Anorexia has the highest mortality rate of all mental disorders. Without treatment, up to 20% of people with serious eating disorders die. But people with anorexia do not want to change. They don’t want help. They don’t want to eat. So, how do you change the behaviour of a person who does not want any help? Well, let’s find out in this episode of What Monkeys Do.
In this episode, I speak with Mette Bentz, a psychologist and PhD, who works in the child and adolescent mental health centre in the capital region of Denmark. She is a specialist in the treatment of anorexia. She will help us understand the severity of the illness, what to look for and how we treat it best.
Anorexia has the highest mortality rate of all mental disorders. Without treatment, up to 20% of people with serious eating disorders die. But people with anorexia do not want to change. They don’t want help. They don’t want to eat. So, how do you change the behaviour of a person who does not want any help? Well, let’s find out in this episode of What Monkeys Do.
In this episode, I speak with Mette Bentz, a psychologist and PhD, who works in the child and adolescent mental health centre in the capital region of Denmark. She is a specialist in the treatment of anorexia. She will help us understand the severity of the illness, what to look for and how we treat it best.
Hello, and welcome to What Monkeys Do. My name is Morten Kamp Andersen. And this is a podcast about what it takes to make a change and make it stick. This podcast is about change. And the changes we've talked about so far have been changes that we have decided ourselves that we've taken upon ourselves to do or are okay with. But there are also changes that we go through which we have not chosen ourselves, a messy divorce may not be our choice, our partner simply left us or at work, the company is restructuring and your job role changes, and you don't like it, but you have to embrace it. Those are changes that you have have to go through, but you may not want to. And then we have a completely separate category. This is where people are doing something towards themselves, which ultimately may cost them their lives. And the people standing next to them have no choice but to force them to change. Now this could be an addiction, like alcohol or drugs, or how they eat. Anorexia is in that category. It is a really serious mental illness. In fact, it has the highest mortality rate of any mental disorder. Without treatment, up to 20% of people with serious eating disorders die. But people with anorexia don't want to change. They don't want help. They don't want to eat. So how do you change the behavior of a person who really do not want any help? Well, let's find out in this episode of What Monkeys Do. My guest today is a psychologist and PhD. She works in the child and adolescent mental health center in the capital region of Denmark. She is a specialist in the treatment of anorexia. Welcome to you, Mette Bentz.
Mette Bentz:Thank you very much more than I'm glad to be here.
Morten Andersen:Yeah, I'm really looking forward to this. So in this episode, we'll talk about how to recover from anorexia nervosa or just anorexia for short, how to help a person who do not want help. But before we begin, can you tell us a little bit about you and how you came to work with anorexia?
Mette Bentz:Yes, I certainly can. Well, actually, I started out as a nurse, a registered nurse that figured out I wanted to work more specifically in this psychological and psychiatric era. So I went back to university and studied some work. Before going into the field of eating disorders, I work in other areas with children and adolescents with different kinds of challenges. And I got interested in how important it was to work with the important people around the young person. And I actually developed quite, almost for how important those people are. And maybe they can do more for the young person, I choose what I can say or do as a psychologist. So I really got interested into working with those around the one but the challenge, then I wanted to gain some experience in psychiatry, and I actually wasn't focused on eating disorders at all. But well, I was lucky to get a position in the the section for eating disorders. And here I am still after 14 years.
Morten Andersen:Wow. So let's try to start off with trying to understand anorexia better, I guess it can be sometimes difficult to know if somebody has anorexia standing next to them. So what are some of the symptoms to look for, in another person, if that person has anorexia, not
Mette Bentz:The main symptoms and those that constitute the diagnosis. First of all, foremost that you avoid eating sufficient amount of food, you have a restrictive eating pattern, we sometimes call it so simply avoiding food that can maintain or make your body gain weight, then, of course, that will entail a significant weight loss. So the significant weight loss is also part of the the diagnosis, the part that actually makes it so serious. And then there is also a more psychological aspect pertaining to this. The disturbed body image or the disturbed experience of your own body, the fact that you can feel fat while you're in my ciated, or the fact that you can compare yourself to everybody in the classroom and draw the conclusion that you're the biggest person there even though it's not a physical reality, all these aspects of a disturbed body image. So those are the main categories then also, of course, the malnutrition will impact The body's way of functioning, which specifically the hormonal system. So worth the rest, or puberty development will perhaps go into a pause, girls will lose their menstruation if they started menstruation. So those are signs that the body is shutting down because there's not sufficient nutrition. And then, of course, there's a lot of other symptoms following the fact that you need nutrition that are more nonspecific, like you lose your temper easily, you get sad or anxious that you use not to be and you get pale and tired and you feel cold all the time have no energy, you don't remember what teachers said in school and all those nonspecific symptoms that simply follows the fact that you're not getting enough nutrition.
Morten Andersen:And I guess many people have tried to go on a diet. So try to restrict eating, I guess, many people look at other people and feel fatter than they actually are, I guess there must be a line when we call it normal focus on weight. And where we say this is actually an issue, is there a BMI index level? Or is there certain body functions that stopped to work? Or what? When is it anorexia, and when is it just being too focused on our own weight?
Mette Bentz:That depends a little bit actually. But in the ICD 10 diagnosis system that we work with in Denmark, it states that if you lost 15% of your expected body weight, so let's kind of BMI limit. But probably that will soften up in the upcoming revision, because you can have lost 12% of your body weight and be severely ill. So we'll go with significant weight loss with some kind of impact on the bodily functions. Yeah.
Morten Andersen:Okay. So losing a lot of weight, till a level where I'd actually may even hurt you having a distorted body image. And I also know that, or I've researched that many girls, they will try to get a certain weight level, but then they will level that down and level that down all the way. So they can't actually even stop themselves and saying, so when I get to this amount of kilos, then I'll be satisfied. It's actually a virtuous negative circle, is that correct?
Mette Bentz:That is very much growing. And maybe that's part of what makes it so difficult that you can start with a quiet down, simple weight loss that's not dangerous in anyways, it's very innocent in a way, but then it triggers something that starts a maintaining cycle that drove me further and further down in it, and makes it impossible for you with your own wills power to, so to speak, lift yourself up with your bootstraps and get out of it again.
Morten Andersen:I said girls, but as I understand it, most people who are suffering from anorexia I actually women, I think it's something like 90% women and 10% men. I don't know if that's correct. But why is it mostly women?
Mette Bentz:I don't know. Really, because since we don't quite know the reasons or the what causes and reaction. It's also difficult to say, why does it cause it more in girls? We know that genetic and biological factors play a role in causation. And therefore it's, it's reasonable to think that there's something in girls, the genetic makeup of girls that makes them more vulnerable, then, of course, also, it's there have been a lot of theories put forward regarding our cultural influence, where the values of self control and the bear values of good appearances, that we tend to set higher standards in those values regarding girls than boys. I think that's in a way it's changing in these years. So maybe we will get to see more increasing number of boys in the future? No,
Morten Andersen:I think I read that up to 50 to 80% of the causes seem to be genetic. So there's been twin studies where basically, we've been trying to figure out how much of this is genetic and how much is not. But you said, We don't really know where the causes of anorexia is, how far are we in understanding why why people develop anorexia.
Mette Bentz:Not that far, actually. I'm afraid. You're right, the fact that we know that genetics play a role. I guess we didn't know that some decades ago. But we also know that the genetics are very, it's a very complex, it's more of a widespread pattern of changes in the gene area rather than one specific gene. And it may not not even be a specific gene pattern for anorexia but more for vulnerability for a range of different things. I know that there was working in those areas or looking for the genetic, genetic aspects of it. For instance, the hormones that regulate our our moods in our Anxiety and our that that is closely connected to how we regulate our appetite, appetite as well. So there's something more a little bit more nonspecific there. But also we know it's not 100%. So we know there must be something else, which might be suicidal, cultural, probably is, as we mentioned before, and there also might be some influence some environmental influences that are more personal. Like, for instance, having been an overweight child, being bullied, perhaps having difficulty finding friends or finding your place in, among your peers, that kind of stressors in life, there seem to be a little more of that. But then again, that a lot of young people experience that without getting anorexia. So I think what we know the most is that it's multifactorial, which in a way means that it's complicated. And there's many paths.
Morten Andersen:And and even though we know that, let's say 50 60% is genetic, we haven't found the actual genes yet. It hasn't either we can point to a single gene or, you know, a multiple of genes and say, if you have them, then you're very likely. So it's still very nonspecific. I read that in the US is estimated that 9% of all women will suffer from anorexia during their lifetime. That's a huge number. So are there more people suffering from anorexia today than there has been in the past?
Mette Bentz:It is right. If you're looking at the Danish numbers, the the number of young persons receiving an anorexia diagnosis in child and adolescent mental health care in Denmark have been growing, but so has the number of all other kinds of diagnosis that you can get within child and adolescent mental health care. And the numbers for anorexia has not been growing more than the rest of them, actually, some diagnosis have been exploding quite a lot more than the number for anorexia. So maybe there's more, or maybe there's more illness, more generally speaking, or maybe the threshold for getting help or getting a diagnosis have been lowered, maybe there's less stigma, maybe adults around the young people are more aware that they need to seek help. So all these factors may account for the fact that we diagnosed more.
Morten Andersen:Okay. And I guess one of the things that has changed over the last Say, say 10 years is the advent of social media. And from my own perspective, I would think that that would have that would make two changes. One is obviously that you are more exposed to people from all over the world. So when I grew up, I could compare myself to the people in my class and the class next door, but that was literally it. Now I can compare myself with, you know, hundreds of 1000s of people who most of them are photoshopping themselves on social media. So as I was researching for this, I found a number of YouTube channels where they're actually girls who were encouraging other girls to behave in ways that would make you lose weight a lot that would lead to anorexia. So people will also giving each other advice on social media how to lose weight. So I guess social media can really make you know, people who are vulnerable, easier to become ill with anorexia,
Mette Bentz:and social media, you can choose to follow only those that are thinner than yourself. And social media is very adept in promoting unhealthy or unrealistic body image ideas. You can furnish Photoshop, everything Of course, you can get a positive response, you can feel you're part of a community that promotes how to be anorexic or how to cheat your parents or your therapist and all all these kind of tips and tricks. You can find them online if you want to.
Morten Andersen:I have a young daughter, she's using TikTok and I was just looking at what it is that and most of the girls that she's following, at least are very thin and very beautiful. And I can understand why sitting in your bedroom, looking at those you feel that you are inadequate, or you want to look like that and you will do whatever it takes, you know, you can start on some innocent behavior like exercising more or you know, losing some weight because you want to look like that person on TikTok, but then it evolves into becoming a mental illness. Is that right?
Mette Bentz:Yes. And perhaps that makes it a bit difficult for parents and friends to really know when, when is it too much? Because it's it's healthy to exercise but when exercises controlling you when you are feeling really bad with yourself, if if you hurt your leg and you couldn't go the one go running, if you have to do it every day, even if your grandma has birthday, all those kinds of signs that this is taking over your life and ruining other aspects of your life. It's a gradual process, difficult to say when is it too much but The fact that it's ruining your health or your psychosocial life, that's definitely an indicator that this is too much, and it's out of your own control.
Morten Andersen:So anorexia is essentially a mental illness. And some of the signs are that you have significant weight loss, the weight loss can be so much that a significant part of your body may not function. Well. You are preoccupied with food, you think about food all the time, and you compare your own body to other people's body. And you may not even have the right vision of image of how your body is you feel you're fat, but you're actually quite thin. But anorexia is very dangerous, because it is it has a high mortality rate. And that is because if you continue to lose weight, you will actually die. Or you may die because you have some other disorders as well. Because as I understand it, there are some common bi-disorders as well. Can you can you tell us what, what people or girls often with anorexia they also suffer from?
Mette Bentz:Yes, well, actually, I think you will find that almost all other psychiatric diagnosis have elevated frequencies in a population that are suffering from anorexia. But when you see young persons that I do then with that would be primarily I think, what we see most of the anxiety disorders and autism spectrum conditions, but it might be anything else. And in the adult populations, for instance, you'll see a higher number of personality disorders.
Morten Andersen:Okay, so it's not just anorexia that this person is battling with, it's also maybe anxiety or depression or autistic spectrum disorders or any other personality disorders. Interesting. Okay, so that was a lot about what anorexia is, I think the the really interesting thing is also how do we help people with anorexia? But first, let's have a break. So now we understand anorexia better. The question is, how do we treat anorexia? I know that you're primarily work with something called Family Based Treatment? Can you tell us what that is, and how a typical treatment course is.
Mette Bentz:So a family based treatment is family therapy format, where you engage the whole family, and especially the parents, to help the young person suffering from anorexia to start doing what she feels the most, which is eating, sufficient for waking. So it's, it follows techniques and interventions from other formats for family therapy, but focus in them specifically on going against the symptoms of anorexia. And specifically in the beginning to start with nutrition, nutrition. So it's built in three phases, such just a way to have things in order doesn't have to be three. But in the beginning, we focus on the somatic, the physical security, to the parents take over responsibility for the child's eating, and helps the child eat enough for restoring a healthy body, then we go into phase two that are more focused on gradually handing over responsibility for eating to the young person, himself or herself, in an age appropriate level, of course. So in phase one, you may say that parents take away some autonomy from the young person. And then in phase two, they need to work with giving it back to the young person in a manner so that that it's not giving back to anorexia, but giving back to the healthy part of the youngster. And I think some of the things that surprises people is that we need to focus on eating and weight gain, firstly, because it's so difficult, so why, why go head on to the most the thing that your child fears the most. And also, many people will think, well, it's not about food and must be about something else. So why not focus on something else, and then maybe it becomes easier to eat? Yes. And while it is probably right, that there might be something else, then it doesn't make it easier to eat. And the longer time a young person is underweight, the more self maintaining it gets. So the prognosis will be better if we can help parents help their child gain weight as fast as possible.
Morten Andersen:So if that person is also suffering from anxiety, what do you essentially saying is in phase number one, we'll focus on getting the weight up to normal because the person cannot function properly before we get that. Now, I said in the beginning that when we're dealing with people who have anorexia, they don't want to change they don't want to eat so You're saying that well, the parents you have to make the person eat? And on the other hand, I suppose the girls don't want to eat? How do you solve that problem?
Mette Bentz:Yes, well, first of all, I maybe I would like to nuance a little bit. So that well, it's more than might be a part of the illness, that you don't really appreciate how serious the disorder is, or you doesn't really recognize the rational arguments, because there's something else that have taken over your your train of thought. So it's part of the illness is what we might call ambivalence, that in a way, you want to listen to your parents and you want to live a normal life and then another part of you are terribly feared that that will imply that you will be the fattest person ever, and look like the Michelin Man or whatever. So for some, it's difficult to recognize that it's actually a serious as it is, and then again, for others, they do appreciate that this is difficult, and this is out of out of my control, but they are so afraid to confront it, that they cannot muster the ability to do it on their own. So there's many different nuances to it, rather than just they don't want to change, I think part of them wants to change.
Morten Andersen:So if you have a girl who have, you know, over, I don't know how long been eating, I don't know, 500 calories been lying to your parents got into your her mind that she is really fat. And the worst thing that can happen is that she will eat. Now you're telling her parents? Well, you have to make sure that she eats, I don't know, three 4000 calories a day. And it's really important. If she does not then she could end up dying. How does the parents do that? I mean, how do you help them do that?
Mette Bentz:When we are talking about children and young persons, I think we benefit from the fact that they are under age, and they are in their care of their their parents. That is, of course a judicial issue. But it's so much more than that. It's also a psychological issue that kids develop and grow in their sense of self and how they are in the world. getting support from parents parents are the attachment figure we might we call it in psychology, they are the ones that you look to for comfort or guidance or support when things are difficult. So in a way, we benefit from the pet, the fact that most of these young kids coming to treatment, have attachment figures, that is typically mom and dad that deep down, they have a feeling that okay, they they look out for me are they actually in they have known in the past what was right and good for me, and they will care for me. So even though they will, they will say I don't want to eat, we we kind of benefit from the fact that they have attachment figures that they can rely on. And they have some kind of basic trust towards the parents. So when parents in a consistent, warm empathic way, keep on insisting You have to eat this, I know you're afraid, this is what you need, trust me, you have to eat, so on so forth, then actually that creates a strong framework, a psychological and social framework that makes it likely for the kid to let the voice of mom and dad in a way speak louder than the voice of anorexia in her in her head. So I know that it can feel like you're actually forcing your child to eat, I think the term force would fit better in what we do with house in hospital. But at home, it's not forcing it's creating a framework so strong that it's very much likely that the kid will will follow in and try to work with you, at least some of the time. And as they gradually gain weight, then their mind becomes a little better. And they can better work with the rationality of sites and see several sites of things and all that.
Morten Andersen:How important is it that the child understands that he or she has a problem that they recognize it as a problem? How important is that for the treatment and success of the treatment?
Mette Bentz:for young people who have mums and dads to him to engage in treatment, they do this, it's not necessary. It's more necessary that mom and dad know that there is a dangerous issue here threatening threatening my child's health, and he's not able to deal with it on her own. A bit like if she was starting using drugs to manage stresses in school, I think most parents also would interfere and say, Well, I sympathize with how you feel school is stressful. But this is not how you're you're not allowed to solve it this way. I've tried to help you another way. So I think it's in a way it's in line with parents intervening when a child has endangering his or her life or or development.
Morten Andersen:It reminds me a little bit of when you make an intervention for somebody who is an adult alcoholic, to maybe go into rehab. And what you often do is you make an intervention in that person's house. So you gather friends and family to call them and say, I think you have a problem I think you should go to, to rehab. And here it's also attachment figures in a sense, where you trust that person, and you may not have a personal insight that that is actually I am at that level of addiction. But if those people tell me that I have a problem, I will do it because I trust them. I guess it has the same dynamics.
Mette Bentz:I think you're absolutely right. And it often struck me and touches me the how, in the very first family session, often it seems new to the young person to actually hear this joint narrative of the whole family on how this has been coming into the family life and his affecting has been affecting everybody in the family and actually being, you know, forced in a way to hear how mom and dad and siblings are actually very worried for them. It's kind of an eye opener that really touches them, which is a very touching moment to witness actually.
Morten Andersen:Yes. So if we think about how can you help a person who do who do not want to change how you can help a person change? Well, one of the first things you can actually do is you can, if you are an attachment figure, a good friend or somebody who that person trust, you can actually have an honest conversation with that person about this is where I see you are at and that may spur that person into may not have a full awareness of one's own situation, but at least have a trust in I need to do something, as I understand it, you're working on a research project where you're looking at the effectiveness of family based treatment, can you tell us a little bit about what what the findings are or what we know about the effectiveness of family based treatment,
Mette Bentz:we investigated how the family based treatment work or what outcomes it produces, when you use it in a government funded service, as we have in Denmark, compared to the the research settings abroad, where the randomized control studies are made, it compares very well. And within 12 months, 57% of young persons with anorexia nervosa will have fulfilled treatment, going through all the phases and does not need any more treatment for the eating disorder. That may not be so that every single one of them are totally out of every symptom for eating disorders. So that's one of the other findings that many more of those than the 57% are actually weight restored, which is not well, it's not no surprise, because parents are really, really effective in this department. But some will be weight recovered, but still have some thoughts and feelings around food that are difficult and maybe require extra support from parents for a longer time period. And I think, actually, that's one of the benefits of having the family involved, involved, that they can actually continue the support after treatment has ended here, yet, but the main finding is that we we help a good proportion of young persons, then the next part of the study is what we actually made it for it was to to say okay, so this proportion that does not gain benefit will from family based treatment. Who are they? What characterizes them? How can we identify them? And how early in treatment? might we be able to identify them? Because that would be the starting point of well, improving treatment?
Morten Andersen:Yes? And what are some of the things that we can say, must be in place? So let's say that you have a father and mother and an a sibling, and the father is working a lot and therefore not really present? So it's really on the mother to do it? Is will that still be working? Or does it need to be the whole family working together on this? Does it matter if the family is is a divorced family? There's socio economic reasons. I mean, is there anything we know that is better for a recovery in a family based therapy,
Mette Bentz:we do know that when parents are aligned, it works better. It doesn't have to be that they both do equally in the same or take charge of the equal numbers of meals. But they can be aligned in many different ways. As long as they are creating, in a way a joint front that the kid and anorexia knows that there's no way I can divide them and have that feel sorry for me because mom wants me to eat this and all that. So as long as parents are aligned, then there are many different ways that they can share, share the work between them, but it's it's really stressful to do so if the dad works a lot and mom is doing it all alone. I would still talk with this, this couple of parents that they might want to rearrange that for me. Get rid of time because it's it's very stressful and mom will need some, some timeouts. And she needs to be relieved. Okay, so parents aligned, that's important. Yes. And also that parents are willing to enable to, you know, stand forward as authority figure for the child and say, right now, this point of time in your life, I know better, huh? My theory, I may not be right. But I have a feeling that for Danish parents that is particularly difficult, or maybe for North European parents, because we value independence and autonomy very much. And parents really feel that they are being a tyrant, if they say you have to do this, or you cannot do that.
Morten Andersen:Yes. So I can see if you have a 17 year old or 18 year old daughter who's who's almost about to move out of the house and you have spent some years trying to encourage her to be independent and make decisions herself and you've stepped back from from many decisions. Now you have to go in and really take charge and say, I control a large portion of your decisions around food, but also what you do in terms of activities in your spare time, everything exercise you're not allowed to exercise have for a while, and things like that, that that will be a complete reversal of how they have had a relationship for the last 567 years.
Mette Bentz:Yes, and it gets more and more difficult the older the child gets. And we can see that in effectiveness studies actually, that the younger the patient is when we start a family based treatment, the better is the outcome. But still, this stands from parents who need to be able to do that. And I think actually, that also requires that parents can do this shift of thinking that this is care. It's not only control, it's not primarily control, it's primarily taking care and taking adult responsibility. So if you cannot make that transition, then you will feel that like the worst parent in the world. And you would feel that my child will never speak to me again. And she will never love me anymore. And all the worst things that we fear as parents, yes. Okay, so there's a few things I need to also say. So we also know that blaming and, you know, reproaching, saying, see what you're doing to the family, see how difficult you're doing, you're making me feel putting blame on the person with anorexia, it's understandable, and very much so but it doesn't help it more works against treatment. So it's very important to separate the young person from the illness, so that the young person can, you know, feel the empathy for her struggling, while parents are still taking a stance towards anorexia, I think those are the main factors ingredients that needs to be in place for family-based treatment to work,
Morten Andersen:okay, so, parents needs to be aligned, they must be willing to take ownership, so to speak of the cure of their teenage daughter, and then trying not to blame. So and I guess in order not to blame, you have to see this as almost as an illness taken over a child. So it is not separate the the child from the illness, so to speak. So it is the illness that you do not like and not the child.
Mette Bentz:Exactly, that's very important that you need to continue saying that to yourself until the child again and again.
Morten Andersen:Okay, so and and the reason why family-based treatment works so well is that it is it is going on in her environment, so to speak. For instance, if we look at the success of of getting people off drugs, so people go into rehab. Now one of the things that is difficult for that person is that going back into the same environment, will actually make it more likely that that person goes back into the addiction because you've not changed anything about the environment. Now, this is actually the reverse here, you keeping the person in the environment where in her room where she was learning the tricks of losing weight without parents knowing it and so on. That almost seems counterintuitive. Why Why does that work so well here?
Mette Bentz:Well, I think actually, it may be so well so effective, because you actually learn new habits and new skills in overcoming something difficult in your, your everyday home and with your closest others. Because before family based treatment, the primary the treatment to go to was to put kids into hospital for a long duration of time away from families. And it was even customary to say that parents you would be disturbing treatment so you're allowed to one short visit a week and one letter a week or something like that. So we actually did the opposite in the older days. And while that can also be effective in gaining weight, then we have exactly the same problem, as you mentioned with addictions that when you go back home, it's very difficult to generalize what you have experienced in hospital and use it back home. And especially when you're doing it as a young person on your own, and your parents have not been part of that journey. So I think that the fact that your parents is part of the journey, and you are exposed to new eating habits in your own home, and you can much sooner return to seeing friends and going to school and having the joys of everyday life that actually should motivate you to get out of anorexia, you can easily get in contact with that.
Morten Andersen:That's really, really interesting, what you're saying there that what actually works is that you teach a person new habits in their old environment, and therefore, that will actually sustain it more. So you're breaking old habits and inserting new habits, so to speak, in the same environment, and that is why it is effective. That's really interesting. Great, well, so far, we've talked about anorexia and the treatment of anorexia. And I'd like to see what we can learn from the treatment of anorexia and how we can apply it to other changes. And I actually think that you have said a number of things which are, which are really interesting, the last thing we just talked about, which is that keeping people in their environment where they develop the addiction, so to speak. I don't think anorexia is an addiction, but but it actually not quite. But but but you keep it in that environment. And then you teach them new habits, that's a really interesting thing. Have we seen that work in in addiction as well,
Mette Bentz:in addiction, I actually don't know much about treatment of addiction. When you treat kids with anxiety disorders, we know that it's very important that exposure, the gradual exposure and response prevention can be done in a way that can be transferred to your everyday life and preferably actually be done at home as well. So often you teach parents the skills also of exposure and response prevention, when you're inside in kids. So I think it probably covers a lot of other areas as well, I guess, but I wouldn't be sure.
Morten Andersen:Now, in a previous episode, I spoke with a Judy Grisel and Judy Grisel was, well, it's a fantastic story. So she started off as a as a as an addict, and then became a drug addict, and then was a homeless person and lived on the streets. And then she made a change. And she became she went back to university became a professor neuroscience and wanted to figure out, what is it in our brains that make us prone to addiction? And during the interview, I asked her, so how could you go from being addicted to drug to go to university? What was what was the trigger there? And she actually said that what was important for her was that she was replacing her addiction with a new, healthy goal. So she wanted to find out, why is it that we became become addicted, and she went for that, I just wonder whether you've seen that work in your practice as well, where you have girls who have been obsessed with their body and obsessed with looking maybe like a particular person or obsessed with reaching a particular goal, whether replacing that goal and having a focus on that, which is a more healthy goal, whether that will help in in a situation like that.
Mette Bentz:It doesn't specifically ring a bell, I think, because actually, what I think more often is that it seems effective when the young persons are able to kind of broaden out a little bit not so focused on one simple thing, but be a little bit more tolerant towards how things can be not so simple and more nuanced and not black and white. So to let go of the need, that everything shouldn't be actually securely predictably unequivocably in order for you to feel comfortable to actually be able to feel comfortable even though you even though you don't know exactly what you're going to do the whole day or what you're going to eat or who you're going to meet. You know, to be more tolerable towards the general unpredictability of life that seems very helpful. But mostly, I think for most young teenagers, the fact that they actually have the experience that anorexia took away from them for a while, the connection with peers and going to school and meeting up with friends. So actually getting back to that creates a strong motor which is very very wonderful to see that, okay, they actually want their life more than they want direction now,
Morten Andersen:letting go of control, so to speak, and also not seeing things black and white is actually something that will help people get get rid of anorexia. I think the last thing you've also mentioned a number of times is having support from people around you that you trust a lot. Now, obviously, many teenagers, even though there are conflicts between parents and them, they still trust their parents to do the right thing for them. I guess, some may not have family close by, but or could be in a situation where they are not there to support you. But having people who do love you a will, that you trust will do the best for you. Having them to support you is actually a major benefit for making a change is,
Mette Bentz:I think it's the most powerful ingredient in life, to have support because I mean, all of us meet challenges that we cannot cope with alone. So the experience that you give your child, if you help your child through anorexia or any other disease, the experience that you can get help from others. And you don't have to cope with everything alone. I think that's such an important lesson. And maybe actually, another lesson I think the parents have so powerfully helped their child learn is that you need to be able to separate subjective and objective reality that your feelings is not always the same as reality, and that you can feel fat without being so just like you can feel alone while people are still reaching out for you. So the ability to separate what you feel in the here and now in what is in reality, it's a it's an important important lesson that I see parents again and again, teach their child while they are helping them to eat.
Morten Andersen:Fantastic. I must admit that researching for this, I was surprised about how many people suffer from anorexia, I was very surprised about how lethal it is house, how serious it really is. But also reading through the treatment of it. I was surprised about how difficult it is to treat. And I think it's therefore an excellent case to think about how do you help people who do not want help, because it is very important, they do get help. And it's really hard to actually treat. But I think your lessons about some of the things that you've mentioned about what actually works. So using people, family who can help, because people trust the girls trust them that actually is really important that you do it in their own environment and change important mindset and behaviors and habits in their own environment actually is really good. And then what you said about making sure that we should get away from the black and white-thinking and have a more sort of nuanced thinking and not making not confusing objective reality with subjective reality also is really important. Thanks a lot. I think we learned a lot about change and a lot about how to help people, especially with with anorexia, I want to say thank you, to you, Mette, for a fantastic interview. I really appreciate your time.
Mette Bentz:Thank you for putting into awareness this very important topic was a pleasure.
Morten Andersen:Thanks a lot. What a great interview with Mette. I took three things away from the conversation. One, we can help people change even if they really don't want to change. People with anorexia are suffering from significant weight loss. And if they are not helped, they will continue to lose weight until they can no longer function. It is a serious mental illness. But it is possible to help them even if they at first do not want to be changed. If they do not recognize that they have a problem. Even if they shout out loud that they will rather die
than eat. Two:We can learn three things from family based treatment and apply to other changes. We can learn that having support from people who loves you, and who you trust. That helps a lot. In the case of many people with anorexia, this is the parents but it's actually true for all. We can also learn that teaching new habits in the existing environment helps a lot. treating the person in a hospital and then to be sent home afterwards does not give the same outcome. better treat the same environment that the mental illness or addiction or bad habit occurred. And finally, let go of the black and white thinking and separate objective and subjective reality. Feelings are not reality. That also helps Point number three, we do not need to know why something happens to change it. We know very little about the causes of anorexia, the exact role of genetics, the exact role of the environment and which factors are important. But we do know a lot about how to help the individual. And maybe there is a lesson there. We don't have to know everything about why something happens in order to change it. anorexia is a lethal mental illness and Mary's work is important. How can we treat young girls who are losing weight to the point of killing themselves who really don't want to change? So thanks a lot for that work Mette. Until next time, take care