The Applied Mind
The Applied Mind
#10 - Dr Jay Raman - Beyond Body Image: Eating Disorders, Comparison & Self-Worth
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In this episode of The Applied Mind, I sit down with Dr Jay Raman, a Clinical Psychologist, Senior Lecturer at the University of Newcastle and Founder/Director of the Three Squares Lab. We explore the psychology of body image, eating disorders, weight, shame, comparison and self-worth.
Jay brings over 18 years of clinical and supervision experience, along with research expertise across body image, eating disorders, cognitive remediation, obesity, emotion regulation and health psychology. We unpack why body image concerns are so common, when they can become clinically serious and why eating disorders are never as simple as “just eat more” or “just stop worrying about your body.”
We also explore the role of social media, photo editing, comparison, control, emotional regulation, family support and the deeper psychological mechanisms that can keep people stuck.
This conversation is for anyone who has struggled with food, body image, exercise, appearance, or self-worth, as well as parents, partners, friends and future clinicians wanting to better understand how to support someone through these challenges.
Listen to the full episode of The Applied Mind with Dr Jay Raman on Spotify.
This episode is proudly brought to you by GRecovery, the Central Coast's leading destination for health, wellness, and performance recovery. From infrared saunas and ice bars to massage therapy and soft tissue treatments, they've got all the science-backed tools to help you feel and perform at your very best. To book your next session or learn more, head to gerecovery.com.au. That's gerecovery.com.au, you know how we met.
SPEAKER_01Do you want to give a little spiel on that? Because I think that's quite interesting.
SPEAKER_00So we um, I think it was late last year, I'd applied to do an overseas trip uh in Nepal, and it was kind of a last-minute decision for me. I was like, saw this little advertisement in the uni, and I thought, oh, you know what, I'll just apply for it and see what happens. I actually didn't think I was going to get it. I thought it was one of those things that you apply for, you put your name down and never really hear anything back about. And yeah, I started progressing through the stages of getting accepted to go on the trip. And then lo and behold, we were in the pool. And I remember um probably like a week into the trip, I was having a good chat with you and about the research that you were doing and and your clinical experience as well. And I was quite excited to do my honours project with you as well. So I wanted to like have a good little chat. And for those people listening that know me, I am very bad with keeping my possessions. I lose them all the time. Quite unorganized. We're in the middle of Nepal, and we've gone out of the airport to the place that we were staying, and we were doing projects while we're over there as well. So you need your device that you brought with you. We get back to the hotel and I open my bag up, and I have left my iPad at the airport. So we're in the middle of Nepal, pretty far away from the airport, and we're all walking around in the streets, and I've been messaging with the security that work at the airport to try and get this iPad back, and we've managed to figure out where it is. And so me and Jay jumped in a little taxi to go back to the airport. We left the group, and I thought that would be a good time to chat to you about what we're gonna do and hopefully get get you on the podcast. And we're sitting in the middle of some of the busiest traffic I've ever been in, and we're talking about the podcast. Now here we are. So, yeah, thank you so much for coming on. For the listeners who are unfamiliar with your work, how would you describe your clinical and research focus?
SPEAKER_01First of all, Eddie, thank you so much for inviting me to this podcast. Um, I think it's a privilege to speak to your listeners. So thank you, much appreciated. By way of introduction, I'd been a clinical psychologist for a very long time now, almost touching three decades. And I like all clinical psychologists, I see myself as a scientist practitioner. What it means is I work both as a clinician and also a researcher. In practice, what it really means is I don't just study about emotional disorders like body image issues or uh eating disorders. I sit with real people in real life who are struggling with these uh disorders, and I do evidence-based assessments, establish treatment goals that's been proven by research to be working, uh, do interventions. Um, and I also, as a researcher, study the underlying mechanisms for all of these disorders. I think it's important for your listeners to know the value of a scientist practitioner because it it's important because it keeps our work grounded. Uh, the research informs what we do in clinical practice, but our practice also informs, it shapes our research questions and we study about these disorders. Yeah.
SPEAKER_00So, what first drew you to body image and eating disorders research and work?
SPEAKER_01Um I actually came into this through my work in eating disorders. Um, I'd I'd been uh researching and working uh uh clinically in this space for quite some time, and one thing that became very clear is uh just the very high prevalence of body image issues and also how pervasive it is really, um, body image concerns are not just in eating disorders, but in a lot of emotional disorders. Yeah. So it's not uh what I'm trying to say here is body image issues are not just sitting alongside eating disorders. It's actually a key risk factor in what in how people really think about themselves. Uh just a bigger picture, Eddie. Like yeah, I'm here, I'm talking about self-image, not just body image, but in body image really impacts you know bigger stuff like self-image, self-confidence, self-worth, self-esteem, the whole bit. And it also touches big time on how we think about food, for example, and how all these patterns develop, you know, over time, but in a big way. So in a very organic fashion, my clinical work and my research with uh eating disorders kind of translated into my interest in uh body image uh issues. Uh, and because I felt that it's such a big part of the picture, and if we don't intervene it from a preventative fashion or from early intervention uh model, then it can escalate, these issues can escalate into bigger disorders. And yeah.
SPEAKER_00So for listeners who are unfamiliar with your work, how would you describe your clinical and research focus?
SPEAKER_01At a very broad level, my work focuses on body image and eating behaviors, as you know. But what I am particularly interested in is not just what people think. I mean, don't get don't get me wrong, what people think is again very important. The content of it is important. We do deal with it in therapy and research. But my uh interest in research is also about how people think. Yeah, not just what people think. So not just the content, but the process, the thinking style. Uh, by that I mean the patterns and uh processes behind thinking, things like attention, for example, how we attend to the stimuli around us, the world around us on a day-to-day basis, our habits that develop over time. When I say habit, I mean uh our thinking, habit, habitual ways of thinking, habitual ways of feelings, and habitual ways of behaving, and all of that. And also how um flexible people uh um are in their thinking style. I'll give you a little example. When I say flexibility in thinking, cognitive flexibility as we call it, it's how quickly we are able to move from a problem to a solution. Now, of course, we are humans, so we are going to go back to our problems, but again, how quickly we are able to move from that to a solution-focused way of thinking, so that flexibility in thinking styles and also metacognitive thinking, right? Thinking about our thinking. So, all of those things which I would deem as brain-directed ways of learning and thinking, that's what I'm really interested in.
SPEAKER_00So, when you would look at the field now, what would be some of the biggest misconceptions that you would see?
SPEAKER_01I would see that one of the biggest um misunderstanding is that body image and eating disorders are superficial stuff. Now you would hear about it all the time uh out there in our community, that it's about vanity, it's about appearance, it's about, oh, it's just food, it's just willpower, you know, it's something that can be controlled very easily. Whereas in reality, in from clinical practice and also from research, we know that they are a lot more complex. A lot more complex. They're often tied to deeper psychological processes like mood, anxiety, stress, a sense of self-worth, emotion regulation, um, and coping, and even trauma. That's a very big thing. We'll keep it for another podcast, maybe. So, what I'm trying to say is that these are really complex processes. And at the time that people are employing certain behaviors as a coping mechanism, they are meaningful, they are helpful, but for a very short time, in the longer term, they can become very harmful. Yeah. So when we reduce them to comments like, oh, just eat normally or just be more confident. And those kinds of comments we hear out there all the time. We are missing what is actually driving these behaviors. So we should take care not to oversimplify them. Yeah.
SPEAKER_00So before we dive into any topics that are a little bit deeper, what would be one thing that you wish just the average person in general would understand about body image and eating disorders?
SPEAKER_01I think I would want people to understand that no one chooses to struggle with this. No one chooses to, you know, experience these distressing thoughts and feelings. These patterns uh develop over time and they often serve a purpose. Like I said uh just you know in my previous response, it it it uh it serves a purpose. Um, it helps people to cope or feel in control or manage difficult emotions for the shorter duration, but the longer duration, it's actually pretty harmful. So it's we should view that not really as a weakness, but it's about understanding what's underneath and helping people shift that. Yeah. So at the very least, like I said, we should not oversimplify these issues.
SPEAKER_00I want to kind of dive into the topic of body image first. At what point would you say normal appearance becomes like clinically relevant levels of distress?
SPEAKER_01See, um, psychologists, well, it's a very big question, um, and I can talk on this forever. But um, for the sake of this podcast, if we can kind of make it uh, you know, three really important things that makes um body image issues uh clinically relevant, uh, we can talk about three critical factors. The first one is frequency, the second one is intensity, and the third one is impact. For example, um, how often are these thoughts and feelings occurring? How much of the mental space is it really taking from performing your day-to-day life to your you know satisfaction? How distressing they are, and whether they're affecting functioning, for example, your work life, your relationships, um, your social life, your eating behaviors, how much are they impacting on all of these important um aspects in your life? So we would be looking at uh the frequency of occurrences, uh, the intensity, and also the impact.
unknownYeah.
SPEAKER_00For sure. Can someone look completely fine or healthy or in society standards normal externally, but still be experiencing severe body image distress internally?
SPEAKER_01It's a very good question, and it's a very important question, Yeri, because absolutely, and this is something we quite often see clinically a lot. Um, I actually teach um professional and uh clinical psychology students, and I all the time I tell my students and my interns, regardless of why people coming to your session, always screen, at least if you can't assess at the time, screen for body image and um eating disorders because you'll be very surprised with what you find out. Yeah, so body image experience is a very internal experience. So someone can look completely fine externally, but be struggling quite significantly inside in terms of their thoughts, emotions, and even behaviors, very hard to pick up externally. They might be often comparing themselves to others, be feeling very anxious about how they look or engaging in behaviors like checking all the time, avoiding social situations. All these, all these behaviors can be happening, but we can't just pick these up just with how they are looking outside.
SPEAKER_00So, just on that one question, you said they can be complete without checking. What would be an example of that?
SPEAKER_01Yeah, like uh checking how they look in the mirrors very frequently, seeking uh reassurance from friends, from family members, all the time. I mean, we all do that. All of these can also fall into uh what we call normal behaviors, but with when things become um significantly uh well clinically significant, this can go over the threshold. So it's creating a huge level of distress inside. In fact, I would say we we would call people with body image issues uh silent sufferers. It it all happens in a very quiet fashion, but it's not clinically insignificant anymore, if I'm making the point across.
SPEAKER_00Yeah, definitely.
SPEAKER_01So what I'm trying to say here is you can't just see body image distress just by looking at somebody. Yeah.
SPEAKER_00I'm thinking like talk about the the internal process of body image and body image distress. What would you say keeps that distress going over long periods of time? How does it continue through someone's life?
SPEAKER_01Hmm. So you're talking about why do these things get maintained? Yeah. Yeah. It often starts with something as simple as comparison, right? So seeing someone else, noticing something about your own body, and that creates a feeling, uh, often uh discomfort or shame. Then people try to manage that feeling, uh, maybe by checking in the mirror, uh, changing how they eat, avoiding situations or seeking reassurance, like I said before. The problem is these behaviors give uh short-term relief, but they actually reinforce the concern over time. So the cycle keeps repeating. There are two words we should remember here, which is reinforcement and habit. Yeah, so this is where things like shame and self-esteem and fear of negative evaluation comes in. If someone's self-worth is so so closely tied to how they look, then any perceived flaw, we have to remember it's the perception of the flaw, not the flaw itself. They may not even exist in real life, it starts feeling really significant. Shame can make people feel like there is something wrong with them, not just their body, but them as a person. And fear of negative evaluation, you know, worrying about how others might judge them, can make people more vigilant, more focused on their appearance, and more likely to engage in those checking or avoidance behaviors. So um emotion regulation again is a very important thing, which kind of maintains these behaviors, but it's also quite central. So for many people, these behaviors, whether it's checking or high restrictions or avoidance or ways of managing uncomfortable emotions, and they also become maintaining factors over time.
SPEAKER_00So the emotional regulation side is addressing the earlier stages of these beliefs and feelings, so you can tolerate some discomfort and um negative emotion rather than developing these beliefs and habits from the negative emotion to address it or counterbalance it almost.
SPEAKER_01Absolutely. Absolutely. So what we are trying to uh do in preventative work at our lab, we are doing some very interesting work on how to prevent body image uh dissatisfaction to become, to escalate into something bigger, is to teach good emotion regulation strategies. So um habitual, unhelpful, habitual ways of thinking, feeling, and behaving, you know, it doesn't take over.
SPEAKER_00Yeah. I want to go to again the earliest stages of how these disorders and levels of distress even can develop. One of the interesting, one of the more interesting topics for me that I wanted to talk about was the side of family and development and just early learning in general. So, how do early developmental experiences actually shape someone's you know, current and future relationship with their body?
SPEAKER_01This question I think I need to tread very carefully because um parents and caregivers actually want the best for their children, right? They want the children to be healthy and fit and all of that. So uh I need um your listeners to understand that I have a lot of respect for how parents think about their children and you know uh and their well-being and all of that. But when we think about body image, for example, it's it's really important to understand that it doesn't develop in isolation, it doesn't happen overnight, it develops over time within relationships and within environments. Yeah. So, and early experiences play a very big role. The messages we receive uh growing up, it can be direct or indirect. Um, they start to shape how we think about our bodies and what we believe they say about us. And family is often the first place this happens. Comments about food, weight, or appearance, even when they are um well intensive intentions, like I said before, can sometimes send a message that how you look is important or that your body needs to be managed or changed. And it's not always what is said directly. And we have to remember this, and this is a very important point that children are very observant. You know, now we know beyond reasonable doubt through research that's been done for decades and decades, you know, Albert Bandura. With social learning theory on observational learning. Children are like sponges. Yeah. Even when we know that, when we think that they're not looking at us, they are not listening to what we are saying, they are doing exactly that. And not only that, they are learning from it. So they notice how parents talk about their own bodies, how they they relate to food, or how they respond to weight or appearance in other people, like the parents' friends, for example. So sometimes parents are trying to help, maybe encouraging, um healthy eating or concerns about well-being, but the message, how the messages are being delivered to the children, can be internalized. For example, um, parents say something fairly innocuous, but the children may get the message that there's something about my body that isn't quite right. And over time, they can shape how someone relates to the body more broadly. As people grow up, peers and social experiences also become very important. We hear all the time, you know, teasing, bullying, comparison talks, or even early uh romantic experiences can reinforce the idea that appearance is linked to uh acceptance or rejection. And we talked about you know emotion regulation early on. The sooner these skills are taught to children early on, the stronger they'll be out in the real world when they're experiencing challenges like these. Yeah. So uh what we often see later in life or these early experiences, they just don't disappear, but they start showing up in patterns, and we should be mindful of that.
SPEAKER_00I find that really interesting. I think that's something a lot of people probably don't think about is the indirect forms that uh the indirect messages, sorry, that the kids are getting. And that's an interesting point that I hadn't thought about, even just with with parents and talking about their own relationship with their bodies, or maybe they're talking about someone else's um health or something like that. Yeah, I can see how that really develops this association of self-worth and value almost um really ties into how I look and my relationship with my body and things like that. Going back to the start of that question, you addressed how you want to tread really carefully with the parental aspect of that. What would you say caregivers could focus on if they want to support healthy body image? We talk about the direct and indirect ways that kids are getting messages. Is there a way that we can positively influence that early on as well?
SPEAKER_01Right. I think the most important thing is to um send a message that a child's worth is not tied to that appearance. Yeah, that that's a very important thing to do. So, this in reality, um in uh in pragmatic ways, what this means is shifting the focus away from how the body looks and more towards what the body can do, functioning aspects of the body and who the child is as a person, their strengths, their interests, their values. Yeah, but the frames of reference need to get shifted. And a big part of that also, Eddie, is modeling. Yeah, modeling as a human being. Children are constantly observing how adults talk about their own bodies, the food, their exercise, and even small comments like, oh, I feel terrible today, I need to lose weight, can have an impact. I mean, this is real stuff we are talking about, and we make comments like that about ourselves all the time. So the answer to what to avoid needs to be it's less about never saying the wrong thing. I mean, we all say, you know, not the optimum stuff many times, but it's more about being mindful of giving repeated messages that are unhelpful. So we have to start looking at what pattern of messages that we are actually sending to, you know, children out there. Uh, comments that focus heavily on weight and shape or appearance, even if they are framed as concern, can sometimes be internalized as, hey, something is not okay about me. So that's not a good message to give to children.
SPEAKER_00Just a question on one of the things you said at the start, and you were talking about we want to focus on the the function of the body and and the good things that it can do. How would you translate that um to a person that's suffering with a disability, someone that is physically impaired and struggles with that function aspect day to day?
SPEAKER_01Of course. It's a very good question, Eddie. And this is why early on I said body image is a very um complex issue. It's very nuanced, it's multi-layered, and um lots of things come into the equation. And so far, what we have discussed, I've touched only the tip of the iceberg, right? So um when it comes to disability, uh, for example, and the functionality aspect of it, there's a lot more than just functionality when it comes to body image, right? We are talking about a human being, and the value that we have as a human being, uh the functionality is one aspect of it, but our image of ourselves, our self-image, is a lot more than just the functionality, right? It's what we are able to contribute to ourselves and to the outside world as a human being. So this is why I said one podcast is not enough. So um when it comes to disability, for example, we can touch on so many things like human value, um, uh functionality, not just with that's attached to our limbs or any one organ in our body, but functionality as a human and what you're able to contribute to your own life, and what you're able to contribute to the world out there. So your relationships and you know, Bick, the father of cognitive psychology, he talks about a very interesting thing called the cognitive triad, which is the view of self, the view of uh the world, external world outside of yourself, how you view that, and the view of your future. Yeah. So when you're talking about someone with a disability, it's not just the functionality, it's how you are going to be viewing of yourself and how you're going to look at the world around you, and how you're going to look at the future of yourself and the world. All of those things should matter a lot. And so bring in how you think about it from those angles, and also about how you're managing your emotions, how you're coping with it in a helpful fashion, and how you're going to bring in more quality of life.
SPEAKER_00And all these things would be equally as important for someone that's not disabled.
SPEAKER_01Absolutely.
SPEAKER_00Yeah.
SPEAKER_01Yeah.
SPEAKER_00One of the like really interesting topics for me was to talk about social media and the influences that social media has, I think, to so many examples, and we could have a whole podcast on this topic itself. Um, how has social media changed the way that people experience their bodies? I'm thinking, for example, is it creating almost new vulnerabilities for kids that are engaging with social media at really young ages, or is it already just amplifying those vulnerabilities that are already existing?
SPEAKER_01That's an interesting question, especially, you know, uh today. Um I don't think social media has created body image concerns. Uh it's, I mean, we we have always had magazines and we have had TV for a very long time, and we have had celebrities for a much longer time.
SPEAKER_00Very true.
SPEAKER_01So I don't think social media has created body image um concerns, but it has certainly changed the intensity and the way that people experience them. And that's quite um uh uh significant, I think, the amplification aspect you mentioned. In the past, people were exposed to idealized images, but now they are actually part of a process, right? So they're editing themselves, they are posting, and they're tracking feedback. It's just amazing how much tracking that happens. And I know a lot of people who uh keep a very who are very vigilant about the tracking and they delete posts and messages when it doesn't show enough number of likes or the right emojis.
SPEAKER_00So is that reinforcement?
SPEAKER_01It's huge reinforcement happening and uh they are comparing in real time, so which is quite a huge risk factor when it comes to escalation of body image concerns. So it's no longer just passive viewing, it's a lot more interactive and it's very constant. It's like an eye but never blinks, it's it's always on. Uh it's become kind of a digital mirror that's always there. And what happens is over time that can make people more focused on appearance and more critical of themselves. Um that's quite a big risk factor, I think. Yeah.
SPEAKER_00Currently just finished uh Darren's uh course at university. He was on the podcast earlier, and we learned a lot about instrumental conditioning and learning theories of learning in general, um, or conditioning. It was clear that that wasn't the only way that we learn. But I think about just the general points of instrumental conditioning and the reinforcement schedules, how you're posting to social media, and it's that instant close time, like you're posting and you're instantly getting feedback as to whether it was successful or not. So it's this continuous reinforcement, but it's also variable, like sometimes you're getting good feedback, sometimes you're not, and it's going to increase that engagement with social media. I've always looked at social media uh from probably a negative point of view. Like I try to really limit my engagement with it, and I think a lot of people should. But is there a way that social media can positively influence body image to counteract some of the negative messages that are going around?
SPEAKER_01Yeah, absolutely. Social media is not inherently harmful, it really depends on how it's being used, yeah, and how people engage with it. That is um is and you know, I've been um looking at it, and especially in the last few years, it's actually there is a growing space online that promotes body diversity, um, it promotes recovery and more realistic representations of people, and that can actually be very validating uh for people, um, especially those who might be feeling very isolated in their experience. Um, so social media can be um very um useful and it can also provide access to communities, it can provide access to education and support that people might not otherwise have. I mean, in Australia, we are just so like remote and rural communities, it's you know very hard to access face-to-face support as much as people need. So social media can actually provide all of those things if people can only manage the algorithm, you know, the feeds that they are getting exposed to and how they engage with it. Yeah, yeah.
SPEAKER_00On on that point with the algorithm and and just the the continuous cycle that's going around on social media, um I think yeah, the positive, the positive, what's the word, the positive narratives that are going through is really good, but people are obviously always going to pay more attention to the ones that maybe target or or impact their vulnerabilities or their self-esteem. And it's that negative kind of cycle that's going around online where people will judge someone or maybe they feel insecure themselves about something, and so they're they're really projecting that back into the algorithm. Is that like continuous cycle what you would say is contributing the most to negative aspects of social media use?
SPEAKER_01See, with artificial intelligence these days, there are just so many challenges, and I do not think that we even know or we are cognizant of what challenges there are. Some of the um uh medias, you know, pick up even when as you're talking to a friend, they pick up keywords and then you get in your feed, and you may not even have intended for the feed to come through. So I think the time has come for us. We need to be extra vigilant about those feeds and how we engage with those feeds, uh, even in terms of you know how long you look at a certain feed, for example, um, and make sure that you engage with healthy uh aspects of social media. And that's there's plenty of the healthy stuff that's out there. So we need we I think the time has come where we need to be extra vigilant as to what we engage in.
SPEAKER_00Consciously engaging with social media rather than just passively reverting to it. Yeah, yeah. Have have some purpose of use rather than just checking it for the sake of checking it every single moment.
SPEAKER_01Exactly. And to be in the driver's seat, you know, not uh uh let social media dictate what we can view rather than you know us being on the driver's seat and deciding what appears on the social media.
SPEAKER_00Yeah, such a good point. So I want to transition more into the eating disorders. We've spoken a bit about body image now. When does concerns about body image cross the line into disordered eating or a clinically relevant eating disorder? And probably to start, what are some types of eating disorders that people can have?
SPEAKER_01Well, uh the key eating disorders that um some of uh some of them I think your listeners may already be quite uh um aware of. Um uh anorexia, of course, a very popular. Um a very uh small percentage of people uh experience anorexia nervosa, but it's one of the most serious of all um emotional disorders.
SPEAKER_00Um it's the most deadly, I believe.
SPEAKER_01It's the most deadly, yeah, unfortunately. Uh there is also um the uh bulimia, and uh there is binge eating disorder, which is um connected to higher weight. Um, but binge eating disorder can also um exist without uh in people without um higher body weight. And of course that is RFID, which is a new kid on the block, it's been just recently recognized, which is avoidant uh restrictive um intake of you know like eating disorder. So uh they're all um disordered eating and they're all equally serious, although they come in different names. Yeah.
SPEAKER_00I remember when we were talking, um, I think it was in the poll, just about the topic and things that we could talk about. And one of the things that you said to me that really stuck with me was people don't just sit within one category of eating disorders. And it's I remember the point that was really it really stuck with me. You said you have to be especially careful with treatment to not just address the one eating disorder, and as soon as you're starting to see the symptoms of that relieve, finish the treatment because it can really easily transfer into another uh disordered eating behavior.
SPEAKER_01Yeah. I'm I'm glad you remember that, Eddie, because we talked about so many things, and um this actually makes me um you know um say this right now. It's this is why it's very important to go to a qualified um clinician who has been trained to address eating disorders in clients because it's very uh it's a complex thing. And if you uh, for example, if people are having difficulty, this is just an example, if people are having difficulty with binge eating disorder, for example, and they are living with a higher body weight, and they go to someone who is not very well trained in eating disorders, uh, there is always a risk, and if this person has had anorexia previously in their life, then if that is overlooked, then there is a danger that when they uh remit from binge eating disorder, they may actually shift back to anorexia nervosa. So a very comprehensive assessment, uh, evidence-based psychological formulation and evidence-based um treatment goals and intervention plans, very, very important. And this can be given only by someone who has been trained to uh address eating disorders. I think we have diagnosed a bit, sorry. No, that's okay. But that was a good idea.
SPEAKER_00That was a really yeah, really good. So to address some of the core drivers of eating disorders, what would you say the key psychological processes or processes that most significantly underpin eating disorders and disordered eating?
SPEAKER_01There are a few key psychological processes, as you said, that tend to underpin eating disorders. Um, but Eddie, they all work together. Yeah, they don't work in isolation. That's that's an important thing to remember. One of the most central aspects is overvaluation of uh weight and shape. And this has been researched um by very many research teams around the world. And I think this is one of the key um risk factors in eating disorders that people who escalate from um just you know being worried about uh eating and then self-correcting and not having that develop into an eating disorder. What separates these two groups is an overvaluation of um uh shape and weight. Um alongside that we often see um difficulties with emotion regulation.
SPEAKER_00Yeah, you mentioned that with body image.
SPEAKER_01That's right. So the same thing uh spills over with eating disorders. So eating behaviors like very high restriction um with what people eat or binging, having binge episodes can become ways of coping with stress, anxiety, and um difficult emotions like mood. So emotion regulation again is a very uh key factor, I think, in eating disorders. But there is also a strong role for things like perfectionism. Some people have that as a personality type. I think one of your listeners' um questions later on, it's about hey, is there a personality type that's associated with eating disorders and body image? My very short answer to that question, which is relevant here, by the way, is um research has not given us it about a certain personality type, which is more prone to body image disorders or eating disorders. But there are some personality traits, you know, for example, perfectionist perfectionism. Or a very rigid thinking style, uh very regimented way of thinking about life in general, that's more uh that can be key uh risk factor to developing an eating disorder.
SPEAKER_00Definitely a lot of body image advice and like we said before, a lot of positive narratives going around, but a lot of negative narratives going around as well. Based on the research that you've seen and conducted, uh, what would you say actually helps to address this?
SPEAKER_01There is certainly, like you're saying, um a lot of um uh lot of advice online, and uh not all of it is helpful. What research has consistently showed is that change doesn't really come by fixing how we look, it comes from changing patterns in how we think, how we feel, how we behave. So it comes from uh changing, repeating patterns of thinking, feeling, and behavior. And uh it's not also like I said early on, not about just what we think, it's also about how we think, yeah, our thinking style. How much attention are we giving to certain types of stimuli around us? Are we selectively attending to those things? And how are we responding to the stuff that we have just attended to? Yeah, are we selectively rehearsing those information in a way that it gets pushed to long-term memory? Because if you know, we attend to a lot of things, but if we don't keep rehearsing them in memory, it doesn't stay there. It gets dissipated. So how we rehearse those information in our memory, how we process them cognitively, are we giving them enough weighting, or are we just saying, hey, I don't want to think about it too much. I want to move on to other useful things in my life, you know? So cognitive processing, emotional processing. Are we actually giving it so much weighting emotionally that it stays with us for the longer term? Or are we emotionally telling ourselves, it's bothering me now, but I'm going to do something proactive about it, something that's more solution focused? Yeah, all of those things and how we behave about those things. Are we going to be standing in front of a mirror, checking ourselves for a very long period of time? So it takes so much space in our life, or are we going to say, I'm I'm not going to be doing those behaviors, I'm going to be doing other stuff, I'm not going to be avoiding my social interactions. I, you know, there was actually a book written called Feel the Things and Do It Anyway. So it's about exposure and that desensitizes, you know, our feelings about stuff. So all of those things come into play, and that is health available. You know, people don't have to do it alone. You don't have to feel alone. That is health available, and we'll talk about it.
SPEAKER_00Yeah, on that point, um, and we'll jump into some listener questions um probably after this, actually. One of them also along lines with my question here: why is accessing support for eating disorders and disordered eating in general so difficult, uh particularly in Australia?
SPEAKER_01Well, um, it is and it isn't. Yeah. It is because geographically we are just so spread apart. Um and it is also, and it's not like you know, people who live in metro areas or um have easier access. When you're looking at uh parents of young children, people working long hours, and we just touched on disability, for example. There are so many um uh difficulties, even people living in metro areas, you know, having difficulties accessing help. However, there is also thanks to technology, there are lots of um um different uh modes of help available. You know, you look at uh I think I sent you a slide this morning with uh various different um uh agencies offering help. For example, Butterfly Foundation, they're providing uh support uh online helplines and resources. Um and uh the Australian government, you know, I have to really give them this one this time. Um they're they're providing uh Medicare rebates, um 40 Medicare rebated sessions for people with eating disorders, and that's quite a lot of sessions really, and this is on an annual basis. All people need to do is go to the general practitioner or a psychiatrist and get a care plan done, and they get access to uh 40 um Medicare rebated sessions to see a psychologist. So there is help available, uh, online resources. A lot of psychologists are doing um telehealth, so you can access if you can't travel um physically to go see a mental health practitioner, you can go see them. Um, you know, you can access uh help through telehealth, so that is help available. Um, so the key message I want to provide to your listeners is you don't have to do this alone. Do not feel alone because you're not alone in this. Help is available, and at any time in your journey with body image issues or um eating behaviors, you ever think, hey, maybe I should seek help, then that's the time. That's the time point where you should pick up your phone or go online and seek help. That's a very good time to actually do that.
SPEAKER_00Yeah. And I think just on the point with government addressing it, um, it probably ties into some of the misconceptions. But like we said earlier, it's got the highest mortality rate, like anorexia, for example, sorry. And I think overlooking eating disorders as maybe not that significant or not that dangerous is one of the key problems, um, and probably one of the the social factors that contribute to people not seeking help. So yeah, it's it's almost it's positive and negative. We want to, you know, not create these scared messages and and fear factor messages around eating disorders, but at the same time, we want to really emphasize that it's important to address, it is dangerous, and the 40 sessions are there for a reason. Um, yeah, just to make that point.
SPEAKER_01Absolutely. And this is one of the reasons I think it's been off the radar for too long a time, because of the stigma attached to it and whatnot. But now we know that there is no need for any kind of stigma to be attached to body image issues or eating disorders. I'll just very quickly mention about a survey done by Butterfly Foundation. This was a while ago. Um, more than 70% of, and this is Australian dollar, okay? So it's very relevant to us. More than 70% of us have problems with body image issues. I mean, I'm laughing, but it's no laughing matter.
SPEAKER_0070%.
SPEAKER_01More than 70%. So uh this is why um my lab, my research team, and myself, we are just so excited, we are so passionate about preventative interventions, preventative stuff. So we don't allow these things to escalate into say body dysmorphic disorder or a full-blown, you know, diagnosable eating disorder, and we prevent it early on. So um, yeah.
SPEAKER_00Yeah, yeah, super important. Um, before we jump into the listener questions, I thought of one when you were talking before, and it was kind of addressing that reinforcement aspect of body image that obviously spills over into eating disorders and tying into self-worth body image as a whole. If we were to say emphasize or compliment someone on the way they look, and maybe that's a positive, like it's a positive compliment, not a detrimental or negative compliment, is that almost significantly impacting the relationship with someone's body as well? Because we're we're complimenting them, like maybe for example, like, oh, you look great, and maybe they wake up that day and they think, oh, I look really skinny that day, or I look fit today, or whatever it is. And if they're getting that positive reinforcement from it, are we almost emphasizing that relationship with their body?
SPEAKER_01You know, um even psychologists may have very differing views on this. So um, whatever I'm going to say, take it with a grain of salt. I think as a community, as a society as a whole, we should perhaps shift the, take the heat of appearance and learn to compliment people on so many of the other things we can compliment people on. This is my just my take on it as a psychologist. As having seen people with body image issues and eating disorders for a very long time, I think we attach too much weighting on appearance. Yeah, right from the time babies are born. You know, we how many times, you know, we uh look at little girls especially, and we say, oh, you're so cute, and this, you know, you this pink is your color and it's so beautiful, and it makes us feel good, and I'm pretty sure it makes them, the little kids, feel very good. But just think where we are going with that. The messages that's being uh imparted in a very implicit fashion. Nobody means any harm. In fact, we actually want them to feel good, but how much of those messages get tied down to appearance?
SPEAKER_00Yeah, yeah. And there could be someone in the same room sitting there that has never gotten a compliment about that, and they're watching someone else get complimented, and that's indirectly reinforcing it.
SPEAKER_01Yeah. So uh all I want to say is there are just so many other things about us that would that deserve a compliment.
SPEAKER_00Yeah, personality.
SPEAKER_01Personality and the work we do and the contributions we make and those and so many hundreds and thousands of other things. So perhaps as a society, I think we should move away from just appearance-focused um yeah, compliments. Yeah.
SPEAKER_00I want to um thank all of our listeners who wrote in with their questions. We got quite a lot of feedback. I posted a little poll on our story that let people write in questions to ask you. We got so many. I had to really cut back on the ones. So I'm sorry for anyone listening if we don't address yours. Um, I've kept everyone anonymous, but I will read out the question pretty much as it was written. Let's do like a little quick fire response if that's okay with you. So the first question I have is how does bulimia affect a person in the long term even after they have been treated?
SPEAKER_01Why see? This is quite an important question, Eddie. I'm glad this got asked. Uh, first of all, bulimia, um, what research tells us is that it's got a remit relapse cycle. Yeah, more than other eating disorders in bulimia, people can have a remission, and then that is, you know, not all the time, they they can lapse, and then again they can get better. The good thing about bulimia also is that uh the prognosis is very good. A very large percentage of people, high percentage of people, do get better and stay better for life. So that's the good news about bulimia. That said, going back to this question, there can sometimes be lingering effects. Yeah, physically, depending on the duration and the severity of uh what they have experienced. There may have been impacts on things like um uh dental health, digestion, um, electrolyte balance. A lot of people don't um really have not given thought about the loss of electrolytes during the bulimia phase, but many of these um uh things improve uh significantly after recovery. Uh psychologically speaking, some people might still notice um certain vulnerability to stress, patterns of self-criticism. I don't know if you have uh watched Taylor Swift, she was recently on YouTube. She's amazing, she's such a champion, she has overcome you know some really hard um in the eating disorder phases, but she talks about how even in her total remission phase, some of those things do reappear and how she overcomes that. It's very interesting to watch that. So uh it is very easy to get some um a tendency to fall back into some of those negative stuff, but um, it's always uh important to keep contact with your therapist and to go for um um not you know weekly, monthly, or even a six-monthly kind of uh touch-ups, but but in bulimia, it's important to keep afloat psychologically because there is help available to do that day-ups prevention strategies. Yeah, yeah.
SPEAKER_00Funny that you mentioned Taylor Swift. My um my girlfriend Brooke loves Taylor Swift and I don't mind some of her music, I will say that. She's she's got proof of that now. Um, but I always play the role of oh no, I don't like Taylor Swift, I don't listen to her. But yes, she has been very positively influential for that space. I do, I do agree, yeah. So, next question I have. I think a close friend of mine is struggling with an eating disorder. What's actually the best way for me to support them without making things worse? They haven't spoken about it outwardly outwardly yet, but I don't want to make her feel uncomfortable.
SPEAKER_01Yeah. See, this is a really thoughtful um question, and it's I have a lot of respect for um friends like this who are um thoughtful enough to notice and to want to support, and um, and that itself is uh a very important first step. Um the most helpful approach, I would think, is it usually to come from a place of care rather than um concern about specific behaviors. So instead of saying something like, um, I think you have an eating disorder, or um, you know, I see that you're eating in a certain fashion, which would not be received very well, it can be more helpful to say, I've noticed you don't seem like yourself lately, or I care about you and how are you going, those kinds of very general statements. Uh, so keep it open, keep it not judgmental. I think that's the real key to it. And you don't really need to have the right words or solutions, just create, just create a space where your friend feels safe to talk, and that itself can make a huge difference. So it's okay if they are not ready to open up. What matters is that they know that you're there if they do want to talk about it.
SPEAKER_00Provide a space for it.
SPEAKER_01Yeah. And if the conversation does open up, you can gently encourage them to seek support, whether they are talking to a general practitioner or reaching out to services like Butterfly Foundation, which offers confidential advice and support. So be present, be kind, and let them know that they don't have to go through this alone. And that itself is, I think, a huge thing that it can offer.
SPEAKER_00For sure. The next question, um, quite vulnerable for whoever wrote this in. So thank you. At what point do I know that what I'm experiencing isn't just normal and that I might actually need to seek some help or treatment?
SPEAKER_01Well, that's such an important question. And I think the key thing is um that please do not wait until things feel severe enough to seek help. A very helpful way to think about is um if is it starting to take a lot of your mental space? Is it starting to feel more distressing, or is it influencing your behavior in ways that are affecting your day-to-day life enough? Yeah, so things like constantly thinking about food or your body, you're starting to feel anxious or feeling ashamed or guilty around eating or avoiding situations. Avoidance is a very big risk factor, or it's starting to feel that your mood is feeling getting tied up with how you look, for example. These are signs that this might be more than just a passing concern. And it's important to remember the entire um thing about what we have talked about today, the uh body image concerns and eating behaviors, it exists on a continuum, right? These things don't just come up overnight. So we are human beings, we react to life events. Um so we and we all bingit at times, uh, to the point where we are uncomfortably full. Um, we all, you know, um uh feel that we don't, we are not quite up there in some social situations, like with body image, happens to the best of us, right? But these things need to be self-correcting. After sometimes we think, okay, you know, we'll just carry on with life and we move on and we do helpful stuff. But if those things do not happen, if the self-correction doesn't happen, yeah, if you're if you find yourself getting stuck with certain aspects of eating behaviors that you think this is not really helpful, or body image concerns, you think, oh, this is kind of taking a lot of my mood space and my mental space, yeah, that that's when you think this is not okay, because now it's kind of getting escalated, maybe still not to a clinical staff level, maybe subclinical, but don't even let it go to that space to preventative work on yourself and you be on the driver's seat, you drive your life, yes, and seek help.
SPEAKER_00Yeah, definitely. Next question. I've noticed that sometimes what's going on mentally can show up physically. How much of eating disorders is actually psychosomatic?
SPEAKER_01Yeah. It's a good question because um of the choice of uh the word psychosomatic, because that I think that is a bit misleading. Um psychosomatic, um, because what we have talked about today, uh body image concerns and eating disorders, they these are conditions where thoughts and behaviors and physical processes are all interacting in a very real fashion, in a very complex fashion. So it's not just the mind, it's not just psychosomatic, it's mind and body working together. So where psychological and physical processes are very tightly interlinked, yeah. So um these are whole body conditions and not just mental ones. So it's I wouldn't call them just psychosomatic.
SPEAKER_00From your experience, how do eating disorders actually affect the people around someone like their family or partners? I don't know whether to speak up or go see a psychologist on my own. I don't want to stress my family out.
SPEAKER_01Okay. I understand what you're saying here. I'm speaking to the listener, of course. Um eating disorders certainly do not affect just the person who's experiencing it. Who's experiencing it? It affects, you know, it's it's like a ripple effect, right? The family, when they come to know of it, close friends, when they come to know of it, they do have emotional reactions to it. So I do understand what um you're asking. However, it's also very important to understand that you don't have to do this alone. Yeah. By not talking about it to very close friends, to family members whom you can trust, you are actually keeping it all bottled up inside and you don't deserve to do that. At the same time, you don't put the weight of um uh responding to what you're going through to families or friends. Because, first of all, they may not have the qualifications or the skills to deal with such a complex, complex stuff that you're what you're going through. So by all means talk to people you trust, but also like I've said quite a few times already, use it on the driver's seat, seek help. There is help available. If you can't go somewhere in person, there is online help for a start. By all means seek help.
SPEAKER_00Yeah. I think the the other point that I would add to that, um, the way the question was worded with I don't want to stress them out. Um your family and your partners are probably going to care. And that's actually a good thing. And if you're sitting there going, I don't want to add stress, if they knew what you were kind of experiencing on the day-to-day, that's and they if they knew that they could do something or if they knew that they could help, I'm sure everyone would rather know and be able to help or be able to support than not know. So I think, yeah, definitely important to validate the fact that they can have emotional reactions for family and partners, but that's not necessarily a bad thing, it means they care. Um, yeah, that would be the only other point I would add. I'd love for you guys to speak about APIs in undiagnosed people and how it can present neurotypically. So you mentioned before that that's the new kid on the block.
SPEAKER_01Well, it's certainly getting more attention uh these days and uh well-deserved attention. Um, ARPID is um really, it stands for avoidant restrictive food intake disorder. And it's quite different to other eating disorders because it's not driven by body image concerns at all. Instead, it's more about avoidance of food, often due to things like um sensory sensitivities or lack of interest in eating or fear of negative consequences like choking or discomfort. Um you would have known, you know, with some people, we uh families would call them fussy eaters. So we just don't know what is driving that behavior. So what we are increasingly recognizing is that of it can be uh present in people who might otherwise appear quite typical in their development and their functioning. Neurotypical.
SPEAKER_00I was going to say that's a that's a good point to speak on. There's a lot of um not debate but conversation around autism and ADHD and people with sensory differences experiencing alphas and it's neurotypical people as well. Everyone has sensory preferences, not just neurodiversities.
SPEAKER_01Yeah. Also, we have to understand that there is a spectrum here, right? So many people um have preferences, fair enough, or go through phases of selective eating, again, fair enough, which is quite normal. So that that's not off it. So let's not go all over the other side and say, no, I don't like broccoli, we have off it kind of stuff. Uh, to just to bring some lightness to it, that's all. But with off it, the the the key difference is uh the level of impact, yeah, whether it's affecting uh nutritional intake, uh, physical health, social functioning, or causing significant distress. So we have to see off it in perspective. So it's not just being a fussy eater, it's about when patterns of avoidance start to have a real impact on um health and daily life.
SPEAKER_00Yeah.
SPEAKER_01Yeah.
SPEAKER_00Last question for the listeners' questions. Um, bit of a funny intro to this one. Hello. I saw something on your story the other day about having questions about an ED, about eating disorders for an episode. I didn't respond fast enough, so hopefully it's not too late. Firstly, I love your pod. Thank you. And for context, I study medscience with a focus on neuroscience and psychology. I myself have a history of disordered eating plus bulimia, plus a few comorbid mental health and physical conditions. Throughout my experience, learnings and emerging research being conducted, the correlation between long-term chronic health conditions as a result of eating disorders are quite significant. Is this something that is often seen in practice? If so, how do you support patients who now deal with chronic disease? Good question.
SPEAKER_01So good question. Um, and it's also a very insightful question, and it sounds like it's coming from both uh lived experience and also the studies. Um, and this is something we do see in practice when eating disorders persist over time, they can have uh significant effects on uh physical health, uh things like gastrointestinal issues, uh cardiovascular strain, uh, hormonal disruption and uh bone health.
SPEAKER_00Especially for females with the hormone disruption.
SPEAKER_01Yes, very true. So for some individuals, even after recovery from the eating disorder itself, there can be ongoing or chronic health conditions that need to be managed. So, in terms of support, the focus now becomes more holistic and multidisciplinary. Yep. So it's not just about the eating disorder by itself anymore, it's about supporting uh the person in managing both the physical condition and the psychological impact of living with that physical condition. Uh, because we often see that uh chronic uh health conditions can bring their own challenges. I mean, psychologically speaking, uh just think about you know frustration, grief, grief of time lost, right? And grief of quality of life lost during the eating disorder phase or a sense of loss, and those experiences can interact with previous um vulnerabilities, you know, around control, body image, or coping. So part of our work is also about helping people develop new ways of relating to their body, particularly when it may feel unpredictable or change. So it's it's about adjustment. There is a phase of adjustment. So what is important is we work together as a team. Uh we bring in uh general practitioners, we bring in specialists, we bring in dietitians, we bring in psychologists to support both physical and the psychological well-being. And from a psychologist's perspective, we work on flexibility in thinking, self-compassion. Eddie, self-compassion is so under-researched and not woven enough into treatment of eating disorders. And our lab is doing, this is not for self-promotion by any way. I, as a researcher, you know, I'm very excited that our lab is doing fabulous work on weaving in self-compassion in lots of our studies. So um just going back to this question, focusing a lot, helping people focus a lot on self-compassion and building sustainable uh coping strategies. So all these become very important in um dealing with chronic health conditions.
SPEAKER_00Yeah, definitely. Well, yeah, thank you for everyone that wrote in. Um, I think that's definitely something I'm gonna continue doing because there were some really insightful questions there. So just to wrap up, what are your final thoughts on our topics? And um, if you could leave one message for any of the listeners, what would it be?
SPEAKER_01I think that is one thing I want people to take away from this podcast. It's that these issues, body image issues and even eating behaviors, far more common. Yep, you're not alone in this, and it's a lot more complex than we realize. And they are not about vanity or willpower, but about how we think, how we cope, and how we relate to ourselves over time. And importantly, change is possible. That's a very important message, and I want your listeners to really believe in that that change is possible. I see it all the time at my clinic, and not by trying to fix the body, but by shifting the patterns that shape our relationship with it. Yeah. Really tell Mary, what is more important than our own relationship with our body and our mind? That's the most important bit. And we lose it all the time. We think what others think about us, how others perceive us is more important. But what's really important is what we think about our own body. So if something we have talked about today resonates with you, you don't have to wait. You don't have to do this alone, and support is available. Um, this is one thing I very quickly want to mention that because it's such an emotive topic, if at the end of listening to this podcast you do feel not so fantastic, that is lifeline support available. 24 by 7. Just go to Google, type in lifeline, it'll give you the contact numbers. Call them, even you know, not for anything, um, long term, just to have a vent, and you'll feel much better. And uh, Eric, thank you so much for this opportunity. I think it's a privilege. I love talking science, taking science to the public, and this is such a lovely opportunity. Very grateful, really appreciate it.
SPEAKER_00No, thank you. Thank you so much for coming on, and yeah, I'm keen to collaborate in the future. Thank you.