchor yourself in the present moment. And you can describe what you are seeing and hearing and feeling and touching around you, right. So really making contact with the present moment and just noticing that, because so often we can get kind of pulled into our thoughts or stories or even just our feelings that can, and it can feel like this feeling belongs in this present moment, right. And sometimes it does a little bit, but not a whole. And so really trying to make, really making an effort in a sensory and cognitive way to be present in the here and now. And then the other thing we did yesterday was the split screen imagery. So, we all use FaceTime and these kinds of communications now. And so, when you’re using FaceTime, this is not a plug for Apple, but when you’re using FaceTime, there’s a little screen with your picture in it, and then there’s a bigger screen with the person you’re talking to in it. And so, imagining that the present moment is the bigger screen and the past, if you’re having an intrusion from the past and you know that you’re having an intrusion from the past, the past is the little screen. And maybe you can even make the little screen black and white. And maybe you can even change the channel and or mute it. And maybe you can make it like fuzzy so you can really see the present moment. So, some of these imagery techniques because our imagination, our thoughts, these are such healing experiences. They can be also terrifying experiences if we’re getting swept back into flashbacks. But we can use that superpower also in a way to really highlight the present moment too and highlight soothing resources and soothing imagery.

Sam: I love that using your imagination to work for you rather than against you.

Ashley: I really liked that exercise that we did yesterday. I’m curious how, you know, so thinking about your clients with eating disorders, what is some of the main work that you might do around that with someone might be experiencing a large deal of dissociation.

Sarah: You know, when I’m working with somebody who has both, who has this comorbidity, I’m really thinking about how the eating disorder symptoms are boosting their dissociative experiences. And so, if you’re not eating enough, then you’re not going to be cognitively present enough to be really in the here and now. And if you’re using binging and purging or other behaviors that are more active, you’re also kind of throwing yourself into these behaviors instead of being in the here and now. Right. And so, I try to talk to people about that and just give them some education and on like what my concept, what my theory about this is and see if that might be true for them. And then ask them if they might take a healthy risk to be here more with me in the present. Because I don’t ever want to take, I can’t take away dissociation from anybody, right. It’s not my job. And it’s also not, uh, it helped like, I want to give people choice. How do you want to use your dissociation? And, um, when do you want to be present? And is it taking away from your life to not be more present sometimes? Um, and so just exploring that with people, I think is how I think about the eating disorder behaviors.

Ashley: Really appreciate that approach. That sounds very…

Sam: …inviting.

Ashley: Yeah, inviting. I was going to say gentle and really completely validating for somebody that is having this experience.

Sarah: Thank you. It was not easy learned, but I got there.

Sam: Yeah. Well, thank you so much for your time and for your workshop. We learned so much, and we really appreciate you being here.

Sarah: Thank you so much for having me. So wonderful to meet you.

OUTRO

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.]