CHECK YOUR HEAD: Mental Help for Musicians

Lindsey Stirling "Reboot": Anorexia Nervosa Recovery with Dr. Christina Wierenga (UCSD Eating Disorders Center)

• Mari Fong • Season 4 • Episode 3

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CHECK YOUR HEAD Podcast "Reboot" of Lindsey Stirling & Dr. Christina Wierenga speaking on Anorexia Nervosa recovery for Eating Disorders Awareness Week, 2025.

Mari Fong interviews Lindsey Stirling, singer-songwriter, violinist, and dancer, and Dr. Christina Wierenga, Professor of Psychiatry and Clinical Neuropsychologist at UC San Diego’s Eating Disorders Center for Treatment and Research. 

Lindsey Stirling shares her story of anorexia nervosa and the depression and anxiety that came along with it. Lindsey’s anorexia started in college and she takes us on her journey to recovery and maintenance of her condition. Currently on her 2021 Christmas Program tour, Lindsey recently dropped "Lose You Now" featuring Mako.  Next, mental health and eating disorders expert Dr. Wierenga shares new research on anorexia nervosa and the treatment steps that often takes a team of specialists to treat this serious condition.   

“Be brave, ask for help, and be persistent in finding the mental help that you need.” For free and affordable solutions for mental health and addiction recovery, visit: http://checkyourheadpodcast.com/

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SPEAKER_02:

Welcome to the Check Your Head podcast, the podcast where notable musicians and experts share their stories and solutions for mental health and wellness. I'm your host, Mari Fong, a music journalist and life coach for musicians, and today we're celebrating the holidays with an entertainer who's built her career on being a singer-songwriter, violinist, and dancer with music that crosses from pop to rock to EDM. Her albums Shatter Me and Brave Enough both won Billboard Music Awards for Top Dance Electronic Album, and she's collaborated with musicians such as Amy Lee of Evanescence, Rivers Cuomo of Weezer, John Legend, and Christina Perri. Our featured musical guest today is Lindsay Sterling, who's currently on her Christmas program tour, singing holiday tunes from her album Warmer in the Winter and dancing with her signature violin. Lindsay shares her story of anorexia nervosa, an eating disorder, along with the depression and anxiety that came with it. Lindsay shares her solutions for recovery and the daily maintenance that keeps both her mental and physical health in top shape. Next, we have expert Dr. Christina Waringa, a professor of psychiatry and co-director of the research program at UC San Diego's Eating Disorders Center for Treatment and Research. Dr. Waringa will share facts on anorexia along with the tried and true treatments proven to be most successful in combating this condition. But first, let's hear Lindsay Sterling share her story. I went to your Artemis tour. It's almost Broadway-like because you've got music, dance, costumes, and so many different themes to your music. And what I loved also is that you have this message of empowerment, being your authentic self, and also going for your dreams.

SPEAKER_01:

Well, thank you. My biggest hope is that they'll be like, wow, that was really fun. And oh, gosh, I want to go out there and do good things and I can do it.

SPEAKER_02:

Yeah. And you know, you're doing that with mental health. You have a song called Shatter Me. It talks about overcoming your eating disorder and touches on depression. What condition or what situation came first? What did you notice first?

SPEAKER_01:

I noticed the depression first. That's what made me realize something was deeply wrong. It came from me opening up to my mom and expressing to her. I was away in college. I feel like that's a very common time for people to start to sink into mental illness and mental health struggles is because you're away from home, you're experiencing a lot of uncertainty, and you're trying to decide who you are. But also those people around you, like your parents or your siblings or your best friends that have known you your whole life, they aren't there to be able to notice from the outside that something's off. Those people that can monitor you because they love you, they're not there anymore. You're surrounded by new roommates and new friends, and they think This is Lindsay. But even through the phone, my mom was realizing that something was deeply wrong. There was a very specific moment where I realized something was really off. And it was the depression that I recognized first, even though it was the anorexia that came first. The anorexia caused the symptom of depression. But depression let me realize like, oh, I need to peel back the layers and figure out where this came from.

SPEAKER_02:

Well, what was that specific moment?

SPEAKER_01:

My sister was my roommate. And... We were best friends growing up and were inseparable. And then she's my roommate in college. And by this time, I had become pretty unhealthy and not myself. I remember she was in the other room with our other roommates. There were six of us that lived in this tiny apartment. And they were all laughing at some story that one of the girls had told and just hysterically laughing. And I didn't even have the energy to get up from my bed to run in and be like, what's going on? Normally that's what I would do, normal Lindsay. But I just didn't feel like I could, didn't feel like I would be invited. I just didn't have the emotional energy to go and try to include myself. And then my sister Brooke comes into our shared room and she plops on the bed and immediately started doing her homework. And I remember wishing so badly that she would tell me what they were laughing at. So I looked at her. I thought, I don't even know her anymore. Actually, I don't remember the last time we laughed like that. And I just became acutely aware for that moment that something was wrong. Something was off. If I couldn't connect with the person that I connected with better than anybody in this world. And if I didn't feel the courage to say, hey, what was so funny? I just didn't feel like I had that with her anymore. And so that was the moment that gave me not only the realization, but also the motivation of like something is deeply wrong inside of me. And I need to figure it out because it's not worth sacrificing that. And so relationships, really, it was the relationship with my sister that made me willing to fight to figure out first what was wrong and then willing to fight through whatever it was to get it back.

SPEAKER_02:

Well, you mentioned just in that short answer, symptoms of depression, not wanting to get out of bed, not having the energy and not really feeling connected with even the closest people around you. I mean, I've gone through depression. I know exactly what it's like. It's so hard because these are people that you love, but you can't feel that connection anymore. And then also, when you're very depressed, things that are normally funny are just not that funny. And that is also really hard because good emotions are gone. You're only left with these bad emotions that kind of haunt you throughout the day and night.

SPEAKER_01:

Mm-hmm.

SPEAKER_02:

But you said you first started experiencing your eating disorder. Would you consider it anorexia? Would you consider it bulimia? It

SPEAKER_01:

was anorexia for sure. I just stopped eating basically.

SPEAKER_02:

Okay. And then what was going on in your life during that time? And what was your whole mindset about stopping eating? You know,

SPEAKER_01:

I think I've been prone to it my whole life. I have memories from being a tiny child. I think I was like six or seven years old and I was putting on a snowsuit. So I remember we were all getting ready and my mom was making sure everybody fit into a certain snowsuit and I put mine on and I remember looking in the mirror and just feeling like I looked so fat in the snowsuit. And I remember taking a belt and putting it around my waist to give myself a waistline and specifically bringing it to the snow so that I could put it on. I told my mom it helped me keep on the snowsuit, but it was really because I just had to see that I had a waist. So that was at like seven years old. So I think I've always had food issues. It finally manifested itself when I was in college. Like that's when it became a problem and I sunk into it and I allowed it to kind of take over my life and control me. And it came from the place of everyone saying the freshman 15 was a thing and I was determined not to get the freshman 15 extra pounds and also feeling insecure. And that's when I feel my eating disorder start to creep back in. Even nowadays, like even though I'm past it, it's still like, hey, tries to come back in whenever I am overly stressed or I'm feeling very unsure about whatever it is I'm going through. And college was the first time that I felt that that strongly.

SPEAKER_02:

College is a time where it's very stressful in so many different ways, right? There's so many unknowns. But you talked about insecurity. You talked about stress. And you also talked about how recovery is kind of a day-to-day thing.

SPEAKER_01:

Absolutely. I like to look at it like I went through my recovery from A to B, from that moment when my sister was on the bed next to me to when I felt like I finally could eat something bad for you and feel good about myself. That was a huge moment for me when I was like, oh my gosh, I feel like I'd made it over this huge mountain for the first time. Then there's those little relapse moments that happen I never had an enormous relapse where I fully got sucked back into it, thankfully. I didn't allow that to happen because it was so clear to me how that stole so much of my life, feeding into this eating disorder and allowing it to control me and allowing it to steal relationships and passion. Everything became sacrifice to that eating disorder. Nothing else mattered besides calorie numbers. numbers that showed up on the scale when I stepped on it. My whole life was consumed by these thoughts of trying to maintain this eating disorder and appease it. It was such a strong, horrible memory of a person that I really hated. I hated myself when I was stuck in it. It was enough for me to always remember nothing is worth going back to that. Although sometimes it starts to creep in, I feel like I've learned to manage it pretty well. I still have food issues. And sadly, it's part of my relationships still. It's something that I have to be openly communicative with people I'm dating about. The fact that I struggle with this, sometimes I'm going to have a little moment where my eating disorder comes back in and makes me feel horrible about myself. And luckily, I've had really great relationships that allow me to have a safe space to talk about that and say, I'm sorry, this isn't about you right now. This is because I am having a moment with my eating disorders trying to come back. And it's all mental. It's not physical anymore. It's not like I starve myself anymore. I don't go back to the physical manifestations of it so much. It's the mental mindset of self-loathing and self-hatred over not exercising or eating something bad or having a bad weekend with food, like whatever. It's more the mental state where I have to maintain to keep pulling myself out of it over and over again. Okay. You're talking about your mindset.

SPEAKER_02:

Yeah. So when you looked in the mirror, you looked at your body. I mean, were you focusing on the things that you didn't like about it? I mean, how unrealistic was your vision of what you saw in the mirror was? I

SPEAKER_01:

mean, I know to this day, I still have a very unrealistic expectation of what my body should look like. And that's really sad because I work hard on staying fit. In order to do the performances I do, I have to be in a pretty high caliber of fitness and I take care of my body. And yet I just have this very unrealistic expectation of what my body should look like. And I just have to remind myself that that's really not possible. And in order to get that body that I think I want, it takes a sacrifice that I am not willing to give. And that's where the mental health comes into play. It's like, if I was to look like that, what I think I should look like, My sanity has to go out the door because I have to sacrifice everything in order to be that. And weighing the pros and cons is so obvious that like, no, my expectation is just plain unrealistic for my body. And so I need to accept that. And it's something I continuously accept about myself back in the day. I didn't understand that. And so I'd look in the mirror and it would mean that I hated myself because my hips were too wide or my stomach wasn't as flat as I wished it was. And so I was willing to give up whatever it took in my own mind. Because to be anorexic, it's a full-time job. You literally don't think about anything else. I remember going on dates and not being able to focus on the conversation because I'd be panicking inside because he took me to a pizza restaurant. The thought of focusing on him was out the door. All I could do was barely keep up a conversation because in my mind, I'm trying to make a plan. I'm trying to make the plan of how I can eat just enough that he can not think that I am anorexic and also the plan of where I could go home and I could run. You're constantly making plans that will hide slash keep you from eating too much slash making up for whatever it is you ate so that you can equal it out in your mind. Like if I ate a piece of pizza, if I ran tonight and ran tomorrow morning and didn't eat lunch, that will make up for it. So anyways, it's just a constant mental blur so that you don't have anything left to have a friend, to have a passion. There's no room for it. When I look at my body and if I'm not happy with it, I stop myself and I'm like, well, what would it take to get the body that you think you want? So even when I was doing all of those things and I was 20 pounds lighter than I am now, I still wasn't happy. So I was like, okay, this is 100% a problem in my mind. And I remember learning that an anorexic mind, I can't argue with logic. Logic will always win because if you can talk facts to your mind, if you keep doing that, it will win over this ambiguous, like, well, you're not enough. Well, here's the fact. So learning more about it increasing my knowledge of nutrition helped me to talk sense to my brain and then weighing the pros and cons. It was quite a process to get to this point where now I can talk myself through it when I'm having those moments of like, ah, but I may sound like I'm super deep in it, but I actually live a very happy, what I feel is very healthy and normal life. I just have to have these little sit down talks with myself occasionally.

SPEAKER_02:

Well, you know, I think that's an important point to bring out because When people sometimes think of mood disorders or eating disorders, conditions like that, it's not like we live it day to day. It's something that's there. And then there's a maintenance that happens. And you're talking right now about maintenance and educating yourself to know the tools to keep it in check, recognizing it and saying, you know what, this is what I have. And a lot of people, it takes time to even embrace to say, I have depression or I have anorexia. Was that a tough journey for you?

SPEAKER_01:

You know, I was in denial about it for a really long time. I think my mom had mentioned it several times. Like, I think you have a problem. Not everyone thinks like this. And I remember just breaking down one moment when I finally realized it just all kind of sunk in finally. And it will sink in until you are ready to accept it because all the signs were there. Everything was there. And finally there was a moment and I'm so grateful for my mom because it was on the phone with my mom. And I finally voiced the words, I think I'm anorexic. And gosh, I get teary-eyed just thinking about it. But it was almost like a weight was lifted off my shoulders because her response was, you know what? That's okay. And we can work with that. We can figure this out. We all learn to solve problems our entire lives. Learning to play the violin was like problem-solving. Oh my gosh, my pinky can't hit that note. Oh my gosh, this is uncomfortable for my hand. You're learning every step of the way how to form your muscles to be able to fit this uncomfortable instrument that doesn't make sense until it does. And so being able to name it and put a label on it, it was like, okay, now I know what I'm working towards. Now I know what I can do to try to fix this and find the Lindsay again that has been completely lost. So for me, it was a huge relief. It's such a constant journey with mental health. I've figured out new things about myself even within the last year. Wow, suddenly I had pretty bad anxiety and I didn't realize I did. A lot of people experienced that in the pandemic and it was like, oh my gosh, okay, since I now realize that I'm struggling with this right now, now I can like address it and I can say, hey, I see you anxiety or I see you eating disorder and I'm going to learn to understand you so that I can now cope with it and live the full life that I know I can live.

SPEAKER_02:

Yeah, it's a long journey and it's a lot of trial and error to find out what works for you and your body physically, your body mentally, all of these things. But you said that you realized your anorexia when you worked in a treatment center for troubled girls. Is that when you recognized the symptoms?

SPEAKER_01:

That's not what made me so much realize it. It just was very ironic that I was going to school to be a recreational therapist, And I wanted to specialize with girls with eating disorders. So I don't know if my internal mindset was telling me, you need to study this. But then I started working at this treatment center at the same time, working with a lot of girls that have eating disorders. And so it did help me realize it by seeing these outward signs from all these girls I was working with who were very severely sick in this way. So I think if I hadn't been working in that environment, I don't think I would have to the realization myself. So it definitely was like just many little clues along the way, you know, but it was through my close relationships with my family that finally had the real, you know, I get it. Okay, I see it now.

SPEAKER_02:

It's so good to have a support system, whether it's family or friends or even like an online support system. Sometimes support can come from strangers or people you may not know very well.

SPEAKER_01:

To that point, I went to group therapy and I went to therapy as well with an individual therapist, but I found group therapy to be by far the most helpful. And I went to the BYU counseling office and she said, there's a support group of girls that have had eating disorders and then have had them and they pair you up and it's a, oh my gosh, that was game changing to go to. And it took so much courage. I skipped the first week because I was too scared. to go and say this aloud in front of people. But the second week, I remember telling my roommates I was going to a study group and it was a super secret meeting of girls. So we all felt very safe there. And I remember listening to them voice their concerns and the way they felt about simplest things like going on a date or going to a party. I was like, oh my gosh, other people feel this way. And it was really interesting to go from, like when I first realized I was anorexic, it was this mindset of like, wait, not everybody thinks like this. Not everybody thinks about food all the time. Not everybody's like constantly worried about, oh my gosh. So first it went from not everyone feels like this. And then I felt so alone. Wow, I'm alone in this. And then going to group therapy made me realize there are other people that feel like this. This isn't a healthy or normal quote unquote mindset, but I'm not alone. Like this is a thing. And so we can work through this together.

SPEAKER_02:

sometimes our conditions can make you think a certain way, negative thoughts, thoughts of worthlessness, self-doubt. Can you tell me some of the things that you thought of while you were in depression or while you were in your eating disorder?

SPEAKER_01:

Yes. When I was severely depressed and severely anorexic, I mean, it was to the point where I would look myself in the mirror and just... myself so much even voice the words I hate you to myself because I was so sad and I wasn't always like that so the person I'd become I hated that person who took away who I was really like I didn't know where to find the real Lindsay and so I just felt so like so worthless just going back to that place alone is what always motivates me of like it's not even worth going there

SPEAKER_02:

the other thing that is difficult is you're talking about being somebody that you feel like you're not, which is another thing that happens when you're in a mood disorder. You don't even recognize who you are sometimes with your thoughts, with your behaviors, and it's scary. Was it ever a time where you actually thought about ending your life or having suicidal

SPEAKER_01:

thoughts? I never struggled with suicidal thoughts. It was purely worthlessness and hating myself, but I never got to that point ever. somehow.

SPEAKER_02:

Okay, that's good. But it's important to note because those can be thoughts that go through your head during those times. What encouraged you to really start talking about all of this to your fan base and basically in general?

SPEAKER_01:

It came pretty natural for me to talk about it once I felt like I was in a really good place with it. It didn't feel good to talk about it when I was in the midst of it. But talking about mental health to me was so important because this is something I once felt so alone in and also something I was so unaware of. If I had understood at a younger age that eating disorders or that just unhealthy body image was a thing and body dysmorphia and all of that. I didn't even know about it really. I just knew they were words. I think everyone goes through some kind of a struggle where they realize, oh my goodness, I'm feeling really anxious or I'm depressed right now. It could be situational. It could be seasonal. It could be whatever. I just feel like, wow, this is so normal and it should be normalized. And so that's what kind of gave me the courage to talk about it. I wrote the song Shatter Me and it almost felt like an easier way to write about it was to personify it. And so I put it in the perspective of a ballerina stuck in a snow globe because that was an image that encapsulated how I felt like I was trying so hard to be this image of perfection, you know, this perfect ballerina spinning and what kept her perfect was snow globe. That image first came to me because I remember being in a little shop one time when I was really sick. And when I was very anorexic and seeing the snow globe and thinking I was that ballerina, she's stuck inside there. Everyone thinks that that little porcelain globe is just her perfect little world, but it's actually a cage. It's not protecting her. It's caging her. That was what inspired the whole shatter me ballerina story. And it was the first time I'd really expressed my anorexia. It felt easier for the first time to do it through a character. Well, I think that

SPEAKER_02:

describes it Perfectly, especially with depression as well. Sometimes you feel like you're trapped inside something that you can't get out of or people don't actually see what's going on inside of you. And sometimes you have thoughts that you can't even get out with words because of a depression or mood disorder. Now we're going to get to a time where things turned around for you with the depression and the eating disorder. What was that for you?

SPEAKER_01:

You

SPEAKER_02:

know, I can't

SPEAKER_01:

even pinpoint a specific moment per se. I just feel like there were little victories along the way where I was like, you know, I'm getting signs that I'm getting better. I remember my parents taking me out to Cheesecake Factory when I wasn't doing well. They didn't know yet that I was anorexic. And I remember we were so quiet on the way home. And it's because they could feel that something was off about me. And it's because I was in this... spiral in my head of hating myself based on what I'd just eaten and punishing myself in my mind already. And I could just tell something was wrong and where they're like, are you okay? And I was like, yeah, fine, fine. But I remember two years later on my birthday, I told my parents, I want to go to Cheesecake Factory. And I remember being so happy that I enjoyed what I ate and I ate what I wanted. And I didn't judge myself for things. And I remember just being so proud of myself in that moment. because I chose that I was going to eat that, and it's okay because I eat healthy most of the time, and I sure as heck deserve to reward myself sometimes. Occasionally indulging yourself to eat what you actually want and saying, I deserve this, that's a healthy mind versus always telling yourself you cannot have those things. Little victories like that just remind me that I'm still on the right track, and we all deserve to indulge and feel okay when we do that. That's part of life. That's what makes life beautiful and worth living are those moments where we say, I'm going to enjoy.

SPEAKER_02:

Well, also celebrating wins, whether they're big wins or small wins. And I think life is full of small wins, especially on a journey that has to do with a lot of trial and error. But when you have something like anorexia, at that point, there could be some kinds of therapy or things that you had to learn in order to eat in a healthy way. What kind of therapies or techniques did you learn to start controlling that?

SPEAKER_01:

I really did turn it into like a part or full-time job. Like I was going to college at the time. I was going to group therapy twice a week. I was going to a therapist once a week. And then I also started to meet with a nutritionist and I hated going to nutritionists. It was the worst. They would just tell you that you need to eat more. You need to eat more of this food, which included the terrible word of fats. And all these things that in my mind were like curse words to my body. I remember the moment when I hit 100 pounds. I remember crying because I was so sad and realizing that fat was being added to my body. So as I sat there crying, as I looked at the scale, I also gave myself a pat on the back because I was healing. You know, anorexia is such an interesting thing because one, you're dealing with an addiction. It's a mindset addiction where you are addicted to this lack of calories and you're addicted to the habits. It's very habitual and the results are addicting of seeing the scale go down. And so when you start to see this process reverse, it's weird because it's measurable. You have to face it every day, multiple times a day, and talk yourself through it. I remember sitting and eating food, and I would eat it and hate it. It was like a physical and a mental process. Because the eating disorder has taken over your mind and your body, it felt like it was me. Looking in the mirror, I would say, I hate you, because it felt like it was me. And it was really helpful to learn to separate myself from the eating disorder. I read this great book called Life Without Ed. This girl decided to talk to her eating disorder and treat it like a dysfunctional, abusive relationship. Because the eating disorder will reward you when it feels like you've done good and it makes you feel good about yourself in that moment. But then it makes you turn to self-hatred the moment you've messed up. And so it really is an abusive relationship where you feel comforted by it. and betrayed by it. And so I would talk to my eating disorder and I would talk through the facts and be like, I need to eat this meal. This is good for me. Fats can be good for you. And I would talk through the things I'd learned, the facts. And when I passed 100 pounds on the scale, I told myself, this is good for you. You're not even in your ideal body weight yet. This is healthy. This is what's going to help you. I would talk to my eating disorder. I didn't deserve to talk to that way when it would tell me that you're fat. You should eat that. I would talk to it and say, I don't deserve that. I deserve better and I don't need you anymore. You were here for a time and maybe you comforted me when I thought I needed it, but I don't want you anymore. That process of learning to separate myself made me start to recognize when the real me was coming back and this parasite that had taken over me was starting to slip away.

SPEAKER_02:

It's almost like a fish swimming upstream because this eating disorder, this anorexia, it can be very charismatic in the way it talks with you. I'm curious though, if let's say in your mind, you were able to achieve this perfect body, what would that mean to you? What would that bring to your life?

SPEAKER_01:

You know, I don't think it would have brought anything. It was a mental disease where you're chasing after something that one is never going to be satisfied. I was so skinny and yet it was never enough. But it's just kind of funny how the chain reaction happens. We all want to be loved because we just want to be happy. Okay, well, being loved makes you happy. So how do I get love? Oh, I need to just be what everybody needs me to be. And if I'm beautiful and if I'm thin, the guys will like me. I better eat less. And then all of a sudden, you're giving up everything in order to be thin. But it's like in the search for being happy and being accepted and loving myself, I gave up all the things that actually would have made that happen. It's just like you were on course to get something and then you just kind of got off course chasing something completely, completely different because having a skinnier body wouldn't have added anything to my life. And at the end of the day, it's like it never would have been enough. If it wasn't enough where I was at, it never would have been enough. And that's the logic coming into play. You know, and even now I'm dating a great guy. And when I have like a moment when I turn to him and I'm just like, I'm sorry, I'm being really quiet and awkward right now. It's because I'm having a moment where my eating disorder is trying to come back and it's telling me I'm worthless. I think you're beautiful just the way you are. Like if me being thinner, what is it for if it's not for the person who loves me? Like he doesn't need that. And so what does this add to my life? Absolutely nothing. You know, and it's that logic that kind of helps.

UNKNOWN:

Yeah.

SPEAKER_01:

You get back on track again. Like it's never going to make people love you more to have a skinnier body ever.

SPEAKER_02:

Absolutely true. And I think it's great that you've also included your family, your friends, the guy that you're dating about what's going on with you inside, because it's so important to understand that to also have them understand why you're behaving a certain way. Sometimes with depression or anxiety or any kind of mood disorder, we can seek professional help. And you did with a support group. Have you ever gone to a psychiatrist or had any kind of medication that assisted you in any of those situations?

SPEAKER_01:

Yes. And, you know, actually it was last year about this time. I was struggling so badly with anxiety. And, you know, it was an arena I wasn't familiar with. Finally, it was because of my sister. She was like, you should just try talking to a psychiatrist about anxiety. I think you have really severe anxiety and it's just getting out of control now. So I finally went and I got medication and it was some trial and error to figure out the right dosage. But oh my gosh, it was amazing when I kind of got through the clouds of it all to be like, oh my gosh. I feel like myself. I think a lot of times we don't want to take medication because you're afraid it's going to make you not feel like yourself or it's going to numb you or make it worse. And it did for a second while I was in that process of trying to figure out the right one and the right dose. But once we figured it out, I felt like myself again, the self I hadn't felt like for a while. And it didn't cure all my bad days, but it made it so that when I did have a bad day, oh, my tools actually work. I can use the tools I've learned from therapy. Oh, I can use them because my mind is not so darkened that I can't even turn to my tools. It just gave me the ability. And it made me realize, I was like, dang, I remember I did go to a psychiatrist when I was anorexic and they prescribed me medication, which I even picked up, but I never had the courage to take. I really think it would have helped a lot. I really needed it, but I wasn't in a place where I felt like I could take it. And I was almost like stubborn, like I can do this myself. I can muscle my way through this. I really think it would have helped me a lot quicker if I have allowed that to help me. And I'm not saying everybody should run to that first. So it's a great option to look into to see if it could work for anyone.

SPEAKER_02:

Yeah, oftentimes, just from the stories that I hear on the podcast, is that just accepting what you have is a huge struggle and also accepting help. beyond saying, I want to do it myself. Because I think that's the natural course is I can handle this. I can do it myself. I could figure this out, which is what we do often in life. But with something like an eating disorder, mood disorders, getting professional help will give you guidance toward what can work and what has worked in the past. It is still a trial and error with medication and therapy because not all medication is going to work well for you or your body, but it can make you have that stronger foundation and also make you feel more like yourself, which is what happens when you find the right medication for you. And you know, the answers may not even be medication. It could be lifestyle change. There's a lot of other things that could do. It

SPEAKER_01:

could be dietary. It could be all kinds of things. So yes, it's just interesting how I remember I was like, wow, I probably really could have benefited from a little

SPEAKER_02:

extra help. You talked about noticing your anxiety during the pandemic, and that's been a tough time for a lot of musicians. What do you do on the day-to-day to help prioritize your mental health? What's in your mental health toolkit?

SPEAKER_01:

Yes, I feel like one of the things that I did every Every single day through the entire pandemic was I would work out first thing. It just started my day on the right foot by getting up and knowing I had something to start my day with and I would work out. Then I'd make myself a yummy breakfast of oatmeal or a shake. At least started my day off with endorphins, you know, because I think that's a big thing that can quickly make me depressed is if I don't get the natural endorphins from a workout. And then also I end my day every day with a gratitude journal, which has been game changing for me to have that. Throughout the day, I am just a big proponent of listening to yourself, allowing yourself, understanding that I have depression or sometimes I have days where I get super anxious and allowing myself to stop and be like, you know, it's okay that you feel this way. It's okay. But this doesn't mean it's true. And I've really learned to differentiate between Something that can be so real inside of us, like the fact that I felt fat, that was real to me. Or the fact that in my mind, I'm thinking to myself, oh my gosh, this isn't going well. And my anxiety starts to like talk and talk and talk and take over. That may be real to me, but doesn't mean that it's true. It doesn't mean that it's anybody else's reality. So really like take these moments to let my brain talk to itself and figure things out so I can stop a spiral that can so easily take over an entire day.

SPEAKER_02:

Oftentimes, mood disorders can lie to you. They're really good at that. It feels real when you're thinking them, but knowing the facts and having to combat that inner voice that is trying to take you down. Oh, another

SPEAKER_01:

thing, probably the most important thing. I love self-help books or books on wellness or podcasts such as yours. I just have... some kind of audio on that's really positive in that way it just puts myself in a really good self-awareness space of like I get to make choices about how I feel about myself or reminding me about positivity or reminding me about my ego and not letting that overcome me like whatever the book is I'm reading it's really good for me to just do a little dose of that every day and I feel like to me that's almost more efficient having that daily check-in with a positive thing than therapy.

SPEAKER_02:

It's almost like therapy. You're like absorbing all this amazing knowledge and all that amazing education that you can use, you know? So total props to you for that. Now, I know that you've also done some charitable work with places like, you know, Atlanta Music Project. You have the Upside Fun, which sounds like you started especially for the pandemic.

SPEAKER_01:

I started it during the pandemic, but it was actually stemmed from something I had been doing for a couple of years. But something that I'm just super passionate about is people that get trapped in medical bills. And our system is so messy for that. And so many people get really stuck in it. After watching my best friend and my dad both go through and then pass away from cancer and spending so much time in the hospital with them. And then it's such a heavy, hard experience for anyone to go through. But then to also have to carry the medical bills afterwards. The Upside Fund is something I started to help my fans who are going through a medical crisis, whether it's helping them pay the bills or the medical bills. Just helping people navigate through that situation is kind of what the Upside Fund is meant for.

SPEAKER_02:

You have such a diverse fan base. I noticed when I went to your show that you have people that are adolescents. all the way to grandmothers and grandfathers in the audience. It's almost like a whole family can go to your show and be completely entertained. Is there anything else that you would like to say about your music, your tour, about mental health in general?

SPEAKER_01:

I feel so blessed that I'm getting to go out and do these kind of shows. It's been truly amazing. You know, it's been good for my mental health for sure to be able to go out and do what I feel like I was born to do and get back up there and make people smile. That's what I love. So I just am so appreciative to everybody who's come out and I hope that it's been, you know, I hope it's made them smile. We're also really excited for our Christmas tour. But as far as mental health, I think there's so much to be said for just looking at yourself and just giving yourself that time. To be like, am I the person that I really think I am? You know, am I the best version of myself? Or has part of me been covered up or slipped away? If that has happened to anyone, there are ways to get back to the person that you feel like you are. And there's always hope. I can honestly say I feel like I'm back to living my fullest life. And, you know, and I'm so grateful for that. The huge pitfall I hit once upon a time because it turned me into a person who's now self-aware of my health and my mental state. The fact that I hit so low made me no choice but to like really investigate. And so, yeah, I hope that people take a chance to look inward and say, where am I at? And am I my happiest? Am I my fullest self? Because there are answers and there's always, always hope. Who you are today is not who you have to stay. And I'm a huge believer in that.

SPEAKER_02:

Next up, we have Professor of Psychiatry and Clinical Neuropsychologist, Dr. Christina Waringa. Dr. Waringa is also co-director of research at UC San Diego's Eating Disorders Center, specializing in the neurobiology of eating disorders such as anorexia nervosa, and also actively treats patients with anorexia. Dr. Waringa will share evidence-based treatments along with new research on anorexia that will shatter old myths about this condition. Now let's hear Dr. Waringa share her knowledge and advice. Lindsay Sterling was so good about sharing her symptoms, her experience, her therapy, and how she got better. So we're going to focus on anorexia nervosa because this is what Lindsay is living with. Can you share some facts about anorexia?

SPEAKER_00:

Absolutely. You know, anorexia is a really puzzling disorder for a number of different reasons, right? If you think about just the ability to starve oneself, that is very difficult to do. And most people that try to lose weight can stick to a diet for a little bit of time, and then they usually rebound. So diets and weight loss Programs are not that effective. Yet individuals with anorexia are able to consistently starve themselves and lose a lot of weight. So that makes you wonder, what is it that enables these individuals to successfully starve themselves? And there's new research coming out suggesting that anorexia is really a brain-based disorder. So there are a lot of myths. about anorexia, which has contributed to the stigma over the years. People assume that eating disorders, anorexia is a choice, that it is a disorder of privileged white women, sort of a vanity disorder. And what we're learning is that it is in fact hereditary. If someone, especially if a woman has someone in their family family that also has an eating disorder, they are at 11 times more likely to develop an eating disorder than a woman without a family member that's affected. And so there is strong genetic hereditary components. We're learning that there's brain differences in those with eating disorders. These are real biologically based disorders. It's not somebody's fault. So it alleviates the blame of That's often associated in the guilt that's associated with having a mental illness. And so often we share this information with our patients and parents in particular, because in something like anorexia, when a child is refusing to eat, the child's experience is one of anxiety and fear of weight gain, fear of what this food is going to do. The parents' experience is they're being willful. They're being obstinate. They're being difficult. And when a parent can learn that what's actually happening emotionally for this child is that they are terrified. And they're terrified because the signals that the brain is giving them is telling them that this food is risky, that it's not rewarding, that there's nothing good coming from it. Parents are able to step back and say, oh, okay, I understand where this is coming from. I can manage this without... getting upset at my child. And patients have said to us, oh, now there's hope that I can recover because this isn't something I did to myself. And I know that I can rewire my brain through behavior and practicing new skills. And that's, this isn't something that I did to myself. So I don't have to feel guilty about it. I have hope that recovery is possible.

SPEAKER_02:

We could say the same about mood disorders. Sometimes people feel like we can control it or we've caused it ourselves in some sense. And we can also control getting out of a mood disorder. And if that was the case, mood disorders would not exist because they're really so challenging and so difficult to be in when you're in a bad bout of mental illness. And I know that you've done research. You've done neural imaging on the brain. And so are you saying that there's a certain part of the brain that is activated for people that have a predisposition to eating disorders?

SPEAKER_00:

Yes, that's exactly right. And I love that you use the word predisposition because that's exactly what we think is going on is that there are individuals that carry these risk factors or vulnerability factors that put them at greater risk for developing diseases. an eating disorder. Their regions of their brain respond differently than people without eating disorders. And so I mentioned the hereditary component is a risk factor, but how genes translate risk is actually what we're beginning to realize is through personality. And so individuals with eating disorders tend to share a lot of personality traits. And these include things like being perfectionistic, maybe tending towards high anxiety and obsessionality, high achieving. So in combination with weight loss, which can exacerbate these personality characteristics, it can throw somebody into developing an eating disorder. And Lindsay mentioned this, how difficult it is to get out of a a mood disorder or an eating disorder, oftentimes you don't realize when you're developing one. Lindsay did not realize that she was developing anorexia until she was doing very poorly. That sort of speaks against this idea that it's a choice because most of the patients that I've worked with have not chosen their eating disorder. They slowly realize that something is wrong and it takes them a long time to figure out what is going on.

SPEAKER_02:

That is what happened with Lindsay. And she said that even as early as six or seven years old, she remembered looking in the mirror and wanting to cinch her snowsuit because she wanted to see a waist. That's her first memory of really being very body image conscious. But when she went to college, that on top of feeling insecure and the stress of college, that it came out as full-blown anorexia where she had symptoms. And she also experienced feelings of depression and anxiety. So oftentimes there's concurrent things that are going on, right, with an eating disorder.

SPEAKER_00:

Exactly. What Lindsay's experience was highlighting what we sometimes call premorbid, predisposing factors like insecurity or discomfort with your body. Things that exist, they're not problematic. until somebody experiences other stressors. And sometimes those stressors are environmental trauma, bullying. Sometimes those stressors are related to puberty and hormonal changes. Eating disorders tend to onset during adolescence when there are a lot of brain development changes, hormonal changes. And what happens is oftentimes that increases depressed mood and it increases anxiety and one reaction. to that is to restrict food intake, whether it's intentional because you're uncomfortable and unhappy with your body. And so this dietary restriction and weight loss then contributes to this vicious cycle. So in the short term, it serves to regulate those emotions. It reduces the anxiety. It might numb out some of the depression, but weight loss in the case of anorexia actually then exacerbates long-term depression and anxiety. And you find yourself in this vicious cycle of restricting to feel better, but then the effects of starvation actually amplify those negative emotional experiences. And that's when it becomes very hard to get out of that vicious cycle. You know,

SPEAKER_02:

she did talk about depression. And I had a bad bout of depression. I lost my desire to eat. I could not feel the hunger response. And it scared me, of course. And I had to force myself to eat because I knew I had to. But in the meantime, I was losing weight. Do people with anorexia have that hunger response? Do they have it and they deny it? Or what is it that's going on there?

SPEAKER_00:

That's such a good question. And I think there's individual differences. A lot of people with anorexia will say that in the depths of their eating disorder, they lost those hunger signaling. And that's sometimes a sign of recovery is when those hunger cues come back. Other individuals will say that they could still feel the hunger signals. Our brain imaging research actually suggests hunger is such a motivating factor to drive somebody to eat, right? And in individuals with anorexia, hunger in and of itself does not activate the reward circuits of our brain to drive drive eating. So there's some indication that whether or not somebody subjectively feels hungry, somebody with anorexia, their brain response to those hunger signals is dampened. So hunger doesn't serve to motivate eating like it does in people without an eating disorder, which can help explain why they're able to avoid the temptation of eating. It's just not as rewarding.

SPEAKER_02:

One of the things we didn't talk about as much is that anorexia has the highest mortality rate of all the psychiatric disorders. So it's very important to start treatment as soon as possible because most people I would think come to you, they've already lost a lot of weight and there's already been negative effects that have happened with their body beyond just losing weight.

SPEAKER_00:

Absolutely. And that is such a scary statistic. And it's such a real statistic that anorexia has the highest mortality rate of any psychiatric disorder. And it's at 10%. 10% of individuals with anorexia die from either medical complications related to the disorder or death by suicide. So there is a critical urgency to intervene and intervene as soon as possible because Someone's life is at stake here. And unfortunately, the treatment is actually asking the patient to do what is most scary for them, which is gain weight and eat. And your experience when you were depressed and had no appetite, and I've been there too, where it feels impossible to eat. And that's what therapy for eating disorders entails. Something called intrasception, which is your sense of your body. altered interception or altered sense of their body. So even eating a tiny little bit can feel incredibly distressing. You can have terrible GI symptoms and feel full when you're not full. And so although it's absolutely critical, it is what makes recovery and treatment also very scary and difficult.

SPEAKER_02:

Can you take me through the steps of treatment, what you normally recommend for someone with anorexia? Absolutely.

SPEAKER_00:

Now, Anorexia, because it involves such severe medical symptoms, it's really important that people who have anorexia and bulimia, because bulimia is also very dangerous, seek treatment by specialized providers that are well experienced in treating eating disorders. Because oftentimes it really takes a team. It's important to have a physician who is monitoring weight and ensuring medical stability, a nutritionist. who is helping with meal planning and making sure that individuals are meeting their nutritional sufficiency in a way they're able to eat because it is so challenging. And then psychologists and psychiatrists for med management. So I work at UCSD and we offer a partial hospitalization program, which is considered higher level of care. So what that means is that individuals who are in treatment with us are in treatment six days a week. 10 hours a day. So it is very intensive. And that right there speaks to the severity and the need for treatment for eating disorders because they require oftentimes a high level of care to help weight restoration and helping with emotional factors as well. There's lots of people that are perfectly able to be treated at an outpatient basis. And coming from an academic medical center, we really... emphasize the importance of evidence-based treatments where they've been studied and researched and shown to be effective, the reality is eating disorder treatments are not very effective. And about 50% of people relapse after treatments. And so we as a field need to develop better treatments. And people that are seeking treatment, it's really important that you find treatments that have an evidence base. And one way to do that is by identifying academic medical centers or seeking treatment through programs that are affiliated with university hospitals and colleges.

SPEAKER_02:

That's great advice. Lindsay mentioned also the importance to her to be involved in a support group. Can you tell me the advantages or the benefits of a support group? Absolutely.

SPEAKER_00:

I think it is invaluable to participate in group therapy. And I can't tell you the number of times that I've said something and it falls flat. And somebody with lived experience says it and it resonates because it is authentic. It's coming from their own personal experience and it is so powerful. Here at UCSD, we do lots of group therapy. Most of our curriculum is group-based. And we have parent support groups. One thing that I haven't mentioned is just the importance of having some support when you're going through recovery, whether it's a parent or a spouse or a roommate. It's really hard to do recovery on your own. Lived experience is important. So valuable because it provides a more authentic perspective than anything else.

SPEAKER_02:

And there's nothing like having someone by your side that has been in your shoes. They could speak from an emotional standpoint and also talk about their recovery and giving that person hope that, yes, you can do it. I did it. You can do it too. You know, we talked a lot about therapies. Are there any medications that prove to be a good supplement when you have an eating disorder?

SPEAKER_00:

There's only one FDA-approved medication for eating disorders, and that is Vyvanse for binge eating disorders. So what is typically done is off-label treating other symptoms of eating disorders, like Abilify or Lamictal. tend to be really helpful in treating anorexia. And in part, because they work on both the dopamine and the serotonin systems, which are both implicated in anorexia. So those tend to be antidepressants and mood stabilizers. Atypical antipsychotics tend to be prescribed the most.

SPEAKER_02:

You've educated us a lot on anorexia. Is there anything else that you would like to say about anorexia or about mental health in general?

SPEAKER_00:

I am just so grateful that you are opening the conversation. One of the reasons I love working with folks with anorexia is that the personality traits that put them at risk for the disorder are also traits that set someone up for immense success in life. It is really exciting to be able to help somebody change the course of their life so that they're able to achieve the things that bring value to them. hoping that this will bring people hope that recovery is possible. A

SPEAKER_02:

big thank you to our musical guest, Lindsay Sterling, and our mental health and eating disorders expert, Dr. Christina Waringa. For more information on Lindsay Sterling and to purchase tickets to our 2021 Christmas program tour, visit lindsaysterling.com and follow Lindsay on her socials at Lindsay Sterling and at Lindsay Sterling Music. For more information on Dr. Christina Waringa and UCSD's Eating Disorders Center, visit eatingdisorders.ucsd.edu and follow them on their socials at UCSDEDC. You can also find this information by visiting checkyourheadpodcast.com for a long list of mental health and solutions for recovery. So until next time, be brave, ask for help, And be persistent in finding the mental health that you need. at Check Your Head Podcast. Watch us on YouTube and support us with a kind donation on checkyourheadpodcast.com. Check Your Head Podcast is sponsored by a 501c3 nonprofit with all donations being tax deductible. Thank you for your support and thank you for listening.

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Mari Fong

Host
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Kat Jensen

Producer