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Podcast Transcript

Episode 12: Lesser-Known Eating Disorders Part 1

[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.

Ashley: Alright. Hello, Podcast Family. Thank you for joining us again on another episode of All Bodies. All Foods. It is Ashley and Sam, we’re back for another episode and just want to thank you for joining us again, you all. And today we really wanted to bring in some education for you. We’ve been hearing a lot, and probably you have too, a lot of conversation about some lesser-known eating disorders or lesser-known eating issues. And so, we really wanted to bring in and kind of explain some of these terms that you might be hearing. So, we received a new DSM, it’s the DSM-5, and for those of you that don’t know, that stands for the Diagnostic and Statistical Manual. It’s what we as clinicians kind of diagnose from when we’re working with any sort of mental issue, mental health issue. And so, in that new DSM, we finally got the diagnosis for Binge Eating Disorder, which was a huge diagnosis for us to have. And prior to that, so we had had Anorexia Nervosa, which we’re, we would really see kind of the restriction and the body image piece come up with that. We had Bulimia Nervosa, where we might see the restriction and the binge-purge come up with that, and again, the body image piece. And then we had what we also called Eating Disorder Not Otherwise Specified or EDNOS, and that’s kind of where that binge eating, prior to our new DSM, had fit. I’ve got Sam here with me today because we kind of wanted to talk about the different things that we got.

Sam: Yeah.

Ashley: The different language that we have now to kind of work with our clients.

Sam: It’s great to have the language. And I have to mention also that it’s so impressive that when we opened our doors in 1985, Renfrew was already treating binge eating disorder. We couldn’t diagnose it, but I mean, this has been around forever. It’s not like binge eating disorder just appeared.

Ashley: Right, right.

Sam: This has been around for decades and decades and longer than that. And we have been treating it. The good news is that now that we can diagnose it, we can better understand it, there’s research now around it there, you know, we can fund it when you have a diagnosis, you can actually get funding, which is really important, especially because of the disparities and accessibility issues in health care right now. Binge eating disorder is the most common eating disorder. I think when people think of eating disorders, they think of anorexia, and there are so many other eating disorders and eating issues that people struggle with.

Ashley: Yes.

Sam: I’m sure folks have heard so many different terms in the media, there are so many different journalists that do stories and news pots on these different terms floating around, and it’s confusing because it’s like, “Okay, do I have an eating disorder? Do I have disordered eating? What’s the difference?” You know, “How do I know that maybe I’m getting into the territory of something really serious?” Especially because every, you know, disordered eating so normalized in this culture. So, this episode is so needed. And every time I create a post on social media about lesser-known eating issues, it practically goes viral every time, and that tells me that people want to know more about this and there’s only so much I can share in a thirty second TikTok. So, let’s do this episode, let’s talk about these issues so that we can recognize them, you know, you can recognize if someone you know might be struggling, but also if you might be struggling, and understand how these things are treated and break down the stigma around them.

Ashley: Yeah. Hopefully with this we can give you some language, and like Sam was saying, we can give you some better understanding of kind of all of the things that we’re seeing. And I want to just say, we recognize that every person that comes in is an individual and has their own kind of individual story, right? And so, it’s, you know, diagnoses are helpful because they can tell us where to go, you know, and they may not encapsulate everything that you might be experiencing or that your loved one might be experiencing. So, we just want you to know that we know that, we see that, we see you and hear you and hope that you find this material helpful.

Sam: Right, well most folks aren’t going to fit neatly into a category. And we know that as clinicians, we know that and, you know, sometimes we do need to diagnose for funding purposes and things like that. And the way I see diagnoses, it’s sort of a way to communicate generally what’s going on for someone, but everyone is so unique and if you don’t fit neatly into these categories, you’re not alone, most people don’t.

Ashley: Right, right, exactly. So, we wanted to break down a few of these terms for you all. So, the first one, we kind of talked about this a little bit, but the first one I want to dive into is just Binge Eating Disorder, because again, it is not new by any stretch of the imagination. And so, Binge Eating Disorder, we’re gonna see someone that might eat more than kind of a “normal amount” in one sitting. They may eat more quicker, more rapid than usual. They may not realize what they’re doing or kind of, you know, um, what’s the word I’m looking for Sam, like—

Sam: Well, there’s sort of a dissociation that happens.

Ashley: Dissociation, yeah, yeah.

Sam: And I’ve heard it described, there have been qualitative studies which, by the way, those are studies where people are interviewed and they can just talk openly about their experience. They describe it sometimes as being in a trance, losing track of time. So, it does sort of have this dissociative quality to it and there’s a loss of control. So, the person who is binge eating, while they’re binge eating, it just feels like total chaos. And “I can’t, it’s like I can’t stop. I don’t know why I’m doing this. I don’t know how long I’ve been doing this. They’re just sort of in a trance.”

Ashley: Yeah. And really, and I will say also it doesn’t really matter what the food is that the binge is happening on. It could be anything.

Sam: Anything.

Ashley: Yeah, absolutely anything. There also might be that sense of shame attached to it, and there might be some body image concerns with the binge eating.

Sam: Usually there are. Right, usually there are. It’s not uncommon for someone with Binge Eating Disorder to have a history of dieting, a history of yo-yo dieting, weight cycling, a history of thinking that certain foods are goods, certain foods are bad. Like, “These are binge foods. I’m only allowed to eat these foods when I binge.” Very common.

Ashley: Any other thing about binge eating that we should touch on?

Sam: Folks with Binge Eating Disorder are very distressed by having this disorder. And, you know, we’ve heard, we’ve talked before about weight stigma, but there’s also Binge Eating Disorder stigma.

Ashley: Yes, there is.

Sam: That, you know, those with Binge Eating Disorder experience—I think sometimes it’s this internalized stigma, this shame that, “What’s wrong with me that I can’t control myself?” So, there’s a lot of shame around it, oftentimes there’s internalized weight stigma if someone’s in a larger body. So, there’s all of these oppressive forces that are also affecting the person psychologically and medically. I mean, we know weight stigma and Binge Eating Disorder stigma has an effect on our health. I mean, I think that that’s so important for everyone to understand, that these oppressive forces are harmful to us medically and psychologically. So, victims of weight stigma and weight discrimination and Binge Eating Disorder stigma, they’re, it’s impacting them across various domains.

Ashley: And it can feel, because it’s kind of impacting so many pieces and parts of someone it can often feel so overwhelming and, “I don’t really know how to get out of this,” and “This is a behavior that I’m in and I’m just staying in it because it’s too much for me to even think about getting out of this.” Right? Like, it can be so overwhelming because it can literally impact every part of your life.

Sam: Oh, absolutely. Absolutely. And it doesn’t help that folks with Binge Eating Disorder, you know, might go to the doctor and the doctor tells them that they need to lose weight.

Ashley: Yeah, yeah.

Sam: And what we know about treating eating disorders is that we need to take the focus entirely off of weight loss while we’re treating the eating disorder. There’s other markers of health and wellbeing that we can use to measure progress. And I should also mention that binge eating disorder can happen to anyone in any body size. Let’s not forget that.

Ashley: Yes.

Sam: So, you cannot possibly look at someone and know what kind of eating disorder they have. You can’t look at someone and know how severe their eating disorder is.

Ashley: Right. And you may have mentioned this already, Sam, I can’t remember if you did, but Binge Eating Disorder is the most commonly diagnosed eating disorder.

Sam: Yes, exactly.

Ashley: Right? We see that more than we see Bulimia, more than we see Anorexia. And often, I think though that culturally, and maybe this has to do with media, this has to do with, you know, the different movies that you see, but our culture gets stuck on Anorexia, the diagnosis of Anorexia. Which is, I mean, neither of them are great for us, you know, I mean, they’re both very harmful and we need to work on those. But Anorexia is actually the least common diagnosed eating disorder. Isn’t that correct?

Sam: Exactly. And isn’t it interesting that most people, when they think of eating disorders, like, the face of eating disorders is the thin, white, teenage urban-suburban girl with Anorexia. And it’s fascinating, it’s like, any movie that comes out—I remember on Netflix To the Bone came out and it was a chance to spread eating disorder awareness, and the movie had some positive aspects. However, it was another example of, you know, perpetuating that myth that, you know, that first of all that Anorexia can only happen to young, thin, affluent white girls. And that couldn’t be further from the truth. I mean, Anorexia can happen to anyone, and by the way, it can happen to anyone in any body size.

Ashley: Anyone in any body, anyone of any ethnicity. We are seeing this. Yeah, I really wonder if, is it our field, was it culture? You know, we really kind of, as a society, like you said, we’ve had this view of eating disorders being a particular person in a particular body type. And what we know is that is just not true. Any person of any background can have any eating disorder. Absolutely any.

Sam: Any gender, any sexuality, race, ethnicity. I, almost every interview I’ve ever done, whether it’s with a journalist or, you know, a news anchor, I always try to throw in the phrase: “Eating disorders do not discriminate.”

Ashley: Yeah.

Sam: Yeah. They can happen to anyone, you know. There are folks who I’ve heard say, “Well, I can’t possibly have an eating disorder, I’m in my 50s.” Yes, you can!

Ashley: Yes, yes.

Sam: And as a matter of fact, we treat so many folks over the age of 30 at Renfrew that we even have an entire track called “30 Something and Beyond” because we can actually create a little community with folks who are coming in for treatment who are over that age. So, if you’re listening out there, I know there’s someone out there listening who thinks they’re too old to have an eating disorder. Guess what? You’re not. And you’re never too old for treatment. I’ve seen folks recover in their seventies!

Ashley: Yes.

Sam: So, it’s never too late. And I think that’s another misconception, “Oh, I can’t go to treatment, it’s just gonna be a bunch of teenagers there.”

Ashley: Right.

Sam: No!

Ashley: You know, there really aren’t. It is a— it is a wide variety of ages that we work with, you know?

Sam: Yes, absolutely.

Ashley: Yeah, we, we definitely see the gamut of ages in there. So, just want to say that again to you all. It really doesn’t matter—it doesn’t matter how old you are, it doesn’t matter what your background is, it doesn’t matter, male, female, non-binary. Eating disorders can happen to everyone.

Sam: Right.

Ashley: Yeah. So, hopefully today we can give you some language to maybe just do some internal checking. Maybe language if you know somebody that’s struggling with an eating issue, we hope this is helpful.

Sam: Yeah. So, there are so many lesser-known eating disorders. Actually, I think it’s fair to say, you know, eating disorders other than Anorexia are not as well known.

Ashley: The lesser-known—

EVERYONE LAUGHS

Sam: Right? I mean, we can talk about Bulimia, we could, you know, we can certainly talk about OSFED, which is the umbrella term for when you don’t fit neatly into the traditional eating disorders, Anorexia Bulimia, Binge Eating Disorder. OSFED, thankfully, we have that diagnosis for someone who’s clearly struggling. But, you know, the criteria is strict for some of these other eating disorders, but someone could still be really suffering medically, psychologically, socially. But they’re like, “But I don’t, I don’t fit, I don’t fit.”

Ashley: Right, this doesn’t, this doesn’t fully—right. “This doesn’t encapsulate what I’m actually experiencing.”

Sam: So, luckily we have OSFED as a diagnosis we can actually write down and tell insurance, like, “This is what this person is dealing with.” But there are a lot of different terms that fall under OSFED that might have been—yeah, you might have heard them before in the news or just in passing, but maybe we can talk a little bit about the umbrella of OSFED.

Ashley: Those terms. I do want to say OSFED stands for Other Specified Feeding and Eating Disorder.

Sam: Yes, thank you.

Ashley: I know we get in our clinical brains and start talking that way. So, yeah. So, the OSFED category was also new for us in the DSM-5. And so, some of the terms—I’m just gonna throw out some names here, Sam, and then maybe we could just like go through those.

Sam: Absolutely. Let’s do it.

Ashley: Okay. So, some of the terms that you all may have heard on TikTok, on social media, you know, in your psychology class, we have all sorts of things. So, Night Eating Syndrome, Diabulimia, which again, we’ll kind of explain to you all. Orthorexia, Drunkorexia, a recent one, Bigorexia—that’s B-I-G, Bigorexia. And then I think Atypical Anorexia. Am I missing any, or are those kind of the ones we’ve heard?

Sam: Well, I think let’s talk about those because I think we’re hearing some of these terms a lot. But I will say again, you don’t even have to fit these terms to have OSFED. OSFED is so, you know, diverse that, you know, you could have a very unique symptom presentation and still be diagnosed with OSFED without it being Drunkorexia, without it being Diabulimia.

Ashley: Right.

Sam: But yes, so let’s—maybe we can start with Atypical Anorexia.

Ashley: Sure, sure.

Sam: Because this is such an important topic, and it’s caused a lot of—it’s a very hot topic, I think, amongst the clinical and medical world because there is a push to eliminate it completely and just put it with Anorexia. Because the reality is, Atypical Anorexia—someone who has atypical anorexia is struggling with the exact same behaviors and symptoms—

Ashley: As anorexia.

Sam: As anorexia! So, someone who is terrified of weight gain, you know, has obsessive thoughts about food and weight. Someone who is severely restricting and trying to lose weight. It’s all consuming, it’s affecting them medically, it’s affecting them psychologically, socially. Their world has become very small and the only difference between Atypical Anorexia and traditional Anorexia Nervosa is that Atypical Anorexia is diagnosed for someone who is not technically “underweight.”

Ashely: Correct.

Sam: Right. And so, it implies that—and I think sometimes folks who are diagnosed with OSFED / Atypical Anorexia, it feels so invalidating because it’s like, “What is this some lesser form, some less serious form of anorexia?” And a qualified clinician will know, because they’re up to date on the research, qualified clinicians know that Atypical Anorexia is just as dangerous, just as severe as Anorexia Nervosa, if not more so. So, the studies that have come out about Atypical Anorexia, it’s like, there’s this—So, the studies tell us that folks who are, you know, losing weight restricting malnourished, they are suffering psychologically, some of them are suicidal. They’re having all kinds of medical issues. And the misconception is, out there in this world, that if you have some weight on you, that somehow you’re immune to any kind of medical issue. Almost as if, “Oh, anorexia is not gonna hurt you until you’re underweight.” And that is false.

Ashley: Right. And in fact, if someone who is “overweight” goes to the doctor, sometimes they’ll say that they lose weight, and the doctor doesn’t know how they lose weight, often they get praised for that weight loss and not asked, “What are you experiencing? How did this happen? Can you tell me a little bit more about what’s going on?” Instead of those types of questions, they might get praised for losing the weight and then move on. And then yet again, feel completely invalidated, yet again, feel completely unseen, and not know where to go, right? Like, that might feel very, very confusing for them.

Sam: Absolutely. And it sends the message, “Well, I guess I should just keep doing what I’m doing.”

Ashley: Right, right. Which often they know, “Something’s not right here.”

Sam: Of course!

Ashley: Like, “This doesn’t feel good. Something is not right, and I need help.”

Sam: Right. Because they, again, I talk about this so much in so many trainings, you can be malnourished at any weight.  And malnourishment comes with its own set of psychological and medical issues. And so those with Atypical Anorexia, if anyone out there is listening who knows that you have this or you’ve been diagnosed with it or think you have it, I just want to send you so much compassion and validation that your struggle is real. You deserve help. It is not a less serious form of Anorexia.

Ashley: No, no.

Sam: It is dangerous. It’s hurting you, and there’s help for it. And so, I get that there are unfortunately a lot of medical providers, you know, there are mental health providers unfortunately out there as well, dietitians who might not get that. And I hate to say it, but unfortunately, eating disorders are just not covered the way they should be covered in most of the training and education for people in this field. Unless you specialize in it.

Ashley: And even that sometimes can be hard like, “Where do I go?” I mean, Sam, you and I are both clinicians, and I distinctly remember having a substance use class, like a whole class pulled out on substance use and focusing on that, and we had nothing on eating disorders. Nothing.

Sam: Right. It’s not uncommon, it’s not uncommon. And so, a lot of people in the field, in the eating disorder field, end up learning about eating disorders through a very specialized internship or residency. For instance, I got most of my training through my postdoctoral residency at Renfrew. And that’s when you’re flooded with all of the information and experience, and you do your own study around it. But it’s a major issue in graduate schools, medical schools, eating disorders are just not—they don’t get the attention that they deserve. I mean, these are—eating disorders are one of the most deadly psychiatric disorders in the DSM, second only to opioid use disorder. So why aren’t we, why isn’t there an entire course on eating disorders?

Ashley: Right. That has been my question for years.

Sam: There should be! Folks with eating disorders are at elevated risk for substance use, they’re at elevated risk for suicide. How are we not learning about these in graduate school? So, there needs to be more on it for sure. And that’s why I think this podcast is so important, not to toot our own horns here. But I hope this is one way we can spread education about eating disorders. And I’m so glad you brought up substance abuse because I think it brings us into our next topic, which is Drunkorexia.

24:56

Ashley: Drunkorexia, yeah. And before we get onto that, I just want to say, truly, if there is anyone that has—if eating, if body image, if this stuff feels—or the lack of eating, or the purging, or the overeating. If any of this feels consuming and like it is literally impacting you from every angle of your life, you’re unable to do the things that you used to enjoy doing, you’re constantly thinking about this—please reach out, please reach out.

Sam: Yeah.

Ashley: Call us, we’re here to help you. Call a friend. Let somebody know that you need support. I promise you, your people will want to support you and we’re here for you too, so please reach out. So, I just wanted to throw that out there, Sam.

Sam: No, thank you. And I’ll even add into that, if you’re a college student, which by the way, you know, that’s the age group where onset of an eating disorder is pretty common. Most colleges have a counseling center. I just read a study, I think 22% of students have no idea where their counseling center is on campus.

Ashley: Oh, wow!

Sam: Yeah. Go find your counseling center, go there. There usually are therapists and psychologists. Go there, say: “I’m struggling with food.” By the way, Renfrew, we do a lot of trainings at college counseling centers. So, hopefully you’re at one of the counseling centers we’ve, you know, we’ve gone into. Right, right. But, you know, the counseling center is free, usually. There’s a certain amount of sessions that are free. Every university is different, but I just want to remind any students out there, we know the age of onset for eating disorders, adolescent, young adult period. So, college is, like, really a sensitive time, vulnerable time for folks. Which is, you know, I think a segue into Drunkorexia also because drinking on campus is widespread.

Ashley: Yes.

Sam: And Drunkorexia, I’m sure many folks maybe have heard that term in the news. There have been quite a few news outlets that sort of did a spot on Drunkorexia, because it’s kind of attention grabbing. It’s a little sensational the term.

Ashley: It is, yeah, the term.

Sam: And everyone kind of wants to know what it is. But we—there’s a push to change the name of it to Food and Alcohol Disturbance, FAD, F-A-D for short. And there already has been some research on Food and Alcohol Disturbance aka Drunkorexia, because we want to better understand what’s going on here. Because it’s clearly something many, many people struggle with, but it’s not a legitimate psychiatric diagnosis yet. Now, I predict in the DSM-6 we might see Food and Alcohol Disturbance. So, when this episode comes out, I wonder if it’ll land in the next DSM. I hope it does because I cannot even tell you how many people dabble in Drunkorexia. And then there are folks who really, really suffer with an extreme version of it. It’s on a spectrum, like most things in life. So, when we talk about Drunkorexia, what we’re really talking about, this is someone who is suffering from a substance use disorder and an eating disorder. And so, the presentation that we typically see and college students, by the way, are at high risk for this, especially college students who identify as female. So, it’s an attempt to avoid weight gain by saving up all your calories during the day so that you can binge drink later. And it’s really, it’s really dangerous because there are a lot of complications that happen with Drunkorexia. You can get a spike in your blood alcohol level and end up blacking out. You know, it’s associated with malnourishment, vitamin and mineral deficiencies, alcohol poisoning. Drinking on an empty stomach just also really, you can get yourself into situations where, you know, you feel traumatized, you don’t remember what happened. You’re—it’s very disorienting.

Ashley: Right, right.

Sam: And so, Drunkorexia is also associated with anxiety, depression, sleep disturbances and other mental health issues as well. So, I think, one of the things that fuels Drunkorexia, especially on college campuses, is the fear of The Freshman 15.

Ashley: Okay.

Sam: We hear this all the time. By the way, The Freshman 15 has been debunked, you can look it up. Right? Because there’s this—I mean, there’s just this fear in general in our culture around weight gain. That weight gain always means: “I’m an unhealthier version of myself if I gain weight.” Meanwhile, college time is such a transitional period, most people, their bodies are gonna change. That’s natural and normal.

Ashley: Right. Your patterns, your behaviors, your everything is changing.

Sam: Everything is changing.

Ashley: Yeah, your stress levels—which all play a part in what your body does.

Sam: Exactly, exactly. So, the studies around The Freshman 15, what they found is because of all those changes, stress, sleep, you know, there’s all these transitions that are happening, your body might respond by gaining weight. But what they found actually was that your body sort of settles out once it sort of gets into a routine. And the weight gain is not a dangerous thing. And I think this culture treats it like it is. There’s this belief, and this terrible fear around weight gain, that folks are willing to severely restrict so that they can still drink alcohol.

Ashley: Right.

Sam: And I remember I did a post on this on TikTok and it got hundreds of thousands of views, and people were very upset by the idea that this is disordered eating.

Ashley: Really?

Sam: Yeah, because there’s this— it’s, you know, it doesn’t surprise me too much because there’s this belief that, “Well, if I’m gonna drink, I shouldn’t, you know, I shouldn’t have these calories during the day.”

Ashley: Right, “I should save.”

Sam: Right. And there’s this belief that that’s healthy. And the reality is, again, everything is on a spectrum, so this can happen in a way that maybe won’t impact your life very much. Maybe there’s some minor restriction and some very modest drinking, you know, and so maybe it’s not impacting you really physically or mentally. But the reality is, the more— the further down the spectrum you get with Drunkorexia, the more likely you’re going to experience medical and psychological issues from it.

Ashley: Yeah.

Sam: So, you know, on the far end of the spectrum is someone who maybe restricts all day so that they can binge drink at night. And it just causes so many different issues and this person is really suffering.

Ashley: Yeah. And there’s so many risks with doing that, right?

Sam: Right, exactly. Yeah. So it’s a thing, it’s—there’s a word for it. Eventually I think we’re going to have a diagnosis for it.

Ashley: Food and Alcohol Disturbance,

Sam: Food and Alcohol Disturbance. And like other diagnoses, there will be criteria to meet that will probably be very specific. But I want to be clear that—and this is true for all other eating disorders also, you don’t have to meet that strict criteria in order to still be suffering.

Ashley: Right, right.

Sam: And you can still improve your relationship with food, your body, or with substances, without having a formal diagnosis for one of these things. And I think so many of us can benefit from just improving our relationship with, you know, with our bodies or with what we’re consuming.

Ashley: Oh, definitely.

Sam: Yeah. So, that’s what Drunkorexia is, for anyone out there wondering. And it’s so common actually, you know, with eating disorders, it’s very common to have a co-occurring substance use disorder when you have an eating disorder. We see these two things together so much that we actually created a substance use track at Renfrew. Bcause there were just so many people who needed the treatment for both, and what we know as clinicians in the eating disorder field, is that you cannot only treat the eating disorder and ignore everything else.

Ashley: Right.

Sam: Because what will happen is, if you treat the eating disorder, but you don’t treat the substance use, then those substance use urges and behaviors are probably going to increase, unless you address those simultaneously.

Ashley: And/or they might move to something else even.

Sam: Yeah.

Ashely: If that makes sense. I at one point worked at a coffee shop and, you know, was right across the street from an AA meeting, and the amount of— large amount of espresso shots that were ordered in coffee drinks for that stimulation. Right?

Sam: Right.

Ashley: Like if we, if we don’t—I’m saying that to say, if we don’t actually work on the whole picture, right? You know, our clients are just gonna continue to feel like they’re suffering. I mean, it’s just going to continue to be hard and to hurt for them. So, right, we kind of, we have to look at all of this, the substance use, the eating disorder. We have a trauma tract for the same reason.

Sam: Exactly, exactly. We have to treat it all, and the way we do that is we have to target the common denominator of all of these behaviors, whether it’s restricting, binging, purging, substance use, self-harm, whatever it may be—we have to find the common denominator, which is usually emotional avoidance. And if we can target that and help people regulate their emotions, regulate their nervous system, figure out why they’re doing what they’re doing, experiment with new patterns, facing fears, all of that stuff, and getting more comfortable with feeling.

Ashley: Yeah.

Sam: We often see then all of those symptoms decrease. So, you cannot—if there is a provider that wants to work with you, and they’re like, “I’m only going to work on one thing,” you can expect an increase in those other areas. You have to treat it all at once. So Drunkorexia, moving on. What should we do next?

Ashley: I know, there are so many. Let’s, um, let’— can we talk about Night Eating?

Sam: Night Eating? Yes! Night Eating Syndrome. Yeah, absolutely.

Ashely: Because, well, I would just say, I find this one fascinating. I’ve had so many people that have maybe—I’ve worked with at Renfrew or in my private practice and we’re, again, kind of looking at what their behavioral patterns are, what we’re seeing them engage in. And Night Eating Syndrome is different from Binge Eating Disorder.

Sam: It is, it’s very different. Although I feel like, during assessments—so, an assessment is when you go in and you meet with, you know, an admissions person and you talk about your whole eating history and everything. It’s like, you know, an hour or two. I think in the assessments, people think that their night eating is just a part of their Binge Eating Disorder and it’s actually separate. So actually, Binge— what most people don’t realize is that Night Eating Syndrome can actually be diagnosed alongside other eating disorders, as a separate entity. So, Night Eating Syndrome is different from Binge Eating Disorder. And, so there’s a few reasons for that. One is that someone with Night Eating Syndrome, they are not engaging in binge eating episodes in the middle of the night. If they are, that could more fall under the category of Binge Eating Disorder. But there’s a difference here because those with Night Eating Syndrome, what happens is they repeatedly wake up in the middle of the night and they have this thought, and this is one of the things that separates it from Binge Eating Disorder. They have a thought that “There is no way I’m going to be able to fall back asleep unless I go eat something.” And that’s the belief that drives the cycle. And so, what happens is, the person gets up, they eat something, they remember eating it. So, it’s not a sleep disorder in the sense that— there’s certain sleep disorders where you’re sort of maybe sleepwalking and you have no memory of what you did.

Ashley: Right, right.

Sam: But with Night Eating Syndrome, actually, you do have a memory of eating, you’re conscious of what’s going on, and you eat, and then you eat enough to the point where you feel like you can get back to bed. And so, it’s not—it doesn’t really meet criteria for a binge eating episode, that loss of control.

Ashley: Right, that’s not there.

Sam: The eating rapidly. And so, there’s very specific criteria for a binge eating episode. And so, Night Eating Syndrome, you know, I think years and years ago people used to just call this a midnight snack, but actually, this causes folks a lot of issues. It’s very distressing, it’s very disruptive to sleep. Oftentimes people don’t like that they’re eating in the middle of the night, they feel like it affects their digestion, it affects, um, they feel guilty about it, there’s a lot of shame around it. And actually, I actually do a training on Night Eating Syndrome and the differences between that and Binge Eating Disorder. But from what I’ve discovered through the research, it seems like people with Night Eating Syndrome aren’t really disclosing that they’re doing it because they’re embarrassed. So, they might be going to their doctor and their doctor asks them, you know, “Do you have any eating issues?” And I think people are much more likely to say, “Yeah, I binge eat.” But they’re not, actually—not everyone is actually disclosing that, “Actually, I wake up in the middle of the night, multiple times a week ,and I go down to the kitchen and I eat something, because I truly believe there’s no way I can fall back asleep unless I do.”

Ashley: So this is a pattern that’s happening multiple times a week, Sam?

Sam: Yeah, exactly.

Ashley: Two to three?

Sam: So, the criteria, I’d have to look up the exact criteria, but I think it does happen multiple times a week. But I think the important thing is that you can have both Night Eating Syndrome and Binge Eating Disorder.

Ashley: And Binge Eating Disorder.

Sam: And there’s a slightly different approach to treating Night Eating Syndrome, because you might be referred out for a sleep study. You know, there are other interventions that probably wouldn’t be necessary with only Binge Eating Disorder. But there are some, you know, if we look at a Venn diagram of Binge Eating Disorder and Night Eating Syndrome, one of the common features is that both, in both scenarios, the person is probably undernourished. They’re, you know, they might be experimenting with dieting and weight loss. And so, the night eating could be a way that, you know, the body is trying to say:  “I’m not getting enough nourishment.”

Ashley: Gotcha, yeah.

Sam: And then you sort of get stuck in the cycle of waking up repeatedly and eating. But treatment is available and, you know, people can recover from it. And then you can get a full night’s sleep, and then you’re nourishing yourself properly during the day and, you know, the other issues also resolve, you know, oftentimes with malnourishment, depression, anxiety, those intrusive thoughts, all of those improve with nourishment. So, yeah, Night Eating Syndrome. We don’t talk about it enough, but I think a lot of folks struggle with it.

Ashley: Yeah, I was just sitting here thinking to myself, like, “Somebody that’s listening that’s maybe experienced this before—” Because I agree with you, I do not at all feel like this has talked about enough or a lot.

Sam: Yeah.

Ashley: I wonder if somebody is feeling seen, maybe?

Sam: I hope so.

Ashley: You know, or heard for the first time. Again, give us a call, talk to your therapist, right? Like—

Sam: Or your doctor!

Ashley: Or your doctor. Let someone know that you’re experiencing this and that you are recognizing that, “Oh, I can actually get help for this.”

Sam: Right!

Ashley: “I don’t have to continue to feel distressed about this pattern.”

Sam: Exactly, exactly right. And yeah, I think your doctor could be a good place to start. And this is a diagnosis, actually. It is in the DSM-5, it’s under OSFED. Night Eating Syndrome, there’s research on it, there are books on it. So, it’s out there. Do, you know, do professionals know everything about it? No! I mean, that’s why I am passionate about doing trainings on these things, but it’s in the DSM-5, you can advocate for yourself and say, “I think I have Night Eating Syndrome, it’s in the DSM under OSFED.” You know, and you can— I think advocacy is such an important skill when it comes to your own mental health and your physical health. You know, to go in and say, “I think I know what’s going on here… because I listened to All Bodie. All Foods.

BOTH LAUGH

Sam: We’re here to help you advocate for yourself. Night Eating Syndrome is a real thing, it’s a diagnosis.

Ashley: Yeah. Well, Sam, what do you think? You wanna, you wanna dive into another one?

Sam: Let’s do it.

Ashley: Okay. So, here’s one that has kind of come up recently, that I would say I’ve seen actually quite a bit on social media: Bigorexia.

Sam: Oh, yes. Yeah. So, this is a new, newer term.

Ashley: Yeah. Is this one in the DSM, Sam?

Sam: It is not in the DSM.

Ashley: It is not, okay. So, it is like a new-new term.

Sam: It’s new-new. I think that someone with Bigorexia—we come up with these terms in the field because there are people who are struggling, all struggling with the same thing, and we need a word for it, and this is how diagnoses get created. Again, I think Bigorexia, it might not be that exact name, but I think this pattern of disordered eating hopefully will land in the next DSM. So, I just want to say about Bigorexia, it can happen to anyone, any gender. But I would say those who identify as male are probably at highest risk, given— just given this culture, and given toxic masculinity, and the ways men in general are taught, you know— they’re taught what they should look like, and how they should be. And I think Bigorexia is a symptom of a very sick culture, essentially. So Bigorexia is, you know, when we think about disordered eating, what we’re really talking about—so, you know, in the gym world, they call it “bulking and cutting,” right?

Ashley: Okay, yeah.

Sam: But in the eating disorder world, when we really look at these behaviors, we call it “binging and restricting.” And so, these behaviors can become so severe, and someone can become so disconnected from what their body actually needs, in pursuit of a very muscular yet very lean build. And so, this is called Bigorexia. So, it’s sort of a combination of an eating disorder, because we have the restricting and then we have also the binging—

Ashley: The binging, right.

Sam: You know, #CheatMeals. I’m sure you’ve seen those, right?

Ashley: Yes, yes. Or #CheatDay.

Sam: There have been studies on that hashtag, and the amount of food that we see associated with those hashtags would meet criteria for a binge eating episode. So, cheat meals are really just a fancy way of saying that you’re—it’s a binge eating episode. So, we see it’s a combination of an eating disorder and those very specific behaviors, and body dysmorphia. So specifically, muscle dysmorphia. So, this is when someone believes that, you know— Well, first of all, they’re obsessed with becoming muscular and they continue to view themselves as not muscular enough. Even if other people are telling them, “You are very, very muscular.” It’s like they just cannot see it and cannot believe it.

Ashley: Right.

Sam: So, there are a set of behaviors that, of course, on a spectrum, always on a spectrum, can range from mild to very severe. I mean, just like Drunkorexia, right? It could be at the far end where someone is restricting heavily, maybe even abusing stimulants, you know, abusing different substances in order to get that lean look. But then maybe engaging in binge eating episodes when it’s their “cheat day,” and really these behaviors can eventually start to not only cause medical issues, but major psychological issues, anxiety, depression. What’s scary about Bigorexia is that, you know, yes, those who identify as men are at higher risk. And what’s scary to me about that is that we know from the research that men may be much less likely to seek help for this, because most men who eventually do land in treatment for an eating disorder, they often—it’s a very late diagnosis. So, they sort of let it go on for quite some time before they realize that they need some help. And men have a higher risk of hospitalization and even death when it comes to eating disorders. And I should also mention, 40% of those with Binge Eating Disorder identify as male.

Ashley: Wow, wow.

Sam: And cheat meals are—not all cheat meals are binge eating episodes, but the amount of food in many of these situations would meet criteria for binge eating. Because again, we’re looking at an amount of food that’s much larger than what someone would normally eat in that time frame and under those similar circumstances. So, you know, folks with Bigorexia, again, can happen to any gender. Males, those who identify as male are at higher risk, but these folks are really suffering and, by the way, their world gets very small. Their whole world is, like, the gym, training, getting bigger, getting leaner.

Ashley: And if they can’t engage in that, in the gym and training and getting bigger, the amount of anxiety that comes up if they’re unable to go to that training session is, like, off the charts often.

Sam: Oh, absolutely.

Ashley: So intense. And when, you know, sometimes we even see panic attacks come along with that.

Sam: Exactly, exactly. And I would say some warning signs of Bigorexia might be someone who continues to go to the gym even when they’re sick, even when they’re injured. Maybe they’re even abusing protein powders, steroids, you know, all of these substances in order to achieve this look, this like InstaBod, right? We see a lot of these accounts on Instagram and social media where also I think there’s this drive to monetize their account. And there’s this belief that, “Well, I need to look a certain way to get those followers, to get those likes.” And it’s just yet another reinforcing factor where it’s like, “Okay, the more I pursue this body type, the more engagement I’m getting on social media and that’s just another factor that can feed into it. There’s been studies on that, also. But yeah, I mean, these behaviors end up causing a lot of suffering mentally. And socially, by the way, you know, it’s like—

Ashley: Yeah, because you’re not engaging with your friends. I mean, you’re kind of pulling back so that you can go to the gym.

Sam: Right. I think, you know, with most eating disorders, the nature of an eating disorder is, it’s so all-consuming that you lose touch with what’s truly important to you. You lose touch of your values, and it becomes your whole identity. It can, in many cases where, you know, someone who’s struggling with Bigorexia, it’s like when you look at their—like, if it’s a pie chart of their values, it ends up being like “muscles” and “the gym” and “getting lean, food, lifting weights,” and, you know, it’s—you lose sight of relationships. And you lose sight of the things that you truly care about. That’s the nature of it, yeah.

Ashley: We say a lot with eating disorders that they are disorders of disconnection. And we see so much of that, not only, like, you know, internal disconnection where you’re turning off those hunger fullness cues, you’re turning off cues that, you know, as you were mentioning, someone with Bigorexia might still go to the gym or still work out even if they’re injured. You’re turning off that signal that your body is desperately trying to tell you, “I need to rest, I need to rest,” right? So, disconnection from the self, but then also disconnection socially, disconnection from my value system. And I also want to say that it’s not always an intentional thing. These can really kind of develop quite unintentionally and quite innocently, you know, initially. And then someone might get so far in on that spectrum, as you were mentioning, that they look back and realize, like, “Whoa, my life is very different than it used to be and/or maybe than what I want.”

Sam: Right.

Ashley: So, if you feel that disconnection even, reach out. Ask for help. We’re here to help you.

Sam: Exactly, exactly. So, I know there are other lesser-known eating disorders we haven’t covered, but we’re also running out of time.

Ashley: I know! I was gonna say, why don’t we do a second episode, Sam?

Sam: Yeah.

Ashley: I think this material is so helpful, and I think that it would be beneficial to maybe spend some time—some more time.

Sam: Yes, I agree. I would really like in a future episode to cover ARFID, to cover Orthorexia, and just disordered eating in general. I get the question a lot, like, “Do I have an eating disorder or do I have a disordered eating? And how do I tell the difference?” And we can talk a little bit about how ARFID is treated, and who is at elevated risk for ARFID. These concepts and terms are just so important for everyone to know. With eating disorders, the faster you can get a diagnosis and get treatment, the better. Get some support. Eating disorders are best treated, you know, ideally quickly.

Ashley: Right.

Sam: But we have to know—we have to first know that we’re struggling with an eating disorder. And it really can get lost in this culture. So, I hope this podcast can help folks out there know the signs.

Ashley: Yeah, yeah. Thank you so much, Sam. And you all, thank you so much for listening to us. We hope that this has been helpful. We say this, but again, thank you for listening to All Bodies. All Foods. And if you liked the episode, if you found it useful, please check us out, please rate us. Please leave us some comments. Let us know what you would like to hear! Let us know what you would like for us to cover. You can subscribe, rate, leave a review and share with others. Follow us on Facebook, Instagram, Twitter, and TikTok, where you will see Sam.

Sam: You will see my face on there.

Ashley: We are @RenfrewCenter. So, that is our name on all of those outlets. And then, if you ever have questions or want to connect with Sam or myself, you can reach us on our email: [email protected]. So, thank you all again, we greatly appreciate being with you and we’ll talk to you next time!

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.

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