Eating Disorders: Signs, Symptoms, and How to Find Help (Part 1)

"You can have an eating disorder and not be in an underweight body." 

This powerful insight from Dr. Elizabeth Wassenaar, Regional Medical Director at the Eating Recovery Center, challenges everything we think we know about food, weight, and mental health. In this eye-opening episode of RECOVERable, host Terry Maguire sits down with Dr. Wassenaar to dismantle the dangerous myths surrounding eating disorders.

Find mental health and addiction treatment near you: https://recovery.com/

Dr. Wassenaar, a triple board-certified psychiatrist, explains that eating disorders are real, brain-based biological illnesses—not matters of willpower, vanity, or "just a diet gone wrong". We dive deep into why these conditions are curable, the difference between "disordered eating" and clinical diagnoses, and the alarming rise of anorexia and bulimia in younger children.

We also address the "pathological aloneness" that often accompanies mental illness and why community and connection are the strongest antidotes to the isolation of an eating disorder. Whether you are struggling yourself, worried about a friend, or curious about the signs of eating disorders in men and boys, this conversation provides a compassionate roadmap for understanding and seeking help.

Chapters: 00:00 – Intro 00:32 – What is the one thing society should understand? 02:06 – Why are eating disorders considered a mental illness? 06:34 – Is there a typical age when they start? 08:37 – Why are eating disorders starting at younger ages? 12:22 – How should we communicate with each other about bodies? 14:53 – What does disordered eating actually mean? 19:54 – When does it become a medical or mental health crisis? 23:45 – How does tracking calories and macros play a role? 37:34 – What are the signs a friend might have an eating disorder? 50:17 – Do guys get eating disorders, too?

Questions the Video Answers:

1. What is the difference between an eating disorder and disordered eating?
2. Can you have an eating disorder if you aren't skinny?
3. Are eating disorders a choice or a mental illness?
4. What are the early warning signs of an eating disorder in a friend?
5. Why are eating disorders becoming more common in children?
6. How does social media impact body image and eating habits?
7. Is it possible to fully recover and be "cured" from an eating disorder?
8. What should I do if I feel suicidal due to an eating disorder?
9. Do men and boys struggle with eating disorders?
10. How can I talk to someone about their weight without being hurtful?
11. Why do people use eating disorders as a way to regain control?
12. What is the most fatal mental illness?
13. How does "diet culture" reinforce disordered behaviors?
14. What are the free resources available for eating disorder support?
15. Why is connection and relationship important for recovery?

#eatingdisorder #mentalhealth #recovery

Transcript

SPEAKER_02 0:00

You can have an eating disorder and not be in an underweight body.

SPEAKER_03 0:05

Dr. Elizabeth Wassenar is the regional medical director at Eating Recovery Center. A triple board certified psychiatrist, she leads clinical excellence in the treatment of eating disorders, guiding families and teams toward recovery and healing.

SPEAKER_02 0:20

As soon as we comment on someone's body, we are making a statement about the present, the past, and the future. It's saying, I am placing your worth in how I perceive your body.

SPEAKER_03 0:34

Welcome to Recoverable. I'm your host, Terry McGuire. Joining us today to talk about eating disorders is Dr. Elizabeth Wassenar. Thank you for joining us. Thanks for having me. I'm looking really forward to this conversation because while food and body image and all the things are constantly around us all, I actually don't know a lot about this, and I'm looking forward to learning from you. So before we dive into the top internet questions, let me ask you, as a doctor who treats people with eating disorders, is there one thing you wish society understood about both eating disorders and the people who have them?

SPEAKER_02 1:07

There are many things. If I had to narrow it down to just a few. One, I really want people to understand that eating disorders are a real mental illness. They are a brain-based biological illness that has genetic components, environmental components, and social components that maintain the eating disorder. And that it is not a willpower, it is not vanity, it is not just a wish to make oneself look better. Eating disorders devastate lives. But the other side of that, that's so critically important for anyone who has an eating disorder or loves someone with an eating disorder, is eating disorders are curable. They respond well to treatment and accessing treatment can be a challenge, but I want anyone who loves someone with an eating disorder to not give up hope that your loved one can recover.

SPEAKER_03 2:01

Curable is a huge word and it's very different than treatable.

SPEAKER_02 2:05

It is. That is such an important delineation. So I think that when I say curable, I mean that you can survive beyond an eating disorder. Okay. And so it doesn't mean that it is something you don't remember, like a cold that's curable, and then you don't even remember having it. Yeah. Right. Eating disorder will change the course of your life and you will have that as a part of who you are, but you can live a life without having that eating disorder be right there in your side view, always influencing your experience.

SPEAKER_03 2:41

You use the term mental illness or mental health condition. I don't think a lot of people think of an eating disorder as a mental health condition. It's more behavioral in a lot of people's minds. Why is it important to understand it as that?

SPEAKER_02 2:53

That's it's so important to understand that eating disorders are a mental health condition because they do actually originate in the brain. The brain of a person with an eating disorder is different. Uh, there's functional differences, there's morphologic differences, uh, there's differences in the way the brain interacts with itself, just like other mental illnesses. So we know that depression and anxiety and substance abuse change the way your brain interacts with itself. Likewise for eating disorders. So eating disorders are very often what we see is the external behavior. Yeah. We see the way people interact with food or interact with their body. But it's important to recognize that the eating disorder is in the brain and it requires comprehensive treatment. It's not enough to just change behavior. Uh, you also need to address why the eating disorder came into be. You need to address how it continues to influence you, the kinds of thoughts you have, and you need to be vigilant. Um, the thing about an eating disorder is that they are treatable, they are curable, but there is a risk of relapse. And one of the things that can cause a relapse is dieting or weight loss, which is especially pertinent in today's world where we see a lot of prescriptions for weight loss with GLP1 receptor agonists, but we also see a real influence of diet culture and weight loss culture across every kind of social media platform, every kind of platform that we have. So when you have had an eating disorder, you you do have to be careful. Um, there is a risk.

SPEAKER_03 4:34

When you say it's not just a matter of having more willpower or making behavioral changes, I'm trying to put myself in the position of someone who is struggling right now. And I can hear that. And there's part of me that would be so frustrated, I can't do it myself because that's what I'm white knuckling and trying to do. And there'd be a part of me that I hope would be a little comforted by comforted by that.

SPEAKER_02 4:56

Absolutely. And I think that's the dialectic or the both and of it, um, is that it is not just a behavior change. Behavior change is actually a very important part of pursuing recovery. But just changing your behavior without addressing any other part of the eating disorder isn't going to be enough. Because as anyone who knows who's tried to change a behavior that's intrinsic, that's kind of like your brain is wired that way, you can only white knuckle it for so long. And that there's an experience of every day, it's so hard. Yeah. And so I do hope that there's comfort in this that you don't have to do it alone. It's okay if you're not able to do it alone. It's actually one of the things we say in the field that is I I hope people can hear is that relationships replace eating disorders. And so part of the eating disorder may actually be a pathological or dysfunctional belief that you have to do this alone. Nobody wants to do it with you. Nobody cares enough about you to know what's really going on inside your head, or if they do, they would reject you. That's a part of your eating disorder. That is what the eating disorder is telling you is that you have to be alone. So part of seeking recovery is actually seeking out relationship with people that can help you interrupt those kinds of thoughts and support behavior change.

SPEAKER_03 6:31

It's very much reminding me of conversations about addictions and depression, both of which are very isolating. And a not a cure, but a treatment, a positive thing is connection. Absolutely.

SPEAKER_02 6:45

Absolutely. And I think, you know, I do think that this is sort of a core part of a lot of mental illness is pathological aloneness. So there's normal aloneness. We all like our downtime, sure, but pathological aloneness says that nobody wants to be with you because of that mental illness. And the eating disorder absolutely has that as a part of it too.

SPEAKER_03 7:09

Is there an age when eating disorders typically start?

SPEAKER_02 7:12

So eating disorders can present across the entire lifespan, but we generally see them in times of intense developmental change. So we see them come out when people transition to junior high, to high school, to college. Menopause is a time when we see eating disorders occur or recur, job changes, things like that. Um, and the reason for that is that eating disorders oftentimes are a manifestation of a situation that feels overwhelming. So a series of changes. We know that most eating disorders are associated with trauma. Um, and sometimes that is a identifiable trauma that we can all sort of identify, look from the outside and say that is a traumatic event, like a weather event or a school shooting. Sometimes it's a change that is a normal part of development, going to a new school, parents get divorced, move across the country. But for that individual, it felt overwhelming. And the eating disorder offers a way of regaining control. Very often, changing how you interact with food and your body is a way of regaining control. And for some people, and perhaps in certain developmental times when you're more vulnerable, then that sort of catches in your brain. And we call that the click. So you're you transition from a thing that you're in control of and you're doing to a thing you're not in control of, and that the mental illness starts to take over. We do see it present at very at more specific times. We're we're more vigilant around specific developmental times. What I will say is that we are seeing eating disorders start to occur in younger and younger individuals. Um, and so we are seeing now uh anorexia nervosa and bulimia nervosa occur in kids who are still in late elementary school. And they are engaging in eating disorder behaviors, they have eating disorder thoughts, um, and they are needing intense treatment.

SPEAKER_03 9:12

Why do you think eating disorders are starting at younger ages?

SPEAKER_02 9:16

I think that there's a couple of reasons eating disorders are starting at younger ages. I think that social media is absolutely a component of it, being exposed to so many of these ideas in a format that is designed to potentially interact with a developing brain in a way that's problematic. Yeah. And I think that overall, there's a lot of things in our world that feel really out of control. Uh, we saw this through COVID, that so many young people were so incredibly impacted by not only eating disorders, but mental illness uh as a as a whole. The eating disorder often was one part of the way that mental illness was impacting them. Which brings us back to the isolation and the disconnection. Yes. Exactly. And so I think that that is persistent, that society has changed in some way then from where it was five years ago, well, now six years ago. And it is impacting a whole generation.

SPEAKER_03 10:14

So, how much harder is it to have and to treat a condition where it feels like it's a solution versus a problem?

SPEAKER_02 10:24

So it makes eating disorders as an entity a uniquely difficult mental illness to treat. Because part of the eating disorder is that it functions as a solution. It functions as a thing that the mental illness says, you know, this is gonna help you feel better. And society reinforces that. If you say to someone, you know, I just I just don't feel like the best version of myself, they might say something like, Well, maybe you should eat better, or maybe you should get some movement.

SPEAKER_03 10:54

Or maybe you should drop some weight. How many times do you hear that?

SPEAKER_02 10:57

Exactly. Yeah. And so, you know, and there there is good evidence that moving your body, getting sunshine, that eating food that nourishes you, those things do make you feel better. So it, you know, this is the thing where eating disorder takes a thing and it twists it. It's like the upside down on stranger things. Oh, interesting. It, you know, it takes a thing that is meant to be healthy and it turns it upside down so that it's not healthy. And actually, it sets up a series of sort of you you can't ever do good enough. You will never satisfy the eating disorder. You'll never lose enough weight, you'll never eat healthy enough, you'll never lift enough uh and left weight, you'll never build enough good muscle, your body will never be good enough. And so it sets up this sort of, you know, catch 22 of you have to always do more, always do more, always do more. Meanwhile, when people lose weight in our diet-obsessed culture, they do get positive reinforcement. It is not uncommon. All of us, I bet every single one person listening here today has had someone make a comment about their weight, positive or negative, um, positive if they lost weight and negative if they gained weight.

SPEAKER_03 12:14

And positive is negative, right? Because when you say you like you look great, that means what, six months ago I didn't, a year ago I didn't. Exactly.

SPEAKER_02 12:21

We, you know, as soon as we comment on someone's body, we are making a statement about the present, the past, and the future. We it is intrinsic in it. It's saying, I am placing your worth in how I perceive your body. And that is so harmful because it creates a self-limiting paradox. You are stuck in that cage now. Um, and so rather than your body being a thing that allows you to live a full, joy-filled, messy big life becomes a thing you have to control.

SPEAKER_03 12:57

So, what's your advice as a doctor who treats people with eating disorders about how we communicate with each other? Should we just never, ever comment on someone's physical appearance or body?

SPEAKER_02 13:07

You know, I do think that commenting on physical appearance and body is problematic. Um, because what it says is that my perception of your body is more important than your perception of your body. So I think that the way that we comment on each other if if we need to is to say, gosh, I really enjoyed being able to walk around the lake with you today. And, you know, let's do something fun with our bodies together and and share joy and how our bodies can function for us and how it can bring us more, more life. I I think that, you know, if you have someone in your life and you're worried that their body is limiting them, then that the conversation is I'm concerned about you because I love you and I see that you're not living your best life, but not maybe you should lose 10 pounds so you can walk around the lake. Or gain. Or gain 10 pounds. Exactly. Exactly. So it, I think that we have to be very careful. These sorts of conversations should be had when you have a different kind of relationship. So you already have a good relationship with someone, and then you can sort of maybe have conversations about how to, you know, how you like to share time together. Yep. Making comments about people's bodies that you don't know well, or we see all the time in the press comments about celebrities' bodies, uh, I think it's very, very problematic because what it says is your body is here for my consumption rather than your body is here for your function.

SPEAKER_03 14:40

And when we hear, that is a beautiful way to put it, by the way. I didn't mean to jump past it. When we hear those comments, we don't think they're just talking about the celebrity who has lost too much or gained too much, and all that's in air quotes for people just listening. Um, we hear it as a judgment of us. It's it's hard not to.

SPEAKER_02 14:58

That's exactly right. So when you make a comment about one person's body, especially in a public format, you're making a comment about bodies at large. Yep. Uh, you're making a comment about all bodies. When someone is hearing that, and especially if they are vulnerable, uh, if they are young, if their brain can't sort of say, well, that's not me, that's them. Um, it sets up a situation where you're commenting on their body.

SPEAKER_03 15:27

Yeah. I told you I was gonna have a million questions that I'm supposed to be asking the internet, so I'll get to it. The number one search about eating disorders is what does disordered eating actually mean?

SPEAKER_02 15:38

So disordered eating means a wide, wide variety of things. And I think we need to be thoughtful about the fact that there's a wide variety of normalized eating across various cultures and and across the world. Um, I think when we're talking about so disordered eating means that your eating behaviors are getting in the way of you living your life. Um, and so that that can mean a lot of things. It's it's a very, very wide definition. Okay. But it and again, it requires some individual reflection. So is this getting in the way of my life or is it supporting my life, the life that I want to live? And if it's getting in the way of the life that you want to live, then I think you need to ask, ask yourself some more questions regarding how much it's getting in the way of your life and how much that's sort of influencing you. Some disordered eating, we can all look at and say, that's disordered, for instance, engaging in voluntary purging behaviors. So making yourself throw up or using medications to change how your body interacts with calories. Some things become culturally normalized. One thing that we see come up across the board from time to time on TikTok, et cetera, is what's called a hack, quote, air quotes, which is um where you chew your food and spit it out so that you don't have to have the calories. And we will see large populations of people, especially in high school or college, sort of all engaging in that behavior. And that is disordered eating. So I think there's also a component of disordered eating that is modifying how your body interacts with the calories. It's a little bit amorphous. It's a it's hard to pin down. It's like one of those things you more know it when you see it.

SPEAKER_03 17:28

Is disordered eating different than an eating disorder, or is there a Venn diagram overlap?

SPEAKER_02 17:34

Yeah, there definitely is a Venn diagram overlap. So uh disordered eating can be a part of an eating disorder. It's not always. And so when we think about diagnosing an eating disorder, in psychiatry and in the mental health field, we use the diagnostic statistical manual, version five, TR.

SPEAKER_03 17:50

DSM, most of us call it. Yeah.

SPEAKER_02 17:52

Yeah, DSM five. Uh so there's a almost a checklist of things that we in the field need to meet the criteria to define a disorder. Okay. But I think more broadly for individuals out there who don't have a DSM on their bookshelf, you we diagnose a mental illness when it's interfering with the life that you want to live, when it is causing functional impairment. And the sort of maybe it's a Venn diagram, maybe it's more of a spectrum of we move towards these disordered eating behaviors, but when they start to accumulate, and then they also are going along with um interfering with your mood, with your sleep, with your ability to function, uh, then we move into more of a diagnosable eating disorder.

SPEAKER_03 18:36

So where's the line between somebody being a picky eater, which is what I grew up being called, or an overeater, which is what some of my siblings were called? You know, where's the line between I just eat the way I eat and the way I eat is causing a physical problem or mental problem for me?

SPEAKER_02 18:54

Yeah. So there's really two main things that I look at as a psychiatrist. Uh, one is the functional impairment. So, how much are you losing of the life that you should be living to this disorder, to this behavior? And, you know, so I will ask questions about how you spend your free time. What decisions have you made that were influenced by your need to engage in this disordered eating pattern? Okay. And then the second piece that we look at for eating disorders is medical compromise. And this is a unique part of diagnosing an eating disorder that isn't so much a part of other diagnosable mental illnesses, is that we very often say that there needs to be some demonstration of malnutrition or medical compromise because of the disordered eating behavior. Okay. So it's not the way it looks, it's what it's doing to your body. That's right. That's right. And this is at such a critical point, is that so malnutrition, which means your body doesn't have enough calories, doesn't look away. So we have, I think, an old idea in our society that we can look at someone and we can tell whether or not they have an eating disorder. But the reality is, is that malnutrition looks like anyone. They'll look around a room. Um, chances are good there's somebody in that room with a disordered eating pattern that's causing them malnutrition. Eating disorders are shockingly common and highly underdiagnosed. And so I think that we, when we're diagnosing it, we're looking at these two components of functional impairment and medical compromise.

SPEAKER_03 20:29

When does an eating disorder become a medical or mental health crisis?

SPEAKER_02 20:34

So I think crisis sort of is uh, again, a bit of a relative term because we're going to need to look at what's happening in that person's world. But very often uh it becomes a mental health medical crisis when someone has been engaging in a behavior or a series of behaviors for a period of time and it has really affected their physical health to or mental health to a point where we're at an inflection point. And so we often see people present to treatment when they're in crisis, when they've gotten to a point of saying, I cannot go on like this, or someone says, You cannot go on like this. And they're presenting to the hospital, to their physician with physical symptoms that are incompatible with life. Eating disorders are the most fatal mental illness. I wouldn't have guessed that. Yes, they are. So anorexia nervosa is the most fatal mental illness due to two factors. One is the medical compromise, the medical crisis, and two is suicide. Eating disorders are uh inextricably linked with suicidality and with completed suicide. And we know that in the field, like that is that is one of the things that makes it a crisis. So you don't necessarily need to have a medical crisis to need support for your eating disorder. If you are at At a point where you're saying, I don't want to live. And it can be either I don't want to live because I don't think I can get better from this eating disorder, or I don't want to live without this eating disorder. Oh. That is a crisis and you need help. And I want, I want you to know that you could reach out for help.

SPEAKER_03 22:17

And we are going to talk a lot about treatment in part two, which will be next week if you're watching this when it first posts. But when you say reach out for help, let's I in case someone listening is thinking, I think I'm there, what do you mean by reach out for help?

SPEAKER_02 22:31

I I want you to reach out to the kind whatever is accessible to you.

SPEAKER_01 22:37

Okay.

SPEAKER_02 22:38

So if you have people in your life, um, trusted adults, friends, a physician, a therapist, I I want you to let them know today. Say, I need, I need to tell some, I need to tell you something. If you don't have that person or you're not sure, um, please make use of crisis resources, a suicide hotline. Um 988. 988, exactly. Uh, make use of crisis resources. Those people will be trained to help you navigate a mental health crisis, a suicidal crisis. And then the third thing, if you just you're like, I just don't know what to do, you can take yourself to an emergency room. The physicians there will know what to do. They will know how to help you stay safe. It may not feel like a long-term solution. It's not meant to be. The long-term solution is addressing the eating disorder. But today, if you're not sure you're going to get till tomorrow, I need you to make contact with a person.

SPEAKER_03 23:37

Tell me what to say if you walk into an emergency room in that situation, because you're not very resourced and you're not at your, you know, peak cognitive self at that point.

SPEAKER_02 23:49

So I think I I want you to speak your truth, to say, I have an eating disorder if you can. Or you could just say, I feel suicidal and I have a plan and I don't think I'm going to make it till tomorrow. Say that.

SPEAKER_03 24:02

Wow. It seems odd to pivot to another internet question here after that, but I'm glad we addressed it. And as I said, we'll be talking more about treatment in part two. Does tracking, because there's such a common tracking these days of macros, calories, protein intake, all the things, does that play into eating disorders?

SPEAKER_02 24:20

It does. So tracking food intake, tracking calories burned is very fad. There's lots of apps, lots of things you can download, AI, all these things. Um, and in and of itself, tracking what you eat, tracking your macros, tracking your vitamins, tracking how much you work out, it's not, it's not problematic. And, you know, it can be a way of organizing yourself. So again, we have to sort of notice how much time and energy are you spending doing those things. Oftentimes when I'm working with people who have eating disorders, uh, it's not just tracking, it's also making the balance work out. Okay. The calories in is always less than the calories out. Or I'm eating a bit less today than I did yesterday and a bit less tomorrow than I did today, so that every day it's a little bit less, or you're tracking your weight and it needs to go down. So it's it's not a sort of just objective, I'm collecting data for data's sake, so I can kind of see like, did I get enough protein this week? Um, it's a, I'm tracking this data, it's taking a lot of my time, and I have to change something about myself within this data.

SPEAKER_03 25:33

You've made it very clear that eating disorders are a medical condition, a mental health condition. And it's so important to realize that. So when people are convinced or talk to you or treat you as though it's a choice, it's a lack of willpower, vanity gone wrong, what's the danger in those assumptions about eating disorders?

SPEAKER_02 25:54

The the critical danger in that is that an individual with an eating disorder doesn't get the help that they need. So in that is you just need to try harder or you're doing this to yourself. I think one of the most dangerous things that we can say to someone with an eating disorder is just stop. Just stop doing it. Just eat. I'm I'm gonna make you dinner. Come over, I'll make you dinner, and then you'll eat it, and then you won't have an eating disorder anymore. Yeah. Right. So I think that, you know, we know that when this stuff goes off the rails, it's not a matter of willpower. It's not a matter of vanity. It is societally reinforced. And so that's the thing that makes it so hard is that it can appear externally like you you're meeting the sort of requirements of society. Yeah. Um, but again, we get back to what's happening inside of you? How much time are you spending each day thinking about this, doing something about it, or avoiding things because of it? Um, and so that it is not vanity.

SPEAKER_03 26:55

Okay, another top internet search is can you have an eating disorder if you aren't skinny?

SPEAKER_02 27:00

I love this question. It is so important. There's so many take homes from this. This one's one of them. Absolutely, yes, unequivocally, yes. You can have an eating disorder and not be in an underweight body. Eating disorders can happen to any body. And like we've said, malnutrition does not look just one way. And so um, it is so critically important to know that you can have an eating disorder even if your weight has never changed. You can have an eating disorder even if you live in a larger body. We have individuals without a doubt who, when they were younger, their body was a certain way and they didn't have an eating disorder. Maybe it was a smaller body, more straight-sized body, we say sometimes in the field. And now they're in a body that's a larger body and they do have an eating disorder. So we we really have to dispel this myth that an eating disorder looks away, or that only skinny people have eating disorders.

SPEAKER_03 28:02

Because again, that means somebody is unlikely to get help because they're unlikely to realize that that's what it is too.

SPEAKER_02 28:09

Individuals who live in larger bodies are mess less likely to be identified or screened for eating disorders by health professionals. They're less likely to self-identify as having an eating disorder, and then the cherry on top, they're less likely to be able to access treatment because they have restrictions on their ability to access treatment because of the size of their body. And so even though we've made so much progress in trying to push back on these sort of urban myths about what eating disorders are and how they look, we still see people every single day that can't access the care they need because they have not lost enough weight, they're not sick enough. And um, I just think it's a it's a huge, huge travesty and it's keeping people sick.

SPEAKER_03 28:54

So when you said professionals also fall into that category, if I am of anything, just not what you think a person with an eating disorder looks like, and I walk in and say, like something's just wrong, or I'm preoccupied. I don't even know if I'd say that, but let's say I knew that. Is a doctor likely to, you know, take one look and say, you're good?

SPEAKER_02 29:15

I wish it weren't true, but unfortunately, we physicians are also trained in a society that's diet culture, diet-minded. Yeah. And um, I think that there is a lot of disordered eating behavior and eating disorders that in larger people, larger bodied individuals are excused as health behavior. I'm gonna air quote that for those of you listening. Health behavior that if someone was critically underweight, we'd say, oh, well, now it's a problem. Why do we do that? Why do we do that? The the individual sitting in front of you is just as impaired, just as dysfunctional because of the behaviors, because of the amount of time and energy they're spending. And we have this really toxic false dichotomy that in a larger bodied person it's seeking health, and in a smaller bodied person, it's a part of the mental illness.

SPEAKER_03 30:12

So eating disorders are not about the number on the scale or food.

SPEAKER_02 30:16

That's right. That's right. Eating disorders are not about food. They're not about food, they're not about weight, they're not about food, they are about um, they are about control, they are about the brain being dysfunctional, telling you that you have to be smaller, you have to change your body in order to be acceptable. And intrinsic is that is a belief that you are not worthy unless you change your brain. You are not worthy of being in a relationship, you are not worthy of being loved, you are not worthy of this life unless you change your body. So it manifests with food, it manifests with exercise, it manifests with counting calories and body dysmorphia, body dysphoria. But the core of this illness is that unless you change your body, you don't deserve this life. And that is something that we have to keep pushing against. And it's a reason why I think it's really hard to do this alone, because that's a hard belief to challenge on your own.

SPEAKER_03 31:16

I've got this stack of questions here, but I really feel like we need to dive into that. Because if somebody is watching and thinking, I I just have to, I just have to whatever, start, stop, whatever. Being told, like, oh, I just want to like put my hand on somebody's shoulder or something and say, honey, you can't do it alone. It's not that you can't do it alone. It's that it can't be done alone. Is that the a message you're trying to communicate? It is, it is. Yes.

SPEAKER_02 31:42

It it's it's a I I hope it's a compassionate message and people are hearing it like a hug from a loved one.

SPEAKER_03 31:50

That's what I'm feeling. It's like what I'm wanting to reach through. Yes.

SPEAKER_02 31:54

You you can't do this alone. Yeah. And that's part of recovery, is not doing it alone. So I I think that it is again, you know, we are our society is also very, very individualized. We're very, very, you know, we we like to do things on our own. We have we have that kind of built into our cultural DNA.

SPEAKER_01 32:13

Figure it out.

SPEAKER_02 32:14

Figure it out, but bootstraps, all the things. But the in this case, I want people to hear this as part of the treatment is accepting the belief you cannot do this alone. Make that your mantra, you know, and and that's not weakness, it is strength. Um, and I, you know, I think that it's a way, eating disorders have a way of taking some of these cultural beliefs and making them really toxic. Um, and so, you know, the idea that your your body is your own, that you can make your body, you know, strong and healthy, um, but also that you uh work best in a community. Um we all do. That's that's well, AA.

SPEAKER_03 32:55

I mean, think about all the things. Yeah.

SPEAKER_02 32:57

Exactly. We know that when you don't do this alone, it actually takes better. It recovery treatment, it it goes better when you don't do it alone.

SPEAKER_03 33:09

Um, I consider myself a mental health advocate. And so I'm hearing this whole thing through that, and I live with depression. And when I get down enough, when it gets bad enough, I can't do it alone. And I go on meds and I go to my doctor and I go to my therapist, I get to a place where I call it, now I have a floor beneath my feet again. And from there, I can make better choices. And and some of it's not about choices, but going forward, but I can't get out of the pit without help. I'm great. I mean, it took me a long time to learn that. So I hope somebody listening doesn't feel weak, saying, Oh, I didn't, I thought just some people did or weak people did, or rich people did, because they have access to resources. I need help. So let's talk about, we'll get to treatment, but what is somebody who doesn't have the funds to go into a treatment facility? And this will have to be short because I do want to talk about this in part two. But if I need help right now, other than a hospital, if where I'm just thinking, maybe this is what they're talking about, and maybe I can't do it alone, what's the next step?

SPEAKER_02 34:15

So I think that the the next step is to check your insurance, check to see if you can access a therapist, if you can access a dietitian, if you can access people that know about eating disorders with any of your resources. And and so if you don't have any of that, um, there one of the the other sides of social media is that there is a much larger and more robust community of people who want to support other people pursuing recovery now than there ever has been in the past. So there are support groups online, there are free resources through many, many organizations uh that support individuals that are just learning. Maybe I have an eating disorder, supporting individuals who are on the other side of treatment and trying to figure out how to make a life without an eating disorder. Um, throughout the entire sort of course of treatment and recovery, there are resources and most of them are free that are especially our peer support sorts of things. I, you know, in our community, we have an organization called the Eating Recovery Foundation. And they have um support groups led by professionals who volunteer their time to create an environment where people can come together. They have a group for people who are over 45. So, you know, if if you are at a stage in your life and you're saying, I do not want to sit with college students who are just figuring out how to live on their own for the very first time, like I've lived a life and this is still a problem. There's a space for you. And so I really, and that's available across the country. So it is not just because of the advent of virtual spaces, we actually have so much more in the way of recovery spaces online that are accessible. And then in those spaces, you know, many times they are able to give you resources that you may not have known about. Right. The reality is, is if you walk today into your primary care doctor's office or your medical provider's office and say, I, you know, I have an eating disorder and I need help, a lot of times they may say, gosh, I don't know what to tell you to do. Um, because there is a critical lack of education about eating disorders in both health spaces. And so it does fall onto you to maybe do a little bit of research, or this is something else you can ask your community for to say to a loved one, listen, I I think I have an eating disorder and I don't know what to do next. Can you help me Google some stuff and find some things that look safe? So I think that there are resources and they they do require, unfortunately, a little bit of legwork. It's it's not something that everybody's gonna just know exactly where to find it for you.

SPEAKER_03 37:06

And without doing an ad, I am going to say that we do have medical reviews on recovery.com of the information on topics, including eating disorders, so that you're not going down a rabbit hole in learning things that aren't true or are hurtful. And whenever you do an online search, your algorithm changes and your feed changes. And so I recommend blocking and unfollowing liberally because not everything that comes to you is going to be helpful.

SPEAKER_02 37:30

That's such an important point about social media is that what when you go online looking for recovery resources, the algorithms are not smart enough to not send you non-recovery resources. So be unscrupulous, unfollow people that aren't helping you with your mental health. Take social media breaks and ask people to help you go through your feed and find things out. Sometimes people have to create a whole new profile because it's so hard. The algorithm gets gets so uh woven in. Yeah, sticky is the right word. You know, sometimes it can be a little bit like the witness protection program. Like you have to create a new identity without an eating disorder.

SPEAKER_03 38:09

Well, speaking of the internet and questions, another commonly searched question is what are the signs that my friend might have an ED disorder?

SPEAKER_02 38:17

If you are worried about a loved one, a friend, um, the things that you might start to notice is that they are becoming more preoccupied with food, exercise, their body, and it is beginning to affect their ability to be in relationship with you, to do things that matter to them. If you're in school, you might see them start to struggle with doing their schoolwork. If you work with them or they're a work colleague, you might see them struggle with their work tasks. The eating disorder really has a way of taking the things that are important to you and making them less important than the eating disorder. So you know your friend, you know the things that matter to them. If those things matter less now than those disorder eating behaviors, then that is something to be concerned about.

SPEAKER_03 39:03

And the symptoms or the signs that you just described are not all food related.

SPEAKER_02 39:10

That's exactly right. That's exactly right. So again, you might notice that your friend's body is changing, or you might notice that all of a sudden they're not eating the same way. Um, and but those things aren't necessarily an eating disorder. And, you know, I think that when you are wanting to how do I have this conversation with them? Yeah. Um, again, we get back to noticing the things that they value that are now less important than the behaviors. So to say to your friend, you know, I know that being a mom is one of the most important things to you, but I've noticed that you're just spending so much time at the gym or tracking your calories that you're not spending as much time with your kids. And it seems like to me that this is impacting your life. Can we talk about that? Describing what you're seeing versus judging. Exactly. Versus saying something like, gosh, you've lost a lot of weight. Do you think you have a problem? That is not a helpful thing to say. No, it's not helpful. It puts someone on the defensive. Instead, to say, I love you, I care about you, and I've noticed this thing that's important to you has become less important. Can we talk about that?

SPEAKER_03 40:24

I don't even know if I need to go here. The next question that people ask online is how do I bring up concerns of possible eating disorders without making it worse? And I think you just answered it. But I would like to dive into it more because I think that describing what you're seeing is probably way safer than placing any kind of a, and I think it means on it. Is that your understanding?

SPEAKER_02 40:44

I I absolutely yeah, I think that's so important is is to when you're trying to have a conversation with someone about something that is likely to be sensitive. This is not just eating disorders, this is kind of anything. Sure. If you sort of take it, take the behavior and then make an assumption about what that means, you've jumped past the part where you've asked the person to engage with you about it. And now they're on the defensive about trying to defend themselves from the thing that it means rather than having a conversation. You might find out that your friend has just really gotten into, you know, I don't know, something that's healthy, um, but it's taking up a lot of their time. And you can be curious about that with them and help them notice if it starts to take away from things that they're uh that are important to them. People's values and priorities change over their life. That's normal. That's that's a normal thing we should be supporting is, you know, growth and change. Um and so, you know, when you make that mistake of sort of saying, like, well, I've noticed you're spending a lot of time at the gym and I think it means you have an eating disorder, right? Rather than they have a new community of people that they feel really connected to and are are thrilled at how strong they're getting, you know, I think that these are the sorts of nuanced conversations that we should be having with our loved ones.

SPEAKER_03 42:03

There are also classes at gyms and they can take time.

SPEAKER_02 42:05

That's right. That's right. Sometimes it takes a lot of child time at the gym. Um, and you you can certainly say, I'm worried that I never get to see you anymore and I miss you. And they might unfortunately say, you know, my priority right now is like I'm training for this marathon and I want to spend a lot of time doing that. And I'm sorry, and I miss you too. And then that's a good conversation.

SPEAKER_03 42:27

Good conversation. And we're in no position, you are as a doctor. I'm in no position to diagnose. So if I say I think it's an eating disorder, I think you have anxiety. What do I know?

SPEAKER_02 42:37

Yeah. And I I that's such an important point. And I think this is, you know, a broader conversation of how we use mental health diagnoses as sort of like a catch-all, like, I think you're depressed, I think you're anxious, I think you have OCD, without really understanding.

SPEAKER_03 42:50

The weather's so bipolar. Think of how we toss these diagnoses. Yeah. I just yeah, I know.

SPEAKER_02 42:55

It's I think it's so undermining and demoralizing for people who really have these diagnoses. And a diagnosis of an eating disorder is a really serious thing. Um, it is a life-changing diagnosis. And so I do want people to be careful with their language.

SPEAKER_03 43:13

You just said a diagnosis of an eating disorder is life-changing. That is news to me. And I hope some of the people watching or listening. How so?

SPEAKER_02 43:23

So a mental health diagnosis is a big deal. Yeah. Um, what that means is that you have a thing that's that's happening to you and with you. And in you, in you that's affecting your brain, that's affecting your body, that is changing your lived experience. And so when I diagnose someone with an eating disorder, I'm saying, okay, listen, um, all of these things that you thought were just normal, or you knew that they were a little bit of a problem, but you didn't know it was that much of a problem. I am saying now we have moved into. A new space and you have a diagnosable mental illness and mental illnesses need treatment and need ongoing vigilance and need support and need community. Um you you can't just walk out the door and go back to the life that you were living uh and things will resolve themselves. So I I think when you get a diagnosis of a mental illness, it is sort of this inflection point to say um something's going to have to change. Mental illness across the board, not just eating disorders, but they generally aren't self-resolving, self-limiting things. They require you to change something about your life. And so when someone gets a diagnosis of an eating disorder, it requires them to change something. And because eating disorders are, you know, multi-systemic, brain-body-based disorders that do require specialized treatment, I think it is a big deal to get that diagnosis. You have to find new resources, find a new community, um, find new ways of living your life to protect yourself from worsening.

SPEAKER_03 45:11

You offer such a unique perspective because how often do we get to ask the person who actually does the diagnosis? So peeking behind that curtain, what's the normal reaction? Are people like you're wrong, or is it a sense of relief? Like, I knew, you know, good. It's not just me not doing it well enough.

SPEAKER_02 45:28

I would, it's across the board. So the reaction is as individualized as the person I'm sitting with. So for for some people, it is a relief. Um, for many people, it's a surprise. Uh I I have an eating, this is an eating disorder. Um, especially individuals who have binge eating disorder are often really surprised that this is an eating disorder. This is not a lack of willpower or you just you just didn't figure it out about food. Right. There, there is uh quite a bit of denial about this can't be an eating disorder. That's not what this is. Not me. There's a very much of a not me situation with a lot of eating disorders. Part of that is intrinsic in the disorder itself. Okay. So an eating disorder will sort of hide in plain sight, um, in that it is a becomes a part of your identity, um, an individual's identity. And it can be very, very hard to tease apart that you are not your eating disorder, and your eating disorder is not you. The eating disorder, especially anorexia nervosa um and bulimia nervosa, will often tell the individual that their best self is their eating disordered self. Say that again. Yeah. So your best self is your eating disordered self. And the more you do your eating disorder, the better you are as a person.

unknown 46:53

Wow.

SPEAKER_02 46:54

That'd be hard to fight. It is so hard to fight because oftentimes the thing that led you to starting the behavior was not feeling very comfortable in your own skin or something felt out of control. So it really does create a situation where treatment is hard. It requires a great deal of support for not only interrupting the behaviors, but also having a supportive environment to redefine how you know yourself and how you find your worth.

SPEAKER_03 47:24

So as a doctor who diagnoses and treats eating disorders, you do a lot of explaining to people about, hey, this isn't you. This is something you have that's changing how you behave, that's changing how you interact in the world. How is that understanding important for people outside of the diagnosis? Because if we understand that, I would just think there'd be so much more empathy and so much less judgment, or rather, I would hope.

SPEAKER_02 47:49

Absolutely. I I think it's it's a critical part of understanding how to support people with eating disorders is to recognize that this is not something that you can just like say the right thing and then they'll stop doing it. Yeah. You know, I often say uh in to my teams, this is not a knowledge gap. They know already they're here. Um, you know, I work in a treatment environment uh where we have very high levels of care. It's uncommon people are sitting in my office these days without the knowledge that they have an eating disorder because they wouldn't have gotten to me until they already knew that. Now they still might be saying, I know you think I do, and the insurance company thinks I do, and my parents think I do, but I don't think I do. Um, but you know, I think that if if we as a society could understand that this is this is not something we can just say the right thing about. Um, but we can say the wrong thing. So understanding that eating disorders are a mental illness absolutely can lead to more empathy, less judgment, and I think open opportunities for people to get help and receive help that just don't exist today.

SPEAKER_03 48:56

Almost everything you're saying is making me think of addictions and the conversation I have around addictions. Uh, is there is that a an appropriate analogy?

SPEAKER_02 49:04

I I think that there's a lot of overlap of the addiction space and the eating disorder space. These are both brain-based illnesses that affect your biology, that affect your medical stability. Uh, they are both disorders that are uh very protective of the themselves, like the the disorder wants to protect itself. And so it will drive the individual to behave in ways that are not aligned with who they are, their integrity. So, you know, individuals with eating disorders, uh, like individuals with substance abuse, are lovely people with a high degree of integrity. And in service of protecting their eating disorder, they will behave in ways that break relationships, that break trusts, yeah, that cause ruptures that are very difficult to repair. So I think that there, it's an apt analogy. There's a lot of overlap. Um, there's also the overlap of community is required, and you can't do this alone. And trying to do it alone can be a part of the illness. And then very often there's also a part of it where you have to admit that you have to surrender. You have to admit that the eating disorder got stronger than you. I will often ask people when I'm trying to help them understand sort of how this went from um sort of behavior they were in control of to something they weren't in control of. When did you first realize that you didn't have control of the behavior? And, you know, they will sit and think back of like when did it become a thing I had to do versus a thing that I wanted to do? Um, and then when did it move from a thing I had to do to a thing I could never do good enough? And so I think that in these ways, there's so much overlap in the communities.

SPEAKER_03 50:52

It sure sounds like it. The fifth most asked question on the internet do guys get eating disorders too.

SPEAKER_02 50:58

Absolutely, yes. So this is something that is unequivocal. Guys get eating disorders, guys have eating disorders. Um, and guys can have every kind of eating disorder. So there are a number of different eating disorder diagnoses, and they look just a little bit different, um, but have this overlap of that you have a relationship with nutrition that's impacting your ability to function and your medical stability. Um, guys absolutely get eating disorders and are, again, less recognized because people do not screen men for eating disorders in the same way. And eating disorders can look different in men. So in men, we will see more of what's called orthorexia or um excessive health-driven behaviors that is not necessarily about thinness, but can be sometimes about muscle mass or fat percentage. And again, we see the same patterns of things, um, compulsive tracking of how you're spending your calories, what calories you're taking in, your micronutrients, uh, how much time you're spending in the gym or away from your family. You know, it can look slightly different, but men absolutely get eating disorders. Is the stigma different? It is. So, oh, it is. Oh, the stigma for men with eating disorders is so challenging. One, again, we have so many myths about eating disorders, um, to the point where there are recovery spaces that are gender specific. So it can be exclusive to men. It can also be exclusive to people who don't identify with the gender or um are transgender. And so just finding spaces where men can find a community can be difficult. Um, and also, again, men, you know, when you have male friends, they they may not have the same uh understanding of how eating disorders can look like in men. Um, we can hear the same sorts of dismissive comments of like, oh, you just have to eat more, or, you know, cut your carbs or things like that, or this, you know, this doesn't happen to men. Um and I think that it reflects also a larger cultural shift that men get mental illness too. Yeah. Men have feelings too. Um, so you know, I think that that there is a lot of stigma for men to be able to be identified as having eating disorders and then to find treatment spaces and communities that feel supportive, but they are out there. So if you are a man with an eating disorder, or if you are a trans person with an eating disorder, non-binary person with an eating disorder, there are communities that are developed that are in place specifically to support communities so that you can share experiences with people who have a similar lift experience.

SPEAKER_03 53:46

And where do you recommend someone in those uh communities would go to look for those?

SPEAKER_02 53:51

So, you know, I would start with um so the uh Academy of Eating Disorders is a great resource, as is the International Association for Eating Disorder Professionals or IAdept, we call it. Um, both of those have really, really good resources. Many treatment facilities, mine included, Eating Recovery Center, have communities that uh are dedicated to online spaces for support. Um, our our communities live on our web page and we have Facebook communities. So, you know, there, there, there's a lot of ways to access this care.

SPEAKER_03 54:23

Good. We're gonna end this episode here and we'll be back next week. You brought up a lot of, you know, anorexia and bulimia and some others. I wasn't skipping over those. We're gonna talk about them next week, as well as treatment options, because it's very important, obviously, that people understand when we say, hey, you can't do this alone, that we tell them what kind of help is available. So Dr. Wassenar and I will be back next week to continue this discussion. And again, we'll be looking at different treatment options and how they work, and as well as diving into the specific diagnoses of eating disorders. Please join us.