78. Let’s talk about eating disorders

In this episode we break down the psychology behind eating disorders - from anorexia to bulimia and binge eating disorder. Amalie Lee, the Host of the Recovery Talk podcast joins us to discuss her own experience with anorexia and as an eating disorder recovery coach as we break down the triggers and origins of eating disorders, the misconceptions, how they impact our psychological and emotional well-being and the journey to healing and recovery.

If you or someone you know needs help or for further information and psychological services on eating disorders, please see the following:

Australia - The Butterfly Foundation

https://butterfly.org.au/get-support/helpline/

USA - National Eating Disorders Association

https://www.nationaleatingdisorders.org

UK - Beat Eating Disorders

https://www.beateatingdisorders.org.uk

Canada - National Eating Disorder Information Centre

https://nedic.ca

Worldwide - https://www.verywellmind.com/leading-eating-disorder-charities-and-organizations-4145389

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:05):
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.

(00:26):
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

(00:46):
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

(01:08):
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.

(01:30):
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

(01:52):
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

(02:15):
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,

(02:38):
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.

(03:00):
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

(03:23):
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

(03:44):
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.

(04:05):
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

(04:25):
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

(04:46):
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,

(05:06):
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

(05:37):
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

(06:01):
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

(06:24):
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

(06:47):
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

(07:09):
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

(07:29):
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

(07:51):
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

(08:12):
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

(08:37):
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

(09:00):
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

(09:22):
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.

(09:44):
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.

(10:09):
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.

(10:33):
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,

(10:55):
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

(11:16):
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

(11:37):
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

(12:02):
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

(12:25):
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

(12:48):
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

(13:11):
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

(13:35):
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

(13:55):
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

(14:17):
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

(14:41):
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

(15:01):
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

(15:22):
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,

(15:47):
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,

(16:10):
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

(16:31):
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

(16:55):
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,

(17:16):
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

(17:38):
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,

(17:59):
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,

(18:24):
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

(18:45):
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

(19:10):
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.

(19:33):
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

(19:56):
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

(20:17):
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

(20:42):
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

(21:05):
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

(21:30):
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

(21:51):
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

(22:14):
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

(22:34):
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

(22:56):
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,

(23:17):
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

(23:37):
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

(23:59):
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

(24:20):
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

(24:41):
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.

(25:07):
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

(25:31):
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

(25:53):
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

(26:14):
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

(26:36):
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

(26:58):
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

(27:19):
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

(27:44):
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

(28:09):
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

(28:29):
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

(28:52):
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

(29:16):
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

(29:38):
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,

(30:00):
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.

(30:20):
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

(30:46):
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

(31:07):
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

(31:30):
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

(31:55):
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,

(32:16):
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

(32:37):
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,

(33:01):
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

(33:24):
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

(33:44):
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

(34:05):
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

(34:26):
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

(34:46):
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.

(35:08):
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

(35:28):
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

(35:53):
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

(36:14):
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

(36:38):
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

(36:59):
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

(37:22):
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

(37:43):
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

(38:07):
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.

(38:30):
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

(38:51):
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,

(39:13):
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

(39:37):
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.

(39:58):
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.

(40:22):
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

(40:46):
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

(41:07):
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

(41:28):
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,

(41:50):
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

(42:13):
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

(42:35):
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.

(42:56):
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

(43:17):
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

(43:40):
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

(44:01):
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

(44:24):
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.

(44:44):
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

(45:06):
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

(45:28):
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

(45:49):
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

(46:14):
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

(46:37):
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

(46:58):
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

(47:18):
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

(47:41):
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

(48:01):
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,

(48:23):
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

(48:44):
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,

(49:05):
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.

(49:26):
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

(49:48):
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

(50:09):
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

(50:32):
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

(50:54):
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

(51:14):
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

(51:36):
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,

(51:58):
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

(52:19):
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

(52:39):
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

(53:00):
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,

(53:21):
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

(53:43):
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

(54:05):
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

(54:28):
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

(54:49):
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,

(55:10):
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

(55:32):
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

(55:54):
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

(56:16):
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.

(56:37):
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.

(56:58):
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,

(57:20):
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

(57:41):
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

(58:03):
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

(58:25):
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

(58:46):
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,

(59:09):
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,

(59:29):
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

(59:51):
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

(01:00:11):
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

(01:00:32):
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,

(01:00:53):
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,

(01:01:15):
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
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I really hope that this episode taught you something, that

(01:01:37):
you learned something that you can bring it into your
own life or the lives of people around you. That's
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(01:01:59):
and we will be back next week for another episode.