[CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. Welcome to Behind The Bite podcast. This podcast is about the real life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. . Well, hello everyone and welcome back Behind the Bite podcast. Eating disorders are probably one of the most confusing illnesses to so many people, not only to the people who don't have them, but even to those people who do. When I work with loved ones of those who have an eating disorder and discuss some of the most common thoughts, feelings and behaviors of someone who has an eating disorder, it really can be one of the most difficult conversations we have. And I totally get it. When I think back to my eating disorder, talk in my head as I like to call it, ed talk, I know that if I had told anyone back then what I was thinking, they would not have understood me at all; things like, okay, I didn't work out my 60 minutes today. Only 52 minutes. I have to work out extra long tomorrow and make sure I eat even less today. Those thoughts, when I think about them, it's like, wow, what was I thinking? It wasn't even just the thoughts. I would feel extremely anxious and it would consume my entire mind of the rest of the day and little did I know back then that not everyone thought and lived like this. I really thought that everyone did. So here today, I'm excited because I have a guest with me who's here to discuss more about eating disorders and help makes more sense about what are yes, very complicated and confusing illnesses. Rachelle Heinemann is a licensed mental health counselor based in New York. She specializes in the treatment of eating disorders, disordered eating and body image issues. She also works extensively with those challenged by depression, anxiety, relationship difficulties, and career stress. In addition to her practice Rachelle has taught courses in eating disorders and body image issues at undergraduate programs and as continuing education for clinicians. She's the host of the podcast Understanding Disordered Eating, and she is part of leadership at IADEP, which is the International Association of Eating Disorder Professionals in New York. Welcome to the show. [RACHELLE HEINEMANN] Thank you for having me. I'm excited to be here. [CRISTINA] Well, I am very excited. As my listeners know, I've had a two week break, so really refreshed and excited to have you on. So I know I introduced you, but I love to hear just from your own words how did you get into the field and get started into I guess where you're at now and where you're working and all that. [RACHELLE] So I'm based in New York. I'm a licensed mental health counselor. So I'm a therapist. I specialize in eating disorders and all things relationship with food, which sort of goes unsaid with the depression, anxiety relationship stuff is always attached. I mean, who are we kidding? But I think what was very interesting is that I never thought I would become a therapist. To me it was like I was on the track to business major. I was very into finance, which is very different from therapy. I think I just took a couple of classes in undergrad and I had some family members become therapists. Then I went to therapy myself and I was like, oh, this is cool. Then some internships in business were super, super boring. So naturally I switched. But I think the work that I do, which is much more deep work, analytic work, was I have to attribute to my internship when I was in grad school, that completely came out of the blue and I'm forever indebted to them. So I do work with a lot of deep work, more of disordered eating because I think people with full blown eating disorders and medical complications, there's a lot of behavioral stuff that goes, that's usually not my forte, but usually work with people on the deep work stuff and with their relationship with food, what does it mean? Why is it there? All that jazz. I talk about it on my podcast all the time and that's me. [CRISTINA] Well, I know you and I talked before about some typical things we hear and working with people who just have disordered eating or eating disorders. One of the main things is I guess this notion of like, oh, you can just stop eating or just eat or just stop these behaviors that people objectively looking at somebody's going, why don't they just stop doing it? Even for themselves, I think I hear some people ask, why can't I just stop binging or stop doing this? Or why can't I just, whatever the just behind that is. And I'm wondering like how often are you hearing those kinds of things and how do you deal with that in your practice? [RACHELLE] Yes, probably just as often as you're hearing them. So quite often. I think just coming at it from a position of understanding first, it's extremely frustrating when you're engaging in a pattern of behavior that makes absolutely no sense to you. Why can't I just stop? It's a frustration because we know different. Our logical mind is saying one thing and everything else is dragging us the other way. So it's extremely frustrating, but I think we need to add in so many more pieces of information to that part of the conversation, because otherwise we do continue to get stuck in that. So the idea that our relationship with food, whatever part of the spectrum you may fall on, and every specific symptom serves a function. It's there for a reason and we have to understand what the reason is, because if we don't understand it then, and even if we do try to get rid of the symptoms, it's going to come out somewhere else because that function still needs to be served. [CRISTINA] Exactly, to your point, I will see people come out with, maybe they've been in a residential or an IOP or a higher level of care, come out to my outpatients and they're on a meal plan say, and then especially if I'm working with teenagers, the parents are like, oh, well their eating disorder's gone now because they're eating their meal plan. For anyone listening, maybe who's on a meal plan now or has been on one, that's just being on the meal plan, but that's not getting to what you're talking about, which is that's the symptoms, is the eating, but what's underlying all of that. Just because you can follow meal plan and eat, it doesn't mean the eating disorder is gone or treatment is over. [RACHELLE] Yes. I love that you're bringing this up. This is something that's really hard for me to hear, especially when it's a parent talking about a child, however, hold a child may be that on the surface, it seems like the eating disorder has gone away. So they are eating regularly and consistently their movement looks a little bit more, I guess, "healthy." The symptoms are either decreased or completely eliminated. That is exactly the point. That is where the, like the hardest part of the journey, if you will, because you're no longer turning to your symptoms to do what they've done for you in the past. You're having to feel all the feelings, deal with all that pain without numbing out dissociating, distracting. So I would say that point is actually a really, really tough one. [CRISTINA] So what would you say, let's say a parent is listening or even somebody who's on a meal plan is listening and they're saying, "I've seen my medical doctor and see my vitals are stable and I'm weight restored and I'm eating my meal plan," and they say, "I don't need treatment anymore. I'm fine." They're in your office, like what would you say to somebody at that point? [RACHELLE] So I would talk about the idea that the symptoms are really just scratching the surface. If we think about an iceberg, what we see on the top is just the tip, but what's on bottom is, I mean, infinitely larger than what we see. This is not to scare anyone that this is so much bigger and so much scarier, but it gives you a lot of information that there's so much underneath. We now have an opportunity, because you're not completely immersed in your eating disorder, we have an opportunity to uncover what that is. And way that I like to conceptualize this is that eating disorders are very intertwined with our emotional experience. What we find very often is that people with eating disorders, and this is I'm probably with so many symptoms, besides for eating disorders have a very difficult time connecting with their emotional experience because the opportunity that an eating disorder creates is actually one for a person to dissociate from their painful emotional experiences. So the way that I like to think about this, and sometimes I use the analogy, not even analogy, but the example of a toddler. When they start to feel something and they throw this huge temper tantrum, it's chaotic internally. I mean, clearly they are freaking out about not getting the red lolly and it actually feels that way to them. So in order for them to regulate, they mean the people around them to soothe them, to teach them how to learn, how to soothe. Once they internalize that, then they can do it on their own. But if they didn't have that, then the feelings continue to be just as big and chaotic as they go through their life. Now here's the key when we have feelings and they're feeling that big, they don't just go away. That's when they get channeled into our body, into our symptoms or specifically eating disorder symptoms. So part of how we have to look at our symptoms, or sometimes at this point in recovery, it's more our urges or our history of symptoms is they are clues to our past emotional pain that's coming up today. We need to decode that in order to understand what we need to process. [CRISTINA] So if anyone listening and saying, oh, that sounds like a lot of work. How am I going to go back in time and try to out all my past pains or isn't there some quick fix or some way to just like do something different or what'd have to do all this heavy duty work. I mean, because it sounds like maybe to somebody like, oh my gosh, I have to go back in time and figure this all out. I don't know if you get this question, but I just like, how long is this going to take? [RACHELLE] Yes. Oh, it's the question that I don't have any answer to. I don't know what you respond to this question, but I think that part of what I like to say is that let's say this person is 25 years old. It took you 25 years to develop this way of interacting with the world. It's not going to take us three months to undo everything. So I think we have to give ourselves a little bit of credit to how we started showing up in this world but I also think that it's not really just an end goal. There's a process to this. The process can be, we can hit milestones and we can feel better on this process, it doesn't mean that the only thing that we're trying to hit is the end goal. So I sort of try to reframe the quick fix versus long-term solution and more so this is a process. Are you willing to jump in with me on this process? [CRISTINA] I think as we're talking about this too, like you bringing up such a great point of like the eating disorder, the symptoms all do serve a very protective purpose. You don't just have an eating disorder for no reason. Like, don't look at it like this big, bad thing. It's like, okay, you were smart enough to try to figure out something that when you were in such emotional turmoil and pain and you couldn't tolerate it anymore. You found something in your world, whatever that was to try to numb it out. We all need that sometimes. We just cannot stand all of the emotional turmoil and pain sometimes when we're overwhelmed. It's like, okay, so just looking at it that way, it's like, that's what you chose to do to try to cope, to try to take control over something. I don't know how often people look at it. Like this was my attempt to try to take control over things that felt very out of control. [RACHELLE] I mean, I like to insert some, the word emotions in there. It's things feel chaotic because internally I feel chaotic. So my emotions feel completely out of control. I don't know how to put a lid on it and so I'm going to try to neutralize my chaotic emotional experience by channeling it through my restriction, my binging, my purging, my insert, anything right now. So I like to see it as an emotional chaos and emotional control because it ends up being ironic because the second we give up control or "give up" the control that's when things start to feel a little bit less chaotic. But I think that it's more so reflective of our inner experience. [CRISTINA] So I think if anyone's going okay, so what do I do when I feel emotionally chaotic inside? Is that part of the work that you do with people as well as helping them figure out other ways to help manage that or is it more like, I'm wondering if people listening are going okay, so is it a matter of figuring out why I'm emotionally feeling chaotic inside or is it okay when I do feel that way, I have to figure out ways other than turning to my eating disorder to manage it? [RACHELLE] Yes. That's a really good question because I think often when people learn some of this, they're like, okay, this is chaotic. How do I fix it? And I think thinking about anything that's disorganized, even thinking about your closet, if it's completely disorganized, it's not so much oh my God, what do I do to fix it? It's we have to slowly organize each piece. So the chaos comes from a complete disorganization and I think one of the things, and obviously this is part of the process, it doesn't take one day or one session to do is to slowly organize what's going on internally. That could be in the moment identifying what's going on for you. if you have access to that. If you don't have access to that, to start to learn how to put more vocabulary into your language so that you can identify that and slowly start to organize what's going on internally. So I would say the very first thing, if someone is just looking at this and like, I have no idea what to do with this, besides for, I mean, preaching to the choir here, but therapy is obviously going to be so, so important. But the idea is if we're looking at eating disorders as protective, it's this dissociation from our painful emotional experience. There's a complete disconnect of the mind and body. And working toward some sort of healing will entail bridging that gap. So I would say one of the most important pieces to do in the beginning and then through your process is to start bridging that gap. I would say even just physical awareness. So even taking a second right now, like pausing the podcast, taking a second, head to toe scan, what's going on in my body? What's in my head? Do my shoulders feel tight? Is my jaw clenched? Are my hands clammy? Is my leg fidgety? Does my chest feel tight? All these different sensations, the only thing you have to do is identify it. That's it. We can slowly work up from there but I think the very, very first step when things feel chaotic is to identify what is it that's actually happening in my body right now? [CRISTINA] I think that can be hard too. It's so uncomfortable to be in your body because along with this comes, maybe even body image issues too, or pain from past traumas or things. So when people maybe did, if you did stop and do the body scan, like, did you blip out? Was it very uncomfortable? Was it hard to do? I think a lot of times people don't like being present and aware of how they're feeling on their body. [RACHELLE] I think that to your point about trauma, if trauma is carried in the body, then it would probably be very important to do an individualized trauma treatment plan for this person specifically, because if being in your body is so unsafe, then we have to sort of do a little bit more preliminary work before we can actually bring you to your body, bridge the gap, bring your awareness to your emotions and then start to organize them and then start to sooth yourself. So just want to put it out there that it might be really difficult for some people. Maybe that's where it's your sign to start working with an individual therapist who specializes in eating disorders and in trauma so that you can start to feel a little bit more safe in your body. But I would say for somebody who's maybe in a little bit of a different situation and it's just sort of uncomfortable, they never really did it before, to notice the discomfort. That's awareness too. You don't have to go further than that. It's just like, I feel uncomfortable somewhere in the middle of my body. That's great. [CRISTINA] I think that's a fantastic thing. If anyone would think like, just try that every now and again, even if it's once or twice a week, just to start. But if you could do it maybe once or twice throughout the day, it is interesting to notice, like you said you're clenching your jaw. You're like shaking your leg. It's a clue your mind, body is connected and those things are telling you something. Like if you're clenching your jaw, it's like, are you stressed? Are you angry? What's going on? If you're shaking your leg, what's happening for you? What's going on for you right at that moment, just to clue in and maybe ask more questions to yourself about yourself, like having more of that awareness. [RACHELLE] Absolutely. I think if it feels overwhelming to break it down into very distinct steps. So the first step is just awareness identifying what's going on. You can ask these questions later. If you don't want to ask them now, or you have no idea where to go with them, that's fine. I think we do have to make space for each step. If you have no idea what the answer is, and you continue to do it and work with your therapist to try to figure out what some things are, what's difficult about being in the moment, all of those things are really, really important. So what I'm positing is that maybe you're asking some of these questions to yourself and you're coming up with absolutely no answers and that's okay. Because it's an intricate incoding of our past experience in our body. It's not going to be simple. That's the whole point. It's not going to take one journaling session and oh, that makes a hundred percent sense because our psyches are so much more complex and genius than that. [CRISTINA] I think to your point about where the role of therapy comes too, is there is a lot of, I don't know, or help me navigate this, or why is this happening? Or why do I tell myself I don't want to keep binging, but I do it every night or I did it again. Or like, why is this so hard? Because I hear a lot of people say, I don't know why I do this. I'm so frustrated with myself. Like this doesn't make sense. Even if they maybe are hearing us and saying, okay, I'm hearing you say like this eating disorder has a purpose, but what's the purpose. I wanted to stop and I don't know how to do that. I think that's where the role of like you or me, a therapist can help you navigate that, is like, that's really a difficult thing for anyone to figure out on their own. If you knew, then maybe you wouldn't be having an eating disorder to be in with. [RACHELLE] Exactly, you wouldn't be here if you knew. I think that's to the point of that, it's so much more complex than we give it credit. But I think that if somebody is further along on the journey of recovery and they're not binging every single night, they have a lot more understanding or awareness of what's going on and they're eating consistently, not engaging in restriction. There is a way to use either therapy or journaling or sometimes just spacing out. Some people aren't journalists and just like to space out for minutes or 20 minutes or however long. So what I like to think about is we'll use the example of binging is what are the feelings that are coming up for you around the binge? Very often we get the feeling of guilt. So that's a big one. Like I shouldn't have been in that. What's wrong with me? All of those thoughts that come along with the guilt. Now, to me, there's something about the feeling of guilt that has a history that might be about the food and about the binge and about how you feel about yourself for binging, but that's only a piece of the puzzle. So let's think about how do you feel about guilt? What do you normally do with guilt? I'm guessing it's not something that you like to feel. Then sometimes I like to take several steps back. What happened earlier today? What happened earlier this week? What were things that were going on? And I think very often, this doesn't happen all the time, so just putting this out, this is a generalization, but very often what we find is that there are interactions, there were experiences that might have evoked the feeling of guilt. It just feels too much to feel guilty about something else. As much as it's so uncomfortable, it's terrible to feel guilt after a binge. It's, I mean, physically uncomfortable, emotionally uncomfortable, terrible, but there's something about it that feels different than feeling guilt about any other thing in the world. It's much more tangible. It's almost socially acceptable to feel guilt after a binge. So if we think about it, what's my relationship with guilt? What's my history with guilt? What is this guilt really attached to? Then we can start really decoding those clues. [CRISTINA] So when you're doing this more work with people looking at like, okay, the resulting guilt what's going on, how often do you find that people just look at you blank and go, I have no clue. I just feel lost. Because I find that at some point maybe along the recovery, people feel this hopelessness or like I'm never going to get better. I'm wondering, what would you say to somebody listening right now who's going, I've tried for years, I've gone to therapy, I've never gotten better. Nothing works. What would you say? [RACHELLE] I mean, first of all, that's a really tough one because these people have been trying for years and it's not like they're lazy and it's not like they're inconsistent. They've been doing everything that they could. They've been taking the advice of people who they trust and it's not working. I think the phrase, I don't know, really stands out to me because there's something in the I don't know that lets me know this person doesn't yet have any language to describe what's going on internally. I think if we take it almost to, if we're going to think about educational levels, if we're going to take it to a graduate level and say, well, let's understand how your binge is associated with guilt and how that's connected with your past experience this person in terms of their language is nowhere near that level of education. We have to start from the beginning. We have to start from zero and build up. So for the person who doesn't know, one tool that I absolutely love is the emotion wheel because very often they'll have no idea what they feel about anything. They might feel upset, sad, or mad. Like those are the things that they feel and if they look at the specific emotions inside of the emotional wheel, then they're sort of able to, people can't see what I'm doing with my hands, but they're sort of able to come outward and see what other categories might be associated with these very general emotions and start to build up the vocabulary. So I wouldn't start with eating disorder behaviors. I would just start with, what's coming up for you today. You had an argument with your boss. What came up for you? You have no idea. Let's look at the wheel. Let's look at a list of emotions. We're assuming that you're probably feeling, if you're feeling upset, mad, or sort of in the angry category, what's one other word that you can use to describe it a little bit more in detail? And doing this very slowly with what feels like the most mundane interactions in your day to day life is going to build that vocabulary, build that language so that eventually you're able to put so many more pieces together. I don't think that it's reasonable for us to think people can go and jump to all these putting other pieces together right after listening to this, I think it's about building from the ground up. [CRISTINA] I love how you just said lots of people don't have the language and they don't know it's the not knowing and you helping them get that vocabulary. I think that can instill some hope. So when they start to really go, okay, maybe I do know more than I think I do. Like it's really learning themselves and giving people, I think it is about inspiring hope that things can change and they can move forward. [RACHELLE] Yes. I think also people come at this and saying, this is my eating disorder. This is the problem I have to fix. The way that I conceptualize it is yes, that's what it looks like right now. But I see this as we want you to have a robust emotional experience that feels like you can take your emotions as cues, what they're intended to be and not as something to run away from. We can almost put your eating disorder on the side for right now, because right now we're talking about you as an entire being. So thinking about this in that way is helpful because we're not talking about getting rid of this other thing. We're talking about building a fulfilled, we'll use that meaningful life as opposed to taking away the eating disorder. [CRISTINA] I also love what you said about, it's not that somebody's lazy or they're not trying, and that they've tried so hard because man, when I look at people who come to my office, I'm like, you have tried so hard for so many years and it might have started with somebody taking on like a diet like years ago. I mean, but that takes a lot of effort, a lot of energy. I mean think about how much time, effort and energy it is. It's all consuming of your life when you are trying to measure food or log in the hours at the gym. It's like so much time and effort and energy. You are like the least lazy people ever. I think that's where the hopelessness and the frustration comes. It's like, I don't know why this is happening. What am I doing wrong and I think maybe from us, they're getting a message of like one thing but in the outside world, they are getting those messages of like, maybe they are lazy or maybe something is wrong with them. Why can't you, like I said in the beginning, just stop this or just change or there's this instilled fear, I don't know if you hear it from your patients, but if I don't stop this I'm going to have diabetes or I'm going to have this or heart or all these bad things are going to happen. There's a time crunch. I have to fix this now. I have to stop because all these bad things are going to happen if I don't like. So there's that added stress too, of like, oh my gosh, I'm really doing something "bad here." That's maybe where the guilt comes too. It's like, I'm sabotaging my life. I'm not doing this right. Then maybe they're getting shamed from other providers or family or whomever society even. But it's a lot. [RACHELLE] I don't know about you, but pressure never motivates me. It makes me want to run the other way, just hide in bed and pull the covers over my head. So that never helps anyone. There's this, I'm not sure if it's an Instagram or just a quote from Jennifer Roland talks about a lot how if somebody says, oh, instead of binging, just take a bath. They've never actually been there. It's really not like, oh, just stop this and do that. That's really such a reductionist and inaccurate way to describe what recovery looks like. It's an over time thing. [CRISTINA] Right. Because okay, so you go take a bath, but like you're saying the why, the underlying reason for why you needing to numb out or escape is still not understood or looked at, or there's still the need to escape. Like you said, it's like, you're just not really understanding the whole picture of what's going on. [RACHELLE] I think the one thing that stands out to me the most is compassion. We have to have compassion for ourselves that there are reasons why this was developed. It's protective. It serves a function. Even if we don't understand that today, or even in the next couple of years, we have to have compassion for ourselves. This is a painful experience. It's frustrating. It's so many things and we have to just make space for the fact that sometimes this is just really painful. [CRISTINA] I think that's very well said, and I hope people do really take that in. I know that's hard for people to have the self-compassion. I'm wondering, I think that's a great place to end because I think people can sit back and if they could be compassionate, that'd be great. But I'm wondering short of that, is there any last words you'd want to impart to anybody who's listening, who's maybe just struggling or confused or just in limbo right now with their disordered eating or eating disorder? [RACHELLE] Yes. I think that sort of echoing the piece of bridging the mind, body gap, that if it feels like an okay challenge for you to do, to start bringing in a little bit more mindfulness into your life. And if you're like me or anything like me, I roll my eyes completely at the idea of mindfulness but I think that's almost the point, that people who aren't like me, who don't like to really bring it all together, it's a scary concept. So it's okay if it's scary but I think the point is that if we do it really, really slowly and just bring the awareness to almost our skepticism, that this could work, the skepticism that, oh, you're saying I just have to identify my physical sensation or my emotional experience, please what's that? That's noticing. That's perfect. Just notice that you feel cynical. That's it. I think just allowing yourself to be where you are right now. You don't have to be anywhere else. That's it. [CRISTINA] That's big word. Thank you so much. As people are listening, you're on the east coast, so I'm wondering if people do want to work with you or find you how can they do that? [RACHELLE] Well, you can find me on my website. That's rachelleheinemann.com or on Instagram at Rachelle Heinemann. My podcast is Understanding Disordered Eating and I am based in New York and I'm currently doing remote sessions. [CRISTINA] Fantastic. Well, thank you again for being here. This is great information and I know lots of listeners are going to probably hear this and maybe, hopefully think about all that you said and shared today. So thank you so much. [RACHELLE] Yes. Just, one last thing is that I know that a lot of this stuff is confusing and maybe people have follow up questions. If you want to just send a quick email or a DM, that's totally fine. You know where to find me now. [CRISTINA] Actually, I do love that you said that. I think when people first hear some thing say none of this made any sense and it is digesting it and hearing it over and over again until it just clicks. So yes, if anyone listening goes, what, what does any of that mean like, yes, reach out, ask questions. It is confusing because none of this does make sense to people who have not experienced disordered eating or eating disorder. That's normal. That's totally normal. Don't think like you didn't get it or something didn't make sense to you. That's absolutely fine. Like you said, you are where you are right now. [RACHELLE] Exactly. Well thank you so much for having me. I loved being here. [CRISTINA] Well, it was great to have you. Thank you again for taking the time. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.