[DR. 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. So today it's just me. It's a solo show and I'm out here in California and we just had daylight savings. So it is light out later now and the weather is also starting to get warmer too, which can be a difficult time for someone who has an eating disorder. Some of you out there listening may know exactly what I'm talking about, but for those of you who don't the reason why is because gone are the cold weather clothes that can much more easily cover bodies and now out come the warm weather clothes that reveal much more of our bodies to the world; so shorts, t-shirts, tank tops, and yes, even swimsuits are going to be the norm during the warmer months that are just around the corner. All of this can really trigger someone with an eating disorder. Now, what do I mean by the word trigger? I think it's a word most of you have probably heard, but I really think it's important to delve deeper into what a trigger is. So put simply, a trigger is something that brings on a reaction and those reactions can vary depending on what the trigger is. When we get triggered, we can have all sorts of emotions. For instance, if I find out that I just won the Powerball jackpot, I'm probably going to be really happy. So me finding out that I just won the jackpot is the trigger for my reaction, which is my happiness. I can imagine in this scenario that I would be very excited about my life and my future. The last thing I would ever want to do is distract myself from what is going on in my life, right at that moment. I would want to be fully present and enjoy everything. However, we can get triggered and have emotions that are completely the opposite of this. We can have emotions that are upsetting and uncomfortable and overwhelming. When we have that type of reaction, we want nothing more than to find a way to stop feeling that way. Really, who wants to be in all that pain? If you're someone with an eating disorder and you get triggered, most likely your eating disorder symptoms will increase. Your eating disorder thoughts, feelings, and behaviors are great ways to get your mind off of whatever just happened or to help you numb out from whatever your pain is. It can be really difficult with eating disorders to clearly see the connection between a particular trigger and the response someone has to it. So for instance, let's say you have breakfast with a group of coworkers and someone starts talking about how they can't eat what's on the menu because they've just started a new diet and want to stick to it because they've already lost five pounds. Now it may not be clear to see the connection between that conversation and you spending the rest of the day, obsessively calorie counting by logging each and every bite of food you eat. But if you think about how this behavior distracts you all day from feeling the intense anxiety that you did after you were triggered by the conversation earlier that morning, it's easier to see the connection. Or I'll give you another example; who has time to focus on the sadness you might feel from a fight you had with your significant other first thing in the morning, when you spend all day beating yourself up for how bad you are for eating a donut for breakfast? In both of those examples, the eating disorder behavior helped distract from any of the uncomfortable emotions that got triggered. So how do any of us know if we're doing something to numb out or to distract ourselves? Basically, how do any of us know what triggers us? Well, everyone is unique and we have our own personal stories and experiences. So we all have our own individual triggers. Even if you think you've identified all of them, something may happen in your life that you were not expecting and you get triggered out of the blue. But the important part is to get a general idea of the major triggers in your life and once you know that you can start to practice ways to manage your responses. For example, I often have patients come in to see me and they tell me that they have no idea why they keep binging. They're frustrated because each time they do it, they tell themselves they will never do it again. They want to stop because they feel horrible and they feel guilty. They hate the way they feel after both emotionally and physically, but then they just are so frustrated because it keeps happening. They describe it like something that just takes over their body and before they know it, they look down and they're shocked at what they just did again. Sadly, most of the time, people who tell me this feel like they're feeling, that they're lacking willpower, or they're not strong enough to stop doing it. They feel really awful about themselves. If you're someone out there who can relate to this at all, please listen to me. Please hear what I'm about to say; you are not failing. You are not choosing to continue to do this. You are not lacking willpower. You have an illness, you have an eating disorder and you need help. You are turning to the food to escape, numb out from, or distract yourself from some negative thought or emotion that resulted from a trigger of yours. You got triggered and you are just trying to cope. And food, your binging has helped you to cope. So now that's your go to when you need immediate relief and it is important to understand just how difficult it can be to stop using your eating disorder to cope, especially if you've had one for a long time. I say this, not to discourage anyone who is seeking recovery or in recovery now. I say this so that you can have some compassion for yourself. Do not give up and do not feel like you are failing or tell yourself that you screwed up if your eating disorder pops up after something triggered you. It is really important to understand that an eating disorder is a temporary fix, if you will. I guess that the, for lack of a better word, it's a temporary fix for your situation. So, as in the example I gave above with a person who had an argument with their significant other, they engaged in their eating disorder behavior so they didn't have to think about it all day. Engaging in eating disorder ultimately doesn't fix the situation, but it certainly makes it feel better in the moment. Over time, the eating disorder is going to have a lot of negative effects if you keep doing it. So it is important to not continue having that as your main source to help you cope when you get triggered. Let's just be real here. We are all going to get triggered at times in our lives. Luckily there are more effective, sustainable, and healthy reactions to triggers than engaging in eating disorder behaviors. If any of you know my background, my history, I had my eating disorder so I can sit here telling you personally, there are other ways to deal with triggers and cope other than engaging in eating disorder behaviors. But in order to break the trigger to disorder behavior response, it is important to identify your personal specific triggers. So how do you start to identify your triggers? Whenever you take on an active change, awareness is the first step. Identifying the events, people and situations that trigger your negative emotions will help you either avoid that particular trigger or prepare a way to handle it in the future. Like I said, everyone has their own unique set of triggers, but I think it's important to discuss what some of the common triggers are for those of you who have an eating disorder, or maybe you're in recovery from one. So I'm just going to give some examples. Any major changes or stressors like breakups, relationship struggles, financial struggles, work stress, moves, starting college, starting a new job, those can all be really big triggers. Also numbers. So many types of numbers can be triggering when you have an disorder. Numbers on the scale, they can be the worst, especially if you know you're going to go to the doctors and you think, oh my gosh, I got to get on that scale. Or if you are body checking and you are going on the scale yourself, if that number's up, it can be extremely distressing. Other numbers that are really distressing or triggering can be sizes of clothing or seeing the calorie count next to food items on a menu. I hear that so often. It's just really triggering for a lot of people to see that. Something else I hear a lot is photos. Photos can lead to all sorts of negative emotions, whether you're seeing photos of yourself or seeing them on social media. I know we all take so many photos of ourselves and it can be really difficult if you have body image issues, because if you're scrolling through them and you're scrutinizing them searching for that perfect shot, that can be really distressing because you can be so critical and pick apart every little part of yourself. When you do that, the inevitable consequence is negative self judgment and negative body image. But it's not just the pictures you look at of yourself. It's the ones, not of yourself, the ones that are on social media, because we are bombarded with so many photographs on social media of unrealistic, ideal body images. The message is clear. Those images, the ones you see all the time, that's the body type that is considered acceptable. It's considered beautiful. These photos, they create an impossible standard to try to live up to and constantly seeing these images can trigger a lot of negative feelings and be constant reminders of what a failure you are. That's what you start telling yourself, it's not true, but that's what starts to happen. Food can also be a really big trigger and it's a challenging and unavoidable trigger because we need to eat to live. So we are going to have to deal with food. However, just seeing food can be very triggering and the more food you see, the harder it can be to cope with it. So going out to a restaurant, I hear this all the time, it is one of the most triggering things for people who have eating disorders and for many reasons, one the decision about what to order can be exhausting because ED is in your head, your eating disorder thoughts are in your head, screaming at you so loudly about which foods are good, or which foods are bad, or which ones you're allowed to eat or not eat based on so many things like what you did earlier that day, what you ate earlier that day, did you exercise? I mean, it can be exhausting in your mind just thinking about what is on the menu and what you can order. There's the social aspect of eating with others. That can be difficult. If you're looking at what others are eating and comparing your plate to theirs, you can start feeling competitive and it gets stressful because you're looking at, okay, am I eating more than them, less than them, or am I eating the wrong foods, the right foods? It's a lot. So if you are listening to this and you know what I'm talking about, if this is one of your triggers ask yourself what do I do after I leave a restaurant? How do I manage that for myself? Another trigger can be conversations. Just talking about food can be triggering, but all sorts of conversations can be triggering. Anything related to dieting, exercise, weight loss, or body appearance, I mean, that's overwhelming. So finding ways to avoid conversations that you find to be the most triggering is really important, whether that be simply by trying to find a way to switch the topic, when it comes up excusing yourself to go to do something like use the restroom or take a call, or here's something. What about being able to speak up and say that you really would prefer to discuss something else? If you feel you can have an open, honest conversation with people about your eating disorder and inform them about what topics you need to avoid, because you have an eating disorder that would be a fantastic option as well. But look, I know that's not possible to do with everyone. So it would be great if you could find those people that you could be that open with and have those conversations with, because if they're going to be at social events with you going forward, maybe them having that awareness and knowledge of what triggers you, they could be helpful in switching conversations that come up that are triggering for you so you're not always the one trying to manage those conversations for yourself. Comments, comments can be triggering. People may think they're giving a compliment or being kind, and they have no idea how triggering their words actually are. So if someone says something like, oh my gosh, you look great, or you're looking so healthy these days., they have no idea if that is triggering to you, just like comments about what or how you're eating. If someone says, oh, it's so nice to see you eating. I was getting worried about you there for a while, or, oh, I wish I could eat as healthy as you. Just look at what you have on your plate there. Ah, I just think about comments like that when I look back on my eating disorder and oh, so triggering. Other things that are very triggering for people can be events and activities, things like clothes shopping, grocery shopping, going to holidays, swim parties, going on vacation, going on a date, having an interview for a new job or making a presentation in front of others at work, all those things and more. Just think for yourself about what are some of the things like that that really are emotionally overwhelming for you. Boredom and loneliness can also be major triggers for people. I hear all the time from people that coming home to a quiet, empty home after a long day can be the biggest trigger leading to a binge. They really just don't want to feel lonely or bored or think about anything that was stressful during the day. For those of you who are in recovery, common triggers can be the people, places and things that you spent time with or around when you were in your full blown eating disorder. So it's really important to ask yourself if being around close friends is triggering. That can be hard. So for an example, if one of the main activities you did with your friends together was working out and you now know that working out triggers you, it can be really difficult not to spend as much time with them. You really need to realize that you and your health are the most important to prioritize. If your friends have a problem with that, that's something you need to really sit back and think about, because if they're really good friends, they would have your health and wellbeing in mind and they're not going to stand in your way of you getting better and moving forward with your life. So it's definitely best to avoid spending any more time with people who aren't supportive and understanding of your need to take care of yourself and heal. The same goes for places and things that are connected to the disorder you once had. So I always suggest getting rid of any clothes that don't fit you right now. So if you have clothes that are smaller, for instance, in your closet, I just consider that is just ED sitting there in your closet, taunting you each and every day, like Ed, just saying, "Hey I'm here for that day where you can fit back into me." That is just so toxic. So please just divorce yourself from any clothes that were from when you were full on into your eating disorder. The same, if there was a room in your house where you used to engage in your eating disorder behavior, so let's say you binged in a certain part of the house, it might be hard to be in there without constantly being reminded of what you did there. So, I mean, unless you're moving or something, it's really important to try to have different memories in that room. Maybe trying to redecorate or rearrange the area that might help, or maybe just starting a new enjoyable activity in that room could also help. People also get triggered from their body. So feeling bloated or full that can be really triggering for someone who's in recovery. I don't know if any of you out there know what I'm talking about, but that feeling is very uncomfortable. This can lead to someone having the urge to restrict or do some behaviors like purging or over exercising to get rid of that feeling. So I mentioned awareness being the first step. Well, being aware of what your triggers are is key for sure. But you may be asking like how do I do that? Well, when I'm working with patients, I use DBT or Dialectical Behavioral Therapy. Behavioral chain analysis is what I use to help identify the triggers that led to a particular behavior. So when we use this technique, we journal the chain of environmental, social, and other events that precipitated the problematic behavior. When we link each event that preceded the behavior, this chain provides you insight to the factors that trigger you. But if you're not in therapy, then what do you do? Because not everyone's in therapy. So the next time you engage in an easy disorder behavior, let's say purging after a binge. I suggest taking time to journal about or ask yourself if anything happened before you did that. Anything right before or anything during the day, even, think about the places you went, the people you were with, the conversations you had. Just really spend some time to think about everything and see if you can identify anything that was particularly upsetting or stressful, because that can be a clue about what triggered you. What happens is over time, if you keep a journal or you keep notes, you might start to notice that whatever things keep popping up, so if you're always at a specific place or every time you're encountering this situation or with a certain group of people or find yourself having had this conversation, you come home and you engage in your eating disorder behavior, then this is really a clue like, oh, those are my triggers. An example is like, oh, every time I'm with this group of people, I come home and I engage in my eating disorder behavior. So maybe looking at what is it about being with that group of people? Is it conversation? Is it, are they stressful? Do you feel inadequate around them? What is going on when you're with them that could be contributing to you being triggered and then coming home and engaging in your behavior? Let's say you've gone through some work and you've identified some triggers. Now what? Let's imagine you've identified a lot of triggers, like 35 and on one particular day you have what I call a red flag day. Now, what I mean by red flag day is that the likelihood of you engaging in your eating disorder is very high because one of two things is happening. Either, one of the triggers that you've identified is very emotionally triggering. Basically this trigger typically results in you feeling very overwhelmed and is coming up and is unavoidable. This could be something like a holiday dinner or a red flag day could be one in which many of your triggers occurred in one day. So let's say you didn't sleep well the night before. It could be one trigger. You got to work late so you felt rushed in behind all day. That could be another trigger. You didn't have time to eat lunch because you were rushed and behind all day. It could be a third trigger. Then you found out you were late paying a bill and were charged a late fee. That could be the fourth trigger. So all four of those triggers aren't like big, huge overwhelming triggers, but all four, when you have them together in one day is really a red flag day. Like this is a lot for you. So you're on your way home and you're feeling hungry. You're tired, you're irritable and before you knew your triggers, maybe a day like this, you would come home and binge on everything, anything you'd find that was readily edible in your kitchen and then purge. You would feel guilty and awful and wonder why you just did that. Why did you just make your bad day worse and then spend the rest of your night thinking awful things about yourself? But if you know your triggers and you've identified them and you have the awareness about them and how you typically respond when you triggered now, you have a different opportunity. You have an opportunity to choose how you would like to cope with your feelings. So maybe on a red flag day, your eating disorder urges feel impossible to resist. That's true if, especially if you've been doing them for a long time, but rest assured there are other possible response options for you to rely on instead. I'm not saying this is easy, but it is possible. Absolutely possible. So what options are there? Some of these things I say, people are like, yes, that doesn't work. They sound like they're not great alternatives, but once you try them, you might be surprised. So for example, you can find some inspirational counsel on social media to follow or listen to some music you like. You can write in your journal. Look, I'm just saying anything that makes you feel more positive, more relaxed and more calm is a really good choice for an alternative behavior and can replace the negative eating disorder behaviors that you have been used to relying on. I'm going to be real with you. Like I said, when you first try to use another coping mechanism, other than your eating disorder, it is not going to feel like it works at all. It's not the same, at least, okay, not at first. I remember for me that nothing felt quite as good as going up for a long run to clear my head or nothing felt as good. Nothing numbed me out as much as a binge. So it did take some time for me to find some other things that I turned to to cope. But here's the good news. Over time, negative feelings that are continually paired with another activity, they start getting linked. They create this strong link. So over time, the new behavior that you engage in, it really does become effective in helping you cope. But it does take time. So you just have to continually do it over and over again, and then it does become effective. So although your eating disorder behavior may seem uncontrollable and the number of triggers that you encounter can seem a lot, like insurmountable, please believe me when I say that you are capable of coping with them and managing them. So when you can identify your triggers, you can start to find different ways to respond to them. If you feel triggered, you may also find it helpful to reach out and get help from somebody, especially if your urge to engage in your eating disorder is so strong and you are sitting there and you can't think of any other way to cope. Or maybe you've tried something, but nothing seems to help and you're just frustrated and at a loss. So if you're in that a situation reach out to someone, maybe, I don't know if it's the middle of the day. If you can reach out to your therapist or a trusted friend or any loved one to help you get through that difficult moment, it's really important to reach out to someone if you need to. Because nobody has to battle their eating disorder or deal with a really overwhelming trigger by themselves. It's really helpful if you can just let the person you reach out to know I'm hurting. I'm overwhelmed. I need help. Let them know how you're feeling and what you need from them. Because look, nobody's a mind reader, and I know it can be hard to open up, especially when you have an eating disorder, because there's so much shame and there's so much embarrassment about some of these things that you're going through. But I've said it on other podcasts before, but there is so much relief when you start opening up about what you're going through. You are only as sick as your secrets. It sounds really scary at first to think, oh my gosh, if I reach out to someone and start talking about my eating disorder or the things I'm doing or thinking they're going to judge me. They're going to think I'm crazy. They're going to think all these things about me, but I can tell you, I have not heard from one person that started to open up to somebody that they trusted anything but positive reactions. Again, it's somebody that you trust and you can feel vulnerable with, but really breaking free from all of the secrecy of your eating disorder can really help. In that moment, when you're feeling like I said, overwhelmed from your trigger, if you can vent to somebody or just maybe even get some help from somebody, another idea for another coping mechanism that might help, or maybe just that could be what you do to cope is connect with somebody else and get some support from them. That could be a great way to cope and manage your emotions. So the main thing is for any of you listening out there to realize that we are all human and we all get triggered, and we all need ways to cope when this happens, but your eating disorder doesn't have to be one of them. Take care everyone. Thank you for being here. Thank you for listening. 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.