The world is heavy right now, and so many of us are obsessing over our bodies more than before.
Here clinical psychologist and vice president of MEEDA Carine El Khazen explains why that is. We talk about dangerous coping mechanisms, the temptation to turn to things we can control, and why weight loss seems to be on everyone's minds during the pandemic.
For the perfectionists out there, Dr. Khazen explores how the need to do everything right can make so many of us lose our real voice, and why approval is a dangerous goal.
And for the folks interested in the Middle East, Dr. Khazen discusses how MEEDA (Middle East Eating Disorder Association) is changing recovery in the region.
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The world is heavy right now, and so many of us are obsessing over our bodies more than before.
Here clinical psychologist and vice president of MEEDA Carine El Khazen explains why that is. We talk about dangerous coping mechanisms, the temptation to turn to things we can control, and why weight loss seems to be on everyone's minds during the pandemic.
For the perfectionists out there, Dr. Khazen explores how the need to do everything right can make so many of us lose our real voice, and why approval is a dangerous goal.
And for the folks interested in the Middle East, Dr. Khazen discusses how MEEDA (Middle East Eating Disorder Association) is changing recovery in the region.
JOIN THE CHAT
instagram.com/danaemercer
facebook.com/groups/talkingoutloud
EXPERTS
instagram.com/meedaassociation
Intro
From body image pressures to social media, like sometimes it can feel like the world is full of noise, and that's exactly why we've got to start talking out loud. Welcome to the podcast. I'm your host Danae Mercer, health journalist and eating disorder survivor.
Danae Mercer (00:19)
I'm glad you're here. Hi, guys, welcome back to Talking Out Loud, the podcast, it's all about helping you find your voice and navigating body image issues. I'm your host Danae Mercer. And today we're joined by Carine El Khazen, a clinical psychologist, psychotherapist, director of the Eating Disorder Program at the American Center and vice president of the Middle Eastern Eating Disorders Association. Carine, Thank you so much for joining me today.
Carine El Khazen (00:41)
Thank you for inviting me. It's a great pleasure to be on your podcast today. Thank you.
Danae Mercer (00:46)
Great. I mean, just let's kick off with the big question. We have seen a growth of body image issues across teens and adults since Covid started. Can you talk to me about why that happened and what's going on there?
Carine El Khazen (01:01)
Yes, sure. So I guess there are two main reasons.
First, we need to remember that eating disorders and obsessions over bodies are a coping mechanism.
So when we're not well, we have a tendency to resort to those kinds of if you have suffered eating problem or have had in the past body image issues in terms of stress, you are going to go back to resorts back to those coping mechanisms that are clearly unhelpful and destructive.
But it's kind of easier to obsess on your body rather than on the uncertainty of life. What's going to happen next? When is this going to end?
And people are more isolated, have more time on their hands to scrutinize their bodies on their own at home. Most of the time, they're working from home. So there's more time to think about those issues.
Restricting eating or overeating during those times is also normal, as we said, there are coping mechanism. So basically, you're stressed and you haven't learned to cope with your emotions with healthier ways. So you go back to your old ways or you do more of those unhealthy mechanisms.
So, you start to restrict to eating. It gives you a false sense of control. It gives you a sense of familiarity, of security, and you continue doing it or you indulge in food and then you go into the cycle after of restriction to compensate, that makes you overeat again.
So, I would say stress, isolation and for sure, increased screen time, because one of the major drivers of body image issues is the comparison and the comparison of this is happening to social media.
So when you increase your screen time, you're going to automatically spend more time comparing yourself to other people. Those images, as you know better than me, are completely faked and manipulated. But still the comparison occurs. And this will also heighten body image issues and as a result, the need to stress.
Danae Mercer (03:18)
That's so interesting because I know one of the things that really horrified me at the start of Covid and it keeps popping up, is this trend of meme around like Covid weight gain and the idea it's a side by side picture and the first one is like a very thin body. And then the next one is a larger body or a larger face. And it's like, oh, ha ha, this is me with the covid 19, like a big joke.
Carine El Khazen (03:45)
Yes, absolutely. This has been super triggering for many, many people. Very, very triggering.
Danae Mercer (03:53)
Well, yeah, it's I think it just horrifies me that we are in a global pandemic and for some reason, some reason and maybe you have some idea about why this is. But it seems the obsession instead of really being about the global pandemic for so much of the Internet, the obsession became about female bodies.
Carine El Khazen (04:13)
Yeah. So rationally, one would think that with such a global crisis happening worldwide, one would take a step back and put things into perspective and important things would matter more like being healthy, having your family, being safe and sound, you know, being surrounded with people. This should be the things that you should be starting to appreciate. Maybe before you took them for granted.
And one would you know, one would like to think that such a huge crisis would make you appreciate those things, but in reality, it does not happen.
What's happened is that, again, as a coping mechanism, you have to understand from a psychological point of view, one obsession always has another obsession.
It is easier to obsess on your body weight than to obsess on the well-being of the world. What is going to happen? Are we going to get out of this? Is there going to be a vaccine? Are we going to find a solution?
It is easier for people to go back to obsessing on those things, it's a convenient distraction, they don't have to think about the bigger problems. But yes, one would think that this is a time of reflection and taking a step back and helping you get the bigger picture. But I didn't see that happen very often. Most of the time people started obsessing. So, whether it is about the image for people who have body image issues or other obsessions, but it's a time of heightened obsessiveness on other things, an obsession always has another one.
Danae Mercer (05:56)
Yeah, that's I think that's so true. I know for me, when it all kicks off and even throughout like periods where I found myself, like leaning a bit more in that direction, and as someone who has recovered, those are always like triggers I watch for and I'm very aware of that. But, I can see how it's really easy to just, like, slide back into that safe space.
Carine El Khazen (06:18)
Yes, because on one hand, as you said, it's familiar and it gives, unfortunately, a sense of false security and control.
Plus, you have all the memes and all the messages that you're bombarded with social media love to have the whole medical community saying, you know, when you are confined, don't forget to move, otherwise you're going to gain weight. So even professionals, unfortunately, who are supposed to care for our I mean, the right to a certain extent. But the message is it can be wrongly interpreted.
So people started overexercising during confinement and watching what they were eating, because also this was a message from the health care community, because you're not moving enough, because you're confined in your home, you have to find ways to stay active. And what's happened is that people who have, as I said, addiction got worse.
People who have had histories of eating disorders got triggered. People who are recovering from an eating disorder and should not be exercising and should be increasing their food intake found themselves being consistent with those messages. So this was also detrimental. We have to think of other ways to convey those messages because the way it was conveyed were harmful and detrimental.
Danae Mercer (07:42)
That's really interesting. What would you do if someone with one of the listeners here maybe was struggling with their own body image issues during this time or found themselves creeping into an unhealthy direction or obsessing over food or bingeing? Like what kind of advice would you give them?
Carine El Khazen (08:01)
I think the first the first step is to be aware if someone, the first advice I would give to our listeners, if someone is noticing a change in your behavior or increased anxiety about food or other, you know, related symptoms or change behaviors, like being more irritable around food, being more anxious about exercising, not exercising, you know, usually people reinforce those behaviors, a positive reinforce that if someone is commenting on them in a negative way, then there's a problem.
And, you know, part of eating disorders is that they are physically, unfortunately, at the beginning, positively reinforced by society. And then, you know, there is a big plus of denial in them.
So I think the first step is to listen. If someone in our body obsessed and healthy eating obsessed society is commenting on your eating and advertising habits, that definitely means there's a problem.
That's the first step, acknowledging that there's a problem which is difficult most of the time. And then I think the second step is to, you know, reflect on ever since you started this, let's say health kick or, you know, eating healthily or exercising more, do you really genuinely feel better? Is your mood lower? Do you find that you have less energy than to find the more irritated by people or to find that you have developed some kind of weird moods or to find that you are sleeping, you know, sleeping inside? Do a genuine reflection because these disorders are egocentric.
So, at the beginning they make you feel better. But soon enough, you know, you're going to go into the hell of starvation, and all the symptoms that come with it. Lowered mood, anxiety, irritability. recognition, difficulty to concentrate, to ask yourself, are you really feeling better? Are you really genuinely feeling better?
And has your body image improved because most of the time the body image worsens. That's the weird thing, you know, so I'm talking about severe cases, even with severe cases. If you ask a very low with young girls that has now gained, let's say, 10 kilos, how she feels her body now versus then, she will tell you that she feels much better now because part of being starved impairs your perception.
And at the time, because you are starting to develop those rituals that are extremely severe when you're very starved and a very low rate of body checking, constantly measuring, pinching and all the stuff which worsens the body image.
So one of the message I want to say, I mean, I want to bring out that is that losing weight is not a solution for body image issues. Losing weight in general increases body image issues. So the solution, yeah, is to work on the behaviors that are perpetuating this body image, dissatisfaction, all the checking, all the comparing, all the you know, all the time and energy, then scrutinizing and trying clothes and looking in front of the mirror. All of that makes creates a body image issue.
So, it's not, weight loss is never the solution to improve the relationship with your body. Never.
Danae Mercer (11:40)
That's really that's really powerful. I know when I was at my sickest and my thinnest, I would say I felt the worst about myself, that I felt like you think losing all this weight will make everything better, but it just it just became this really bad and very upsetting spiral.
Carine El Khazen (12:01)
Yes, at the beginning. It makes it better. So at the beginning you feel a sense of achievement, plus is positively reinforced by our surroundings in our environment everyone compliments with loss.
Unfortunately, I think this is the biggest problem we're facing, even though, you know, weight loss in reality is never positive. Weight loss is either a sign that you are struggling with an eating problem or that you are clinically depressed or that you are struggling with a severe anxiety disorder or that you have some kind of cancer or a chronic illness. So it's completely counterintuitive to compliment someone on weight loss, but unfortunately, that's the situation. So, people compliment it gives you a sense of satisfaction and a sense of achievement. You feel that you've achieved something, something meaningful and important.
But then, you know, straight after that, you have to because you bodycheck enough to see fatness despite the extremely low weight. You know, when you want to see fatness, you will see fatness, even if you are at the BMI 12. And I have had, you know, patients at BMI 12 who genuinely thought fastness because when you want to see something, you will see it. And then you reset the standards and you feel, oh, my God, you know, I need to lose more weight in order to feel better.
And that's what anorexia nervosa has, the highest mortality rate of all mental health disorders, because you can never stop.
You're always in the quest of this honeymoon period, the first time, the two last bits of weight and people complimented you and you felt better than your body. But this last maximum a couple of weeks and then you have to go for it. You have to decide the standards and lose more weight because you feel unwell again. You have your body image get worse and you put more weight and it can never stop.
Danae Mercer (13:50)
And now I what you've mentioned a few times about this idea of the approval and feeling good and other people like reflecting back to us and we feel really good.
And I know a lot of the women in my community really struggle to find their voice. Like even I struggled for years to know, you know, to stand up for myself and speak for myself. And I just wanted people to like me. Do you find is that are those personality traits like helping people who struggle with body image issues? Do they do they have those?
Carine El Khazen (14:22)
Yes, they have two things. They have low self-esteem and usually they have perfectionism, Clinical perfectionism. So not the positive perfectionism that can make you accomplish and do good.
Clinical perfectionism that's always looking out for what is not perfect constantly and is never satisfied. And clinical perfectionism comes from some stems of your self-esteem.
People who need to be perfect all the time and people who fear that if they're not perfect, are not good enough and are going to lose the love and the validation of people. There's this constant quest to be perfect all the time because you have the fear of losing people's approval.
And the need of people's approval comes from the sense that you are not good enough as you are to have other people's love and approval. So, you need to always be perfect to get that. So, both are linked in a way.
Danae Mercer (15:18)
And how can someone if a listener does struggle with this kind of extreme perfectionism and low self-esteem, like, what do you do to fix it?
Carine El Khazen (15:27)
I mean, therapy, I would say, you know, when it gets to that, to that extent, you know, positive psychology has lots of good tools.
There's a lot of techiniques, you know, positive affirmations, mindfulness, gratitude, work, self-compassion at work.
But if the issue is severe and if the issue is chronic and if the issue sometimes is linked to childhood trauma, don't have to be traumatic to stay in trauma.
We have the big T, the trauma, the ones that are visible, and then you have the small T that are as detrimental but are not visible. So basically, childhood neglect or being, you know, kind of teased or bullied at school and most importantly, being bullied at home.
The first stigma and the first bullying, unfortunately, happens at home. And parents by, you know, while wanting the best for their children, think that, you know, if they shame them or if they humiliate them, they will motivate them to change their behavior. But in reality, research has shown it does exactly the opposite effect.
So stigma doesn't motivate anyone to change whether, you know, any kind of stigma. I still, a lot of those people have had in their childhood, if not a huge trauma. Again, something that you can see but have had multiple small Ts, multiple small traumas, neglect, having the sense that they're not good enough for their parents, start there and then, you know, you grew up feeling that you are not good enough others and that you need to you know, you were not good enough teen and then not good enough adult.
And then you need to constantly do more to have other people's love and approval.
So I see this extremely it is very common. And it's I mean, it's documented a lot happened in childhood, but that doesn't mean that it's not things that you can work on. And what we do in psychotherapy is, either you can treat the trauma to even though this is more trauma, it's treatable. So I use EMDR, eye movement desensitization and reprocessing, which is a very powerful trauma tool. And there's a lot of work on ecstasy and self-compassion that we do in therapy to basically, you know, restore the self-esteem or at least improve it, not restore it.
Danae Mercer (18:09)
It sounds incredible. And I mean, on that note, I know from speaking to you before, like you were doing amazing stuff here in the Middle East. Will you talk to me a bit about. Like you said there are no inpatient centers, so you work with the only outpatient center like you. Tell me about that.
Carine El Khazen (18:25)
Yes. So basically in the Middle East, there is no residential treatment center for eating disorders that are specialized in eating disorders.
There are no psychiatric or even, you know, pediatric wards that have a team that is trained in the treatment of eating disorders. And very few practitioners around the region are trained in evidence based treatment.
The biggest misconception is to think that any psychologist or any dietitian contributing disorders, eating disorders require a very specific training that you do not get in university. If you do psychology school, a standard clinical psychology school, you have a couple of hours of eating disorders. So it's not enough to train you to be able to treat eating disorders. They have very specific therapies that are that are that have been developed for their treatment. You have CBTE, you have Mantra, you have SBT. So, you have specific therapies and very few practitioners in our region are trained to deliver those treatments.
So, on one hand, you have lack of awareness and you have you know, there's a huge stigma around food issues in other parts of the world, specifically for men, even more than for women. And then let's say the sufferer or the parents can notice some signs and identify some signs.
Then, you know, they take them and they have lots of goodwill to take them to a general psychologists who cannot treat such disorders because they're not trained, most of them are not trained, so mean the association, one of its aim is to train more practitioners around the region to be able to deliver evidence based treatment. This is this is one of our goals.
Another one of our goals is to raise awareness against dieting, because, as you know, all eating disorders go through the diet. And if it doesn't, you will develop it at best, a disordered relationship with food and your body. And Diet don’t work. You know, if you don't develop an eating disorder, you will end up gaining the weight and more with time. And all studies show there is no study that shows that that weight loss diet are efficient. So, we need to. So, this is one of our aims as well. We go to schools, universities, and we speak to students to about the risks of dieting because this is where you can do prevention, but also with the big corporations like Instagram and Tiktok to start to try to help modify the content or the policies regarding pro anorexic content because their children as well.
So, yeah, we work on awareness, prevention and treatment. As in we aim to train many practitioners and we have on our website many, many resources that are dedicated to either professionals who would like to learn more about the treatment and families, carers or sufferers to learn more about the disorder. And we have many self-help books that can also be helpful in certain cases.
And we offer 15 minutes of free consultation with the expert. So if anyone needs a short, you know, conversation with an expert, they can send an email to info@meda.me and someone will get back to them and set up a tele-communication, 15 - 20 minutes of a consultation to help the direct the suffer.
Danae Mercer (22:15)
Amazing. Amazing. And the website is just Meeda.com.
Carine El Khazen (22:17)
Not it is meeda.me
Danae Mercer (22:22)
Perfect. Fantastic. Well I will. All of this will be down in the description below. Because I'm aware that you have an incredibly busy day. But I just wanted to say thank you so, so, so much for joining us.
Carine El Khazen (22:35)
Thank you. I am very grateful and thank you for supporting our cause and thank you for inviting me. And I'm always happy to collaborate, you know, any time you have any project. Thank you so much.
Danae Mercer (22:50)
Well, before we go off, I'll just say, guys, make sure you join us next week for another episode. Thank you for joining Talking Out Loud, the podcast. It's all about helping you find your voice. Carine, one thing before you sign off. What is your favorite uplifting quote?
Carine El Khazen (23:06)
What is my favorite uplifting quote? Wow, that's a tough one. There is so many. Haha. Wow, it's OK not to be OK. I think
Danae Mercer (23:20)
That's beautiful. And because they are relevant,
Carine El Khazen (23:24)
Because there's a lot of you know, you get even worse when you feel that you that you should not you shouldn't be feeling down. So, when you give yourself permission to feel down, then you can start going up and up and start again. So, it's OK not to be OK.
Danae Mercer (23:40)
I love that. It's beautiful. All right, everyone. Thank you so much. And we will see you again.
Carine El Khazen (23:45)
Thank you.