78. Let’s talk about eating disorders

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Speaker 1: Hello, and welcome back to the Psychology of Your Twenties, the podcast where we talk through some of the big life changes and transitions of our twenties and what they mean for our psychology. Hello everybody, Welcome back to the show. Welcome back to the podcast. New listeners, old listeners, Wherever you are on the world, it is so great to have you here. Before we jump into this week's episode, I have a really exciting announcement. We launched merch last week for the podcast. It was designed in collaboration with my friend Sydney, who was on the show recently back when we did the dating in our twenties episode. She is a local Melbourne artist. We have sweatshirts and tote bags we ship worldwide and it's an amazing way to support the show, to show your love to have a really cool piece of fashion, a cool item to We're out and about, so if you would like to purchase a sweatshirt, a toebag, maybe both, whatever you're feeling, please feel free to go to the link in the podcast description or to the link on our Instagram to get your hands on some really cool merch. This is a bit of a different episode to what we normally do. As much as this podcast is very much centered on psychology and mental health, we don't often talk about specific disorders, and I get requests, you know, quite a bit to talk about conditions like personality disorders or mood disorders, but I do often shy away because I like to create content that I think everyone can relate to and that really brings and breaks down those universal experiences of twenty year olds. But this is a bit different the amount of requests I get for this topic, the amount of personal experiences from friends of mine that I've heard. I just think that we can't talk about our twenties without talking about our attitude and our habits towards food and towards health and exercise. And with that comes a very necessary and I think natural discussion around eating disorders. So today we're going to talk about it. This is obviously a really sensitive topic for some people. Whether you have a lived experience or you've been impacted by the journey of a close friend or a family member, you know, this condition is so life altering and emotional and personal. So please take a moment to reflect on whether this is the content you need to hear today. It could be triggering. You know, I won't mind if you listen to something else. This episode will still be here when you're in a better headspace, but just something to flag. I think eating disorders don't always receive the amount of factual, reliable attention they deserve, and when they do, it's often in a way that is really romanticized or based in misinformation or stigma. You know, we've all seen depictions of eating disorders in movies and TV shows. We've seen how disordered eating has been glamorized by social media, from Tumbler to TikTok, and how many misconceptions are promoted out there about eating disorders. So we're really here to set the records straight and hopefully provide a new perspective on the impact they have on our twenties, both from a scientific lens but also reflecting on lived experience. I'm really excited to have on a lovely guest for this episode, who will be joining us later on to discuss her own unique path to recovery. She was so incredibly vulnerable and insightful, so I cannot wait for you to hear from her. But before we get to that, I really do want to give a bit of that bird's eye view from a clinical psychological perspective of what this class of disorders really is and what it means for people who are going through it, who are experiencing it, you know, not just anorexia and bulimia, which I think is what we typically think of, but also binge eating disorder and orthorexia. We're going to discuss the psychological underpinnings and the origins of eating disorders, whether they emerge from childhood or later triggering events, the different classes of eating disorders and how they impact our emotional and psychological wellbeing, along with some of the opportunities for treatment and for recovery. We're also going to hear from Emily a little bit later on. I think that having someone who has gone through this on the show is so valuable because we often only really, like I said, see it glamorized. So as always, there will be more information and links in the description of this episode. I'm just really excited to share a new perspective, to share some of the science and some of the research. So without further ado, let's dive in and talk about the psychology behind eating disorders. In our twenties, eating disorders may seem like a modern day condition that's kind of been created by recent social fixations with thinness and beauty and calories, but there is so much historical evidence they've existed for quite a while because they aren't just cultural or social constructs. They are very serious mental health conditions that originate from our emotional and cognitive experiences, not just our society's relationship with food at a given time. There are reports of people experiencing symptoms of what we would now label as anorexia or bulimia way back in the fifth century, men and women starving themselves because of mental health conditions or for spiritual purposes before we even had a label for what they were going through. In fact, the first known name for anorexia it actually appeared in the sixteen hundreds, and at the time it was called nervous consumption, which is a strange name for it, but the description of the symptoms it really doesn't differ much from our current diagnostic profile eating disorders. As the name suggests, they are primarily related to a class of mental health conditions that pertain to persistent eating habits, behaviors, and compulsions that negatively impact our health, Our emotional state and our general ability to kind of function in all areas of our life. And they are most prevalent amongst people in their twenties. That is, within the typical onset window. It's when symptoms normally climax. And they're also really complex disorders and they're not all made the same. I also think that it's important to note that not all elements of these conditions are solely related to eating. You know, there is a massive cognitive and emotional and mental component to their onset and longevity. It has a lot to do with exercise and a few other things as we'll talk about, But there are three main eating disorders that we would typically say are the most common or that show up in the DSM. So the DSM is the Diagnostic and Statistical Manual of mental disorders. So if you haven't heard about it before, it's essentially like the Bible for all possible mental health conditions, and it's used by clinicians to kind of identify symptoms and provide an explanation to patients. Now, this does not mean that there are not other variations of these disorders. You know, there are only currently three eating disorders in the DSM, but just because other conditions or experiences or symptoms don't have a specific diagnosis, it doesn't mean that they don't exist. There can be variation, and it's actually a huge point of contention and debate around eating disorders and the use of the DSM. You know, not every condition is going to present in the exact same way you know with everyone, and have a simple list of criteria is often going to exclude some people who might not fit the mold. But that is obviously a discussion for another time. The three that do appear are anorexia nervosa, bulimia nervosa, and binge eating disorder. So that's what we're going to talk about today. I think the disorder that we typically think of when we hear the term eating disorder is anorexia. Onset is normally, you know, between the ages of twelve and twenty five, which is really heartbreaking to hear that. You know, children at twelve years old are experiencing this, but really anyone at any age is afflicted by this condition because it is so harsh. It's so harsh on our bodies and it's so hard on our minds. It's characterized by symptoms of extreme dieting accompanied by an intense fear of gaining weight, having a disordered body image, which is eventually means that you don't see yourself the way other people see you. You don't see yourself clearly or objectively, and also drastic weight loss. Now those are the criteria given by the DSM, but drastic weight loss is not always a characteristic of all people with anorexia. And I think just because someone is an underweight or thin, it doesn't mean that they're not suffering. You know, people have different metabolisms, different body structures and shapes. I think it's also worth noting that someone who has just started displaying symptoms of anorexia may still be what we deem a healthy body weight, but it doesn't mean that they aren't still experiencing distress and experiencing symptoms. These instances where someone is not what we would call underweight, it's known as atypical anorexia novosa, and it occurs in situations in which someone meets all the other qualifications. You know, they have restrictive eating, they might be exercising excessively, but they're not currently underweight. And the thing to note is that there's symptoms the you know, some of the other symptoms other than body weight. Between atypical anorexia and what we would say is typical anorexia, they're all still the same. You know. We see food avoidance, we see obsessive compulsive symptoms. You know, for example, people with this disorder, they may have really ritualistic, compulsive eating habits or safe foods that they form an obsession over. They may have this need for a sense of control or what they put in their bodies, but they also have things like anxiety around food and social situations, which comes off as almost social anxiety or potentially a social phobia, but also things like hair loss, chronic fatigue, insomnia, and anemia. It impacts every facet of our health, not just physical. It's something to really remember and someone doesn't have to appear thin to be experiencing anorexia. I think that's something that we really need to reframe, not just in the psychological community, but also within society. Anorexia is actually one of the most difficult psychiatric conditions to treat, not just in the class of eating disorders, but across the board, and it has one of the highest mortality rates associated with it because this level of dieting puts our body under such intense strain, and it becomes an addiction. These methods for weight loss become coping mechanisms, and they become reinforced when people see what they deem as results. And what essentially happens is that the more they are almost internally and subconsciously rewarded for their behaviors and for their habits, the more ingrained it becomes, the more reliant they become. And it's also a substitute for control over other areas of their life, so it's hard to break free on I don't really want that statement to seem like it's meant to discourage people. You know, there are so many people who have and do and will recover, but it is really worth noting. Also, it's quite interesting because despite being I think, the most thought of eating disorder, it's actually the least common amongst those diagnosed with this condition. So only three percent of people who are diagnosed with an eating disorder would have what we would call anorexia. The most common is actually binge eating disorder at nearly forty seven percent, followed by bulimia at twelve percent. So it's interesting that I think when we think eating disorder, we typically think of someone who was very thin and who starves themselves, which is of course a very much valid part of the community. But it's also important to focus on some of the other conditions that people may have. So let's talk about bollimia first. Bolimia has a later typical onset than anorexia, at around twenty years of age, and it does often begin with excessive dieting before we kind of see that slide into what the typical symptoms of bolimia may be. So that is the binging and then purging or fasting that is characteristic of this disorder. So what essentially happens and what people would probably be looking out for if they thought someone was suffering from this is an instance or a repeated pattern of behavior in which someone rapidly consumes food before entering into a period where they try and expel or burn those calories as quick as possible, either through the methods we typically think of, but also by taking laxatives, by avoiding water or excessive sweating like in a sauna or a steam room. Like anorexia, this disorder is also accompanied by an excessive concern about body weight or appearance, and it follows this cycle of kind of normalcy in which someone feels like they're in control, and then a temporary loss of control when consuming excessive amounts of food, followed by anxiety, by guilt, by fear, even and then relief when they are able to purge those calories from their system. And that cycle is what makes this disorder so troubling because it involves the use of food to regulate mood, and it's an important link between all of these disorders. It's not just about food, it's about the use of food as a means for control. People who are living with this disorder, they will often experience a number of other health problems and symptoms, like abnormal heart rhythms due to an electrolyte imbalance from binging and purging, dental issues from the enamel on their teeth being worn down by acidic acid that comes from their stomach nutrient imbalances, and a regular menstrual cycle which is also typical of anorexia, fatigue, burnout, exhaustion, heartburn, ulcers, and anxiety depression so many other things. It's also accompanied by delusions a lot of the time, and this preoccupation with how we look and what we would call is body dysmorphia, so a failure to clearly see what other people see when they look at us, and it has a really close relationship with our self esteem, with our sense of agency, with our sense of security, with our self worth. Bolimia is an interesting disorder because it's actually been suggested across multiple studies that certain individuals may actually have an inherited or genetic predisposition, whereby, if you have a close relative or a parent who was diagnosed with Bolimiana vosa, there is between like a fifty to eighty percent chance that you're more likely to develop symptoms. This is a really interesting insight to me because I think that it shows that these disorders are not just individual, they're not just behavioral, but they all have a lot to do with our genetic blueprint and how our minds operate. Let's talk about binge eating disorder. You know, binge eating disorder is actually a relatively newly recognized condition. It's only really been in the DSM for the past five to ten years, which is so surprising to me because nowadays it is more diagnosed, it's more common than breast cancer, it's more common than HIV. It's more common than schizophrenia, but it hasn't always gotten the recognition that it deserves, and I think that really shows how the medical community can sometimes be quite slow to catch up because I think binge eating disorder, unlike anorexia and unlike bulimia, it's not glamorous and I hate to use that word, but glamorous in the sense that there's part of it that is accepted by society. You know, we accept diet culture as part of society, but we don't accept We're very judgmental around people who we deem as overweight with this disorder. I think it's really important to distinguish between occasional overeating and a binge eating disorder. You know, we all have times when we eat past the point of being full, you know, maybe at Christmas or on birthdays, or just because the food is really young. But in those instances, it's not a compulsion. You have control. It's also not a repeated behavior. It's not life altering. It doesn't feel like something that you can't stop, and I think that's a really important distinction to make. Some of the other core symptoms include eating unusually unusually large amounts of food, often by yourself, or an isolation because of the associated guilt and the associated shame, eating until you are uncomfortable or feel disgusted, feeling like you have no control, And like so many of these disorders that we've talked about, it's often accompanied by social isolation, by problems functioning in your personal life, and occasionally weight related conditions, although that's not always the case. It's much more likely that people who are experiencing binge eating disorder may even be deemed a normal weight and putting that in quotation marks because I think that is very much up for debate what a normal weight means. And unlike other disorders we've spoken of today, binge eating disorder actually has a much later onset, so for women it's in there early to late twenties, and for men it's most typical and onset typically begins during middle age, which is really interesting because I think that we have this misconception that our late teens and our early twenties are the time when eating disorders are most prevalent, but that's really only the case for bulimia and anorexia, which is why I think binge eating disorder is often misunderstood or often not thought of when we think about this class of conditions. There are some really amazing content creators and TikTok's out there who really take us along for their recovery journey. And I think it's really worthwhile to see these people in the media, even if it's social media, because it's important to humanize this disorder and understand it better. Because there are some really brutal misconceptions that you know, it's just for people who have no control or who struggle with their weight, and it isn't really disorder, but it really is. It's diagnosable, and so I think that I would really encourage you to look into the lived experience of people with binge eating disorder. It's just so valuable to really understand where it sits. I want to quickly mention orthorexia so we don't have that much time to really deep dive into it, but I think it's so worth mentioning here because it's a relatively new idea or a relatively new condition. So it was only introduced back in nineteen ninety seven. It's still not in the DSM, but it's become so much more prevalent recently. So orthorexia. It's also known as clean eating disorder, or an unhealthy obsession with eating healthy and only consuming what we see as clean foods, normally in an effort to maintain one's weight or because of an this obsession with optle nutrition to the point where it negatively impacts our well being. It's not completely understood. Like I said, it's relatively new in the scheme of things, but initial theories have linked it to things like OCD, obsessive compulsive disorder, health, anxiety, and this extreme fixation on the purity or cleanliness of what we put in our bodies. Eating disorders often develop in our teen and younger years, although we know that that's not always the case in all circumstances, and there are a number of researched and hypothesized kind of psychological and environmental or social origins or triggers for eating disorders, ranging from our early childhood experiences to other mental health disorders like anxiety, parental upbringing, and even genetics like we mentioned before, so let's actually start with genetics. We know a lot of mental health disorders like bipolar, depression, anxiety, even schizophrenia. They are more common amongst people who have a close relative who has received a diagnosis, and the same goes for bulimia, the same goes for anorexia and for binge eating disorder. There appears to be some genetic predisposition amongst individuals who experience symptoms, and this also has a lot to do with the release of neurotransmitters like serotonin and dopamine, which we know is controlled by our genetic blueprint. So studies have shown that people with anorexia or binge eating disorder, they actually may have less serotonin available to their brain and this impacts things like impulse control and impacts things like our relationship with reward like gratification, and therefore our eating habits. There have been some suggestions that this heritability hypothesis, it isn't about biology, It's about exposure. You know, if you have a parent who restricts food, who constantly talks about their weight, you pick up on that because of your close environmental proximity. And a lot of people think that it's not so much biology, but it's about your environment. But there have been studies that have shown, you know, people who have been adopted who weren't raised with their birth parents or twins who have been separated at birth, Their likelihood of developing and eating disorder is genetically linked. But it is an important, I think factor to bring up here. Our social environment is going to be a massive contribute, not just our close family, but our friends, our school environment, the broader context of our cultural and societal environment as well. And it begins young, it begins really young. If close parental or family figures have modeled an unhealthy relationship towards food, whatever that may be, we learn from that, We pick up that behavior. These people are our teachers, they are our role models, and we mimic what they do. You know, if your family is constantly making comments about your weight or someone else's weight, about the food you're eating, the food they're eating, how your clothes don't fit right, how you need to be strict with what you put in your body, that passes on to us. Other research even suggests that childhood bullying is also a massive predictor, but not just amongst kids who experience bullying, but also kids who have bullied. You know, it's always that saying that the bullied becomes the bully, right, Like this same reasons why someone who's been bullied might develop an eating disorder, are the same for those of people who do bully. It's a self esteem thing, and I think also the opinions of our peers are deeply influential and deeply harmful at a young age when we are so vulnerable. But it also comes from even more insidious and inescapable sources like the media. I think, especially in Western cultures like Australia, there are so many socio cultural influences that promote thinness as the main indicator of beauty, as a contributor to our happiness as a desirable trait, and with that it also promotes an unhealthy relationship with food like crash diets like fasting and calorie counting. Repeated exposure to this rhetoric, to this perspective, it unconsciously feeds into how we see ourselves and not only our relationships with our bodies, but also with exercise and with our food. These environmental and social causes are often the most common triggers I think we think about, but it can be a lot more complicated and nuanced than that. There are certainly personality traits that greatly influence the development of these conditions. Things that have to do with our psychology, things that have to do with our mental health, our emotional state. One of these is OCD, so obsessive compulsive disorder. Like we've mentioned before, this is a tendency to obsess and have intrusive thoughts. So obsessive compulsive of disorder is the kind of experience of obsessions and compulsions that bring about a sense of control. And when we think about how that relates to eating disorders, a lot of the eating habits that we've spoken about, it's not about food. It's not always about the calories, it's not always about weight. It's about using food as a means to bring about control in our lives, especially if you are someone who has experienced trauma or PTSD, if you've never felt like you had power in those situations, food can become a substitute for the control that you wish you had. Perfectionism is another major contributor, especially in people with anorexia. So there is research suggesting that it is an overly represented personality trait amongst these individuals, alongside things like low self esteem, low self worth, loneliness, anger, anxiety. All of those emotional experiences can be projected onto something within our control, and that is what we eat, what we put in our body. It's not just one thing though, it's not just one factor. It's a risk profile. It's a series of things that come together and can be triggered by an event or by our environment, and that leads to this pattern of symptoms that we associated with eating disorders. I think it's really easy to feel like a lot of this is outside our control. Eating disorders are so insidious and difficult to treat at times because it's not as simple as beauty standards. It's inextricably linked to our emotional and mental state. That's why they're called disorders. And I think it also just goes to show how misunderstood this class of conditions can be. There is so much misinformation out there, so much unscientific opinions and research, so many random people trying to give advice, and I think sometimes it's important to take a step back and really look at what the science and the research has to say. And here about people who have actually gone through this. Here from someone with a real life perspective. So that's what I want to do next. I want to bring on our special guest to talk us through how an arexia manifested for her how it impacted her teen years, her twenties, and her path to healing and recovery. I am so excited to be able to bring on our amazing guest, Amalia, who is the host of the Recovery Talk podcast. It's incredible. Additionally, she works as an eating disorder recovery coach and just makes some amazing, amazing content, has some amazing lived experience, and some amazing insights. Welcome, Welcome to the show. Thank you so much for having me. Yeah, of course, I feel like your way of talking about not only your eating disorder but as a class of mental health conditions is really really refreshing. So I was like, I've got to I've got to have you on. I really want to like start the beginning. So you run this amazing podcast called Recovery Talk, and what kind of inspired you to kind of begin that? So ten years ago, Wow, it's been a while. Ten years ago, I was going through my own eating disorder recovery. I was recovering from an eract sinagal subdinge approach subtype and my treatment was pretty good, but I was told a lot what to do, but not why and I'm a person that's so I love science. I like knowing why is this happening to me? Why do I need to do this right? I wanted to know the science of eating disorder recovery right, and I didn't necessarily get that from my treatment. So I essentially started heavily researching eating disorders. And I found so many things, so many studies, so many articles that were so helpful for me, but they were all very well going to say, very scientific, and at that point, also English is my second language. Especially ten years ago, my English was it was okay, but it wasn't completely fluent, so a lot of it was very difficult to understand. And I had a bit of an audience because I've been sharing my eating disorder recovery journey on Instagram, so I had a bit of an audience there, and I was like, wouldn't it be great to take this very scientific, a little bit difficult to understand content about eating disorders and the biology of eating disorders right and share that with more people. So I started a platform called Let's Recover, started as a tumbler, and I would essentially take these studies such as for example, Minnesota starvation Study and studies about eating disorders and translate them to a little bit easier to understand language and share them with a lot of people, and that became very popular, and then one thing led to another, and eventually I started a podcast essentially doing the same thing, talking about the science and psychology of eating disorders from a lived experience and also as an experience ass and eating disorder recovery cult and also someone who has a psychology degree as well. So I'm using a bit of different what can I say come to the topic in different ways and angles, And I absolutely love that because I feel like that's a perfect intersection with what we kind of do on this show, right, Like there are all these sometimes very inaccessible scientific ideas or topics that have a lot of impact on our daily lives. So I absolutely love that. I really want to understand what you're eating disorder kind of means to you. Can you briefly maybe explain you're eating disorder those of us who might not be fully across what anorexio novosa is and the difference between that and bollimia and other disorders. So I started developing and eating disorder when I was in my teens and it was kind of fluck training a bit between different eating disorders, which is maybe one thing that people could be aware of is that and eating disorder people tend to very often create very strong separations between anorexia, bulimia, binge eating disorder, but actually very often they overlap. Right, So I had anorexia and an avosa binge perch subtype is my diagnosis, which essentially mean that it is predominantly anorexia and very significant restriction, but also having elements of binging and then perching afterwards. Right, So it's kind of like anorexia and bulimia overlapping. I started developing that in my teens, and I was I was very very sick. I was very very isolated. I was very unwell, but also a little bit in denial of how bad my eating disorder was. And this is also something, interestingly enough, that turns out to be a key symptom of an eating disorder, is that people with eating disorder tend to be in denial of the severity of their illness and also about the fact that the illness exists in the first place. Right. So I was really struggling, but thankfully eventually I got into treatment it was very very it was rough, right, what did outpatient treatment? And yeah, I have been recovery now for ten years, and it is difficult to understand exactly why I develop an eating disorder and what it was about. Very often when especially when you come out on the other end of having recovered from an eating disorder, you want to know, Okay, what was that all about? Right? Why did that happen? And I eventually I think it was a combination of factors that made me vulnerable. I was quite depressed. I had bad mental health during that time, which made me more vulnerable. I was struggling with you know, my body image, very common when someone is in their teams. And then I also think that part of it was also this is where the more scientific part of it come in. That seems that I had a very abnormal reaction to undernourish length. Right. So people with anorexia, when they end up in an undernourse state, it tends to it tends to set off what I tend to call a switch, right, where a person with anorexia will be rewarded for engaging in, you know, very restricted behaviors which for people without inorexia would not be rewarding at all. Right, So essentially becomes a bit of a vicious cycle where my brain would reward me for engaging in very restricted behaviors combined with a denial of the fact that I was that ill in the first place, Right, And then it just became I was very stuck, right, become very stuck in your state, and your brain is still undernourish, can't quite think clearly either, Right. I think that's a really interesting perspective to bring in terms of the interactions between risk factors. So you talked about you had other predisposing mental health conditions, but also how the condition is almost promoted by that undernourishment, right, Like it is that vicious cycle or that vicious interaction that I think a lot of us when we hear about eating disorders and we don't have that knowledge or that lived experience, or haven't practiced in treating eating disorders, don't really understand how nuanced and difficult that interaction was. So you developed anorexa, you said, like in your late teens, early teens, late teens, yes, late teens, And how did that kind of impact your life? You know? I think often what we forget is that it's not like everything else in your life disappears and it's just a disorder, but maybe it does feel like that. So what kind of impact did it have on you? I felt that the food restriction essensity brought on just life restriction. Right. I was very very isolated because at that point, the eating disorder became my only friend, right, it was, I was. When you're that undernourished, it's very difficult to you know, engage in life, engage in friendships, engage in studies in the same way that you would if you were renourished. Right. And of course different people have different levels of function. Right. There are some people who can be very very severe with in eating disorder, but they may be completely able to keep a job right or do well in studies. And the way that it affected me probably the most, was just the isolation. Right. I completely lost interest in the outer world. Although I was interested in was food. The food obsession was extremely strong. And this is actually, interestingly enough, very much a actually a response to the starvation. Right. You see, people when they're very starved, they become very very interested in food rights and the food seeking behavior. Not necessarily always eating, but things such as cooking for others. Obsession with food very very interesting in food that became my life, right, that was the only thing that I found interesting, So very very isolated. But in a way, I didn't realize how isolated I was because it felt like, oh, yeah, but I don't like being around other people right then. Not get me wrong, I'm a big introuct but jing eating disorder, I just couldn't have meaningful relationship with other people because I was so consumed with my eating disorder. That's really it's quite sad really that it takes over so many other parts of your life. And I think that obsession with food thing is is also it's kind of like common sense, right, like if you're starving your body, your body is immediately going to be seeking out that nutrition and creating obsessions. The other interesting thing that I came across, like researching this was this idea of safe foods, particularly for people with anorexia. And we talked about a little bit briefly before, but can you explain that a little bit more, because I feel like that's such an interesting part of this disorder that isn't really spoken about much. Yes, so with anorexia and also with certain other eating disorders as well. It's very common that the amount of foods that the person like, the type of foods the person can eat without extreme fear, guilt and anxiety response really really shrinks. Right, So maybe someone starts cutting out certain foods, when then they just cut out more and more to the point where they only have a very small amount of so called safe foods, right, and save foods are essentially foods that the person can eat, often in again limited amounts, without as much anxiety as certain other foods. Rights, sometimes there still could be anxiety even eating the so called safe foods, right, So that is essentially what safe food is. I had during the worst of my eating disorder, and what can I say, The amount of safe foods I had was so so small that it was just you can't really sustain human life, right And interesting enough, when you really really restrict your foods to very few foods, then what is very natural is that you're going to start, you know, binging on foods that are fall outside of that safe food repertoire. Right, So I would have binge per genorexias. I would restrict myself to a very very small amount of very specific safe foods. But then as soon as if there was access to other foods, then I'll be very scared of eating them because I felt like I couldn't control myself around them. Right, And you said it said very well, you know that it must be a completely natural response when you are restricting your food intake to be more obsessed with food and have more like food seeking behavior, right, And this is true. The problem is that a lot of people eating disorders, they think that this response is evidence that they should stay away from food. Right. For example, they see a really restrict your intake and then they become obsessed with food. They binge when, for example, chocolate is available. Then they think, oh, this just shows that I should stay away from these foods. These are foods are bad. Right. So the constat against self fulfilling cycle, where you avoid more foods you have, the amount of safe food becomes smaller and smaller, but then in response, you start being focusing more on other foods. Right. I remember during my INNOREXC I would get so much satisfaction out of just reading food recipes, looking at pictures of cake. Right. And this is a very normal behavior, but in the moment you think that will what is going on with me, right, And it just really goes to show that I think a lot of people think about eating disorders just as the behaviors, so just as the restriction, but it has so much to do with the mind. And you know, you have such an amazing scientific knowledge I think about this. So where does that fear kind of come from? Like I know in the DSM they talk about you, it's primarily a fear of gaining weight, It's primarily to do with physical appearance. But I know it also has a lot to do with control, and that fear and anxiety kind of combines with that. So can you explain that a little bit? More? So? There is disagreements in the field exactly about what is this fear? Why do people with eating disorders act so strange? What is going on there? Right? There is no one clear cut answer. But what I would say, from having had an eating disorder myself, and also from working with people eating disorder and having spoken to so many of them, is that the whole fear of fear of fatness, Yeah, it maybe a role. And we live in a society that's kind of reinforced that, right. We live in a quite a fat fulbic society is of course this is reinforced. But I think reducing an eating disorder down to being just about this morbid fear of weight gain kind of simplifies and trivializes it. For me, I didn't necessarily like weight gain was not necessarily a massive fear for me. It was just like I had the fear, but that was not like the driving force. The driving force was that this rules and rigidity. You know, when you have a very undernoish brain, your brain becomes very rigid and very you know, you loose out on that cognitive flexibility. Right. And the way that I tend to see more the fear ass is almost like a phobia. It's like a fear response in the brain gone wrong. Right. So normally we tend to fear things that are kind of bad for us, right. We tend to fear if a big bear comes running after us, we're gonna be like, okay, Well, fear response kicks in to protect us, right, And I see that a lot of times. But with eating disorders and is that there is a wrong fear response towards food, right, or towards certain foods. So it essentially is a bit similar to an anxiety disorder. Right, I tend to sometimes make people understand just how extreme the food the fear can be. It can be kind of like imagine if someone is terrified of spiders, is like being in a room full of spiders crawling towards you. That is how an eating disorder can sometimes feel like, right, and at the same time you feel can feel kind of ridiculous because it's like, why would you be scared of something as fundament and to ask food? Right? But essentially our brains don't always make much sense, and the starvation also reinforce the fear, right, so it becomes a reinforcing cycle with their fear response gone wrong. That is my interpretation of it. But then again, different people in the field will have different different takes on it, some more scientific than others. Right. And I really love how you pointed out the link between in this case anorexia, but really any type of disordered eating or eating disorder, and phobias and anxiety, because they are so linked that there's been studies that have shown that similar parts of our brains are activated by the behaviors that we use to to kind of mitigate anxiety and those that are activated when people control or restrict food, and also that eating disorders are often comorbid, so they occur alongside things like PTSD or things like a phobia, perhaps one that's pretty similar in nature. I really like there was something you mentioned before that we haven't spoken about yet that I think is really valuable, but also something that not everyone will maybe know about. And you mentioned outpatient care. So when did you kind of begin to get help? And I know you mentioned you you're an outpatient in outpatient care or not in an impatient facility? What does that really entail? Outpatient essentially just mean kind of that's the words suggests that you are getting the treatment, but you're not hospitalized, right, You're not in a treatment facility twenty four hours, right, So in patient would be someone who's in a psychiatric clinic or in some kind of treatment residential clinic. Right. So my treatment was outpatient, which meant that I would go to treatment with would see doctor, I would see a dietitian, and also would see my therapist. In the beginning, it was twice a week or sometimes it's a bit more, and then gradually reduced seeing the amount of time I was doing that, right, And essentially I was at a point in my own REXDA, where I was quite poorly physically, was to a point where they were like, if you don't comply with our patient treatment, that we're putting you in patients, right, And I really didn't want to go in patients, right, That I really didn't want to go there. And the reason why I really didn't want to go there was because I knew that if I went in patient, I would have to eat bread with jam. And I was terrified or eating bread with jam. And I was like, if I can avoid eating bread with jam and instead create my own kind of work around that and eat safe foods instead, I would do that. And that's just a lot about how sick I was where that for me, that bread with jam was like my biggest fear, and I was like, I need to do everything to avoid eating it. And it's just so bizarre. But because a lot of times you hear people saying, oh, yeah, I had this turnaround moment I realized I need to work on my health, But for me, it was more just like fear of going in patient was what motivated me to engage with out patient treatment. Right. Just to be completely honest, Well, thank you for sharing that because I think that it doesn't really glamorize it. Of like you said, like there was this massive turning point or I realized that life is worth living. It was like, actually, you know your recovery it sounds like it was still there was still fear in that in that period. There was still there was still this motivating factor of of avoiding or not so much restricting, but that phobia around specific foods. And what was your experience like moving throughout patient And maybe this is a dumb question, but was there a point where you were like, Oh, I'm actually on the end, I'm feeling better, I'm really committed to, you know, being able to eat bread with jam or being able to fully recover from this from this disorder. Yeah. So that's a very good question because when I started recovery, I was very much waiting for like a light bulb moment. I think that is often the narrative here on eating disorder recovery. Don't get me wrong, that is a lot of people's experience. They may just be like, oh, I realized life is short and I'm doing this right. But for me, there I often say that my lightbulb moment was realizing there is no light bulb moment, right, because I was waiting for that moment to happen and it just kind of didn't. Right. The closest thing I came to a moment of WHOA, I'm doing better, WHOA I got this was actually when my brain became properly renourished, right when I had put on some weights, when I'd been eating more consistently for some time. It was almost like my brain went a bit back online, if that makes sense, right, And thankfully I had a psychologist that was very much explaining this to me. So the psychologist essentially said that you may not be completely receptive even for therapy and for talking and talking before you are more renourished. And I put on some weight, right, So I remember the point where I started being like, WHOA, I actually I think I got this, Like I'm better was when I put on some weights. Not saying that in eating disorders magically solved by putting on some weights or eating more, but I'm saying that some of the cognitive symptoms tend to lessen, right, And that is when I was more like, WHOA, maybe there is a life outside of this. Right. Of course, I did have moments during my early recovery when I was like, yeah, maybe maybe I can do this, you know, I had, but the motivation was very ambivalent. And I think this is one thing to be aware of with eating disorders, that people with eating disorder eating disorders recovery can be their biggest fear and biggest goal at the same time. And it's very very common to be very ambivalent, jump from oh I can't do this too, I'm doing this sometimes in the span of like an hour, Like I see this all the time with clients, right, they will be they will jump from one to the other. The ambivalence is very very strong, right, So yeah, that's kind of my experience, but of course everyone has a different experience when it comes to that. That is so interesting because I love what you just said then about you can. You can recovery can be both your biggest fear and your biggest goal. And how when you just in your experience, when you started putting on weight, you found at those cognitive functions started to come back. The perhaps elements of the irrationality that is very much a characteristic of this disorder kind of went away as well. What do you think was the biggest factor in the success of your recovery or what do you think really was able to bring you to a place where you can kind of talk about this now, because I think I was researching this and it was really quite sad but also quite you know, interesting to see that a lot of people with anorexia don't always recover, and it is a really hard psychiatric illness to treat. So what do you think was a contributor to your success or your journey? I think there are several factors here, so I will I think one of them is that, you know, my treatment system was I was quite lucky with having a good psychologist and having access to treatment, right, because that's another thing with eating disorder treatments that very often is quite inaccessible. Right. I was in Norway at this point, which is my home country, and there the treatment is completely free of charge and pretty high quality. So I think that I would kind of think that that the privilege of that definitely was a factor. But of course, even in Norway, when people have access to treatment, not everyone recovers, right, So that was one thing. Having a good treatment support and also a good treatment support that's very much echoed the fact that yeah, you need to eat you need to put on weight. You can't just sit here and talk endlessly with us and walk around it in circles and psychoanalyzs. You need to eat as well, and we will sort the other things, but you need refeeding. I think that for me was very, very crucial. And also think part of it is my personality type. And I see this in a lot of people with anrexia, say the kind of like they're a little bit like, we do this or we don't right very much when I, for example, factionism, it's the perfect actionism in some ways. When I was given the task of recovery, and I was, for example, I was given a meal plan, I was kind of making a meal plan in collaboration with dietitian. We were working our way around it. But then I was very much like, okay, I'm doing this. I'm not half doing this, right. I think that is my personality that I'm very like, okay, all or nothing, I'm doing this, or I don't write so but that is very commentary in some people with a rexia. Right. But then, of course we know that the rates of full recovery unfortunately aren't always so high. You know, the relapse rate is very very high, and that is very unfortunate. I think it comes boils down to lack of facts to treatment, the nature of an eating disorder, and just also sometimes the treatment system isn't always so great. There is a lot of Yeah, there are a lot of misconceptions about eating disorders, even within the treatment system that also make it more difficult. Another thing I think is I found a good I found good support also online, and don't get me wrong, online eating disorder recovery communities can be very, very triggering, especially when you, for example, see TikTok, the recovery community there. I took it. I'm not on TikTok, but I took a look there and I was like, whoa, because I wanted to see what my younger clients we're looking at, because they kept saying TikTok is triggering, can be very triggering. But I was very lucky to access, for example, the scientific papers and learning about eating disorder. And then something kind of clicked in my head. I am very again comes down to the personality type personality thing. I am very like science minded, Oh this is what it is. And then I felt like scientifically, recovery makes a lot of sense. Right, Yeah, that's so interesting. Yeah, yeah, yeah, I think that was big factors for me. Yeah yeah, oh that's really very interesting. And you talked about this very bravely. But like the misconceptions around eating disorders, around anorexia in particular, what are some of those that you come across, perhaps with clients or on social media or just in the general media or rhetoric that we have around this class of conditions. I think the biggest one is weight, right, So, and eating disorder is not necessarily a weight disorder. It is a mental disorder where weight loss can be a side effect in some but not all cases. Actually it is only in the minority of cases with people eating disorders are underweight, right, So, my case of anorexiam being quite underweight, that is one of the more rare presentations of an eating disorder, right, So, I think that is the biggest one. People tend to think that an eating disorder when someone has an eating disorder, you can see it because they're going to be very underweight. That is not necessarily the case. Some people may gain weight, some people may lose weight, some people may fluctuate, some people may not have them any weight changes, and again, it's not necessarily an indicator of the severity of the illness, right, So that is one big misconception. Another one is that misconception that it only happens to women. That is not true. It can happen to people of any gender. And also people tend to think that it happens only to very young people can happen to people of any age. So overall, I think the biggest misconceptions is on who it affects and how it presents right. And I think it was really interesting when I was looking I was researching this topic and going back through papers that I had read previously, really deep diving into it. I was like, you know, there is this image when we mentioned or talk about eating disorders. It's an image of a woman who is very underweight in her early twenties or lighteens. And it doesn't account for the fact that bingating disorder exists or believe me, or that there aren't people who are what we would typically say an unhealthy way or underweight, or there are men or people of many genders who experience this, And I think that's so. I think that's something that we have to kind of retrain the narrative and change the narrative around because it doesn't make treatment accessible, it doesn't do much for the stigma and discrimination. So I think that's an amazing point that you that you brought up. I do want to say, so you do a lot of counseling. I think that's amazing, amazing work. What would be one huge or maybe less huge, just a significant piece of advice that you might give to someone who's listening to this right now, who's like, Okay, well, I want to recover, I want to heal from this. What would you say to them? What advice would you give to them? I think my best advice would be do that work and don't postpone it and think that there's going to be a magical future moment when you're ready to recover, because that's not how an eating disorder work, right. Seek the help now. And also when it comes to treatment, if you seek out help and you find that that particular treatment is not really working for you, right, then it's okay to take another form of treatment. Right. For example, I see some people may start, you know, psycho analyzing their entire childhood and feel like that doesn't really help, and they realize they need a bit more of a practical maybe they need to go for an in patients stay, or maybe they need to be a bit more focused on refeeling, you know, find out something that works if you find a treatment team that you feel is on your side, but also find a treatment team that is against eating disorder. If your treatment team seems to be just fearing the same thing the eating disorder is fearing, that, probably no good, right, I hear this A lot of people have Their treatment team would be like, Okay, yeah, don't put on too much weight. Oh, don't get to you know, you don't be careful, don't eat too much, right, I'm not joking. This is unfortunately, it's I know it's ridiculous, but unfortunately it is a common experience. Right, So find a team that's on your side, and don't postpone and think that you're magically going to be ready in the future, because that's not how I'm eating disorder work. Trust me, I work with people who've thought that, and they've at eating disorders for several decades. Right. But I also want to say that if you are someone who've had an eating disorder for a long time or a short time, recovery is possible. There's another thing. I see people I've had an eating disorder for a long time, did me think that their case is impossible to recover from? But that is not necessarily the case. Recovery is still possible, So please please don't lose hope on that sense. That is such a positive and beautiful message to end on. Thank you so much. I just think this was such an amazing conversation to have, and I'm so grateful that you came on that you are able to be so vulnerable and insightful. So thank you so much for your time, Thank you for having me. And also I'm going to give a plug to your amazing podcast Recovery Talk. You know, I feel like I talk about different topics every week, so if this topic was one that you're like, I want to know more. There is so much psychology behind this, and you talk about it so much on your show in such a beautiful and articulate way. So I will leave links in the buyer in the episode description. And of course what's your Instagram hand or maybe people can give you a follow to see your amazing content. Yes, so my Instagram is Amalia Lee, and I also have a Instagram or oriented towards eating a sort of recovery, which is let's recover dot call dot UK. Well, thank you so much for coming on. If you enjoyed this episode, please feel free to leave a five star review on Apple Podcasts, Spotify, wherever you are listening right now. It really helps the show to grow and reach new people. I really hope that this episode taught you something, that you learned something that you can bring it into your own life or the lives of people around you. That's always the aim. And like I said at the beginning of this episode, we do now have much available, So if you want to support the podcast, you want to allow us to keep doing what you're doing, please have a browse, have a bye, whatever you would like to do, and we will be back next week for another episode.