A Little Help For Our Friends

Eating Disorders: What Friends and Family Need to Know

• Jacqueline Trumbull and Kibby McMahon • Season 5 • Episode 156

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Do you have a family member, friend or roommate whose relationship to food is a little...concerning? Eating disorders hide in plain sight, often disguised as diet culture, fitness goals, or "healthy eating." But beneath these socially acceptable lifestyles lie deadly mental health conditions that claim more lives than almost any other psychiatric disorder.

In this episode, we break down the clinical realities of various eating disorders while exploring the profound ways they impact both individuals and their loved ones. We examine anorexia's deadly grip and how it combines food restriction with a distorted body image so powerful that even severely underweight individuals see themselves as fat. The disorder's perfectionism and need for control create a psychological prison that's hard to escape.

We discuss bulimia's binge-purge cycle, where out-of-control eating episodes are followed by compensatory behaviors like vomiting or excessive exercise.  We also discuss binge eating disorder and the lesser-known ARFID, which involves food restriction based on sensory issues rather than weight concerns.

As you probably already know, these disorders can be incredibly hard on the family dynamic. Eating disorders transform dinner tables into battlegrounds and marriages into war zones. We cover strategies for supporting loved ones without enabling disordered behaviors, emphasizing the importance of family therapy and creating an environment that de-emphasizes weight and appearance.

Whether you're worried about someone you love or seeking to understand these complex conditions better, check out KulaMind to get support and community around loving someone with eating disorders. 

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Dr. Jacqueline Trumbull:

Hey guys, welcome to A Little Help for Our Friends, the podcast for people with loved ones struggling with mental health. Hi, little helpers, today we've got a topic that I think has, um, we haven't talked about very much, which is eating disorders, and this is going to be, I think, mainly like an educational episode, um, just kind of going through the different eating disorders and what it might be like to live with somebody with one of these disorders, because it is, I think, one of the absolute hardest group of disorders on loved ones. So, kibbe, can you tell us a little bit about how KulaMind could help?

Dr. Kibby McMahon:

Yeah, KulaMind is up and running. Our community is thriving. It's really exciting to see everyone coming together and supporting each other having a loved one with mental illness or addiction. So KulaMind is our community and support platform. It teaches you. You know, we talk about all these different skills that we talk about in this podcast, like how to set healthy boundaries, how to take care of yourself, how to understand what your loved one is going through. Like, what are these mental health conditions? So, if you have a loved one who's struggling with, like, what are these mental health conditions? Um, so if you have a loved one who's struggling with eating disorders or anything else, uh, just check us out. We're at KulaMindcom. K-u-l-a-m-i-n-dcom are the link in the show notes.

Dr. Jacqueline Trumbull:

So eating disorders are an interesting one. I've never personally treated it. Um, this is the group of illnesses that I would probably refer out if if I got like a you know a patient with this, just because it's so high risk, and I would really want to make sure that we've got like an you know an expert working with them. On the other hand, though, I feel like disordered eating is so common, so I, though, I feel like disordered eating is so common, so I mean I've certainly like worked with you know people with disordered eating, and like food in general and eating in general has been a topic. But have you you do have experience with eating disorders? It sounds like right.

Dr. Kibby McMahon:

Not extensively. My first internship, my first job in mental health, was eating disorders and actually I I I think it was in college. Yeah, I was in college and I interned for the New York Psychiatric Institute eating disorders clinic and I think it was for a summer, I can't remember I was so like young and it was intense. It was an inpatient unit so it was like the most severe eating disorders you could possibly get. I mean, I mean, I didn't learn a lot about like different psychotherapies that can help them, but I saw what that was like and was my first you know taste of mental health and it was. It was shocking. I don't think I was in fact. When I after I my first you know taste of mental health and it was it was shocking. I don't think I was in fact.

Dr. Kibby McMahon:

When I, after I interned, I thought, oh, I don't know if I could be a clinician, I don't know if I'm strong enough, but yeah, it took me a while to come back from. But I was like, wow, this is a really really severe illness and I think that in popular culture or whatever like popular culture I'm so old, but when people talk about it it's almost kind of like a joke, like people are anorexic or whatever you know, like it's. Eating disorders and body image issues are so common that people don't realize how serious eating disorders are. I'm also shocked that we haven't talked about it because we talked so much about, like your, your thoughts about weight that I'm like, oh, we't talked about it because we talked so much about, like your, your thoughts about weight that I'm like, oh, we've talked about it tons, but I guess we haven't.

Dr. Jacqueline Trumbull:

We're talking about body image and we had an episode on anorexia, way you know, early on in our broadcast. But I mean, I think the reason we have it is because it's not our area of expertise and yet we wanted to do an episode on it, at least kind of a primer, discussing the different disorders, so that people could be aware of the differences and, you know, maybe perk up their ears a little bit if they notice some of this behavior in their loved ones, because we don't, we don't want to keep neglecting it. At the same time, it's maybe something that we'll invite guests on to talk about in the future. But I don't know, should we start with discussing just disordered eating generally?

Dr. Kibby McMahon:

or should we Okay. No, let's. Let's go through the different disorders and kind of break them down, because it it it knowing what the different disorders are. It's kind of confusing unless you have the training that we have.

Dr. Jacqueline Trumbull:

So yeah, so I think you know the first stop is usually anorexia Um, this is the one that most people hear about, um, I think it's. I remember, like growing up in the aughts, and one of the one of the most dangerous aspects, I think, of both anorexia and bulimia is that there can be a lot of uh community around it. There are like Reddit groups, I think, social media groups that talk about Anna and Mia, meaning like anorexia and bulimia, and they'll be talked about as if they are your friends and there'll be like a lot of tips and that kind of thing. And so it can be really really dangerous to lose people to this disorder because they can find a lot of like encouragement for it, like dogging of it online, and I remember being in high school and it was a little bit similar in that case, it was kind of glorified or romanticized to at least flirt with anorexia. Do you remember anything like that?

Dr. Kibby McMahon:

Yeah. And so for people who don't know the actual definition of anorexia, it's extreme food restriction, um, and paired with an intense fear of gaining weight. So usually people with anorexia have low body weight, like they're really underweight, but no matter how small they get, they could still see themselves as overweight. So it kind of has like some delusional pieces to it where it. I mean, I remember in the clinic, um, girls were, you know they, they're mostly girls, their bones were sticking out and they were still saying, like I'm just huge, I'm so fat, um, so there is some sort of like distorted, you know, perception of themselves.

Dr. Kibby McMahon:

Um, I do remember I went to an all girls school and there was a period of time, especially when we were going from, uh, I think it was like in eighth grade, you know the, the kind of the age where you start to like, get interested in boys and start to date more. Um, some, some people started to have sex, right, they started to become like we're like sexual beings. There was like rampant I don't know if it was a level of eating disorders, but diets right.

Dr. Kibby McMahon:

And and it was really praised, like we really praise each other when we would only eat. I mean, even diets can can hide when someone has an eating disorder, right, Like Atkins diet was really popular back in my day, which meant that you only ate like meat essentially, so people would just have like one slice of turkey and like two celery sticks and we'd praise each other.

Dr. Kibby McMahon:

We'd be like, oh my God, it's so great and we'd lose so much weight so quickly. And yeah, it was something that it probably would have taken like a really really extreme case for us to get worried that someone had an eating disorder, but otherwise it was like, oh, they're doing what we're all doing. So, yeah, it was like this really encouraged thing. Yeah, anorexia usually is diagnosed with like rules around eating and and food restriction, like eating really few calories, like when we actually diagnose, when we do the assessments, we ask you know like, don't talk me through a typical day of eating, and if it's a really low number of calories, that's a. That's a sign if they're low weight. But also, yes, if they're really low weight and but exercise, so they might have like normal amount of eating but they're exercising to the point where they're losing weight and not, you know, not getting enough nutrients. That's another sign of anorexia.

Dr. Jacqueline Trumbull:

And it usually has. I mean, what I was taught was that it has a different kind of personality profile than the other eating disorders highly perfectionistic, highly kind of controlled.

Dr. Kibby McMahon:

These people really like control. Anything else that you know yeah, I mean all of all of the eating disorders, especially anorexia, have a lot of comorbidities with, um, anxiety, uh, ocdcd and personality disorder. So there's, and there's, a lot of perfectionistic right in anorexia. Bulimia that we'll talk about in a minute is a lot more impulsivity. So anorexia is, you know, often people with anorexia will come from families that are really highly, you know, into perfection, into achievement, right. This kind of like I can't, I can't mess up. So it's just like this, this need for control that is exerted on the body, right.

Dr. Jacqueline Trumbull:

Yeah, and that's a very different mechanism than than some of these other eating disorders. It's so. It's so interesting because you know I mean anorexia and bulimia can look similar Like if you're you know anorexia and bulimia can look similar Like if you're you know, doing this sort of extreme exercise behavior, trying to limit. I think we think of these as like two disorders with the same aim, but that's not necessarily true and it can be two like different personality sort of subtypes that alter their one. Anorexia is also the most dangerous. It's generally thought of because, I mean, for diagnosis of anorexia you need that low weight which is actually not required for the other disorders.

Dr. Kibby McMahon:

Yeah, it is the most, if not one of the most, deadly disorders that we have in mental health.

Dr. Kibby McMahon:

So if yeah, anorexia kills a lot of people, right. So it's really serious. It's you are undernourishing yourself. So a lot of people with severe anorexia end up dying and they might die of different things. Like they might have issues with their electrolyte balance, right, if you don't eat a lot, your electrolytes are kind of all messed up and some of them might have like heart issues, heart failure, heart attacks. So it's really deadly and beyond deadly.

Dr. Kibby McMahon:

When you don't eat, it messes up a lot of other stuff, right, obviously. But when you don't eat, eventually the hunger cues kind of shut off, so they might not feel hungry. They might even have like this surge of like reward, like dopamine, like runner's high kind of feeling when they don't eat, when they restrict. So it's like reinforcing in a really scary way. And when you don't eat, you'd also cognitively get messed up, right, if you're super hungry and starved, everything else is messed up, including like thinking and decision-making. So they become kind of like addicts, where it's like it hijacks the brain and in fact, if people are so undernourished they can't actually do therapy, right, because their brains are just like I can't eat, I don't know what they're talking about. They can't actually do therapy right Because their brains are just like I can't eat, I don't know what they're talking about. I can't possibly, like you, can't think about your values or your thoughts or changing your perception if, like, you're starving, right. So actually, people with anorexia, like the severe cases, have to eat first before they could actually do psychotherapy, and it was really hard to sit with in the inpatient unit for eating disorders.

Dr. Kibby McMahon:

A lot of patients with anorexia had to be force-fed because they were so close to death, so health compromised, that sometimes they would oh gosh, I mean they would have to sometimes be tied down and given like milk or food, because it's, I mean, it sounds barbaric, but they were like starving themselves to death, right. So you know their safety becomes the highest priority. So they had to be force fed because, and sometimes even like restricted physically because some of them would, once they got the food, they would freak out and like do a bunch of sit ups in their cells, in their beds, or they'd like do running in place. They'd be constantly trying to work out. So you would have to like restrain them from doing that and feeding them. So it just seems like restrain them from doing that and feeding them so it just seems like like opposite of survival mechanisms, right, Like it just seems like someone who's just like their brains are have gone haywire. But it just is really. It really is unbelievable and it's so sad.

Dr. Jacqueline Trumbull:

It's a it's. It's such an interesting one because I think there's something intuitive about it in the beginning, which is diet culture. Right, like so, many of us are trying to starve ourselves a little. Losing weight, even when we're already thin, is very desirable. But then you see these people and it's like how in the world could you still want to lose weight more, like how you are on the verge of death, you are starving yourselves. How is this still happening?

Dr. Jacqueline Trumbull:

But we know that they have a delusional view of their own body types. So we know that if they were to draw themselves, for instance, they would draw themselves with a much different body type than they have in reality, with much more weight on it. So there's, they're not seeing themselves realistically, but it's. It's incredible that even even on the, on the, on the verge of actual starvation, there's still this belief that there has to be more weight loss. And I wonder if, at that point, it is even about weight, or if this yeah, I don't know I think it was about weight or if this, yeah, yeah, I don't know.

Dr. Kibby McMahon:

I think it's about weight and control, right, you know a lot of um. A lot of patients with anorexia have said that they just they were felt out of control in other parts of their lives, like they've been through abuse or you know there's other they lived with you know an abusive family or something, and this was something that they were able to control. Usually they're very smart. Smart, they're good at school, they're thin, they're. You know, because of all this, they're popular. They're getting so much reinforcement for being skinny and I think also our cultural standards for what is acceptably skinny is also off. So they might be starving and people are still praising them. So it just yeah, it's just like such a, it's such a slippery slope.

Dr. Jacqueline Trumbull:

It is interesting. I mean it is the one disorder that you get really like positive reinforcement for a very long time, Like the whole kind of up ramp for this or on ramp for this. Disorder is like losing weight and people admiring you, admiring your discipline, admiring the exact mechanism that is killing you, and then by the time maybe that admiration stops. It's been so kind of embedded in you that this is a good thing to be doing.

Dr. Kibby McMahon:

I read a fascinating article a long time ago, because it's so like counterintuitive that humans have to survive by eating.

Dr. Kibby McMahon:

So it's so counterintuitive that this mechanism would kick in and they would just keep starving themselves until they die.

Dr. Kibby McMahon:

This article, I have to find it and, if I can, I'll link it to the show notes. But one theory is that there might be an evolutionary mechanism happening where, especially in groups that are nomadic, there might be some because we know there's some genetic propensity for getting eating disorders. So there might be something like there's certain nomadic cultures, or even you know, just in humanity, where there might be cases where you need to not enough food, so you have to like travel far distances in order to like find new sustenance and it makes sense for your hunger cues and your body to kind of go into this different mode of like I'm, I'm running, I'm, I'm, I'm not eating, I'm just going to, I'm in nomadic like movement I don't even know the word, but you know what I mean Like we're not eating, we're running and we're going. And so they think that there might be some evolutionary ties to that state where, when people stop eating, it kicks in like oh, we're in danger, we have to survive by not eating. So let's not eat.

Dr. Kibby McMahon:

So, that might be. I mean, it's theoretical. But I thought that was interesting because I was was like why would people do this to themselves?

Dr. Jacqueline Trumbull:

right. Yeah, I mean, it's not like anybody gets praised for becoming depressed or becoming anxious, becoming bpd or becoming traumatized, like there's no positive reinforcement there, but this you've got both like a lot of external positive and social reinforcement and this kind of biological um system that I suppose is reinforcing it as well. So that's super interesting. Um, and you're probably going to see it. I think that we know that this is more prevalent in white cultures, probably Asian as well. It's less, it's less prevalent in cultures that are um, of different body types, of curvier body types. So it does seem that there is like a social and cultural aspect of this. When the culture amplifies thinness, then we're more at risk of this. And then adolescence is a particularly dangerous time, both because that is when our bodies change and put on weight rapidly and that can really freak girls out, and because it is a time when your life is really out of your control, just as you are trying to exercise your autonomy.

Dr. Kibby McMahon:

Yeah, and sometimes not eating has that, like you know, reward, rewarding effect. So it can be emotion regulation, right, it can not only rewards itself, but it could. You know, just it's like a self-harm kind of thing where it distracts from other sensations or emotions that might be intense. And you're right, actually there are. There is research showing that's westernized or developed countries are more likely to have eating disorders. I know now I'm like digging into all of our grad school research and like remembering all the different factoids that we learned that there's something crazy about when there's a link to eating disorder, rates of eating disorders rising. When TV and other kinds of media are introduced to a culture, like when a culture gets access to, like American TV shows or Western standards of beauty, then eating disorders goes up, you know. So there is that environmental component.

Dr. Jacqueline Trumbull:

One thing I've been noticing with my own like body image is I've been going to a lot of like saunas recently and I've been looking around and I'm like you know, most people don't have beautiful bodies, like most people are average looking bodies or like even wonky or disproportionate, right Like there's really different kinds of bodies and it's I think it's the fact that I follow all of my bachelor friends that has me so crazy not even that.

Dr. Kibby McMahon:

I mean like, I mean your bachelor friends, I mean the people, the ones that I've met in person. I just it's just, it's crazy. They are like such naturally beautiful. I mean, they're just like genetic gods, like it's just like are you serious? Like this, is you on a bad day? But not only that, but then we have all social media where there's like filters and then there's everyone doing, you know, body modifications of diet and, uh, you know, like fillers and all that.

Dr. Kibby McMahon:

So everyone's like conforming to a very specific look. Yeah, let's not even talk about GLP-1s, where now people are dropping weight like crazy. So, yeah, I mean, all of this like social comparisons can feed into body image issues.

Dr. Jacqueline Trumbull:

Yeah, I also think it's an interesting like if you are an adolescent and you bring this into your family dynamic. I mean, you have a toddler and I imagine food and eating is already sometimes a battle, Maybe not with dads, I don't know, but with a lot of families with toddlers, right Like eating in the family, eating with like kids, eating behavior can really kind of like hijack the family dynamic and I would think that bringing this back in as an adolescence would bring in a lot of attention and awareness. Yeah, I mean it would.

Dr. Kibby McMahon:

Just if you feel out of control, if you feel like you are being controlled by others, then this is a way to flip that script a little bit my friends back in back in the all-girls school that had eating disorders, like they had pressures from their families, like they were ballet dancers or eventually became actresses or just in the public light, and it's just so much more accepted in, let's say, you know ballet dance school to like comment on kids weight, especially with all those different changes, and so yeah, they're gonna, that's gonna create that kind of pressure and normalize um being super underweight, um. I also did want to mention that one if you, if you're not sure if your loved one has um, like a friend or a sibling has um eating disorder I don't know why I said like friend or sibling, like a few categories. I was just if anyone you know has um eating disorder. I don't know why I said like friend or sibling, like if anyone you know has eating disorders.

Dr. Kibby McMahon:

Um, one thing that's like a it's, it's a tell is not only are they skinny, but um, if they are having different rules about food, like it may not, I think I I watched the show skins, I think is, on netflix.

Dr. Kibby McMahon:

It was an old um, uh, british uh show about teenagers and the one character uh had like it was just like a really good example of someone with severe anorexia. Um, she would have all these different rules like like you chop up certain foods and push them to the side, like they're. They might have different ways to um like just like have rules, so like yeah, to like cut down on the food, like oh, I'm just like I could eat half of this or I'm gonna put on the side. Like they're controlling their food in different ways, like that. Or they have like extreme, like I'm a vegan right, like you're like oh, okay, but then they are using rules and justification like I can't have this kind or that kind, and so diets that are structured somehow become like all these very restrictive rules, or they'll just do things to disguise that they're not eating. So they will like have tricks of um like putting things in their mouth and spitting it out somewhere, or cutting up food to look like they're eating but.

Dr. Kibby McMahon:

And then having like a few bites in different places, but, um, yeah, so it's almost kind of like an addiction where they they are able to hide in plain sight that they look like they're doing normal things but they're actually like eating, you know, super low calories.

Dr. Jacqueline Trumbull:

So yeah, oh, this is one of, honestly, it's one of my worst fears as a mom, as a future mom. Yeah, I'm like, I'm absolutely terrified if, if my daughter or son, but much more likely to be a girl brought this home so we can talk about bulimia, mm-hmm. So bulimia, the core difference, I would say there's two A's, that there's not necessarily any weight loss, but B like you're not, you wouldn't be diagnosed with bulimia if you're underweight, like I think a lot of people think of bulimia as like alternative pathways for starvation, but it's not. Anorexia involves starvation. Bulimia does not actually involve weight loss necessarily.

Dr. Kibby McMahon:

Yeah, I'm trying to remember. Actually there's like a diagnostic criteria. If you're seeing, for example, like intense exercise, the difference is if you're underweight you might be diagnosed with anorexia, but if you are average or overweight you are diagnosed with bulimia. So it can come with those compensatory behaviors to avoid weight gain, like the stereotypical throwing up laxatives, fasting, excessive exercise, but they might not actually be underweight.

Dr. Jacqueline Trumbull:

Right, and the reason so. The second major differentiator is the compensatory behaviors are compensating for binge eating. You're not seeing that binge eating and anorexia, that's starvation. So you might see purging um intense exercise and everything, but that's in combination with low eating. The compensatory behaviors in bulimia are because you've just binged, yeah, and so the binge is actually the first, um kind of response to like an emotional trigger yeah, and, and to be clear, I think people use binging very commonly.

Dr. Kibby McMahon:

So you know, whenever, whenever we do these assessments with you know the skit interview, you go do you eat a lot in a two-hour period? That's like the first question and everyone goes yeah, you're like, give me an example, like, oh, last night I had a whole bag of chips watching a movie.

Dr. Kibby McMahon:

It's like, yeah, that's a lot, but that's not binge eating. Binge eating, binge eating looks like it's just like inhaling like a lot, a lot of food in a short amount of time and it has this feeling of loss and control kind of like. Um, some, some people have described it as like they kind of like dissociate or go numb or go on automatic, like they're just eating like cartons and carts of ice cream and then it's it. Yeah, it kind of feels like a narcotic. It kind of feels like they just like lose themselves in this. Um, and usually that that is a way of dealing with like regulating, like pain or you know, is that distraction, right, but it's like this a lot. I mean, I will say I didn't know what binge eating really was until in college I saw a friend um having a binge. Uh, she had a really rough night where she felt rejected by someone she was interested in and she came home with two huge slices of pizza. We have this thing called Cornette's Pizza near Columbia where it was like literally a foot long slices. She had two of those, ate that and then had two.

Dr. Kibby McMahon:

My Alex, my now husband, was eating a white castle burger. So it's disgusting like little like gray looking burgers like that came in a box so they were eating them and he was like he was eating a lot of it, but she ate. She grabbed and like ate several. So after the two two foot long slices she ate like three or four. And then she grabbed a bunch of candy from my candy bag and ate like 10 starbursts. And then she went and I'll never forget this she took um a couple cans of tuna fish and ate them raw, like with no like mayonnaise or mix it. She just like ate them straight. And I think she finished off with like some canned soup.

Dr. Kibby McMahon:

She really liked and I remember sitting there watching her because I remember it was like on the course of a movie and just watching her just eat this. And she did kind of look like she was not there, like she wasn't talking. She was just like looking ahead and eating like robotically almost, as if she was like sleepwalking, and the amount of food I was like I don't know how physically you could handle. You know, like once you get sick from that. But that's when I was like, oh, that's what a binge looks like. You know, this loss of control. So, um, yeah, that was poor girl. She's better now. She has a great life.

Dr. Jacqueline Trumbull:

Was she eating a purger, I mean, or was she? Was this?

Dr. Kibby McMahon:

Not that I know of, not that, not that I know of. So you can, she might've had binge eating disorder, which is all of that without the compensatory feelings, um and but, bulimia. I remember in the eating disorders unit some of the bulimia I just I mean, imagine that this is my first job in mental health and I was just like, yeah, I'm going to be a psychologist maybe. And there were cases where the binging and purging had its own rituals to it, like I mean trigger warning if anyone's grossed out by this kind of stuff, like body stuff. In fact, this whole episode was tough on you.

Dr. Kibby McMahon:

There was people who had to weigh their vomit to make sure and if it was too little then they would exercise. They sometimes would keep it and store it in their closet and the mom would discover it and store it in their closet and they're like the mom was a discover it, um, or just like really intense, like laxative fasting or diet stuff after like they binge for a couple days and then they'd like starve themselves for several days after, right. Or they would exercise for hours and I mean like on the treadmill for two hours, right. So I mean, yeah, it became kind of this like calculation obsession of like I lost control, but then I had to get the control back, you know, and um, it's a lot more of like this impulsive drug, you know, drug seeking behavior than anorexia looked. Anorexia was like I control everything and everything and this is like I'm out of control and then I have to make up for it. I'm out of control, right?

Dr. Jacqueline Trumbull:

So yeah, it's just, it's just painful to think about how much shame is going to go with bulimia too. I mean the the idea of hiding your vomit or hiding your excrement, right, like you know, these people are deeply ashamed of that and they're they're living like in extreme secrecy because that, that is something that's going to get you rejected very, very quickly, and I mean, people are going to be shocked, right, people are going to be horrified by that, but it's it's, it's like it's compulsive.

Dr. Jacqueline Trumbull:

And my heart just kind of breaks for people who are living that existence.

Dr. Kibby McMahon:

Yeah, that's a tough one. At least they're less at risk of dying than anorexia because they're not undernourished. But they have a lot of health issues themselves. I mean they, as you can imagine, like electrolyte balance of you know, vomiting all the time is totally off. So I think that people can actually have like other health issues based on that and then like just like I mean the throat.

Dr. Kibby McMahon:

Yeah, it's really hard on the throat and the teeth so you could tell someone has bulimia. But if they have of rotting teeth or this moon face people call it Especially because of the pressure and everything Sorry, this is gross, but they'll have a puffy face. So that's a sign of bulimia as well.

Dr. Jacqueline Trumbull:

Oh, that's so sad, I know. So that's a sign of bulimia as well. Oh, that's so sad.

Dr. Jacqueline Trumbull:

I know I believe Britt Nielsen, who was on the Bachelor, opened up about her struggles with I think it was bulimia, and she's given beautiful accounts of what this is like. Anybody kind of wants, like a firsthand account from bachelor nation. I really I remember watching her videos and really respecting her for for talking about it, because she it was no holds barred. I mean, she really talked about what it was like for her to go into this emotional place and you know, and and the shame afterwards, um, I was gonna say I, I think, I, I think it's also counterproductive. I think scientifically our bodies absorb the nutrients very, very quickly and so the vomit actually doesn't really compensate very much for it. But also it probably alleviates the pressure that builds inside the body when you eat that much, and that might be part of it.

Dr. Kibby McMahon:

Yeah, absolutely yeah, I don't know. I mean bulimia of course is associated with that body image concern, right, but it seems to have, as you were saying, different mechanisms of more about like, about like the out of control and the trying to get control back. So it's kind of like this emotion regulation kind of issue, about like feeling totally dysregulated and then trying to get regulation back.

Dr. Jacqueline Trumbull:

Yeah, and of course, binge eating disorder. There's no compensatory behavior, necessarily, but these binges are happening usually like in private. There's a lot of shame about it, a lot of guilt about it and again that kind of dissociative state, um, and this I think like there's a lot of shame also if like this creates, if this exists, in like overweight or obese people who then can have like shame about eating in front of people in general because of the judgment they feel like they'll receive for eating too much or eating the wrong things. So I mean, it's just god, it's like.

Dr. Kibby McMahon:

Anywhere you look within this, it's, it's so painful yeah, yeah, yeah, binge eating disorder apparently is the most common eating disorder. Um, it's not usually, you know, usually people are overweight or, um, average weight, but yeah, it's like, it's like binging and then having like the huge discomfort and distress after I have. I have probably, probably that girl from college had it, to be honest. Honest, because I didn't think I saw her. I mean, I don't know about her purging behaviors, but it's so sad and that, of course, like, as you imagine, with problems with eating a lot, you're at high risk for diabetes and heart disease and other hypertension problems.

Dr. Jacqueline Trumbull:

So it was also very dangerous, okay, so if we have a loved one struggling, wait was also very dangerous. Okay, so if we have a loved one struggling, wait wait, wait, there's one more.

Dr. Kibby McMahon:

There's body dysmorphia, which we'll cover in another episode, because I think you have it we talked about this where I'm like, uh-oh, I think you have a disorder, jacqueline, I think we should talk about it.

Dr. Jacqueline Trumbull:

I do not think I have a disorder Publicly. Maybe be the light or something, but we can yeah.

Dr. Kibby McMahon:

This episode is my way to be like. I think you have some of this. I'm serious, Serious. Loved ones, Loved ones, no, well, one more to remember. I think this is getting a little bit more attention because sensory processing disorders are getting more attention. But avoidant, restrictive food intake disorder, ARFID is when someone limits or controls what they eat because they're afraid of other negative consequences like choking or throwing up like they're. They're like oh, there's certain foods I don't eat because I'm terrified of throwing up, or they don't like the texture. Um, of course there's levels of that. That's normal, but it's especially if it's like the. They really restrict their food, right, they only have certain textures.

Dr. Jacqueline Trumbull:

Um, but it's not about weight, it's about it's not. Yeah, yeah, it's like a, it's just an intolerance, yeah. But I mean like, if you are a loved one of somebody with one of these disorders, I really feel for you. I mean, I feel for anybody with the disorder as well. But to watch someone you love waste away or not be able to control what they're putting in their body and not from, like you know, binge eating disorder is not somebody loving to eat this is not an enjoyable experience. It is a distress tolerance, it's a distress management system that they hate and that makes them feel intensely negative about themselves and it feels out of control. It's not like I'm going to, you know, enjoy my time eating this feast. So you know, I mean it's watching somebody engage in legitimately dangerous behavior and feel like they can't stop. And I do think your kind of journey with it as a loved one differs depending on the eating disorder. But do you have kind of initial tips?

Dr. Kibby McMahon:

I mean the tips are, I mean just know that, just knowing, first of all, and the major tip is knowing these different eating disorders so you could pick it out, cause some people might not already know oh, this is what you know.

Dr. Kibby McMahon:

If someone throws up, that's a sign of eating disorder and not realizing that their friends or their families, like dieting behavior, could be eating disorders.

Dr. Kibby McMahon:

But it's really tough for families and loved ones because it's kind of like I think the issues kind of sound similar to addiction or you know anything else like that, where there's a lot of trust problems.

Dr. Kibby McMahon:

There's a lot of like uh sites around it, right, like I, you know, trying to get your kid to eat or trying to, you know, get someone to eat more or be healthier, and they, um, they hide how much they, they don't eat, right, they like hide their purging behaviors or, um, yeah, you could get into a battle of like control over the person's eating. You're like monitoring their, their eating, and so it could be really stressful because it's, like, you know, eating is such a social bonding experience, like dinner tables, you know. You know family dinners can suddenly become like, you know, a dinners can suddenly become like a battleground, right, and then on the other side, there might be some ways you might be accommodating or even enabling some of those behaviors, like allowing you know that loved one to like not eat as much, or make sure that you only have certain foods or, you know, be okay with their. You know intense purging, but I mean tips. Number one, we all know education, yeah.

Dr. Jacqueline Trumbull:

And also education about therapy. I mean, I think a lot of people think, oh, my daughter has anorexia, I need to get her a therapist. But I would maybe think that it's actually more appropriate to at least additionally have family therapy, because this is a family-related problem.

Dr. Kibby McMahon:

Yeah.

Dr. Kibby McMahon:

I mean to that point, you know, I should link our episode with Nandini talking about family therapy, for, especially like teens and kids with eating disorders, because that really does highlight that.

Dr. Kibby McMahon:

You know, this is the case with all the mental disorders we're talking about, but especially with this, because food is so food and eating are so, I don't know, relational that working on the system needs to happen, right, like making sure that you're not accidentally reinforcing you know, some of that, some of the disordered eating, like, for example, like try not to make comments about their weight.

Dr. Kibby McMahon:

Right, like, I mean even just even just saying like, oh, you're looking good now, or you look terrible, you look so skinny, right, like all these different comments that you could say to one person and it might hurt their feelings or whatever and might not have such an effect, but someone with eating disorder, it'll kind of send them into the spiral, right, like, oh, you look skinny and it could be meant as a compliment, but they go, oh, but oh, I, you know someone's noticing my body, oh, I'm starting to think about how I'm actually fat and you know, it could really, it could really, you know, add to themselves. So, like, try not to talk about like weight, um, or eating or dieting like that.

Dr. Jacqueline Trumbull:

I mean or accidentally reinforce them. If you say, yeah, you look terrifying, you work to accidentally reinforce them. If you say, yeah, terror, you look terrifying, you look like you're starving yourselves, it could be seen as a great time finally succeeding. I mean, we don't know, but it's right. Bringing attention to the way that the body looks is counterproductive. But also, I think like if, if you're struggling with anorexia and bulimia in a different way this I mean especially like as an adolescent, it's it's likely that there are dynamics within the home about control like power and control, and so understanding those and helping your child have power or control in different, healthy ways could be an easier ticket there than being like go work on your problems alone.

Dr. Jacqueline Trumbull:

Go work on your problems alone.

Dr. Kibby McMahon:

Yeah, I imagine that that must be so hard. If you like see your kid essentially starving themselves and not you know, try to get more control over them, right, just be like, no, you've got to eat, right, and that actually will backfire because they're going to try to push for more control. So, yeah, like talking about power dynamics and control and agency and trust and building trust slowly with that yeah, an example of what not to do. I don't know if you heard about Tessa. Have you heard about Tessa?

Dr. Jacqueline Trumbull:

No oh.

Dr. Kibby McMahon:

OK, tessa was an AI chatbot that the National Eating Disorders Association added to its hotline chatbot that the National Eating Disorders Association added to its hotline, and this is also an example of how AI can you know kind of go rogue if you're not careful with it, but it was.

Dr. Kibby McMahon:

it was supposed to. You know, deal with the all the people calling in asking for help with eating disorders, and if you don't, if you don't like monitor and have oversight over the chatbot. This is what. What happened. So it started to recommend like weight loss and calorie counting and like measuring body fat. Like I started to give diet tips to the people calling in to the hotline. Um, yeah and so, so, like of course, the chatbot is just going to do whatever it asks. So they were probably just like it was probably just answering the questions of like how to lose weight, but you don't do that on a on a you know hotline for for eating disorders. So it was quickly taken off.

Dr. Kibby McMahon:

But don't do that Like don't, don't, you know, unmask you have eating to the people with eating disorders, diet tips, but don't do that Like don't, don't you know a mass you have eating to the people with eating disorders, diet tips, but don't do that to your loved ones too. If you see someone who's struggling with eating disorders, try not to step in with your advice, right? Because all of this kind of eating and body image, you know, advice that we have are coming from not having a disorder, right?

Dr. Kibby McMahon:

So if I say, oh, you look great, just cut out sugar, or um, wow, but you look, so you know just the, the, the diet tips that you might have that might work for you, um, or even like compliments or reassurances, might land differently for someone with eating disorders.

Dr. Jacqueline Trumbull:

So yeah, you know, don't do that. You're also probably not a nutritionist, so it's it's probably not necessary for somebody who's like, really, really struggling with this kind of thing. Um, and if you are a nutritionist, also don't, don't go that. But, um, I just think that the the like, maybe the well-meaning advice, can be like oh, no, if you want to lose weight, like, I can tell you how to do in a healthy way, but it's like no, we actually want to take the focus away from weight loss and from trying to control food. Um, binge eating and bulimia come with massive amounts of shame. I think you know, if you are aware of somebody struggling with this, trying to be as validating as possible, trying to be as de-shaming as possible, is helpful.

Dr. Kibby McMahon:

I think, keeping in mind all the things that we said about this where it's very dangerous to your health, right, people with eating disorders might think differently about food and their body image and everything like that, and it hijacks your brain, so it becomes. It's a disease, right? So don't blame them or just assume like what's the problem? Just eat, right. Like, just eat a little bit, you look great, right? So don't treat it like this is something to make fun of them for, or that they're have a moral failing or they don't have a problem. Like, take this as a serious health issue and don't blame them or get mad at them or make fun of them, right? Like teasing can really be awful, right?

Dr. Jacqueline Trumbull:

And I think also like looking out for you know if you are the mom or sister or whatever the case may be, but like really look out for your other relationships. I'm, you know, I've I've worked with a couple who they, their their kid, didn't have any eating disorder per se, but another like really, really rough, um, you know, disorder and tore the marriage apart because they're so freaked out all the time that this is their fault and they're, you know, when you feel like you're dealing with something life or death in your kid, if you're watching your kids starve themselves, then everything you do feels like it has life or death kind of consequences, and so the probability that you and your spouse in particular will start panicking over the individual decisions that you make, it just carries really high risk. Right, like it, you know it. It makes it hard to like this I'm trying to think of of an example Um, let's say there's a, a couple um with a kid who is couple um with a kid who is not eating at the dinner table and the dad freaks out and says you are not leaving this dinner table until you have five bites of food Right, and then the mom is like, oh my God, you're pushing her, you're you're going to make eating an even more stressful experience, and she's like it's okay, honey, it's okay you don't have to eat.

Dr. Jacqueline Trumbull:

But then he's like you're letting her starve, right, like I'd rather force feed her than and then saying like we are going to go in with the same intentions here and we're going to understand that each of us can't be perfect all the time and we're going to freak out. And this is coming from a place of being really scared because we love somebody who's destroying themselves.

Dr. Kibby McMahon:

Yeah, no, that's a really good point. And having the balance between those two sides, right, like you hear the polarizing, you know, I just maybe, I just heard that in what you're saying One is like they've got to eat and we got to make them eat, and the other one's like no, no, no, we don't want to upset them. Uh, eating disorders can hijack, like, the whole family dynamic, right. Like then, what do you do at dinners, you know? Do you have? Do you do you all just like not eat together, just so because it's so triggering to eat in front of um, this one kid, or do you force them to eat? Like what? What do you do?

Dr. Kibby McMahon:

And so, having a balance and having being on the same page, like with a plan of how to do that, and not having all these different rules, but, you know, just being on the same page by having some boundaries but also giving them some agency, like, okay, we're going to have family dinners, we are going to eat meat or whatever. You know, fatty foods might, you know, be otherwise triggering. You're welcome to join, as long as you know, even if you just sit with us, right? So, just, I mean making sure that it doesn't get to. I don't we don't like that word enabling, but either accommodating those you know the loved one with an eating disorder. Don't accommodate too much and shape your whole life and family life around protecting their feelings around it. So even maintaining some level of normalcy and healthy boundaries is really important.

Dr. Jacqueline Trumbull:

Yeah, I mean, I think that you can include healthy aspects of your meal, include fruits and veggies, but not say tonight we're having celery for dinner. You know, not necessarily turn the entire family vegan suddenly to say like, look you, you know you've got your safe foods on the plate. They're nutritious, um, this is what's for dinner. And trying not to get into a power struggle with them, I guess. But I mean this is one I would not wait to get help with. So, finding a really qualified eating disorders therapist if that is in your area, um, you know, finding somebody that you can talk to about this, not isolating, right, like hopefully finding validating friends who aren't blaming you, the parents or siblings or whoever it is.

Dr. Jacqueline Trumbull:

Then you, this family dynamic, um, and you know, like, I actually have a friend who, who grew up in a family who's where his sister had this eating disorder and he felt very kind of passed over. His parents were just kind of like, well, he's fine, you know, we've got this crisis on our hands. So then he, he grew up kind of neglected. So you know, I mean there's just so there's so much here to talk about, um, and that's why family therapy can be so important, right, because it's not actually just about the person with the eating disorder. That little boy is part of the family too and he's kind of wondering what about me? And the parents are freaking out and their marriage is falling apart, and you know? I mean there's all of these different dynamics that need to be brought in.

Dr. Kibby McMahon:

Yeah, and it's like the the extreme examples can take over the whole family dynamic.

Dr. Kibby McMahon:

But also I also think that eating disorders unless people are aware of it it's, it can be sneaky and go and fly under the radar, cause there might be other issues.

Dr. Kibby McMahon:

Especially if you're dealing with someone with bulimia who has impulsive behaviors in general right, they're also self-harming, or they're also driving drunk or they have another addiction or something like that then that might get more attention.

Dr. Kibby McMahon:

But I think when you have a loved one who is like, dealing with a lot of mental health issues include, you know, talking to their therapist that you don't notice right away like, oh, they're eating less or they're working out after eating a lot. Right, like that could seem almost like in the realm of normal. They have this crazy diet that they're following and they're dropping a ton of weight and that's so great because they look so good. Right, Like it is easy to kind of like have those. These disorders be like totally masks, but they are part of the problem and they take a lot of patience and a lot of like specialized therapy to treat, because it's not just like, oh, they start to eat normally and all the problems are are gone like they might be eating and they might actually be, like, properly nourished, which is great, but there might be all those other mechanisms involved that still need help, right, Like you know.

Dr. Kibby McMahon:

Question of control, question of distress, tolerance, question of like their self esteem right, their impulsivity right, this it's, it's all these other things that could be like. Okay, just because the eating is fixed doesn't mean everything else is fixed.

Dr. Jacqueline Trumbull:

Right.

Dr. Kibby McMahon:

Exactly. I feel like we might be scaring people.

Dr. Jacqueline Trumbull:

This is a big deal, super deadly, super dangerous.

Dr. Kibby McMahon:

You might not see it. I mean, yeah, I think that's I don't think we need to freak out over weight loss.

Dr. Jacqueline Trumbull:

But I, especially in like early twenties adolescence, I'd be, I'd be worried, you know, um, if I saw eating behavior drastically change in my kid and fostering an environment of, like you know, we eat healthy, but we eat to fuel our body, not to, like you know, sculpt our body into perfection, which was what I learned.

Dr. Kibby McMahon:

It's important, yeah, you tell me what are the tips for loved ones friends podcast co-hosts of someone you don't have eating? I'm kidding, I just sit, just sit, like I told we just said not to make a joke out of it.

Dr. Jacqueline Trumbull:

Look at me, you know, publicly shaming you for this but what's tough is that it's a lot of people have behaviors along this line. You know, like it's not like I can really go through my week not thinking about what I eat. Every time I have a meal, I mean I calorie count. I'm like if I have simple carbs, you know, then I'm starting to freak out a little. I mean I calorie count. I'm like if I have simple carbs, you know, then I'm starting to freak out a little bit, like how am I going to get? You know, how am I going to reverse this situation? If I have takeout, I'm constantly thinking about, like what oils do they use?

Dr. Kibby McMahon:

Really. Yeah, I shouldn't be surprised. I mean you shouldn't, I mean I? The thing that I get usually is you thinking that you're, you don't look good in like pictures or videos, and I'm like you look great as always. And then you're like look at this, look at this flaw, and I'm like I don't know what you're talking about, but okay, but I didn't realize that, like, every time you eat, you did you do? Do you do something in response to that? Like, do you actually like restrict yourself or do you have compensatory?

Dr. Jacqueline Trumbull:

behaviors. I mean, I don't purge, no, that, um, that's a, that's a no. But I'll go through periods where I'll restrict what I eat a lot. I just can't. I, I don't, I actually don't have the. I don't want to use a positive word here like self-discipline, because I don't want to like reward the idea of restriction, but I usually can't keep it going for more than a couple of weeks.

Dr. Kibby McMahon:

Yeah, that's tough. I remember when I went, you know, when my friends and I all got you know, you know eighth grade started to get interested in boys, started to become sexual beings. I did go on that Atkins diet. I did diet intensely for a couple. I was working out a lot.

Dr. Kibby McMahon:

I probably had an eating disorder if I were to think about it. But I wasn't like severely underweight, but I remember always thinking about it, always thinking about food, what I was eating, I was. It was right, we were writing things down, we were calculating. It was there was no like enjoying the food, it was all. It was all like an achievement. You know, it was all like the same thing as like doing homework and I just remember the, the immense like reinforcement and the power that you get from it.

Dr. Kibby McMahon:

Like you drop weight and suddenly people are nice to you, they're paying attention to you, they're praising you Like they're, they're talking about you as though you are like better than them or somehow like have other skills. Like they're like, oh gosh, I wish I could eat as little as you are. You know, I wish I could be so disciplined as you while I was like eating like one turkey slice for lunch. You know, it's like you really get a lot of social reinforcement. I always remember that and I always remember being kind of scared of that. I was scared at, you know, whenever I think about like cutting back or, you know, dieting or getting healthier, now I always remember and get scared of like the massive change in how people treated you, but also like how much, how consuming it can get.

Dr. Jacqueline Trumbull:

It's a lot to think about.

Dr. Jacqueline Trumbull:

I mean it's it's tough, you know, because when I think about the things I do, you know like I'll try to eat less than $500 for lunch so that I can eat 1000 calories for dinner and then still be at like a calorie deficit.

Dr. Jacqueline Trumbull:

But it's kind of like then you go online and everyone's like here's how to eat 1500 calories, or like here's how to eat 400 grams of protein, so that you know you will lose weight immediately, like it's just, and you do have to think about what you eat to an extent. You know, like I I'm not going to sit around eating 4,000 calories of Pringles, like you know I'm. I'm trying to think about fiber and and so it's not like we're not supposed to think about what we eat at all. But suddenly there's this sort of magical line where we have crossed into like disordered eating territory and it's very confusing because it's like well, how much thinking about what you eat is too much thinking about what you eat. Intuitive eating like what is that? Because some people who have grown up on ultra processed food for them intuitive eating means ultra processed food Like I. Just I don't know what the right answer is for a lot of this stuff.

Dr. Kibby McMahon:

I mean when in doubt, seek help. Yeah, I think that's the biggest tip. If you're not sure, if you're like you notice that your loved one is kind of going nuts Tessa's got some great diet advice I hear, so yeah, Great dieting tips, tips Um, but yeah.

Dr. Jacqueline Trumbull:

Well, on that depressing note, um, you know, I, I mean it, it, these are, these are a really scary group of disorders, like I, I don't think that there is necessarily too much fear mongering here. I think if it's something that you suspect about your kid or somebody that you love and it's worth a conversation and it's, it's worth thinking about, like what kinds of resources are available to our family, um, and I just want to like validate anybody's experience who's out there, you know, dealing with this, because it must be really scary. Okay, well, with that, if you appreciate this episode, um, or any of our episodes, please leave us a five-star reading on apple podcast or spotify. It really helps us out and we'll see you next week. Thank you, or organization presented or mentioned in this podcast and information from this podcast should not be referenced in any way to imply such approval or endorsement.