Debunking Eating Disorder Myths with Experts from The Emily Program

In this episode Dr. Claney speaks with three therapists from the Emily Program, a national eating disorder treatment organization. They discuss and debunk myths about eating disorders, including myths like “you can tell if somebody has an eating disorder by looking at them,” and “eating disorders are a choice.” The episode delves into the complexities of eating disorders, highlighting the role of genetic, psychological, and environmental influences. They also explore the damaging effects of societal diet culture and the misbelief that specific foods can be addictive, advocating for a broader understanding of size diversity and healthy eating habits.

Resources:

Eating Disorder Books: https://emilyprogram.com/resources/books/

Eating Disorder Vlog from The Emily Program: https://emilyprogram.com/resources/videos/

Peace Meal Podcast: https://emilyprogram.com/peace-meal-podcast/

Resources for Families: https://emilyprogram.com/for-families/resources-for-families/

Community Support Groups: https://emilyprogram.com/for-families/support-for-families/

Get Help for a Loved One: https://emilyprogram.com/treatment-services/get-help-now/get-help-for-yourself-or-a-loved-one/

Refer a Client as a provider: https://emilyprogram.com/for-professionals/refer-a-patient/

© Relational Psych 2023

W: www.relationalpsych.group
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Transcript

Carly Claney: [00:00:00] If you want to learn about psychological growth without getting lost in complicated language, you're in the right place. This is the Relational Psych Podcast. I'm your host, Dr. Carly Clayney, licensed psychologist and the founder and CEO of Relational Psych. On this show, we learn about the processes and theories behind personal growth.

Please keep in mind that this podcast isn't a substitute for therapeutic advice, but we're here to point you in the right direction.

Today I will be speaking with three directors from the EMILY program on debunking common myths about eating disorders. The EMILY program is a national eating disorder treatment program specializing in the treatments of all types of eating disorders offered in person and virtually in the states of Washington, Pennsylvania, Ohio, Minnesota, [00:01:00] Georgia, and North Carolina.

Thank you. At the EMILY program, they combine evidence based treatment with personalized integrative interventions to provide the continuum of care from inpatient to outpatient for adolescents and adults of all genders. As we get started, will each of you please share your name, degree, and your roles at the EMILY program?

Kristen Myers: Yeah. Hi. I guess I'll go first. Kristen Meyers. She, they, 

I have a doctorate in public health and a doctorate in clinical psychology. And my role at the Emily program is a director for the Seattle outpatient site. I've been here at this site for 13 years.

Stacy Shilter-Pisano: Kristen, you're so fancy. I didn't know you were a double doctorate. I'm Stacey Shilter Paisano. I'm a licensed marriage and family therapist, as well as a certified eating disorder specialist. I am the director of the Emily Program's South Sound location in Olympia, Washington, and I'm [00:02:00] also the National Director of the Emily Program's CARE, IOP, and PHP, which is a virtual treatment for folks with a pattern of binge eating, and it's available in Washington, Minnesota, and Ohio.

Dee Myers: Hi, I'm Dee Meyers. I'm the director of the Spokane Outpatient Site. I have been here since our site opened 11 years ago. We just had our 11th anniversary. And I also have 15 years of experience prior to that in our community. So I've been treating eating disorders for over 25 years. 

Carly Claney: Wow. Thank you. I think I'm sitting in a virtual room with so much experience and wisdom on these.

So I'm just excited to jump right into what the myths are that we commonly hear about eating disorders and then how we can think differently about them. As we go, I'm also thinking there's going to be probably some terminology that I might ask you to define already, like different types of treatment, like PHP and IOP residential, those kinds of [00:03:00] things.

But you're welcome to explain things yourself if you're, feeling like you're using a word that we might not know of in outside of the community. So we've got a list of these myths here. I think I'll just jump right into them and then we'll hear from each of you on the thoughts around them.

The first myth is you can tell if somebody has an eating disorder by looking at them. 

Stacy Shilter-Pisano: I will take that one if it's all right. And what I will say is, I think there's a stereotype related to what people with eating disorders look like, and I know assumptions get made about a person's relationship with food based on their appearance.

But what we know to be true is that people are genetically gifted in a variety of different body sizes from very small to very large size. Diversity is something that exists in humans, just as it exists in nature, dogs, trees, birds. Flowers [00:04:00] people assume folks with eating disorders oftentimes are underweight and ironically affluent.

But what we know is actually less than 6 percent of people with an eating disorder are underweighted or lower weighted. And eating disorders are experienced by people of all socioeconomic statuses, all ethnicities, all races, all genders, all ages, and all forms of ability. So we're not able to draw any conclusions about a person based on what their body habitus is, their lived experience has been, or their overall presentation.

Kristen or Dee, would you add to that? 

Kristen Myers: Yeah, I think I just would add I like what you included about that there's a stereotype. And I really think people do, look at someone and think they can tell what their relationship is with food. And I think that's widely promoted. I think that concept, unfortunately, is really widely promoted.

[00:05:00] In society that if you eat this way, you will look this way. If you eat this way, you will look this way. And so people buy into that. That's what we're all being told. And so people buy into that. And they think that same thing is true about eating disorders. That if a person looks this way, I can assume they eat this way and I just think that's really unfortunate and painful and just actually not true.

People can be eating exactly the same way as each other and have very different bodies, shapes and sizes as they would because like you said, Stacey, people's bodies are just different from each other. 

Dee Myers: One of the things I've heard said is the only thing you can tell by looking at a person is the degree of your own weight bias, which I appreciated because it is that truth that, if we're making assumptions, those assumptions are rooted in stigma and bias, and it isn't helpful to perpetuate that. 

Kristen Myers: Yeah, [00:06:00] I feel like it's one of these things that's actually sad because, people don't try to change their behavior to change their height because it's like impossible.

I'm saying, nothing's impossible. People have surgeries and things like that. So I understand, existentially impossible. But there is this really big idea that you can change the way your body looks by changing how much you eat or what you eat. And the thing is You can make an impact on your body.

And so then it gets broadened out to this idea that you can and should make your body look a certain way. And the thing is like, depending on what you're doing, depending on, whatever, your body might change a little bit. Your body's going to change as you age. But that's actually a really different thing then, like making your body look a certain way, or even the capacity to make your body look a certain way without really doing tons of damage. That's the thing is you might actually be able to change your body, [00:07:00] but you're really damaging it in the process. 

Stacey Shilter-Pisano: And I think it can be really helpful to, if you're feeling, and it's hard not to in American culture, if you're feeling that you should change your body shape or size, I think being able to question that and explore why you experienced that pressure, because I think there is like this vilification of certain body sizes and glorification of other body sizes, and all of that is rooted in diet culture and some really unhelpful patterns that have been established in our nation. So I think being able to question that should and move toward embracing size diversity overall and. 

D, do you have thoughts in here too? 

Dee Myers: Just a couple things that I would add that were implied, but just to state specifically, is that, you said only 6 percent of people are low weighted, and there is a huge stereotype that individuals in larger bodies have eating [00:08:00] disorders, and that is absolutely not true for so many people.

So you can't tell either way. There's a lot of people who are normal weighted or lower weighted, who have a lot of health issues that you cannot see and there's a lot of individuals in larger bodies who internally are really healthy. Their hearts are really strong. And the visual piece really doesn't mean anything.

And Kristen, you said something about we could all eat the same way and our bodies would look differently. And I just wanted to add, I saw something on social media about if all four of us ate the same way and did the exact same workouts every day, our bodies would still look different.

So you can even add that activity exercise component in there. And there are so many factors that play into what our bodies look like. So whether you eat and exercise the same way would not make us all the same. 

Carly Claney: It's so interesting hearing it said so concretely like that, it makes so [00:09:00] much sense and I can just feel how disconnected that can be then when the stereotype comes up, like when you maybe have that judgment towards yourself or someone else, or you hear something else that's disconnected from it.

And it's just hard to hold those two things at once. 

Dee Myers: And the message that Kristen was highlighting is that we need to try harder. So if you're eating and exercising a certain way and your body is not doing what you want it to try harder.

Kristen Myers: And that's I feel like rolls right into, how do people end up with eating disorders? Because that's one route straight to an eating disorder is, everyone says this is supposed to work, but it's not working quote unquote. And so I must be doing it wrong. I must need to try harder.

I must need to eat less or eat cut out more things or exercise more, exercise different or, whatever, or if it's not working for me, is there something wrong with me? You can just see [00:10:00] how the impact of actually just coming up against just the real reality that our bodies are just all different and they all are at their homeostasis in a different spot from each other .Coming up against that reality while we have the messages we have from society telling us we should be changing ourselves, leaves us really in this bind where, you know, It starts to feel like the only way to make sense of it is that there must be something wrong with me and I must need to keep trying harder or my body's broken and I have to do these things to it to make it like everybody else's or to make it quote unquote healthy or... so it's a real, it's a real trap.

It's pretty scary actually. 

Carly Claney: Is there any room for that wanting to change your body or doing something intentional to lose weight or change the way it looks or feels?

Big question. 

Stacey Shilter-Pisano: I think it's a great question. And I think, [00:11:00] in our culture, I think the statistic and this was a statistic back in. Oh, gosh, 96. so I'm sure it's even more now, but it was, like, 80 percent of 10 year olds are afraid of being fat and, something higher than 85 percent of people have been on a diet at any given point in their lived experience.

And so I think there are a lot of individuals out there trying to shape and alter their body size. And I think it's important for folks to understand that from our perspective as eating disorder professionals, they're playing with fire a bit. What we know is that one in four people who diet will go on to develop a quote unquote pathological relationship with food or a clinical eating disorder.

And that can be really problematic because as somebody is engaging in that intentional weight loss pattern, what can happen is, their mind or their brain can get hijacked by that disordered eating behavior pattern, [00:12:00] by the rigidity of the rules that they're striving to follow.

And, can put them on a slippery slope that moves them into that clinical eating disorder range. That's not to say everybody who diets will develop an eating disorder. Because what we know is that there are certain individuals that are genetically predisposed to being vulnerable or to developing an eating disorder.

And, again, I think there's just that playing with fire element. And what we also know is that 95 to 98 diets or intentional weight loss efforts fail. And like Kristen was saying, the person blames themself, it's my fault. But the reality is We're battling biology when we're trying to change our body shape and size or trying to alter our weight.

And in the same way that I can't change the size of my foot, changing where my body genetically gravitates is not likely something I'll succeed at. 

Kristen Myers: Yeah. And that's, I think that's one of the important things to [00:13:00] remember that people, experience the temporary change in their body and then they can get really excited about Oh, I did it, now I just need to maintain it or whatever. And Stacey, when you speak to that, 95 to 98 percent of those efforts are unsuccessful. That's not just that people couldn't lose weight. That's that many of those people in that study actually lost lots of weight and then gained back more than they lost within five years, so because it's not sustainable because it's, there's so much behind the genetic place that I love the way you said that Stacey that your body gravitates toward as it's homeostasis.

Carly Claney: I wonder if we could define a little bit of what an eating disorder is. We don't need to get too detailed about all of the criteria, but if someone's listening to this so far and thinking, okay when is that threshold or what are we talking about with disordered eating or pathological ways of relationship with food, [00:14:00] can someone define that for us?

Dee Myers: I can start and you two can pipe in. What I usually say is the question when is it an eating disorder and we look at a spectrum of someone's relationship with food in their body and people may be engaging in what we would call disordered eating and not necessarily have an eating disorder.

So there's a lot of individuals out there who try juice cleanses or they're into bodybuilding and so they start eating large amounts of protein and restricting some other foods that they're eating. And for that time period, it's disordered eating, but not necessarily to the length of time and degree that we would call it an eating disorder.

But the longer that someone engages in those things, then we start to look at what is the, Functional impairment in someone's life. And that's usually what ends up bringing somebody to treatment [00:15:00] is a pattern of behavior, a preoccupation with we, we ask all of our clients, what percent of your day do you think about food, eating weight shape?

Most of them say 75%. 80%, 90%. So they're thinking all day long about what they did eat, didn't eat, can't eat, won't eat wish they could eat, did eat, how they're going to get rid of what they eat. Like those are the thoughts that are going on. So there's that preoccupation. And then there's impairment. 

So we look at, is this impacting their social life? Individuals who are really ingrained in their eating disorders have a harder time engaging in social activities because our society revolves a lot of our social activities around food. So they may start to turn down invitations for social events because they don't want to have to deal with the food aspect of that. 

Work and school performance. So a lot of our clients are really good [00:16:00] students, straight A students do all of their homework, do the things and they do really well until they don't. And then their performance starts to decline and sometimes pretty rapidly because they can't keep up with all of that. I've had clients lose their jobs because their eating disorder got so bad.

And then we look at cognitive impairment. So with eating disorders, often comes difficulty concentrating and focusing, which if you think about all of those thoughts that I was just talking about circling in your head, hard to think about other things. We also have clients that talk about memory difficulties and just being foggy brained because they're not feeding their bodies and their brain sufficiently.

And then lastly, we look at physical impairment. A lot of clients can be very in their eating disorder and not show physical impairment for a long time. But often the chest pain, the heart palpitations things like that may bring somebody to an emergency room and that might be where their eating disorder gets identified or they passed out [00:17:00] at school or not eating. And so when that picture starts to... when you can list out the different types of impairment in someone's life, that's when it becomes a clinical eating disorder. 

Kristen Myers: Yeah, I really like how you summarize that Dee and one of the themes that was just coming to the top of my mind as you were talking is flexibility. And I think that's something like if a person is wondering for themselves are wondering for a loved one or, someone they care about can this person be flexible when it makes sense to be flexible.

Can they skip a day at the gym? Can they skip a few days at the gym? Can they, eat the thing they're not really eating that much of when that's what's available. Or when, that's what everyone's going out for this kind of food, are they bringing their own food? 

And can they just be flexible when, not if they have an actual allergy or something, but like things like that.

Are they able to navigate with flexibility or are they getting captured by it a bit, and [00:18:00] stuck in it preoccupied or rigidly. Some of it too is like, how scary is it for the person to not do the thing? If you're checking in with yourself or if you're wondering if people you love might be struggling, that's a place that I think about.

Carly Claney: It's a really helpful description, all of that. And what's so interesting is none of what you said, going back to the myth has to do with what people look like, you didn't say a range of weight, or this is how much percentage of fat you have, or whatever it is, it's so disconnected. It's so much more internal and that psychological interaction with food and body and then the impairment in your life.

Should we move to the next one? I think it's related. Another myth is that eating disorders are a choice.

Stacey Shilter-Pisano: So I addressed this just a second ago, just talking about like that biological or genetic vulnerability or susceptibility. So what we know about eating disorders it is 100 percent not a [00:19:00] choice. They are complex brain based biological conditions that. are influenced by psychology and our environment.

And so when we look at the biological basis, we know the genetics. So there's, I think, around a 70 percent heritability aspect to eating disorders. We also know there's neurobiology. So looking at the brain structure and function of individuals that struggle with disordered eating or clinical eating Disorders their brain structure and function is different than individuals that do not. The hormones are an element that different folks deal with that might make them more susceptible or wind up having them dealing with something. And then we also talk about temperament. Dee just mentioned a few minutes ago about an exacting nature or really good students. Sometimes we see, in the temperaments of individuals that have an eating disorder, there is that tendency toward a heightened [00:20:00] reward sensitivity or an avoidance of harm. Harm avoidance tendency. 

So we also look at those aspects and then we've got these psychological and environmental factors that can contribute. So psychologically speaking I think it's upwards of 75 percent of folks with eating disorders have co occurring mental health conditions that have been diagnosed.

So that might be anxiety disorders, depressive disorders ADHD, PTSD any number of different conditions that may also be happening for an individual. And then environmentally, we've got other pressures that we're dealing with. And that could range in experiences from, an invalidating developmental environment to, just the diet culture in which we live, it's the water in which we swim.

We've been getting messages about food and body since we were pre verbal, and it's hard not to internalize those things. And when we have this perfect storm of different [00:21:00] elements that come together for somebody who is genetically susceptible an eating disorder can develop. And I use the term earlier that it can hijack one's mind or brain, and that literally can be where it doesn't feel to the individual like they have choice anymore because this eating disorders controlling their actions and their choices and next steps.

Dee, Kristen, what would you add? 

Dee Myers: I have something just anecdotal to add that I can't tell you how many times on an airplane if I tell somebody or in a social situation, somebody that I meet that I treat eating disorders and they say, Oh, I wish I could get anorexia for just a little while. Which is a terrible thing to say.

And also you can't choose to get an eating disorder. It's not a choice. 

Stacey Shilter-Pisano: And likewise, just chiming in too, you can't cause one. So we do have parents that also feel, or caregivers in general, or maybe even friends that feel like maybe they activated an eating disorder with a comment or, with modeling [00:22:00] certain behaviors or whatever it is.

And in the same way that you can't choose to have an eating disorder, you also can't cause an eating disorder. And I think that's important for loved ones to know. 

Kristen Myers: Yeah, I would just add I'm a gestalt therapist and in the frame that I look at things, it's really important for me, the value around any of the things that we end up doing for coping or the ways that we orient around making meaning of our life, or trying to support ourselves and navigating the pains or the wounds that we're going through... all of those things when we come to them are our best choice of our available resources in that moment. And so there's really a strong respect for this was what made the most sense at that moment. And, the patterns of whatever psychological coping was happening in the moment when it was getting started, [00:23:00] those patterns have probably been happening long before anything happened with food.

And so the expression with food or relationship specifically to exercise or body judgments or things like that. So, one of my favorite. sayings is it's never about the food and it's always about the food. And but it never began about food. It's always about relationship with self relationship with the environment.

And however, we came by it, we came by it honestly. Essentially, and that was the best choice of the resources we had at that moment. And yeah, there's just a real respect for that. And then that's the, I don't know, the more emotional side of what you were just saying, Stacey. 

And then similarly, I'm not sure quite how to put words to this, but about causing eating disorders like you said, like no one can cause an eating disorder for someone else. And also sometimes we can be doing things that are really activating or amplifying or feeding in, [00:24:00] or colluding with or contributing in some way.

And so it's really important to be sensitive around that and to really care about how we're impacting each other, not that we caused it, but that we also want to be caring around what support this person needs to not develop an eating disorder or to recover or be in the process of recovering from eating disorder.

Yeah, to just hold that dialectic of it's not a thing that's caused by a factor or several factors it's really complex and we want to care about it and be sensitive to it and be really respectful of the process. 

Dee Myers: Great points, Kristen. 

Carly Claney: That makes me think of some of what was said already about diet culture and the environment, culturally or societally that sets the frame to encourage a lot of the things. And I think it goes along with what you said. It's not like society is causing eating disorders, but it's ripe for it. It's an encouragement or a yeah, an environment that could make it easy to [00:25:00] lean into that. 

Kristen Myers: I would even say it's promoting eating disorders.

Stacey Shilter-Pisano: I would agree.

Carly Claney: Moving on to number three, a teenager will outgrow their eating disorder. It's just a phase. 

Dee Myers: I'll speak on this one a little bit. We do know that Adolescence is a common time for development of an eating disorder. There are lots of reasons for that. It is the most common time to develop an eating disorder, and Stacey talked about a lot of the different contributing factors that come together, and we know that adolescence is a time of physical growth, emotional growth, hormonal developing identity, developing autonomy. And With the relationship with one's self and environment that Kristen was just talking about, the eating disorder often develops as a way to cope with all of those things that are happening, and when it's not about the food, but it's all about the food, it just fits perfectly into this because an adolescent can become, very focused [00:26:00] on food and weight.

And those become an issue that we do have to deal with in treatment, but there are so many things underneath there. So for the majority of teenagers who, you know, if someone, a lot of teenagers may diet, may try different things that we would say is disordered eating. But when it is heading down the path and it's moving along that spectrum toward an eating disorder, it is not something to wait and see if they're going to outgrow it.

It's not a stop and pass go kind of thing. And we know that the sooner that we can intervene with treatment in adolescence, then the sooner we can get it turned around. The longer somebody has an eating disorder, the harder it is for them to get into full recovery and sustain recovery.

Stacey Shilter-Pisano: Think piggybacking on that, it is also important not to [00:27:00] take symptoms lightly. I think that's something that we sometimes see caregivers doing or even professionals in the field, thinking, oh, they're just dabbling in that behavior or, oh, that's just something that's arising right now. But, it'll go away on its own. 

I think it's important to take seriously any of the quote unquote symptoms that we might see. So that might be, really restricting one's intake or eliminating food groups or eliminating particular foods, counting calories. Engaging in any form of undoing behavior compulsively, engaging in excessive eating or somebody saying that they feel out of control while eating, or somebody compulsively moving their bodies.

Dee talked about, or maybe it was Kristen, needing to see folks having the ability to take a day off of movement if movement is part of what they do. And, for individuals. That maybe you're getting more [00:28:00] compulsive about movement or really rigid about how often they need to be moving their body or exercising the degree to which they do the exercise.

I think being able to take those things really seriously, because it can be a slippery slope that can quietly get worse. And we want to intervene like he said, as soon as possible. Kristen, I think I interrupted something you were going to say. So go ahead. 

Kristen Myers: No, yeah, I was just going to jump in and say some of what you were saying Dee sort of speaks to, something I was saying earlier to about whatever is happening it's not beginning right now with what we see with food or relationship to body .By the time it gets to a point where someone's been dealing with something psychologically or emotionally for long enough that now they're expressing it concretely with food or exercise or relationship to body. It's already been going on. Whatever, psychologically, whatever pain or struggle that person has [00:29:00] been trying to navigate or cope with has already been happening.

And by the time we see those symptoms, it's really important to note it's if you watch someone get to a point where they were starting to try to restrict the amount of air they needed to breathe, you'd all be pretty alarmed. But that's the part that like society contributes to this real, not just normalization, but reinforcement of depriving ourselves of our most basic biological needs.

And so when it gets to that point for someone, it's really important to take it seriously. And then I was just going to say, use the phrase undoing, Stacey, and I thought, do you want to expand on what you mean by that? 

Stacey Shilter-Pisano: Sure. So in the DSM five, which is our diagnostic statistic manual for eating disorders, it talks about compensatory behaviors, which I think the easier to understand word is undoing behavior.

So essentially any behavior [00:30:00] that a person engages in to Undo or make up for food that's been consumed. So we may also refer to that as purging which can be via making oneself sick. It can be via exercise. It can be via fasting, so it's really just anything that a person does to make up for or undo food consumed.

Kristen Myers: Yeah I highlighted that because, I feel like I hear that every day, like walking around on the sidewalk, talk about, Oh, I, I ate this for lunch, so I have to go burn it off or, or I have to earn my dinner, all of these things are this sort of exchange, transaction as if I have to do things to get rid of food. I've eaten. So I just wanted to highlight 

Stacey Shilter-Pisano: and it's so perpetuated by our culture. I think about on social media around Halloween, right? I would imagine anybody listening and all of you on this call screen [00:31:00] can remember at around Halloween time, the things that get posted about okay, if you can have this Snickers bar, here's how much movement you have to do.

Or if you have this, lollipop, here's how much movement you have to do. And the reality is, food is fuel and our bodies know what to do with it. And we don't, need to earn it. We don't need to work it off, it, it's going to fuel our bodies and our brains and, all of the different processes that our bodies do.

And so it's quite maddening. But I think, the only point I was striving to make was that our culture definitely perpetuates it. I'll stay off the soapbox. 

Dee Myers: I was going to say, I wanted to add, we could do a whole other podcast on the eating disorder ARFID, but when we're talking about teenagers and just a phase, I just wanted to state there is an eating disorder called ARFID, avoidant Restrictive Feeding Intake Disorder. And this is a little different than the other more commonly known eating disorders, [00:32:00] but it's common in childhood and Adolescents as well as adults, but it has to do with selective eating, not eating enough based on, numerous factors such as, say, sensory and textural issues, or maybe a trauma that happened with food, say, a child choked on some food, and then they become fearful of eating it, or maybe there is just a biological disinterest in food. So there's numerous reasons, but this is something that is often looked at as, Oh, my child is a really picky eater. And sometimes kids do outgrow being a picky eater. But if they have ARFID, it is a clinical eating disorder. It's not something that is just going to go away.

And there are whole treatment protocols for that type of eating disorder. And I think it's important for parents to know that their child might have a clinical eating disorder if that's [00:33:00] the case. And that's not something that they will outgrow. 

Carly Claney: That seems tricky to balance with wanting to be affirming or supportive of differences or of preferences for your child.

And do you have any thoughts about that, of that balance? 

Kristen Myers: Yeah, I can jump in. Just one of the thoughts I have about it is, if someone only eats, 10 different foods and they're getting all their nutritional needs met, like, All right. But a lot of times it gets to the point where they're actually not getting all their nutritional needs met.

One of the concepts that I talk with the team about a lot is like, can this person invest in expanding their experience? Are they like, no, I'm never even going to try new things. I'm never going to expand anything. This is it. And this is it permanently. And that's it for good. And what we're supporting is not like that you have to eat XYZ instead of ABC. But what I'm looking at is can this person invest in expanding? Their experience and [00:34:00] expanding what they can access and what they can enjoy and their sort of relationship with food Rather than well, we want them to expand it to the point where they're getting their nutritional needs met number one goal And then beyond that can they just expand it for enjoyment? To be able to enjoy more things, to be able to access and engage in more things, engage in more things socially, have a bigger life, if you will. 

Kristen Myers: And so it's really more for me thinking about, are they in that process? Are they in the process of shrinking or making their life or their engagement small or protecting that smallness? Or are they in the process of expanding? And that, and then it's not about you have to be able to eat this food versus that, it's not so much about that because then that's just being rigid on the other side, but just helping people be engaged in that expansion and expansive relationship to their life.

Stacey Shilter-Pisano: I think all of that was [00:35:00] really great. I think what's also tricky as the parent of a 12 year old, and I observe, what he eats and what his friends eat and the limitations on that. Because I think nowadays youth may be very selective with their eating.

And when, ARFID becomes a problem that we're really wanting to intervene on- again, we want to Intervene and increase variety if is limited, but if a kiddo is not achieving their growth potential. So if their growth has been undermined by the eating patterns, if there is malnourishment of any kind, so they're not achieving their dietary needs, or in adults if weight suppression, is occurring and their, Body is falling below where it naturally gravitates, then we really are, seeing some medical concerns and the need to intervene a little bit [00:36:00] more intentionally.

I think I know people that have very selective eating patterns and their health is okay, and they have no interest in expanding their dietary intake. And while it might be concerning, and I think they could have, More freedom and a bigger experience, they're all right, but we definitely get concerned when, somebody isn't able to achieve their dietary needs or their growth has been stunted or interfered with.

Carly Claney: I like the focus of that being on health. What is your body actually needing? And what are these like internal ways that we can actually measure health? And then how can your life expand? And are you really moving towards greater enjoyment, fulfillment, embodiment? That just feels really rich. 

Stacey Shilter-Pisano: I love that.

And on that topic of health, I have to insert. I think our culture, again, diet culture has us believing that lower weighted [00:37:00] is healthy, quote unquote. And what we know to be true is each body that individuals have is Healthy at its own genetically gifted weight, right? And each body has its own needs to achieve overall health.

And so I think it's ironic when people are... I have clients that are dealing with a restrictive eating disorder and they're critically underweight, which by nature is not healthy. And they talk about their goals for health without thinking about how much it's affecting their heart to not be, achieving their dietary needs or how much it's affecting, their bones or how much it's affecting their reproductive organs, so I think our culture would have us believing that, Kristen's words, getting smaller is healthy. And the reality is, feeding our bodies adequately, moving well, eating well, sleeping well, all of these things are ways to achieve overall health. Not some of the nonsense that our culture would have us [00:38:00] believing. 

Carly Claney: jump to, that... so the myth would be if I'm prone to overeat a food, I should limit my access to that food to prevent myself from overeating it. 

Kristen Myers: Yeah, this gets me into something that I can get really passionate about that people have this idea that if I experience feeling a sense of out of control, or I can't really stop when I want to, or, at the point of satiation I just keep eating this food and I don't want to be eating this much of this food, that a lot of times, and this is socially promoted as well that I should actually just cut that food out of my life.

And unfortunately, a massive contributor to the experience that we can't reach a point of satiation or respect that point of satiation, and that we're compelled to continue eating a food beyond satiation and sometimes into like pretty notable discomfort... A huge contributor to that experience is the psychological experience of deprivation in some [00:39:00] way or another. So if deprivation is a main contributor to having the experience of pushing past fullness and eating to significant emotional or physical discomfort, the solution isn't more deprivation. So it might be that actually like you're not getting your social needs met or it might be that there's some part of you that just wants to run free or I don't know.

It could be anything. Everyone is so different. Like every person is different. Every person is unique. It'll be something different for everyone. There's no, if this then this about any person's psychology, including eating disorders. But there's something inside that's driving that compulsion to keep eating beyond the point where your other body systems are telling you like, we're good. So that's what needs to be attended to. What's actually the driver there. What's not being met elsewhere. If I just take away the food from myself, [00:40:00] then I'm just also depriving myself of that food.

So now I'm creating two or more places of deprivation in my whole person system, rather than actually addressing Oh, gosh, some part of me is compelled to move through with this, and I don't really want this physically. So what's happening for me? What am I needing emotionally?

Dee Myers: I would say that diet culture plays into this so much with villainizing different food groups. Carbs are very villainized in our society right now. Our clients come in, the majority of them are pretty fearful of carbs.

And so I just wanted to add that diet culture perpetuates this myth. 

Kristen Myers: And that makes me want to add to that. If you go back in the decades Almost any of the macro food groups have been villainized, protein in form of meat has been villainized. Fats have been villainized and now carbs [00:41:00] are being villainized.

And so it's just a rotating, It's always one thing or another. 

Carly Claney: Great point. And it distracts from what you're talking about, Kristen, that there's other things, other needs that are not getting met when we're just focusing so much on the food.

Kristen Myers: 100%. 

Stacey Shilter-Pisano: And I think it's important to consider. I came across a term right before this and I was looking up... because I knew there had to be a phrase or a word for the phenomenon of wanting what you can't have. And apparently it's called psychological reactance.

Somebody came up with it back in 1966. And it is very much that. As soon as we're told, we can't have something, there is a part of us that wants that something. And so when it comes to. If we are saying, I can't have that, we naturally do desire for it more. And we do have observed it in various creatures, humans, mice, and that when an [00:42:00] individual is denied access to something and then given access to it, there tends to be a, that tendency to overdo it when the access is granted. And so I think that idea of if I overdo something, I should just avoid that something.

It's actually, no, we should, face that something more frequently. We should have to chew it, that we should legalize it and make that part of our, day to day so that it's not so shiny, it doesn't have so much power, right?

Like I think when we're trying to avoid it entirely, we're giving that food item a power that. that it doesn't necessarily deserve as opposed to, being able to have that unconditional permission to have all foods, and to be mindful of our experience of those foods. And if we are feeling compelled to eat beyond fullness or to eat more, I think that's something to be curious about and to strive to learn something more.

Kristen Myers: I'm so glad you mentioned that because. That's the thing. [00:43:00] It's what we have been deprived of we will tend to overvalue. And so actually doing that is, is enhancing that pull, that power. 

And that people are really scared when we're like, yeah, so you feel like you have that experience with donuts. So let's have donuts around all the time and eat donuts every day for three years. And there's just, so many like tearful and just joyous moments, the day when the person comes in and they say, I didn't crave a donut today, I feel free. Like those moments, but sometimes it takes weeks, months, years, depending on how long your system's been in a sense of deprivation and I call it like rules and rebellion as soon as you set a rule, You're going to have the urge to rebel.

Stacey Shilter-Pisano: And I think just because we're here and it's easy to just shift a tiny bit, I think, to a degree that has us touching on one of the other messages. that we had talked about, which is that food is [00:44:00] addictive or that people can become quote unquote addicted to different foods, or we hear it with sugar and we hear it with ultra processed foods or ultra highly processed foods.

I actually just read an article about, it was an opinions piece on adding ultra highly processed food addiction to the DSM six and, part of the research and data that backs up the argument that food addiction is not something that we should give merit to is this idea that when we are deprived of something, we can behave in an addictive way or a behavior can appear addictive. But oftentimes it has very much to do with the fact that we have been deprived of this something or we're depriving ourself of something. And as soon as we have a bite of that very thing, we have this internal sense of I've done it now. I may as well eat all of it because I'm certainly not going to allow myself to have any more [00:45:00] of this tomorrow.

And so it can appear very behaviorally addictive, but if you actually move toward permission and legalization of whatever that thing is, folks can move into a place of normalization, which doesn't happen with the substances that people can become dependent on, such as alcohol and opiates and whatnot.

The more legalized it is, the more tolerance they develop and the more they then need, but the same thing doesn't happen with donuts or bagels or chips, so I think that's relevant to be aware of. 

Kristen Myers: I just want to underline that what you just said, Stacey, that foods do not have the same physiological addiction process as addictive substances. Foods do not activate the physiological addiction process the way that addictive substances do. I think that's just really important to just spell it out for people because people really think that sugar activates the same addiction process in your brain and it's just not true.

Stacey Shilter-Pisano: [00:46:00] And while sugar is pleasurable and it can activate the reward center of our brain, so do puppies. And I've never heard somebody say that you can be addicted to puppies. Hugging can do it and all kinds of pleasurable things. Yeah. 

Kristen Myers: Babies, hugging, friendship, all the things activate the reward center.

That's not addiction. 

Carly Claney: Yeah, the language feels really important. Thank you so much. All of you. I just really appreciate all of the wisdom that was shared and just expanding the way that we're thinking about it for others and ourselves. It just feels like there was just so many gems here.

So thank you. 

Is there any resources that we can share in the show notes or anything that people want to continue their thinking about this? As it's simulated a lot of thoughts. 

Stacey Shilter-Pisano: I think because we said diet culture so many times anti diet, which is written by Christy Harrison. She coined the term diet culture, so I feel like we should probably give her credit for [00:47:00] that.

Kristen Myers: There's a ton of resources on the Emily program website, like recommended readings and all kinds of stuff about eating disorders. And so I think those reading lists and resources for loved ones and all that stuff, I think would be super useful to link to.

And including anti Diet is a great book. 

Carly Claney: I learned a lot and it was delightful. Thank you. 

Relational Psych is a mental health group practice providing depth oriented psychotherapy and psychological testing in person in Seattle and online in Washington State. If you're interested in mental health care for yourself or a family member, please reach out. Our website is relationalpsych. group.