Episode 3: Eating Disorder Education 101: Helpful Tips for Family Members
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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: Hey Sam!
Sam: Hi Ashley!
Ashley: How are you?
Sam: I’m great, how are you?
Ashley: I’m doing well. It’s time for another episode.
Sam: We’re back! We have more to say apparently.
Ashley: Yeah, we do! So, last time we talked about how somebody can support one of their loved ones in eating disorder recovery or eating disorder treatment, all the above and I feel like we talked about a lot of good things. We talked about educating themselves, being gentle with themselves and with their loved ones. No diet talk.
Sam: No diet talk. No body talk. No comments about weight. All foods fit. No bad foods. No good food. We did cover a lot of ground and at the same time, I feel like there’s so much more we could say.
Ashley: I know, I was thinking the same thing, Sam. I feel like there’s not an end to this, as far as learning how to support your loved one. It is a journey that we have to continue. I tell my clients a lot when I’m talking to them, what if there’s just not a resolve here, meaning there’s not a finality, like we have to just keep learning in this process. We have to keep going. So yeah, you want to talk about that some more.
Sam: Definitely, yes! I work with so many families and I think you’re absolutely right. It’s a process. It’s ongoing. Relationships are evolving, ever changing. So yeah, I think it’s important that we talk more about how we can really support each other, especially when we know someone struggling.
Ashley: So, one of the topics that we really started discussing last time was educating ourselves and there is just a plethora of information out there about eating disorders and I wanted to see if we could expand on that a little bit today.
Sam: Yeah, absolutely. Great idea. It’s one of first things I tell every family: “What do you know about eating disorders because it’s going to be crucial that you learn what they are”, because I think in our culture they’ve been really simplified to food and weight and that just could not be more inaccurate.
Ashley: I couldn’t agree with you more. I find it so fascinating when I’m sitting with the clients, and they have this kind of lightbulb moment when they’re in treatment where they realize my eating disorder is not about the food.
Sam: It’s like an aha moment totally.
Ashley: Total aha moment and then we start talking about well what is it about. At Renfrew we really see an eating disorder as an emotional disorder. Meaning if somebody has an eating disorder, if somebody is using those eating disorder behaviors, they’re using those behaviors as an opportunity to manage this bigger emotional experience that they might be having.
Sam: It’s an attempt to cope. It’s a coping mechanism.
Ashley: It’s absolutely their coping mechanism. So, let’s say somebody has anxiety, let’s say somebody has depression, maybe they’re dealing with PTSD or OCD tendencies and it’s all feeling like too much. I can’t manage this; I don’t know how to do this in life. So, I’m going to use this coping mechanism and enter in the eating disorder. So many times, this starts out very innocently.
Sam: Always! It starts out:
- “I’m going to start this new diet.”
- “I’m going to get healthy.”
- “I’m going to really get my life together.”
Ashley: I love the one you just said, “I’m going get my life together. Like I’m going to get it on track.
Sam: And in this culture, it always goes to food and body. When most people talk about getting on track or being their best self, it seems to always go back to diet and changing their body in some way. We’re conditioned.
Ashley: Yes, we are. I even think about the beginning of the year. it’s the beginning of the year and we are conditioned to think how do we get back on track. How do we diet, how do we fix our bodies? And so, if somebody is having that bigger emotional experience, maybe they are:
- Still in school and they’re anxious about finals coming
- It’s their senior year and they’ve got to pick college or maybe take a gap year
There’s a lot of decisions to make and so enter in the eating disorder and it kind of helps soothe, if you will, the anxiety that that person is experiencing.
Sam: I hear this a lot when I hear the narratives of folks with eating disorders that it gave them something to focus on. It could drown out everything else and how comforting is it to just put all your mental energy into calories, into the scale, into tracking your “progress”, and you feel like it gives you this false sense of achievement, productivity, all these things which are admirable in this culture. What a powerful distraction it is.
Ashley: And in that vein, I’ve heard people specifically like that powerful distraction that gives us productivity, you know, that feels like we’re achieving stuff. I’ve heard people mention that it feels or maybe that someone with an eating disorder is just looking for that control. I’m going to control this scenario, I’m going to take this back and I just want to say, just as a therapist who has worked with a ton of clients with eating disorders, I really think that that undervalues what’s going on with that person.
Sam: It’s a simplification.
Ashley: I don’t necessarily think control is the right word to use, again, I think these symptoms are a way to manage this bigger experience that’s happening. And I think even as we’re learning, you know, again, learning about eating disorders, how do we support our loved ones, let’s shift from that mind frame of: “What are you trying to control?”, “Why are you trying to control something to what’s going on?”, “Is there something bigger here that you need help managing?” or “How can I support you?”
Sam: Absolutely. Making that mental shift can really change the way you will approach your loved one because you have a different perspective on what’s going on with them. And I also want to add, yes, eating disorders are emotional disorders, their attempts to avoid dampen escape, cope with emotions. And at the same time, the malnutrition, we so frequently see in eating with eating disorders worsens mood cognition. So, their ability to think more flexibly, their ability to regulate their emotions is all compromised because of the of the malnourishment and by the way, you can be malnourished at any weight. I think that’s a big misconception in this culture, that oh well my loved ones not malnourished because they’re at this weight, and the reality is malnutrition can happen to anybody.
Ashley: Yeah, absolutely. And that’s the other component of the eating disorder that I don’t even know that somebody who has an eating disorder might even understand, the malnourished brain, when they’re first coming in. Just what you’re saying, that the cognitive flexibility, the ability to think differently, to have multiple thoughts about one thing. It really kind of goes away and we get stuck in this very black and white thinking, it’s very either or and kind of that tricky thing is when it’s that either or in that black and white, it’s good versus bad. And so, if the decision to eat a certain thing or not eat a certain thing is the good decision, but we choose the other one in our eating disorder, then we automatically are bad. Does that make sense? We automatically label ourselves as bad and that is so hard, just so harsh. The negative self-talk that we do in the eating disorder is just so harmful and so yucky.
Sam: Oh yeah, absolutely. I think that’s such a great point. We often see a very strong inner critic, very strong perfectionistic tendencies with many folks with eating disorders. This strong desire to just sort of like be the best at everything. And the problem is society unfortunately defines these ideals for us that are not attainable, not sustainable, not realistic. And the malnourishment in an eating disorder really can make your thinking around that even more rigid and become so hyper focused on hitting that goal weight or counting those calories, just all of those compulsive sorts of behaviors, it just gets worse and worse. I think a lot of families don’t understand what’s happening to their loved one because they’re noticing their loved ones, whether it’s their child or their partner, sister, brother, their personality is changing.
Ashley: The mood is shifting so much, that personality is shifting so much.
Sam: I often must educate families that a lot of what you’re seeing, and I educate my client as well, so they understand a lot of is the effects of malnutrition.
Ashley: Once we can get our clients on a better system, a better routine, they are eating appropriately, consuming nutrition appropriately and suddenly the mood starts to shift, their personality starts to come back. It might take a minute, but it does start to come back. The education component for the family system to understand where their loved one is, is so critical in this because when the personality has shifted or the mood has changed to something that’s very, you know, someone I’m not really enjoying being around, it’s kind of hard-to-find compassion when you’re arguing with somebody the whole time.
Sam: That’s such a great point. I think a lot of times parent and partners, they have such good intentions, they want to help, and they want to try to fight the eating disorder with logic and I often must explain to family members. I say: “I hear how much you really love your child, or your partner and I need you to understand that eating disorders are not rational disorders so they can’t be fought with logic, their emotional disorders.”
Ashley: Yes, I’m so happy that you just brought that point up because I’ve just so much sitting in the office.
Sam: It’s very common.
Ashley: As we educate ourselves, as we learn about the emotional experience that our loved one is having, as we learn about their malnutrition and their brain changing, meaning their mood is shifting, and their personality is shifting. It just helps give us a little bit more compassion when we go into this treatment cycle with them because we know that the more support a person has through their treatment, the better the outcome.
Ashley: A when I say that I mean support. Not you need to do this, you need to do this. But the more support they have, the better the outcome with the person.
Sam: Emotional support specifically, I think is so crucial. Sometimes I have family members who their hope is that they drop their loved one off at treatment and its sort of like, okay, well let me know when they’re fixed and again, you know, it’s always a lot of education and I just think there’s so much misinformation out there with the media and everything. Your loved one isn’t broken, so I’m not going to be fixing them. Recovery is an ongoing process, and we need you, we need you to be a part of this. Of course, with the client’s consent, I always want my client to be on board with having family members involved, but we need them because we need to teach them how to better support what to do, what not to do, how to validate emotions even when you might not agree with what the person is experiencing. You don’t have to agree to validate and teaching those skills because I believe that it’s validating is really a skill like anything else. It’s something you learn, it’s something you practice and it’s something you use in all your relationships eventually, not just with your loved one.
Ashley: Part of validating is giving them the space to have the experience that they need to have as they work on their treatment processes, they work on their recovery process. Part of validating them is also doing your own work and understanding doing that, but also just understanding where maybe your piece of the puzzle fits in to the bigger picture. So, I wanted to ask you, I know that you’ve got a resource that you want to share with us specifically, it is caregiver styles, right?
Sam: Yes, it’s something we teach at Renfrew. At Renfrew, we have the Family Day, we used to call it Family Weekend. It’s called Family Day, it’s an all-day event where we do a lot of education on not only eating disorders, research, treatment, but also the different family dynamics and relationship dynamics that end up unwittingly maintaining eating disorder cycles. And we want family members to really understand how to sort of shift their style into a more compassionate, validating caring style rather than for example, trying to fight the eating disorder with logic, which I think is common. And it makes sense that maybe that’s the instinct because debating with logic can be an effective strategy in many situations, it’s just not effective with eating disorders. So, this is from the work of Janet Treasure, and we’ve been using this for years and the caregiver styles, what I really like about them is that they are animals. So, it is sort of a fun way to talk about some difficult things and to talk about it openly, even with your loved one, they could probably let you know which style they think you gravitate to, especially when you’re under stress and just to normalize that these reactions are so common. Researchers have developed animal models to describe them. So, you’re not alone. This is very common, and we want to just show you a different way to support your loved one.
Ashley: Do you think could you share like a couple of those?
Sam: Yeah, absolutely! Okay, since we already talked about the logical approach, which is so common, let’s start there because we see this a lot in certain family members. I’ve seen it with fathers, but I’ve also seen it with other caregivers too or partners. The Rhino really takes the approach of using force and logic to attack the eating disorder. And I just want to reiterate that the rhino really cares a lot. There’s a lot of passion in the rhino. They want to help, they want to fight this thing, they want to do something actively. And so, what ends up happening is there are, I mean, this might sound familiar to some of our listeners out there:
- “Why don’t you just eat?”
- “You look great.”
- “Why are you worried about your weight?”
- “You look fine.”
- “There’s nothing wrong with eating this.”
- “It’s not going hurt you.”
So, what ends up happening is the eating disorder voice is always listening and they are put in a situation where they are given an opportunity to debate. They are just going to use their eating disorder to fight back and in turn that strengthens the eating disorder voice because they’re going just come up with ways to debate the rhino and prove the rhino wrong and they’re just going to become more entrenched in those disordered thoughts.
Ashley: Yes. Well, because again, if we’re talking about how the eating disorder malnourishes our brain, takes away our ability to think flexibly, then we’re getting to that very black or white place. If again, what I heard you saying was the rhino is very passionate and so desperately wants to help their loved one and they’re saying, “why don’t you just eat that, you look great”. This eating disorder brain maybe has already labeled that as a bad food or already has a response that is like, well, if this person thinks that I look great, maybe that means I’ve gained too much weight already.
Sam: Oh sure. Yeah, the eating disorder voice will twist whatever. I often tell family members that commenting on appearance is just a bad idea because it’s probably just going to not land well, regardless of whether it’s meant to be a compliment or meant to be critical. It doesn’t matter because any comment about appearances is not going to be helpful. Especially comments like: “you look healthy”. Um, you know, “you look good to them”. It might mean I don’t look the way I want to look. They’re seeing a change in my body. What change are they seeing? Do they think I gained weight? You know, I mean, fatphobia is at the root of eating disorders. You know, am I bigger to them? Does healthy mean bigger? And so that internalized fatphobia kicks in and frightens them very much and makes them want to turn to their eating disorder even more so it strengthens those urges. But I think that, you know, oftentimes rhinos need a little help getting more in touch with the emotional part in the relationship and they just need a little support in coaching around how do you target the emotion at play rather than trying to fight the eating disorder with logic. There’s a big difference between saying why aren’t you eating dinner, you need to eat this right now compared to it looks like you’re really struggling right now, I’m wondering what’s coming up for you?
Ashley: Even hearing that example, you can hear that shift in your voice, why aren’t you eating this right now sounds like I’m getting in trouble, versus I can tell this is hard for you right now.
Ashley: That feels like you are going back to that word validation that you meant, it feels like you are coming onto my level and seeing me. I feel seen when you say that to me instead of why aren’t you doing this?
Sam: Exactly. And that’s the name of the game is we want to feel seen in all our relationships. And so, I often help family members say what they see.
- You know, you look sad, did I get that right?
- Or I just noticed your expression changed, what’s coming up for you?
- You look anxious right now. I see your leg moving up and down.
That is so powerful and can really help your loved one also be more aware of what they’re experiencing because many times in eating disorder recovery, one of the very hard things about recovery is learning how to tune into your inner world, notice it, identify it, label it, express it. That’s a lot of work and it’s not easy for maybe someone who has been spending a lot of time numbing out.
Ashley: Right, if they’re in an active eating disorder, everything that I do, I am desperately trying to disconnect from my body and from my experience, I am trying to numb out. I am trying to avoid. I’m not trying to be there.
Ashley: So, for my loved one to label it, it also reminds me that I can label what’s going on. I can also maybe say, I think you’re having a rhino moment, which might lighten the move.
Sam: I’m so glad you brought up this idea of reconnecting to the body. Such an important part of recovery. And it’s not just about, I mean we talked about reconnecting to the body, we’re not just talking about the physical body. We’re talking about the emotional experience in the body. The inter we call it interceptive for anyone out there listening, that’s the technical term. It’s about being able to notice when your heart’s racing, being able to notice when your stomach is in knots, being able to notice when your muscles are feeling tense, that’s body connection and with an eating disorder, gradually, I think the person becomes more and more disconnected from their body and from their emotional experiences which are part of their body.
Ashley: Definitely. And that may have been the culture of their system that they were working in right, is to be disconnected. And so, in recovery, as the person shifts to reconnect, that’s what we also get to ask these family members to do. Connect with your body, connect with your experience, label what you see. I’m curious Sam, we’ve got a couple of minutes left but would you quickly give us one more of the caregiver styles.
Sam: Absolutely. So, which one should I pick? There’s a lot of good ones and I, encourage our audience to, to look these up there, you can find them online. So, let’s talk about the Jellyfish, that’s a good one.
Ashley: Tell us about that one.
Sam: Yeah, really common again, these are all very common. The jellyfish is someone in the family who experiences emotions very intensely. So, they might be sort of that highly sensitive type of person and emotional sensitivity I strongly believe is a gift and comes with challenges. So, someone in the family might be, you know, have that emotional sensitivity, have trouble, may be hiding what they’re feeling.
Ashley: Yeah, when I think of a jellyfish, I think of it kind of like electrifying or like pulsing.
Sam: Yes, exactly. So, this is someone who has a really hard time regulating their emotional experience and not that I’m sort of suggesting that people need to go around hiding their emotions, that’s really not the answer, a jellyfish is someone who is emoting really intensely, so maybe they’re crying frequently, they are get very activated and stressed depending on what the trigger is, but you know, oftentimes and understandably so, if you’re a parent of someone who has an eating disorder, this is, it’s very distressing for you to see them engaging in certain behaviors or suffering and it understandably so, will bring up some emotions in you. The issue with the jellyfish, however, is that your loved one is perceptive. Many folks with eating disorders are very perceptive and in tune with other people’s emotions, very empathic and they’re picking up on the stress, on the anxiety, on the fear and the reactions of their family member. And what they learned to do over time is they learn to suppress their emotions and hide their emotions. Maybe even isolate, maybe even lie about their struggles to protect their loved ones. So, it’s really in a way, it’s an act of love both ways. I mean, the jellyfish is so distressed because they love their child so much and the child loves their caregiver so much and wants to protect them, but the problem is this dynamic is not going to work well in recovery. So, what we need to do is, and again, these are all skills, skills can be learned and practiced, but it’s really about learning how to experience your emotions and be able to tolerate them without becoming so activated that it’s taking up all the emotional space in the room.
Ashley: Right, and once you’re able to tolerate your emotions, experience your emotions, it kind of gets you to that place where you can better tolerate and allow your loved one to experience their emotion.
Sam: Exactly, yes.
Ashley: Where we can both have emotions, we can both label them, we can both talk about them and that be that. Not have a reaction based on whatever either of us or experiencing.
Sam: Exactly. So, part of the work is helping the caregiver get to a place or the partner or the friend whoever, get to a place where they can hear difficult things and not react in a way that feels unsafe to the other person. What we really want, ultimately, is that we want the person with the eating disorder to feel safe, going to them for support and being completely honest about struggling, knowing that the person will be there and support them and not be burdened by their disclosure because I think with eating disorders, another really common story, folks tell themselves is that they’re a burden to other people.
Ashley: Their a burden or I like to ask my clients this, do you feel like you live on an island by yourself where no one understands you. No one gets it and so it’s hard to be authentic. It’s hard to be vulnerable if you feel like you’re a burden or if you feel completely misunderstood every time you open your mouth.
Sam: And of course, you know, there’s a strong desire, they don’t want to upset the people they love. They say to themselves if I tell my mom, she’s just going to freak out. I can’t tell her, you don’t understand. And so, the work then becomes helping mom, hear that news and see it through a different lens, because also we have to look at what are the beliefs, and the stories mom is telling herself about this disclosure. So, that’s why learning about eating disorders is so important. So, we can really understand that you know what your loved one’s going through. Learning how to react in a way that is of course, coming from a place of concern, but also, you’re a source of understanding of compassion, of empathy and that just makes it more and more likely that your loved one will come to you in the future because they know I can tell this person anything and they can handle it.
Ashley: They can handle it. this person knows how to create space for their loved one to come to them and that is so healing, on so many levels, really for both individuals.
Sam: Oh, absolutely. That can be so healing. I’ve seen parents and children, or those partners learn how to do this. These are skills that can be learned, and all of these dynamics can be unlearned. It will probably feel uncomfortable and probably a little unnatural at first and over time, when you practice new ways of existing in your relationships, they start to feel more natural over time. I just want to just pass along some hope that, these dynamics are flexible and they can change as needed with support, skills, and practice.
Ashley: Yes, I love that. Well, awesome. Sam, thank you so much. This was such another good conversation. I’m so glad we were able to do this today.
Sam: Thank you Ashley. I know I we could probably even have another episode, there’s a lot to talk about when it comes to family dynamics. So, I hope this was helpful.
Ashley: Yeah. And to our listeners, thank you guys for joining us again. We hope that you found this information rich and helpful. And keep listening. We’ll have more.
Sam: We’ll see you next time.
Ashley: All right, bye.
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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