Eating disorders—one of the most complex and the most lethal of all mental illnesses. In this episode, Valerie and Helen investigate eating disorders with specialist Neathery Falchuk, LCSW. They reveal that these illnesses can be overcome by treatment and support. Join them for a riveting journey of courage and hope.
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Understanding and Overcoming Eating Disorders: Personal and Therapeutic Perspectives
Episode 10
Helen Sneed: Welcome to Mental Health Hope and Recovery. I'm Helen Sneed.
Valerie Milburn: And I'm Valerie Milburn.
Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational stories of recovery. Our knowledge is up close and personal.
Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts through our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.
Helen Sneed: We live in recovery.
Valerie Milburn: So can you this podcast does not provide medical advice. The information presented is not intended to be a substitute or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers for any health related questions you may have.
Helen Sneed: Episode 10 Understanding and Overcoming Eating Disorders Personal and Therapeutic Perspectives well, we've tackled some complex subjects in our podcast, but nothing has rivaled eating disorders for me. First, there are a number of eating disorders, all of which can be quite individual and yet frequently overlap. A person can have more than one, they can morph over time, and comorbidity is often a factor. Second, the illnesses are little understood, frequently slighted and often underestimated. And third, treatment methods are still emerging. Valerie and I will begin with the basic overview of eating disorders, followed by my telling my own story. Valerie, who has never had an eating disorder, will provide research and serve as our moderator. After my story, we'll explore some of the skills that can contribute towards recovery. Finally, and most importantly, we'll be joined by Neitheri Falchuk, lcsw, who specializes in the treatment of eating disorders. We are very excited to hear what her expertise can teach us.
Valerie Milburn: We are.
Helen Sneed: It's going to be great.
Valerie Milburn: Yep.
Helen Sneed: Now, the interesting thing is. Well, I guess it's no surprise is that throughout our investigation, it's become clear that eating disorders have been exacerbated by the pandemic in ways that no one could have foreseen. The Washington Post reported that an American Psychological association study revealed that 61% of US adults felt they had undesired weight changes since the start of the pandemic. Calls to the National Eating Disorder association hotline have increased by as much as 80% during the pandemic.
Valerie Milburn: Wow.
Helen Sneed: Yeah. I find this just really, really staggering, Valerie. 61% of Americans are concerned about their weight. So can you just tell us sort of the basic about eating disorders? What are they exactly?
Valerie Milburn: I can. And the following information is from the National Eating Disorders association. And they define eating disorders as serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, shapes and weights.
Valerie Milburn: National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. Now, while no one knows for sure what causes eating disorders, A growing consensus suggests that it is a range of biological, psychological and sociocultural factors. Eating disorders are complex, life threatening disorders from which people can and do get better. There are four aspects to an eating disorder. Behavioral, cognitive, physical, and emotional. These disorders are often mistaken to be primarily about food, when actually it is a way of coping with feelings too uncomfortable to disclose. There are three major types of eating disorders. Anorexia nervosa is an eating disorder characterized by weight loss, Difficulties maintaining an appropriate body weight, and in many individuals, a distorted body image. The second one is bulimia nervosa, and it's characterized by a cycle of binge eating and offsetting behaviors such as self induced vomiting. These offsetting behaviors are designed to undo or compensate for the effects of binge eating. The last third major type of an eating disorder is binge eating disorder, the most common eating disorder in the United States. And it is characterized by recurrent episodes of eating large quantities of food, A feeling of a loss of control during the binge, experiencing shame, distress or guilt afterwards, and regularly using unhealthy offsetting measures to counter the binge eating.
Helen Sneed: Well, I know that there are a lot of misconceptions about who actually gets eating disorders. And I think obviously a lot of people think that it's just these are illnesses of young girls, but so what does your research actually reveal because I know it's very different.
Valerie Milburn: There is solid research on the percentages of males and females struggling with eating disorders. For example, when researchers followed a group of 500 adolescent girls for eight years until they were 20, they found that 5% of girls met criteria for anorexia, bulimia, or binge eating disorder. When researchers included nonspecific eating disorder symptoms, a total of 13% of girls had suffered from an eating disorder by age 20. This is something a lot of people don't know. Males represent 25% of individuals with anorexia. And males are at a higher risk of dying, in part because they are often diagnosed later, since many people assume males don't have eating disorders. But binge eating, purging, laxative abuse and fasting for weight loss are nearly as common among males as they are among females. And there's one more statistic that I want to share that is alarming and that is that young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same age peers.
Helen Sneed: That is tragic. It's just tragic.
Valerie Milburn: It is.
Helen Sneed: And not known. I don't think, I don't think this is known.
Valerie Milburn: Generally I agree. This is information that just particularly the information about males is information that I know I learned a lot about as I did the research for this episode and as I've spoken to people about the information I've learned about eating disorders, Others just are unaware of it. And another area that the research is very solid on is the rate of co occurring disorders. And co occurring disorders means having two or more disorders at the same time. And the co occurring disorder rate with an eating disorder is very high. Here are some statistics. Up to 50% of individuals with eating disorders abused alcohol or illicit illicit drugs. And that's a rate five times higher than the general population. And up to 35% of individuals who abused drugs or were dependent on alcohol or other drugs also have an eating disorder, a rate 11 times greater than the general population. Another study, this one of 2,400 individuals hospitalized for an eating disorder have some gave me some astonishing statistics on co occurring disorders because this study found that 94% of individuals
Valerie Milburn: with an eating disorder also had a mood disorder, 92% also had a depressive disorder, and 50% of those also had an anxiety disorder. There are some statistics on suicide and eating disorders that are also startling. Eating disorders, specifically anorexia, has the highest mortality rate of all mental health disorders. So whether it's from medical complications or Suicide eating disorders are known to kill. Studies have shown that individuals with anorexia have the highest successful suicide rates and individuals with bulimia have the greatest number of suicide attempts.
Helen Sneed: I am shocked by this, but it's good to know, but it is truly hard to hear. We also want to look at what causes it. Now, obviously, there are many causes for these eating disorders, but we're going to touch on a few. The first is abuse and trauma. It's difficult to specify what's nature versus nurture, but regardless, victims of abuse and trauma often develop eating disorders. The feeling of loss of control during the trauma can result in the attempt to control food. Also, abuse victims frequently suffer from extremely distorted body images and the belief that their body has betrayed them. Now, Nethery is a trauma expert is going to open up this subject later.
Valerie Milburn: Another factor that is often considered a contributor to causing eating disorders is societal pressures. And there's a great quote about societal pressure and body image that Helen, you and I just love. And you and I call it bathroom stall wisdom because it's on a sign in the bathroom at one of our favorite restaurants, a restaurant that happens to be known for its fabulous desserts. And the quote is. The quote is, reflections in this mirror may be distorted by socially constructed ideas of beauty. And it is definitely interesting about cultural swings because at one point, Rubenesque figures were socially correct. During this time, women were revered when voluptuous, curvy. Now women are revered when thin. So whatever the societal norm, women strive to conform. I know there is an example in my life. Whenever I came home from college, within an hour, my mother would comment on my weight. I was either too thin or too heavy. And there's another experience. A friend of mine was in drill team when she was in high school, and there were strict weight standards. They were weighed once a week. And she said this was the beginning of her obsession with her weight, beginning of her anorexia, beginning of her bulimia. And she believes, although there were many other things going on in her life, that this was a huge contributing factor. Another contributing factor is stigma. And there's so much stigma around eating disorders, I believe, because it's misunderstood. And Nethery will comment on this later. I think stigma equals shame. Stigma equals silence. Silence equals no support, no treatment. There's another kind of stigma in our society, weight stigma. It's discrimination or stereotyping based on a person's weight. And it's damaging and pervasive in our society. I think if we're honest, many of us will Admit to something like not wanting someone who's overweight to sit next to us on an airplane.
Helen Sneed: Oh, it's this. This bias is so. Well, I'm going to talk about it later because it's been such a profound presence in my own life. Now there's something, Valerie, that's been a lot in the news today, most recently, and that's all about studies that are revealing the catastrophic impact of social media on eating disorders. Can you elaborate on that?
Valerie Milburn: Another place there is solid research. Research shows the average American spends more than 11 hours a day using media. That's more than the average time spent sleeping or working each day. And teenagers spend an average of 9 hours a day using media. And that does not include using media in school or doing homework. Now, the effect of this on eating disorders or the effect of it on our view of ourselves or women's view of their body comes from is backed up by more solid research. Research shows that approximately 70%
Valerie Milburn: of women and girls report a decline in body confidence and an increase in beauty and appearance anxiety, which they say is driven by the pressure for perfection from media and advertising's unrealistic standard of beauty. This is another thing that research shows and is has shown up in my life. 79% of girls and even more women, 85% admit to opting out of important events in their lives when they don't feel they look their best.
Helen Sneed: And I have to say that I have had a number of men friends who have had the same issues.
Valerie Milburn: I know the research has backed that up. One last statistic on social media's impact. 90% of women say they will actually not eat and risk putting their health at stake when they feel bad about their body image.
Helen Sneed: Well, this leads to the terrible impact on the body and the physical side effects of these disorders. Eating disorders represent an assault on the body with a host of physical injuries that can be lethal. I have almost died from anorexia and have called it slow public suicide. It becomes this deathly spectator sport. People were watching me starve to death, but they could do nothing to stop it. The physical impact is just downright dangerous. I hear just a few weakness, malnourishment, fainting, dizziness, weakened immune system, amenorrhea, which is when your periods stop. Abdominal distress, tooth decay, esophageal injury, migraine, insomnia, hair loss, panic attacks, obesity, extreme thinness, and of course death. In addition is bodily harm from self injury, alcohol and substance use, and suicide throughout. A dramatically distorted body image, often not based in reality at all, can drive These abuses, the individual can crave control over just one aspect of life in the outside world when everything seems so chaotic, and a sense of control over himself or herself. There's also the belief that weight loss will fix your life. My life is bad because I'm fat. My life will be good if I am thin. A life distilled into this one belief. And that's a good place to start my story.
Valerie Milburn: I really admire you, Helen, for being willing to share your story. I believe it's going to help so many people to hear your journey, your struggle, your battle for recovery, your hope.
Helen Sneed: Well, thank you. I guess I should say. I've had eating disorders, I think, before they had a name. And we would be here for several days if I tried to tell my whole story. So I'm going to try to point out major turning points in the progression of the illnesses across the years that I did battle with food. As I tell my story, please be warned that the language and experiences can be extremely fat shaming. Now, I don't want to offend or trigger anyone, but I believe it's best to be truthful about what happened to me when I was overweight, because I know I'm not alone to begin with. I've been on a diet since the third grade. Now, I've said before that I have amnesia until the age of 8, but I do know that I was a skinny, scrawny little girl when I was nine. We moved and I had more access to the world and new friendships. But I began to eat everything in sight until I was plump. And it wasn't for many years that I would understand why. At the time, it was a catastrophe. I was weighed every day at home. I remained overweight until high school. And I want to say that the bullying was cruel and unrelenting, and I felt completely vulnerable and unsafe. I mean, at any hour of the day or night, someone could attack me or ridicule me. And what could I do? I just sat there, engulfed in shame because I was bad and repulsive. I had no recourse.
Valerie Milburn: Did anyone address the bullying? A teacher, a guidance counselor.
Helen Sneed: You know? No, I can't remember anyone standing up for me. It was just, you know, again, it was just what happened to fat people, you know, you were. You were just an object of ridicule and contempt. But at 15, I learned to starve myself, and I got down to a size that met the standards of the day. It was my first bout with anorexia. Now, when I got to college, by my sophomore year, I had Starved myself into submission
Helen Sneed: and I was able to control my weight, but only in the most unhealthy ways imaginable. As I mentioned earlier, the social pressure was profound and universal. Girls and indeed all women were expected to be slender, well dressed, gracious and modest. This message was so pervasive, it was reflected in magazines, televisions and movies, songs, books, parties and dinners. I found this fabulous quote in healthy place that I wish I had seen back in those days. They say a cultural fixation on female thinness is not an obsession about female beauty, but an obsession about female obedience. And I obeyed.
Valerie Milburn: Yes. So obedience to cultural norms and societal pressures.
Helen Sneed: Yeah, it just, it never again. I was just. I was. I just didn't have the strength to stand up to these ridiculous norms. And I didn't think they were ridiculous at the time. I was convinced that I would be alone in life, and this was my core belief. But I had a brilliant college career, although I fell apart the minute I graduated because I had no people and no structure. And I went into a two year depression, which was the first time that I was incapacitated by mental illness. And I gained about 40 or 50 pounds. Now, somehow in the midst of this, I managed to move to New York City. I knew only one person there and I didn't like her. However, I managed to build a great life with wonderful friends and opportunities. But I continued the binge eating of large amounts and gained even more weight. Now, here's a great one. When I was 23, a fashion designer friend had some advice when I lamented my weight gain. Well, you know what models do, he said, they take laxatives to get thinner. Thus, a bulimic was born. And my struggles with binging and purging plagued me to this very day. For the next several decades of my life, I was relegated to a vicious cycle of eating disorders. Weight gain, anorexic starving, thinness, binging and purging, anorexia, thinness, binging and purging weight gain. And then the cycle would begin again and again. The anorexia did become life threatening. Everyone except the people in my life who were obsessed with my thinness and thrilled by it, told me that I looked like a skeleton, Like I was dying. My period stopped, my hair began to fall out, I was freezing cold all the time and so exhausted I would lie in bed and just watch my limbs flopping around. A doctor told me I was beginning to convulse because my body was devouring muscle. And his only advice was to eat more beef. Through it all, I still felt and looked fat in my own eyes. And when I was hospitalized in my early 30s, anorexia was so little understood that I got very little acknowledgment of my problems with food or any health. I gained weight there, but then became anorexic again and was dangerously thin when I left the hospital. Again, no advice was offered about my condition.
Valerie Milburn: The contrast between my treatment during one of my hospital stays and your description just now of getting no treatment for your eating disorder is an illustration, I think, of the confusing, confounding nature of eating disorders. Once when I was hospitalized for severe depression, I had lost a lot of weight, but I had started out overweight and was not at an unhealthy weight. But because of the weight loss, I was put on an eating disorder protocol and was weighed every morning in a paper thin gown. Having to get on the scale backwards so I wouldn't see my weight. I was swallowed by a staff member. She sat with me while I ate, stayed with me after I ate so that I wouldn't purge. And I was treated unnecessarily for an eating disorder I didn't have. And I think that really shows a contrast that explains that confounding, confusing nature of eating disorders.
Helen Sneed: Yes, and again, it's ongoing. I think I began to do well outwardly. For the next 20 years I've, I've talked about this, my ability to lead a double life, build really a very good footbridge over the sewer that was flowing inside me. I was in New York City, which I loved. I had a great career in active social life, but I was in therapy twice a week and always on a lot of medication.
Helen Sneed: So there I was leading a very successful life. But I was in agony underneath and a slave to food urges and obsessions. Always at the height of my professional success, I went to a new doctor who diagnosed PTSD for the first time. This was like a parting of the red seas for me. It was this doctor who persuaded me to quit my job and go into full time treatment because she was afraid that I was going to kill myself. And that was the beginning of the end for me. For five years I went straight downhill under her career. In all that time, she never addressed my eating disorders or suggested therapeutic methods to deal with them. By then I was taking 12 medications, including one that was known for rapid, rapid weight gain. I weighed over 200 pounds. I was so miserable and suicidal and self injuring and isolating that I just couldn't see a way out. But one day, out of the blue, I took two diet books and I made a list of the permissible foods that they recommended. So I sat and looked at this list for a while and then decided that I could exist on what was permitted. And from that day onward. You won't believe this, but I never slipped. I wrote out the urges, and I began to lose weight rapidly. Then I joined a gym for the first time in my life and became physically fit. I loved being strong. I took it one day at a time. This was never, never a diet. There was no calorie counting, and I never weighed myself. I still don't. It's too triggering. It was transformative. One day, just really, really down and depressed. I was walking down Broadway when I saw my shadow, you know, out in front of me. And I thought, your body is strong. It will bear you through this. And later on across town bus, on a beautiful afternoon, I stood holding onto the pole and realized my body belongs to me. For the first time in my life, I had overcome the childhood trauma. My body belonged to me, not to anyone else.
Valerie Milburn: What a beautiful turning point.
Helen Sneed: It really was. And I took matters in my own hands. I changed therapists and began to use DBT skills, this dialectical behavior which I'm always talking about, to help overcome the food urges and the negative thoughts that had driven me to food in the first place. And I began to change the way I live my life. And I've had to. I had to say, how did you over someone asked me, how did you overcome these eating disorders? I would say, I began to build a life that surrounded them. They were surrounded on all sides. And because there were better things in my life and all these great people and activities, the food urges and the obsessions began to shrink. It's sort of like the way your blood cells surround a virus and devour it. I began to take risks. I went to dinner with friends, and I became more confident that I could find these permissible foods on most menus, which, of course, I could. Fear of weight gain no longer dictated my social life, which it always had. My meds were adjusted. Exercise was exhilarating. Now, if I'm making this sound easy, it was not. It was d*** hard. I lost 90 pounds and it was through eating, healthy eating and exercise, and, you know, I went five straight years without one slip into binging and purging. Now, there were later slips and setbacks, but no one said perfection was possible. It was not what matters, but how you react that pulls you out of it. And I really had to learn that truth. Now, I don't mean to sound pompous and smug about, you know, fighting all of this fairly successfully. It was and still is one of the ongoing battles of my life and surely the one I fought longest across all these decades. But this is the most important thing I'm going to say. Despite the lost pounds, my recovery was never about weight. It was about learning to respect myself and miraculously, my body. I may never love it, but I respect it and am so grateful for what it has withstood. Now, as for today, well, I hate to admit it, but I've had a very rough time with food in the pandemic. After five years, it's had a dreadful impact on my eating disorders. I've slipped with food and I exercised very
Helen Sneed: little because my beloved Jim went out of business. It's embarrassing to admit how I fell back. I mean, it's really, really humiliating. But recently, I've gotten back on track. I've been discouraged, angry, and even depressed. But never have I felt hopeless. I've won this battle before and I will again because I have the skills and knowledge to make a better way. I have this great respect for my body and myself, and that, I have learned, is everything. My body is strong. It will bear me through this.
Valerie Milburn: Wow. Your own validation of your strength is amazing and I understand how essential to your recovery it is. I see your strengths in so many areas. Your love of life, your love and support of others, your integrity, your humor, your brilliant mind. Thank you, Helen, for sharing your strengths with me as a dear friend. And thank you for sharing your story, your hope with our listeners.
Helen Sneed: Well, I do. You know, again, it's our great objective, which is I do hope that this long story can help someone as I was helped.
Valerie Milburn: I know it will.
Valerie Milburn: And I think now is a good time to talk about treatment methods for eating disorders. And Nethery is going to expand on this and we want to expand on the treatment methods you just mentioned and discuss a few more and want to do an overview of this. Although there may be exceptions, eating disorder treatment generally addresses the following factors in roughly this order. The first step in treatment is usually to correct life threatening medical and psychiatric symptoms because without correcting the life threatening medical symptoms, there's nowhere to go from there. The second step is to interrupt the eating disorder behaviors, then to establish normalized eating and nutritional rehabilitation, then to challenge unhelpful and unhealthy eating disorder and related thoughts and behaviors, then to address ongoing medical and mental health issues. And last but very important, to establish a plan to prevent relapse. Another treatment method is hospitalization and in treatment is determined by the patient being medically and or psychiatrically unstable. And this of course is determined by a medical and or mental health professional based on a number of critical factors. Now therapy is important, very important. And though the first step for dangerously underweight individuals is medical stability, it is great to have a therapist from the beginning because as Helen said, regulating emotions is one of the tools to accomplishing the steps toward medical stability.
Helen Sneed: Another thing that I have found to be incredibly helpful was being in group therapy. It was enriching and enlightening. You know, I found companionship and it was with people who were fighting the same battle. You know, it's that thing of you're understood, they get it and it was also a safe
Helen Sneed: place for many reasons, but it was a safe place to learn skills and to learn to ask for help. Now then there's medication. To my knowledge, no medication has been specifically designated to address eating disorders. However, meds can be helped tremendously with symptoms and emotional regulation. I know that this worked for me. Then there are the skills training opportunities. What can address the core urges and thoughts that lead to acting out with food? Well, for me it's dialectical behavior therapy. This was the method that I was taught. It helped me greatly. Now, it didn't act directly on the eating disorders, but it taught me methods for controlling and managing the negative thoughts and feelings that were beneath my troubled relationship with food and my body. I learned to reduce triggers and modulate my emotions and also to take positive action when the urges were tormenting me or opposite actions. As they say, take a walk, call a friend, just throw on some clothes and leave your apartment. Anything to escape those food obsessions. Because what I did learn over time is that they do pass.
Valerie Milburn: Now another approach to treatment is another skill. Another source of help is 12 step programs. Eating Disorders Anonymous is similar to other 12 step programs such as Alcoholics Anonymous in that it is a fellowship of individuals who share their experience, strength and hope with each other to solve their shared problems and assist others in recovering from their eating disorders. There's also Overeaters Anonymous and Anorexics and Bulimics Anonymous. Now you know me a mindfulness. What would you call me?
Helen Sneed: Enthusiast.
Valerie Milburn: Enthusiast. Mindfulness. Enthusiast. Mindfulness is a treatment for an eating disorder is about staying in the moment. Dr. Harriet Parsons, in her presentation entitled Understanding eating Disorders gives an example of a thought process that goes if I accept my friend's invitation to the movie, I might eat popcorn. If I eat popcorn, I won't be able to eat dinner. But if I don't eat dinner, I might wake up hungry. And if I wake up hungry, I might eat too much and not feel well for my run. If I don't get in a good run, then I can't eat lunch. And on and on and on. This is where mindfulness, the practice of staying in the moment, is the healthy choice. Mindful breathing, mindful eating and numerous mindful practices are excellent skills for living in recovery with an eating disorder.
Helen Sneed: You have just described the thinking that so many people are plagued by this constant, constant racing thoughts. I can't eat this, I can't do that. I can't wear this, I can't go there. That describes it very well. I think. Now the final method that I'm going to talk about is body work. Now, there's all kinds of body work. What I used is I worked with a trauma expert whose methodology, whose philosophy was to help release, slowly release the trauma from my body and for me to develop a new relationship with my body, which was a first. Now, I have to say, it could be very beneficial and it could be very triggering. I kind of went in there and never knowing how it was going to go out. The other thing, I guess the overall goal is to, you know, to become. For your mind and your body to merge and to become a cohesive entity. And this helped me ultimately in ways I still can't even measure. But it was not an easy journey.
Valerie Milburn: So the last thing we're going to discuss before we bring Nethery into our conversation is crisis intervention. And we're going to discuss that with her in a minute. But I'd like to get the resource information out there. Now, I mentioned the high mortality rate earlier, but want to emphasize it again now because as we said earlier, whether from medical complications or suicide, eating disorders are known to kill. First of all, if you suspect a medical or psychiatric emergency, such as threats of suicide or medical complications from eating disorder behaviors, seek medical attention or call 911 immediately. Now here are some crisis intervention organizations and hotlines to contact. The National Eating Disorders association is an incredible resource, and they're available
Valerie Milburn: at nationaleatingdisorders.org and there's an online chat from their website. There's a call or text number on their website. Now, the crisis text line we've talked about before, and I'm hoping the number has become memorized. It's 741741. That's the crisis text line for any kind of crisis. 741741. Now for the eating disorders for the National Eating Disorders association, you type connect to the crisis text line or anything you want to connect with. Anytime you want to connect with 741741, just type hello. Now, the National Suicide Prevention Lifeline is 800-273- talk again, 741-741-type hello. Another resource number we haven't talked about is 211. Just call 211. It's a hotline that's intended for anyone who has any type of crisis or who needs any help locating specific resources. And now it's time to introduce Nethery. She is a licensed clinical social worker and supervisor, a certified group psychotherapist, and is owner of Ample and rooted, which is a group psychotherapy practice specializing in working with the LGBTQ community specializing in eating disorders, body shame, sex and sexuality, gender, relationship concerns, trauma, mindfulness, grief and loss, and substance use. Ample and rooted as an inclusive therapy practice cultivates a safe and welcoming space of compassion and connection at ample and rooted, the belief is that it is our birthright to inhabit, trust and honor our physical and emotional selves without shame. Nethery is a past president of Central Texas Eating Disorder Specialist, past board member of Austin Group Psychotherapy Society, and past board member of the association for size, diversity and Health. She lives in Austin, Texas. Nethery Falchuk is a queer, genderqueer Latinx therapist, certified body trust provider, and certified meditation teacher. Nethery, we are so glad to have someone with your breadth of experience with us today. And I want to go back to one of the beliefs that is integral to your psychotherapy practice. That is the belief that it is our birthright to inhabit, trust and honor our physical and emotional selves without shame, because that's something we've been addressing in our discussion today. Welcome, Nethery.
Nethery Falchuk: Thank you so much for having me. I'm thrilled to be here with y'. All.
Helen Sneed: Well, we would love to hear anything that you have to advise us about or to explain or to sort of illuminate. We have a number of questions that we've kind of collected from around the place, around and about. Do you want us just to go ahead with those? Would that be a good way to start?
Nethery Falchuk: Absolutely. I'm happy to expand on any questions you have. Or I can keep talking.
Helen Sneed: Well, keep talking for a while. So we. Because you've just had to listen to a whole lot of information from us, some of which may be incorrect.
Nethery Falchuk: I loved, first of all, your story, Helen. Thank you for sharing that. Unfortunately, it is a very common experience. And for folks who have more chronic experiences of eating disorders and are being missed in treatment, misdiagnosed, undiagnosed, it is very common. So I do want to just reiterate that the emphasis on the myth that there's a certain type of person who gets an eating disorder, and typically the stereotype is a thin, white, cisgender, heterosexual, affluent young woman, teens, early 20s, is wrong. That person makes up, goodness, maybe 20%, maybe, of the overall people who have diagnosed eating disorders, it's a very, very low number. So there are many, many people who are not being treated for their eating disorder. So the statistic of 30 million people in the United States having eating disorders, I think is very low. There are much more people. A lot of people, yes.
Helen Sneed: But you know, it's not all reported or diagnosed or understood, you know. No.
Nethery Falchuk: So even the numbers that we have while
Nethery Falchuk: still alarming and don't even paint.
Valerie Milburn: The whole picture, that's amazing because the research I found just blew me away. And now to have your expert opinion share that they're even higher is so important to get out to our listeners.
Nethery Falchuk: Absolutely. What I love about your podcast and your story, Helen, is that, yes, there is hope that just because right now we're in a transition time, at least, even in the eating disorder treatment field, the traditional model of treatment still focuses on weight control and trying to influence someone's body size. However, what we know is any focus on weight, any desire for intentional weight loss actually is more damaging than it is healing the concept of body respect that you talked about, Helen. Body acceptance, size acceptance, understanding size diversity, and divesting from so completely abolishing the idea that fatness is bad. That is true healing. That's true liberation. And more and more treatment providers are hopefully starting to practice in that way. And that's the one thing I do want to encourage any listeners, if you are trying to find support for your own food or body struggles, is to find providers who specialize in this field and also specialize in health at every size.
Helen Sneed: Tell me, with your patients who are fighting to accept their bodies and love and respect their bodies as they are, their own shape, their own size, weight, where do they find the most positive support in our society or in their lives?
Nethery Falchuk: That's a great question. So community. And I love that you touch on how important group therapy is. Community is incredibly healing and necessary and having a group of people. So I run groups therapy groups specific for folks wanting to find food peace and body liberation. So that is a really helpful place to find connection and support. And there's also social groups. There's a lot of connection online and online spaces, if you just kind of even Google health at every size or body, liberation is connecting with people because the mainstream is a focus on dieting. So our culture is just entrenched in dieting, food control, weight control, and that is incredibly harmful. And it is. What continues to allow eating disorders to fester is the focus on tinnitus.
Helen Sneed: Oh, there's no doubt about it. I am. I wonder, though, looking at the opposite end of things, when you've got a patient who is in crisis, either physically or emotionally or psychologically, what kind of intervention do you do when you feel like the patient's life is in danger?
Nethery Falchuk: Yes. What y' all mentioned of first, we need Stabilization that is absolutely accurate. And sometimes that means getting higher level of care treatment. Maybe it's residential or an inpatient treatment center. It could mean having a doctor continue to monitor physical symptoms. If someone is not able to go to a treatment center, it could be trips to the emergency room. And I do. What is challenging is that the. The way that eating disorders are missed in every nook and cranny in our society and especially in our healthcare system means that sometimes patients going to the ER actually are mistreated in terms of the interventions the ER docs and nurses provide are actually more damaging for a whole host of medical knowledge that I think is beyond my pay grade. And also we would just need tons more hours of time. But I highly recommend anyone interested in reading the book Sick Enough, and that's written by Dr. Gaudiani. This is an incredible book that highlights what the physical manifestations are in terms of eating disorder symptoms, the medical consequences, and how doctors can be more aware of how to treat eating disorders.
Valerie Milburn: Can you repeat the name of that book, please?
Nethery Falchuk: Yes, it's called Sick Enough.
Valerie Milburn: Thank you.
Helen Sneed: Well, Nethery again, just staying in the crisis mode just for a minute. What can you recommend for like family and loved ones who are concerned, but they don't know what to do? And as we all know, having been in therapy can sometimes be part of the problem. And
Helen Sneed: yet they want to help. Do you how do you find yourself wrangling these people with the best of intentions so they don't cause more harm?
Nethery Falchuk: Great question. It's a little different when we're thinking of adolescents versus adults. Adolescents and parents have more ability to have someone go to treatment. It is more challenging when someone is over 18. And part of an eating disorder is a lack of insight into the consequences of the behavior. Part of that is just inherent in the struggle, is not able to see the damage that's being done. That is a very challenging experience. People who are needing more support, who are in more crisis than they think they are, and who are not willing to go or are ambivalent about getting support and family members if they are causing more harm, then I encourage family therapy. That is a good place to start. If finances are difficult or if there's just no provider option in town, there are support groups people can join virtually. And the thing that Covid has provided us is more access to virtual support spaces.
Helen Sneed: True.
Nethery Falchuk: There's a ton out there and I'm sure the National Eating Disorder association will have some listed. I know Project HEAL is another organization that is doing good work as well as the alliance for Eating Disorder Awareness. There's support groups, there's pamphlets on what loved ones can do to get someone the help that they need.
Helen Sneed: Okay. Well, it's interesting you've mentioned group therapy and family therapy. What, what treatment methods and skills training have you found to be beneficial in your practice? Sort of beyond, you know, the therapeutic relationship.
Nethery Falchuk: Yes. Which is the most important part is that connection you have with your therapist.
Valerie Milburn: Absolutely, absolutely.
Nethery Falchuk: Yes. And so if anyone's out there who doesn't feel like they're in a have a good relationship, talk to your therapist about it. Because that's truly the most important part is finding someone you have a. A very good connection with.
Valerie Milburn: Helen. And I know that from years of being in therapy. Yes. We understand that you're familiar.
Nethery Falchuk: Yes.
Helen Sneed: 40 straight years.
Nethery Falchuk: Yes. It is so important that I think is the container that holds the vulnerability that's going to come up in processing all of these struggles. As you mentioned, dbt, that is a really great skills training, focused intervention. I typically weave in some DBT work, particularly when there's more acuity of behaviors, if someone is struggling more actively with urges and acting on behaviors. DBT is a really great modality as well as acceptance and commitment therapy, which is one of my favorites. It really utilizes a lot of mindfulness tenants and connecting with your values, what matters most to you in life. And as you shared, Helen, it is having that life worth living that can help someone move through the discomfort of healing, knowing that it's going to lead you to a life that matters to you. Those two mixed with. I'm a somatic based practitioner, so including the body is necessary. These are harms done to the body and so we need to heal through the body. I use a combination of somatic experiencing and sensory motor psychotherapy to help move some of the discomfort, the trauma. There is typically some trauma experiences that we process as well.
Valerie Milburn: Can you explain somatic to our listeners, please?
Helen Sneed: Yes.
Nethery Falchuk: So somatic is basically soma, which is the body. So it is incorporating the felt senses within the body as part of therapy. So it's not always just a talk therapy. It could be exploring sensations that come up in the body. Any physical movements that the body's wanting to do in response to whatever material is being processed. And it's including the body in helping regulate what comes up.
Helen Sneed: Yeah, thank you. I really can't, again, having been through a body work where some of the tenants that you were describing we did, it can really be so helpful if it's done by the
Helen Sneed: right person. I think it can just be incredible because it is. Well, trauma is embedded in the body and then the whole. So much of my life has been based on hating my body. I mean really hating it, you know. And so anything to have a better relationship with it and to understand how it works I think can be invaluable. Now here's what I've been wanting to ask you about. How do you feel about medication and eating disorders? Because I've heard all kinds of conflicting responses.
Nethery Falchuk: I think medication, and this is true for anything is absolutely an option. It is up to the client if that's something that they want to explore. Many times I've seen it work amazing. Amazingly for folks, the key is to find someone, and particularly when we're talking about eating disorders is someone who's trained in understanding eating disorders. Because if there is any malnutrition that does impact how medication is absorbed, there is some medication that is contraindicated. In folks who are malnourished just because of possible side effects that are very damaging and fatal, it's really important to find a provider who is knowledgeable.
Helen Sneed: I'm sure it's a tough decision I think again because your body already is so battered and these medications for me have been great. But then there are the side effects that are undeniable. What? You know, I was shocked when Valerie started looking into the high incident of co occurrence. I call it comorbidity. How does that affect your treatment of someone who not only has the eating disorder but then Scott other maybe multiple other psychiatric illnesses?
Nethery Falchuk: Absolutely. Yeah. That is, I rarely and I don't think ever have seen anyone just have just an eating disorder. There's always something else. Anxiety, depression, trauma, substance use, adhd, autism. There's really. OCD is another highly co occurring diagnosis. So what that means is treatment must be integrative. So we have to tackle everything at the same time. If there's anything though that is life threatening, so that could be. If the substance use is at a level where it is the most acute and life threatening, that needs to be managed first. Of course, if the eating disorder is something that's more acute or trauma, depressive symptoms, if there's anything that's life threatening, that takes priority. Ideally there would be a treatment center that can incorporate all of the different struggles that someone might be experiencing. But we don't have that right now. So that's an area of concern is that typically it's. They go to a substance use focused treatment center, they just do substance use. Eating disorders typically just do eating Disorder treatment. We need more places that can integrate all aspects of someone's struggle.
Helen Sneed: Well, I'm afraid that's on down the road, but I assume that there are people that are savvy to this and that it will start happening. It's just that it's for the people. To me it's always, but I need help now. That urgency that we all feel in dealing with these things.
Nethery Falchuk: Yes. And just on that one other thing is eating disorders require. The treatment of eating disorders require a team. Not just a therapist, but a dietitian, doctor, psychiatrist, could be. I'm not specialized in ocd, so if I'm working with someone, maybe they see an OCD specialist to help target OCD related exposure, work or therapy. So it does take a team. And that's the one thing I do want to convey is it really does require a wide variety of providers and different expertise.
Helen Sneed: And that of course gets into the problem of who can afford that. Exactly. Where in the country is this offered at a reasonable rate or what clinics or whatever? So it's a tough one, I guess. I'm curious about what are the. You run into this all the time. People ask you what you do for a living. You deal with eating disorders. What, what are the greatest myths and misconceptions about eating disorders that you run into?
Nethery Falchuk: Yeah, aside from that eating disorders look a certain way. That stereotypical person that I mentioned that we've talked about, I think the biggest myth out there is that fatness is bad. And that is very, very, very damaging. Why that is. And we've mentioned
Nethery Falchuk: some 12 step options like Overeaters Anonymous. There are some programs that still encourage weight loss or restriction of certain food types. So even if it's a list of these foods are good or these activities are good and this is bad, that is still encouraging the idea that an external source needs to dictate your own intuitive connection with your food and your body. And it also is the subtext is that you need to be smaller. So eating certain foods so you are smaller. Why? Because the myth is that being fat is bad.
Helen Sneed: I think we're going to have to have you back. We're going to have to talk about this again. It's so multifaceted to try to talk about get all this covered in one episode. I do have a final question, which is what makes you most optimistic for people fighting these illnesses today?
Nethery Falchuk: Oh, why I love this podcast is that lived experience is powerful and I have my own lived experience of struggling with an eating disorder, being a queer, non binary person. In the world. Growing up without any idea of what that meant, you know, I turned to my body to try to control and stay small. And that's so not true today. I personally have gone through my own journey. I've found healing, and I get to be a part of so many people's stories and healing journeys. So that is that I just can see it happen. That gives me hope. And that is what I. Why I show up every day to do this work, is that I see that it's possible. And when someone, you know, my clients who I've been with for several, several years, are able to say, wow, I feel comfortable sitting here in my body with you today, and that. That's why I do this. It's possible.
Helen Sneed: It's a miracle. It's a miracle. And, gosh, I wish. I wish we could just talk for the rest of the day, because you've just opened my mind, and I know Valerie's, and I'm sure all of our listeners, so beautifully, I guess, is the word I would use, and eloquently, you have these invaluable insights and contributions to this exploration. And we really appreciate the chance to hear from someone as experienced and committed as you are to overcoming these illnesses. And I would like to also, just on behalf of the hundreds and hundreds of people that you've helped, thank you for what you've done for them. Because I think in a way, you can look on it as part of the continuum that they will go out and they will be better, and they may help other people get better with all of this, too. So I'm afraid we do have to bring this to a close. Thank you so much. Now, speaking of mindfulness, we're going to conclude with the soothing part of our presentation after all this turmoil, a much needed mindfulness exercise with Valerie.
Valerie Milburn: Yes, we will do that. But first, I want to thank Nethery. Thank you so much for being here. You have brought so much to the conversation, and I also know that you share in my belief that having our dark paths be able to shine a light of hope to others and really does bring value and meaning to our stories. And I'm just so grateful you're providing that to others. Thank you so much for all that you do and for being here today.
Nethery Falchuk: Thank you both for having me, and I'm happy to come back anytime. Or if any listener wants to plug into resources, they can reach out to me, and I'm happy to offer whatever support I can.
Valerie Milburn: Great.
Helen Sneed: Thank you so much.
Valerie Milburn: We will put your information in our show notes. Thank you so much.
Nethery Falchuk: Thank you.
Valerie Milburn: Now, as I always do, I will give a definition. What is mindfulness? Mindfulness is the practice of being hyper aware of the moment. It is being in the present, acknowledging what you are thinking and feeling and accepting it without judgment. Being mindful is about immersing yourself in the present moment to the extent that that you are fully aware of everything you are experiencing in that moment. Today's mindfulness exercise is called Make a wish. And it is what I call instant mindfulness in that it is something you can do in just a few minutes. Literally in about three to five minutes. This one may be about three minutes. So let's start. And if you can close your eyes if you're driving, please don't. And let's start by studying your breathing. We're going to do just two diaphragmatic
Valerie Milburn: breaths. That's breathing in through your nose, out through your mouth, expanding that balloon in your stomach. Let's start with breathing through your nose. 1, 2, 3, 4, 5. Breathing out through your mouth. 2, 3, 4, five. Another cleansing breath in through your nose, two, three, four, five. Out through your mouth. Two, three, four, five. Now ask yourself, what is it that you want? Come up with a wish. Now ask yourself the same question. What is it that you want? Most probably you will get a different answer. Ask yourself again, what is it that you want? Compare those three answers and derive your own conclusion. This exercise will offer you food for thought for the remainder of the day. It may even influence your interaction with others as well as how you treat yourself. Thank you for doing this mindfulness exercise with me.
Helen Sneed: Oh, thank you, Valerie. I have to bring myself back. This was a perfect way to conclude this particular episode. As we've learned, eating disorders are complex, pernicious illnesses that can be overcome. A lifetime of management may be required, but recovery is possible and can be sustained, especially given the treatment methods available. And even more are emerging. Our next episode takes us to the role of law enforcement in mental health interventions. There's a great deal to learn about how law enforcement has enhanced its methods of dealing with a mental health crisis and how to have a successful interaction should the need arise. We'll be joined by Senior officer Jamie Von Seltman of the Austin Police Department. She is a leader in training law enforcement to help the mentally ill when they are in crisis. So please join us for this crucial, life changing episode and I want to.
Valerie Milburn: Thank our listeners for joining us today. As always, we are honored that you have spent time with us.
Helen Sneed: And we leave you with our favorite word. Onward.