Montare Media presents this episode of the Discover U Podcast: Understanding Eating Disorders and Disordered Eating.
Why are eating disorders such a big and growing problem in our world? Is diet culture ruining our psychological health?
JD Kalmenson interviews Robyn Goldberg, a nationally recognized leader in the field, to find the answers to these and other compelling questions. Montarebh.com
Robyn is a Certified Eating Disorders Registered Dietitian Nutritionist and Supervisor from IAEDP (International Association of Eating Disorders Professionals). She began her career at Cedars-Sinai Medical Center, and over the last twenty-four years has developed her own private practice in Beverly Hills, CA. She serves as a Nutrition Consultant for the Celiac Disease Foundation, has been the Nutrition Counselor for the Susan Krevoy Eating Disorders Program, and led eating disorder and body image groups at various sober living facilities in Los Angeles. She has been quoted in The New York Times, The Huffington Post, Shape Magazine, among others, and has been on national television as the eating disorder expert on The Insider. Robyn is the author of the new book The Eating Disorder Trap: A Guide for Clinicians and Loved Ones and hosts The Eating Disorder Trap Podcast.
Follow JD at JDKalmenson.com
Montare Media presents this episode of the Discover U Podcast: Understanding Eating Disorders and Disordered Eating.
Why are eating disorders such a big and growing problem in our world? Is diet culture ruining our psychological health?
JD Kalmenson interviews Robyn Goldberg, a nationally recognized leader in the field, to find the answers to these and other compelling questions. Montarebh.com
Robyn is a Certified Eating Disorders Registered Dietitian Nutritionist and Supervisor from IAEDP (International Association of Eating Disorders Professionals). She began her career at Cedars-Sinai Medical Center, and over the last twenty-four years has developed her own private practice in Beverly Hills, CA. She serves as a Nutrition Consultant for the Celiac Disease Foundation, has been the Nutrition Counselor for the Susan Krevoy Eating Disorders Program, and led eating disorder and body image groups at various sober living facilities in Los Angeles. She has been quoted in The New York Times, The Huffington Post, Shape Magazine, among others, and has been on national television as the eating disorder expert on The Insider. Robyn is the author of the new book The Eating Disorder Trap: A Guide for Clinicians and Loved Ones and hosts The Eating Disorder Trap Podcast.
Follow JD at JDKalmenson.com
JD: Welcome to another episode of Discover U, our podcast exploring innovative and effective solutions to issues in mental and behavioral health. I'm JD Kalmenson, CEO of Montare Behavioral Health, a family of dynamic and comprehensive mental health treatment centers in Southern California. I'm excited to introduce you to our wonderful nationally known guest today, Robyn Goldberg, a registered dietician nutritionist and certified eating disorder specialist. Robyn began her career at Cedars-Sinai Medical Center, and over the last 24 years has developed her own private practice in Beverly Hills, California. She serves as a nutrition consultant for the Celiac Disease Foundation and has been the nutrition counselor for the Susan Krevoy Eating Disorders Program and lead eating disorder and body image groups at various sober livings in Los Angeles. She has been quoted in the New York Times, The Huffington Post Shape magazine, among others, and has been on national television as the eating disorder expert on the Insider. Robyn is the author of the new book, ‘The Eating Disorder Trap: A Guide for Clinicians and Loved Ones,’ and hosts the Eating Disorder Trap podcast. Welcome, Robyn. So happy to have you with us today.
Robyn: Thank you so much, JD. It’s great to chat with you. And I look forward to meeting you in the spring at the conference.
JD: Yes, yes, as do I. The reason I'm personally so passionate about providing quality care for eating disorders is that there seems to be so much shame associated with body image. In my years of doing Chaplain work in the military with prison inmates and other social outreach from foreign countries like Ukraine and Greece, at the core of all the human ills I've witnessed is a fundamental absence of intrinsic validation. In my belief system, being born is God's way of telling you that the world could not continue to exist without your presence and contribution, existential infinite dignity and value.
Discussions about eating disorders are so prevalent in today's world. But it doesn't seem that that was always the case. 50, 100 years ago, nobody was really talking about eating disorders, to the best of my knowledge. As a society, we were more concerned with survival, putting bread on the table. There was less awareness and attention and focus on eating disorders. What changed? Why is it so prevalent today? Does it have anything to do with the fact that we live in an unprecedented time of abundance? Is it a phenomena brought on by the stresses of a more mechanized and fast-paced lifestyle that we live in? And secondly, does it impact all societies equally, or are we finding that eating disorders are more common in certain groups, in certain cultures, or certain countries?
We at Montare have been getting so many calls from people seeking help with this. And that's actually why we're at the cusp of opening the specialist eating disorder program. We'd love to hear your perspective on why disordered eating and eating disorders have been impacting society in a more severe way in recent history.
JD: Excellent question, JD. I think it's interesting, because it's been a topic that has been common, people have spoken about it. But I would say probably over the last two years, really, since COVID, it's just exploded. I mean, mental health and eating disorders have really been out of control. I think so much has to do with social media, more screentime, whether it's remote learning, I mean, everything's been in front of a computer on the phone. I mean, not just for our younger generation, but for all. When you think about it, your doctor won't see you. It's like telehealth. I mean, everything has become this way.
. So, I think one of the factors is, like you've mentioned, abundance. I think abundance definitely plays a role. I mean, it's interesting that you brought that up, but the initial thought that came to mind was, many years ago, I went to Africa with my husband, and we're sitting with our guide from the Masai Mara, with our foldout chairs, eating breakfast with whatever they gave us. And this one guide says, “What do you do for a living?” and I said, “Well, I see people with eating disorders,” and he kind of looks at me like, “What does that mean?” And I start to explain that I help people improve their relationships with food and their body and not be afraid of food. And he was like, “You know what? I'm just trying to get a meal on the table day by day.”
So, and I've been all over the world, on a bike. And I always have like 3 standard questions I ask wherever I go. And it was always people's perceptions about body image and eating disorders. And I think in third-world countries, where individuals are just trying to have access to food, where there is food scarcity, body image... because this is always something I've asked, and I've been literally like, everywhere. And it's interesting how people don't really think twice about it, as opposed to I remember spending like 3 weeks all through China. In the countryside, not an issue. But when I'm in Xian and Beijing and all these cities, Shanghai, it's like as if I was in Los Angeles. I think there is so much promotion, the media, Hollywood, I mean, we're in the mecca of it. I always say we live in the land of eating disorder.
So, I think that is a factor. But I think also, what's really escalated it too, JD, has been the lack of control in so many elements of our life over these last two years. It’s like, “I can't control that I can't see friends. Or can't control what's happening in politics. Or I can't control that we can't go on this vacation,” all these factors. Over this last bunch of two years, let's say, my biggest referral has been to medical stabilization programs. Because the clients are so sick, they're not even candidates for residential. Let alone in IOP or PHP. I mean, I see the sickest of the sick.
So, I think it's just been over the top up this time. And I think those have been factors. Not to mention when you live with people that haven't resolved their own issues with food and their bodies. So, if you have parents or siblings or a partner, and when you're spending more time under the same roof, like even due to COVID, it's like, “Well, so and so has cut out such and such from my diet. Maybe I will too.” And it's, again, I mean, those have been just some of the factors. I mean, I can go on and on about that one question.
JD: I know.
Robyn: But it’s really been intense.
JD: That's very insightful. That's very insightful. And as I'm listening to some of the things that you're talking about, it also occurs to me that, during the isolation in the pandemic where people are not coming and going, and they're less active, on a very technical level, we tend to focus and harp on details, such as every time we walk past a mirror in a much more profoundly significant way than we would when we're going to work, traveling, going to different events and parties. So, there is a dynamic that when we're busier, we're less mindful or we’re less obsessive about certain details that shouldn't be obsessed about.
Robyn: Well, I was going to say, either people are body checking, or they’re body avoiding. But one of the factors you mentioned, I wanted to say is that, for my clients that had problems before the pandemic, will say, “You know what? I've loved that I'm not seeing friends. I've loved that I'm not invited to restaurants,” because Ed or Edwina (as we call the eating disorder voice) thrives on isolation, thrives on loneliness. So, when someone will say, “Oh, come to my backyard. Let's get together for lunch,”
"Oh, no, I'm afraid of COVID.” It’s their freaking eating disorder.
JD: So, correct me if I'm wrong, but are you implying that those who struggled with eating disorders prior to the pandemic, so COVID actually decreased the severity of their symptoms, and their serenity has sort of risen, and they feel a little bit better about themselves, versus those who have never struggled with eating disorders, somehow that became accentuated or exasperated during COVID?
Robyn: Well, no. So, the first part, so the clients that had eating disorders before, they've become more anxious and overwhelmed, but have liked the isolation. They're like, “I wish we always live like this. I wish I wasn't invited. I wish restaurants were...” I mean, and now with the world opening up, it's definitely been a snowball effect.
JD: Got it.
Robyn: There's others like, “How do I go back into the world? How do I see people? I'm bigger. I look different,” and all these thoughts. Or, “No, I can't go out. I don't know what kind of oil they're using. I don't know how big the portion is. Is there salt? Should I not eat in the morning?” I mean, it's like just the thoughts, it's like whack a mole, it's like, “I don't know what to hit first.”
JD: Right. Wow, wow. I guess I'd love to ask the next question, which is really important for all our listeners out there who are not well versed in the nuances of the eating disorder world and treatment, would you be able to briefly describe the various kinds of eating disorders that have been identified? And for example, explain the differences between bulimia and anorexia, and then there's binge eating. Do these behaviors stem from different types of mental health profiles? Meaning, why would somebody be more susceptible to struggling with one of these disorders versus the other? And how does the treatment and intervention differ in these different conditions?
Robyn: So, several things I want to say, JD. So, to respond with the types of eating disorders. So, the most common and the least spoken about is binge eating disorder. For individuals that struggle with eating disorders, 60% of women struggle with binge eating disorder, and 40% of males. And people perceive that an individual lives in a larger body that they are individuals that eat quote/unquote ‘poorly,’ these are all like stigmatizing statements.
So, first, I want to say any person can have an eating disorder. Any one of us can. It doesn't matter what age, what gender, what body shape or size you have, no one is immune to it. And with binge eating disorder, like I have clients that are dismissed from going to the doctor, because like, “Oh, you look fine. Your body fat's fine. Your BMI is fine,” because they're not trained as clinicians. So, binge eating disorder is basically using a significant quantity of food in a short period of time. Doesn't matter what kind of food. I mean, it can be I've had clients that are binging on kale salad. It doesn't have to be a Big Mac or a tub of ice cream. So, it's being able to consume a significant amount of food in a short period of time to suppress or avoid any type of negative feeling that an individual's experiencing. So, that's like their way that they escape and avoid and remove themselves from any kind of feeling. So, I’m just kind of giving you a brief snapshot. So, that's binging disorder.
Anorexia nervosa, which is what I think oftentimes people think of when it comes to eating disorders, actually. Again, you don't have to be emaciated. You could look normal. You can live in a larger body. There's what's called atypical anorexia nervosa, which is like someone that looks normal. They don't look like a concentration camp survivor. And it actually has this second highest mortality rate compared to any other... I mean, you think about illness, I mean, I've... the thing over the holidays that always breaks my heart is like I send Thanksgiving cards, and when I get sent back, like or I'll get a phone call like, “Robyn, so and so passed away from their eating disorder.” And I always get like, a couple of those a year. And it's like, I feel like this is the time of year I find out like who has lived another year, who is...
JD: Wow.
Robyn: And so, I mean, so that... because I've been doing this for coming on 25 years. So, I feel like, the longer I've been around, the more I get those calls, emails, return to sender things notifying me of that. So, yeah, anorexia nervosa is an individual, they can be male, female, I've several non-gender firming clients. I think that's the other thing with eating disorders is that people don't realize, like in the LGBTQ plus, transgender, community eating disorders are significant. And they've been. It's just individuals are having more courage and confidence to be able to say, like, “Look...” I have a client who came out with their gender and was like, “Oh, yeah, I've been restricting all this time too.” But the eating disorder was their coping source to avoid sharing with the family like what the situation is. So, that's, I think, relevant. And I'm sure you see that at Montare too.
JD: Definitely.
Robyn: And another eating disorder that's super common is bulimia nervosa. And people perceive when they hear about bulimia nervosa, that they're engaging in self-induced vomiting. But it could be purging via exercise. They compulsively exercise. It can be through laxatives and diuretics. There's OSFED, Other Specified Feeding Eating Disorder. And it's like, I always like to say, it's like a little of this and a little of that. Like, “Wow, I restrict and then I binge, and occasionally...” I mean, it's like a multitude of eating disorders. And the thing is that oftentimes...
JD: That's fascinating. So, they're not mutually exclusive at all, even though...
Robyn: No.
JD: ... their symptoms are polar opposites of each other, binge eating and anorexia, but they will comingle.
Robyn: Yeah.
JD: Wow.
Robyn: And oftentimes, an individual will start with one disorder, and it moves into another. Or they go back and forth between many eating disorders or more than one. And I think like the name of it, the name of it is less important than getting treatment. And I think there's so much emphasis on the diagnosis in the name. Why? Because insurance, which is like a whole other episode we'll have to have.
JD: Interesting, interesting.
Robyn: And it's for like, oh, insurance reimbursement or utilization review. And it's like...
JD: Practically, it's almost analogous to a drug of choice, as it were. But nobody would say that...
Robyn: Yeah, for sure.
JD: ... they're specifically struggling with this substance and this substance only. If somebody struggles with mind altering substances, we're going to have to find a comprehensive treatment plan that will encompass and include all of those, which that's really an interesting fact that I feel like a lot of people who are not in this world might not be aware of, that the labels are less important. And therefore, in response to the question I was asking, there wouldn't necessarily be a specific prototype mental health profile of a personality that would struggle with specifically anorexia...
Robyn: No.
JD: ... and a very different profile who would struggle with binge eating.
Robyn: Not at all. It could be. I mean, sure, there's genetics and there's a lot of have research on it. But it also can be, JD, I would say like trauma.
JD: Right.
Robyn: With trauma, “Okay, you know what? I went through...” like I have someone I'm seeing, I mean, it's like the psychologist gave me literally a whole scenario, and it's like this person has so much trauma and it's like she's going to be a lifer with her treatment. It's like nightmare after nightmare from rape to needing both legs amputated.
JD: Wow.
Robyn: It’s like I can understand... when I hear all these stories, it’s like, “Yes, this is the reason. Like, your eating disorder was your source of survival.”
JD: Right.
Robyn: “It helped you stay alive to binge and to engage in.” So, it's like to find... I always like to say to clients like, “I'm not here to take your eating disorder away. It served your purpose for you or it wouldn't be a behavior that you would engage in. My role is to help you learn how to legalize all foods and food groups and not pass judgment regarding various foods or be afraid.” But sometimes too, and it's like they do this in therapy, because I'm a part of so many teams. To be able to find something that makes you feel comfortable, or to tolerate the discomfort, like you have to tolerate the discomfort.
Robyn: Right. And it's like in treatment. And ultimately, it's like, “Well, I didn't feel that same like escape when I was binging. But you know what? When I was rubbing my cat, I felt so much better.” It's like, well, you didn't feel that way automatically, it's like through the repetition, trying and trying again. So, I’ll have clients like when we come up with things of what they're able to do, I'm like, “You know what? It's okay, you could like binge. But let's see what happens if you try doing X, Y, and Z for 10 minutes.” It's like, “Okay, yeah. So, I gave myself a manicure, and then I ended up binging.” I was like, “But you're trying something new.” And that's like a win because you're able to, what I call, buy time...
JD: Right.
Robyn: ... by trying to do something else.
JD: Right.
Robyn: And eventually, it's like, you might find like the magic wears off in how it's making you feel with what you thought. Because often it's like that default to be able to react that way.
JD: Right, right. Very insightful. I mean, obviously, as it pertains to symptom management, based on what you're saying, that the intervention and treatment of binge eating versus anorexia would have to differ significantly as it pertains to symptom management. But are you suggesting that, I guess, at the core fundamental level, the recovery and the treatment that you are providing for clients would have a lot of common ground and similarity, regardless of whatever that label might externally appear to be?
Robyn: There's certainly overlap. And my long-term goal with anyone I see is to help them become an intuitive eater. And when people say like, “Well, what does that mean?” And think like, I always use the example of a baby or a small child. Because we're all born and blessed with this internal wisdom to be able to eat when we are hungry, stop when we're satisfied. Not worry the boob won't be there again, “I better drink some more milk.” Or being, let’s say, “Okay, I'm eating to suppress feeling lonely or sad or bored or what have you.” And slowly through the aging process, we become more and more disconnected to stop paying attention to our bodies, hunger, and fullness cues. And we perceive like, “Okay, my body's betrayed me.” It's like I always like to say, like to work on helping a client merge their head and their stomach as one. So, if each person was naturally an intuitive eater, JD, where they could make choices without second guessing themselves and doubting, like, “Should I eat this? Should I not eat that?” or, “No, it's too early 12 o'clock,” I'm like, “Does your stomach know how to tell time?”
JD: Right?
Robyn: So, I'll start with what I like to call mechanical eating, which is more helping a person learn how to nutritionally rehabilitate themselves with understanding some basics about metabolism and how the body works. So, then they're able to have it's like training wheels on a bike. You don't just hop on a bike as a kid. You have training wheels. You have someone holding it. And it's the same thing with what I'll do with clients is giving them a guide or roadmap with working on their safe foods and ultimately, being able to challenge them on the beliefs they've picked up through diet culture and helping them long term. Like, not everyone can be an intuitive eater. I mean, that's the hope. But it's a long journey and understanding like, “Do I eat because I'm bored? Do I eat because I didn't have access to food and I didn't want it waste it, and children are starving in Russia, China, Ethiopia?” Like, so I think it's really getting into the psychology about how a person approaches food and their body and movement. And I really like to dive deep into that with whomever I'm working with.
JD: That is very helpful. Yeah. And that perspective really does provide a lot of clarity. I think I know what you're going to answer to this, but I'm just going to ask it to you nonetheless. So, we live in Los Angeles where diet culture is so prevalent. There was even an advertisement on one of the more prominent streets of the Grinch, the nasty character, the Grinch, and the caption, read something to the effect of, “I slipped some gluten in your smoothie.” And that's the culture, that's the environment.
I feel like the inherent danger, and the unique challenge with the diet culture, and that spills over and manifests itself in fitness and attaches itself to the broader self-help movement, the fundamental fallacy is that, ultimately, the insinuation or the messaging can actually lead to the opposite, the opposite of health, whether it's medical, whether it's psychological. So, all of it is sort of masquerading as, “This is the best thing for you,” when in effect, it can actually be something very different when you sort of integrate that into your lifestyle across the society. So, it's something incredibly important for people to bear in mind.
I want to jump into an important debate, and I would love to get your take on this debate. There is a debate within the eating disorder community, whether someone can truly recover from an eating disorder. Will they ever be able to relate to food like somebody who's never struggled with the disorder? And the truth is, to me, it seems somewhat parallel to a similar debate in chemical dependency. Can a recovering heroin addict ever use marijuana recreationally? Somebody has 10 years of sobriety from alcohol, can they have a social drink and not end up on the table? And of course, there is a critical difference between the analogy and the parallel, in that food is needed and necessary for survival, while drugs and alcohol are fundamentally unhealthy. But what's your take on the issue? Can somebody who has struggled with an eating disorder fully recover and relate to food as a normie would?
Robyn: So, it’s interesting, JD, because when I had my body image groups at the control center with Dr. Rieff Kareem and Transcend, I remember always it's like in the recovery world, and I'm married to someone who's coming up on 28 years of being clean and sober.
JD: Wow.
Robyn: And so, it's a very all-or-nothing way of thinking in that area. And in the eating disorder world, it's interesting you said, “Oh, there's a debate.” I was like thinking to myself, “I haven’t heard that like in a long time.” So, I'm not sure. But I can tell you and I know many people who are to be fully recovered, to be not in recovery, to be recovered period, end of story, is possible. However, it takes, like the research shows, it could take like 7 to 10 years. And it is necessary that the individual has an active treatment team, which includes an eating disorder trained physician, an eating disorder trained registered dietitian, eating disorder trained mental health care provider, and/or if needed, an eating disorder trained psychiatrist to get to that point.
But I will tell you that I know a small percentage of people that hang in there all those years been. And what will happen is, and this is probably why you've mentioned that there's this like debate is because we think like, “Oh, Joe Schmoe is like doing great. They're getting out. They’re eating. They're honoring what they're craving, etc.” And then something rocks their world. There's a death. They get fired from a job, whatever, some kind of trauma. And Ed, who's on the shoulder, works their way back in, and then it's happening again.
So, like I have clients, and I say this, like I'm thinking of like several clients I'm working with now that have wanted to do treatment their own way. The parents are not trained in this, and they've become the experts. They know what's best. And literally, I think of like a scenario where it's like, “Okay, things are going great, da, da, da. We're changing schools or we’re moving or this.” And it's like, then all of a sudden, something's happened, we're back there again after being in treatment, but not continuing on.
And it's common to be burned out with eating disorders. It's exhausting having all these appointments. It's exhausting checking in and having people, “How are you doing?” or being able to be challenged, like, “Okay, you know what? I want you to have bread with butter at your meal today.” It's like a client like, “I want you to bring the challah to our session and eat it. So, you can try it at Friday night.” I mean, like...
JD: Wow.
Robyn: ... people get tired. And then I think what's hard is those around them are like, “Are they going to be better? Are they just going to eat?” But you have to hang in. And the thing is, oftentimes, and I actually, I'm just announcing this now, but you'll know very soon in the next couple weeks. So, with a colleague I've been working on for the last bunch of months, JD, I have an online course for families coming out by hopefully the second week of January. And there's nothing like this in the ED field. And it's like, one of the biggest issues is that the loved ones are not in therapy. They need family therapy. It's not, “Oh, my child, my loved one,” it affects everyone. And that is one of the missing pieces too, because they've not resolved their own biases and their own issues and how to support someone. So, I just wanted to point that out too.
JD: That's very important. And it's a powerful message that you're conveying that eating disorder recovery is so much more incredibly sophisticated and comprehensive than, let's just say, recovery from chemical dependency, which ultimately is about abstinence. And the longer you have that abstinence, the longer your recovery is. But what I'm hearing from you is that this is such a detailed and it is such a long-term plan for the recovery. So, the side you're taking is you're saying everybody can recover completely, but it is a process, and it cannot be compromised. You can’t short the process. You have to really invest in the process throughout the entire time. And that is something very empowering, and it's got to be broadcasted. It's important.
Robyn: Yeah, for sure. It's a lot of what I call seat warming. You're getting used to sitting because you're going to these appointments. And I always say to clients like, yes, like I remember a client's parents re like, “Oh, she's not going to see this week?”
"How come?”
"Oh, it's Knots Scary Farm.” You know what? Sorry, this is more important than Knots Scary Farm. There will be another year of Knots Scary Farm. Like, I've had clients to take like gap years from school or those that have gone away, and, “Oh, I'm going to go away for the semester, or I’m going away to college.” And they come back because they can't handle it. I mean, I have several now that have been abroad, and one that has hung in there that's very, very sick that refused treatment, and now is like petrified that she's going to be going into residential.
JD: Right.
Robyn: Because she's... yeah. I mean, it’s like honestly, things would be enjoyed much, much more. Like, I was discussing with a client's taking a gap year and wants to go to college in New York. And I had said to her, I said, “My big best wish for you is where you can walk down the student grab like a slice of pizza.” She said, “You just want me to eat pizza,” I was like, “Listen,” I said, being able to adapt in any place that you are,” I said, “I adapt wherever I've been. I'm in India, I'm eating whatever they're serving me. I'm in Vietnam, the same thing.” I'm like, New York, I'm married to New York. I think about like the bagels and the pizza and all this stuff.
JD: Right.
Robyn: And to say versus like, I have a client, they’re like, “Robyn, I've been there two years, I still haven't touched a bagel.” Like, that's the problem. Not every meal is going to be Whole Foods.
JD: Right.
Robyn: And green juices.
JD: Right, right. Go eat a bagel.
Robyn: Exactly.
JD: Yeah. I want to move on for a moment. At Montare, we actually have a really neat diagnostic model when it comes to some of the other behavioral health issues and chemical dependency, which identifies various root causes for the behavioral health issues. So, for example, there are circumstantial causes, such as somebody who loses their job, gets a divorce, or was robbed at gunpoint or some other traumatic episode, and begins to misuse substances as a coping mechanism. And then, on the other side of the equation, you can have underlying untreated mental health issues, which cause chemical imbalances in the brain, leading people to try mind-altering substances in order to self-medicate and to find relief to numb the pain.
And then there are hereditary factors which cause genetic predisposed susceptibilities. For instance, some studies have indicated that children and grandchildren of Holocaust survivors are more vulnerable to anorexia. In your experience, do you find that one of these causes is more prevalent than another in the eating disorder populations that you serve? And is the treatment different, is the intervention different depending on the specific pathway that led them to develop the eating disorder?
Robyn: Well, like we use the example with like Holocaust survivors, or I think about clients that have grown up around food scarcity, like the research shows, for example, if a person grows up around food scarcity, they're more likely to struggle with binge eating disorder. I feel like it's interesting that I don't want to say all, but the majority of people seem to have grown up in that element have that challenge, or where someone's a Holocaust survivor. Some, yes. Some, no. I don't like to generalize. I think it is each case by case... but when there's a trauma, it’s like maybe they're needing to see someone for EMDR, or trauma zooms, or some other modality. Or they are getting DBT. I mean, I think this is important, where it's not a one size fits all, and they're able to have other treatments and other modalities blended into their treatment plan.
JD: Interesting. So, there's almost like a dual diagnosis of sorts, where there's the symptoms of what they're actually struggling with, but ultimately, the other side of the equation can vastly differ based on the individual client that you're seeing.
Robyn: Yeah. I mean, that's the same thing in different eating disorder treatment programs. I can tell you, it's not this cookie-cutter approach. I mean, some of them are, unfortunately. Others, it really needs to be individualized per the client. And the thing is too, even if they're incorporating these other modalities, if they're not getting adequate fuel in their body, a starved mind is a starved of body.
JD: Right.
Robyn: And a person is not able to conceptually think straight, be able to track a thought, to be able to be even temperament. There's many factors. So, allowing food to be thy medicine is critical. There's no shortcut around it.
JD: Right, right. This is all so fascinating, Robyn. I would love to wrap up by talking about your book, ‘The Eating Disorder Trap’. And maybe you can share with us briefly, what makes this different or unique in the eating disorder field? And how can people find the book and you in general?
Robyn: Thank you. So, I had decided, if I was ever going to write a book, I wanted to write a book that was different from all the other amazing eating disorder books in the field. I feel like I've supported all my colleagues for a long, long time. So, what makes my book unique is that it's written for everybody. So, you could be a layman. You can be an eating disorder clinician. You could be a mental health care provider. It was really written for health care providers, doctors, and the lack of training. And unfortunately, there's many providers that like someone might come to you, JD, for anxiety or depression, and then you learn secondarily, they have an eating disorder, which was not the original reason they came to you. So, I wanted a book that was a very tangible, easy-to-digest (no pun intended) way that it was comprehensive, that it would be giving a person an introduction. So, how they could support someone, signs that are not so obvious, the role of the dietitian. Like, I have a number of colleagues that have incorporated various screening questions into their sessions as a byproduct of my book.
JD: Wow.
Robyn: Really understanding the medical complications and how there is not one body part spared when you struggle with an eating disorder and being able to understand the eating disorder voice and the team and really what it is composed of. I had a colleague who's transgender who went through the entire manuscript to incorporate appropriate gender affirming pronouns, and that it makes it unique.
But also, the I grew up with my brother, who was very obsessed with comic books and everything in the comic arena. And I think sometimes like I'm a visual learner, sometimes seeing like an illustration could help you understand what the point is. So, each chapter is very serious. But I hired an illustrator to have pictures that are non-gender affirming, non-stigmatizing, that could be like a cute little illustration, then I could dive into what the actual topic would be. So, I've not seen any books that have gone that angle as well.
JD: That is so incredibly awesome.
Robyn: My book, ‘The Eating Disorder Trap’, is available on Amazon. You can go onto the book’s website, theeatingdisordertrap.com, and all the sources are there, as well as my podcast, The Eating Disorder Trap podcast. And I'm able to be found, my Instagram is Robyn with a ‘y’ Goldberg RDN.
JD: I love it. And we can't get enough of the definitive sort of accessible knowledge and awareness and education on something like this. Thank you so much, Robyn, for the great work that you do, and for sharing your knowledge with us at the Discover U podcast. We truly appreciate it. And thank you to all the listeners and viewers for joining us today. I hope you enjoyed today's episode at Discover U.
At Montare, we want you to know that you're not alone on your journey. And to find out more about our innovative treatment programs, you can look us up at montarebehavioralhealth.com, and you can listen to the Discover U podcast on iTunes, Spotify, or wherever you get your podcasts. Wishing all of you vibrant health, and a safe and serene day. See you soon.