On this episode, Karen is joined by Dr. Karen Boortz. For many of us, the pandemic has been full of challenges. We were isolated. We lost our consistent routines and our lives essentially changed overnight. But for those suffering from an eating disorder- this time has been even more difficult. On this episode, we’ll talk about some of the challenges of having an eating disorder during a pandemic. And some tips to get through this difficult time.
On this episode, Karen is joined by Dr. Karen Boortz. For many of us, the pandemic has been full of challenges. We were isolated. We lost our consistent routines and our lives essentially changed overnight. But for those suffering from an eating disorder- this time has been even more difficult. On this episode, we’ll talk about some of the challenges of having an eating disorder during a pandemic. And some tips to get through this difficult time.
Click here for a transcript of this episode.
Dr. Karen Nelson 00:00
[Accompanied by piano music] Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll find the opportunity for healing. Hi there. I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals, a conversation about eating disorders, the podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Dr. Karen Boortz. Karen is a clinical psychologist here at Melrose and a close friend of mine. Karen and I actually attended grad school together, and I'm so happy we're colleagues here at Melrose. For many of us, the pandemic has been full of challenges. We were isolated, we lost our consistent routines, and our lives essentially changed overnight. But for those suffering from an eating disorder, this time has been even more difficult. We'll talk about some of the challenges of having an eating disorder during a pandemic, and some tips to get through this difficult time. Now, before I begin, I invite you to take a deep breath and join me in this space. [Piano music fades].
Dr. Karen Nelson 01:19
Karen, welcome to the podcast!
Dr. Karen Boortz 01:21
Hello!... Karen! [overlapping]
Dr. Karen Nelson 01:22
I was so happy... Karen! [overlapping]. I'm so happy you're here with me.
Dr. Karen Boortz 01:26
Well, I think we actually really need to talk about... why do people make fun of the name "Karen".
Dr. Karen Nelson 01:31
I don't know...
Dr. Karen Boortz 01:32
I mean, we are two delightful women. [Laughing]
Dr. Karen Nelson 01:35
I knooow...
Dr. Karen Boortz 01:36
It's such a bad rap.
Dr. Karen Nelson 01:38
I don't know! If people know us, they know Karens are wonderful. [both laughing]
Dr. Karen Boortz 01:42
Yeah, we're trying to bring the name back here.
Dr. Karen Nelson 01:44
That's right. We're trying to like get some cred here. Well, before we begin, can you introduce yourself and tell us what your job is here at Melrose?
Dr. Karen Boortz 01:52
Yes. I'm Dr. Karen Boortz. I'm a psychologist. I recently transferred to the inpatient team with Melrose. I used to work in the outpatient location in Burnsville, Minnesota, and now I'm working inpatient in St. Louis Park.
Dr. Karen Nelson 02:10
This pandemic has been going on for a long time now, and I know we're all so tired of talking about it. But it really has impacted a lot of people, specifically around mental health. And for us, as therapists demand has actually tripled at Melrose, specifically, but we've noticed an increase just overall, right? Kind of community wide... just culturally, this need and demand for mental health care.
Dr. Karen Boortz 02:37
Yeah, I think it's really tricky because I think a lot of people are now ready or seeing it. And it's hard when we can't provide the care and services they need. And I think it's really hard as providers, and it's really hard on the other end, when now all of the sudden I know and I want the help and there's no one here for me. So I think that's been a challenge.
Dr. Karen Nelson 03:00
Absolutely. Well, I think that piece too... I was actually chatting with someone yesterday that... you know, life was already hard for a lot of us pre-pandemic, and then it's like I was already dealing with the anxiety or depression or relationship struggles and then this pandemic happened.
Dr. Karen Boortz 03:17
Right. Yeah. And, you know, I think people have hard times... maybe even similar or harder times... but I think that was a collective hard time. And the energy of that, and the the timing of that... I think that's just, you know, something we've never experienced, and everybody struggling at the same time.
Dr. Karen Nelson 03:36
We all were impacted in the same moment.
Dr. Karen Boortz 03:38
Yeah.
Dr. Karen Nelson 03:38
Right?
Dr. Karen Boortz 03:38
Yeah. And I think there's some comfort in that, which maybe, has people seeking treatment more, too. You know, I think there's less... maybe a little less stigma that people know they're not entirely alone in the struggle. I think people are talking about it a little bit more. I think people are knowing that they need help. And so I think that has driven people in too.
Dr. Karen Nelson 04:02
I agree. Right, that piece of maybe kind of lessening the stigma.
Dr. Karen Boortz 04:07
Yeah. [overlapping]
Dr. Karen Nelson 04:07
I don't know, what do you think about that?
Dr. Karen Boortz 04:09
Well, I think maybe it's just that I have something to point to, you know? I think sometimes people struggle and they don't feel valid or justified in their struggle. And I think once other people are struggling, more people are struggling, or they have something that they can say, "Here's the tangible stressor here," too, that I think that can be helpful for going in. And we know that there doesn't have to be a struggle, a specific stressor or anything like that, but I think sometimes it can... especially when we're talking about mental health and eating disorders where there's so much shame, I think not being able to identify why or have a reason for it can make people feel worse and hide more in it.
Dr. Karen Nelson 04:50
That is such a good point. Such a good point. When we may be talk about this idea of a pandemic and then in intertwine this idea of an eating disorder, can a pandemic trigger eating disorder behavior?
Dr. Karen Boortz 05:07
Yeah... You know, I think it can. One of the things with eating disorders is so much a lack of control. And I mean, I think control was an illusion. We never knew that next week, you know, the rug could be pulled out from any of us. But I think we had an illusion of being able to plan these things and have this control, especially in the middle of it. In the beginning we didn't know what next week looked like. Nobody knew what their work looked like. They didn't know what happened with the kids, they didn't know what school was going to be. And just feeling totally out of control.
Dr. Karen Nelson 05:40
Tell me a little bit more about how isolation or anxiety might trigger an urge to use an eating disorder.
Dr. Karen Boortz 05:47
Yeah, I think eating disorders are a way of coping. They're a way of managing the stress. And I think the increase in stress and then not having a lot of outlets... You know, we took people indoors, we took away hobbies and interests and friends and all sorts of people. And there was no way to ignore the thoughts that are in there. There's no way to ignore the anxiety. We took away a lot of healthy coping skills, too.
Dr. Karen Nelson 06:14
For sure. That piece that you had mentioned, that illusion of control and then that was taken away because of the pandemic. And eating disorders can kind of bring that illusion of control back in, right? I can hyper focus on what am I going to eat for lunch. Or how am I not going to eat?
Dr. Karen Boortz 06:30
Yeah.
Dr. Karen Nelson 06:30
You know, maybe over-controlling food.
Dr. Karen Boortz 06:33
Yeah.
Dr. Karen Nelson 06:33
Doing some restriction, but then feeling out of control with food, so then binging and then the cycle starts over.
Dr. Karen Boortz 06:39
Yeah, I think it is something people do in secret. It's something people do hidden. It has to do with shame, it has to do with safe spaces. And so I think now that people are there all the time, I think it gets hard to control that. And again I think people understand a little bit more sometimes about anorexia or some of those other diagnosis and the real struggle that is with food. And for some reason we don't realize it's a lot of the similar ideas, it's a lot of the similar struggles of lack of control, and feeling out of control and what we do to cope with that.
Dr. Karen Nelson 07:14
100%. I often talk with people about, "Eating disorders show up on the outside..."
Dr. Karen Boortz 07:21
Yeah.
Dr. Karen Nelson 07:21
"...To manage this pain on the inside." And the expression might be different, right? I might under-control food or over-control food. So maybe I'm binging or maybe I'm restricting. But the purpose, or the function of the eating disorder is the same.
Dr. Karen Boortz 07:36
Right.
Dr. Karen Nelson 07:37
What are some of the things that might be the hardest for those who are existing with an eating disorder during a pandemic?
Dr. Karen Boortz 07:44
Yeah, I think the isolation is one of the hardest parts. You know, I think that eating disorder loves secrecy. It loves isolation, it is big and shame. And if it can have a good excuse to do that, you know, it doesn't look funny to stay home all the time anymore. People might not be as concerned or genuinely might struggle to find things to do or places to go and I think that can be a real challenge. I think the accessing care is a challenge. I think the not being able to be exposed to how other people are struggling... real people, I think... sometimes we just feel totally alone in that. When we're only seeing social media where everyone's talking about how great things are.
Dr. Karen Nelson 08:33
Oh, absolutely. If someone is struggling with an eating disorder during this time, what are some tips you might have for them?
Dr. Karen Boortz 08:40
I think first and foremost is to talk about it, let somebody know. Try to see what you're dealing with. I think trying to sort that out a little bit. Getting assessed... it never hurts to be assessed. It never hurts to understand what somebody would recommend. And the level... I think to sort it out in your own brain is so hard.
Dr. Karen Nelson 09:02
Let's talk briefly about types of treatment or ways to manage eating disorders that we might use as therapists. One of the types of treatment that we use is big fancy words called Dialectical Behavioral Therapy. I almost can't say it [laughs]. So. Yeah, I do know how to practice it. We call it DBT. We kind of use the short term. Let's talk a little bit about that. And for maybe people who don't know, what is Dialectical Behavioral Therapy?
Dr. Karen Boortz 09:34
You know, the great thing about DBT is that it allows... it has concrete skills that someone can take home and can use and parents can feel like they can help. They can practice them themselves because let's face it, we're not perfect as parents either...
Dr. Karen Nelson 09:48
That's right.
Dr. Karen Boortz 09:48
And so there's a lot of things we can do. It is laid out in four different modules. So there is... and a module is just kind of a set of skills. So there's mindfulness which helps us to understand our patterns, understand what's happening, slow down with that sometimes emotion regulation helps us to understand emotions and name them because we're not really taught that enough. And the purpose of the emotion and you know, the ways to use those emotions in a way that's helpful and not harmful sometimes. There's a module of distress tolerance. And this is the one that's really important for a lot of people like, "What do I do when I want to like scream or do other things when it's so intense? I don't know what else to do to tolerate it." That one can be really helpful in terms of distractions, intense stimulus, so using ice, using loud music... are there other things that you suggest?
Dr. Karen Nelson 10:51
Absolutely. I think, another distress tolerance skill that I often recommend to self-soothe... Right, when I'm feeling really, really intense, what are some self-soothes that I can do? So maybe I'm putting on lotion really gently and kind of smelling and engaging my senses. Yeah, absolutely.
Dr. Karen Boortz 11:10
Relaxation mask... Yeah, different ideas like that. We have lots of different ideas, and they can be different for different people. What works for some people might not and so there's lots of variety. And then the last one's interpersonal effectiveness skills. And that's really like, "How do I ask for what I need?" Like, lay that out because we think we do by sharing how we feel, but often that doesn't leave people with, what do I need from that? And how do I get the help I need? And then also setting boundaries and just repairing relationships that might have been really damaged by eating disorders or mental health behaviors. Or just feelings, emotions that were so big, and maybe we did things that weren't helpful. And how to repair those relationships?
Dr. Karen Nelson 11:59
Very good point. I think the piece that I have always found so beneficial about Dialectical Behavioral Therapy, or DBT, is that like you said, it's skill-based. These are real applicable things that not only our patients can do, but their family members can learn and understand. So like you were saying, emotion regulation, "What do I do? ...When I'm feeling super, super intense, how do I ride that out?" So knowing that my emotion can come in a wave, literally just learning that can be helpful.
Dr. Karen Boortz 12:29
Yeah. Feeling... understanding what helps that, what gets it... what makes it more intense because often the things we do actually make those emotions more intense. And then we give you worksheets, right? You have them in front of you, and we give you ideas on how to implement them, how to think of them when you're struggling. Parents, how to support kids when they're struggling, too. And then when you aren't able to, we take a look at that in therapy, and we really play out what happened here? Why weren't you able to use skills? Where could you have used skills? Let's look back at that and see when were some moments and how could we have made that easier for you to think of? Because we get so stuck in our normal routine, it is hard to do something new and insert that. So we examine how to do that for you.
Dr. Karen Nelson 13:20
Absolutely. Because we can be triggered a lot...
Dr. Karen Boortz 13:23
Yeah. [overlapping]
Dr. Karen Nelson 13:23
...in our daily life.
Dr. Karen Boortz 13:24
And then we're not thinking clearly. So to do something new can be hard. And so we'll help you to figure out how to do that and how to realistically. Very often people get handed a lot of skills or can look at that, or can look up, but how do you actually implement those? How do you use them in a way that when you're feeling out of control... [trails off. inaudible]
Dr. Karen Nelson 13:44
Absolutely. I had an example with a client that I was seeing. We were talking about, you know, they got up, and were starting to get ready for work and traffic was really bad. They actually still have to commute. They got into work, their boss was yelling at them, they felt really, really triggered. And we took that example, and started to explore what skills could I use? Could I use self-soothe? Could I use a distract? Could I remind myself that my emotions come in waves? That feels applicable.
Dr. Karen Boortz 14:16
Yeah. And I think where in that pattern could I have started to recognize that I might have been able to... that I needed skills? And that I could have used skills? Because very often we only think about the big incident that led to it, or the thing that happened right before we lost it, or we felt out of control. But we go backwards a little bit and look at a chain of all these events, and try to see like, "Where were some spots that this would have been helpful to do something different?"
Dr. Karen Nelson 14:23
I love it. I really hear you talking about that piece of being curious, not judgmental.
Dr. Karen Boortz 14:49
Yeah.
Dr. Karen Nelson 14:50
...That we're gonna partner with you.
Dr. Karen Boortz 14:52
Yeah, recognizing most of what we do is on autopilot and we need to do it that way. I mean, if we had to stop and think after everything we did, "What do I do next", right? And get in the car.: What do I do next?" Our lives are on autopilot in a lot of ways. Because that is effective. And that's what helps. And then the problem is when we want to change some of the things that have been going on. When we want to adjust that pattern, it gets tricky. And so we're here to just really keep looking at that and trying to be curious, and practice, and try, and re adjust where we need to.
Dr. Karen Nelson 15:29
For sure, this client that I was talking to you about jokes that I'm the kind of eternal optimist because I don't call them triggers, I call them opportunities for change. And he's like, "Literally get out of the room, like I'm done with you as a therapist." And when we're triggered, like you said, that becomes these moments where we can start to explore, "what can I do?"
Dr. Karen Boortz 15:51
Yeah.
Dr. Karen Nelson 15:51
"How am I going to manage this?"
Dr. Karen Boortz 15:52
Right? If you start therapy, and you never have any problems, we've got nothing to work with, right? And so part of it is, and I think that's important, too, it doesn't have to be "I'm so ready for change." Like, "We can do it." And sometimes it's a little adjustment, like, could you have called somebody on the way to work really quick that makes you feel good? Or just listen to a couple songs that impact your mood. It doesn't have to be big things. And so just looking at little steps and little adjustments that people can make, and just really... making them available when we're on autopilot so they become easier to use.
Dr. Karen Nelson 16:26
Tell me about sleep during the pandemic.
Dr. Karen Boortz 16:30
Yeah, I think sleep got so wonky for people, it was really a challenge. It sort of sounds good, like when you go on vacation, and you enjoy your time. But I think we also discover that like that's not realistic. And that's not good for our bodies too, to have a two-day work week, or to be starting at 10 or 11 every day... or to have some of the flexibility that we felt like was useful and was nice to kind of reevaluate, but maybe wasn't good for our bodies in the long run.
Dr. Karen Nelson 16:57
So identifying that piece, what we maybe learned is that schedules are actually pretty important.
Dr. Karen Boortz 17:02
Yeah, absolutely. And having the time in the morning... I had a patient who started just taking a quick little walk when she normally would commute, because it's so funny once you adjust your schedule, like we used to maybe drive a half hour, but now all of the sudden the thought of taking a half hour to do something for myself in the morning... Like I don't have time for that anymore. You do. You did it before. It's about figuring out how to build that in and make it a non-negotiable. And some of those things, too.
Dr. Karen Nelson 17:30
I love that. How does anxiety and depression impacts sleep?
Dr. Karen Boortz 17:35
Yeah, I think it makes it really difficult. And, you know, I think there's a lot of sleep hygiene habits that... so when you're depressed and you're in bed more often or you know napping, feeling really tired, out of schedule, I think it gets tough to get the quality sleep. It gets tough to get real sleep in there, too. Definitely, you know, often anxiety makes sleep much more difficult. And depression can go either direction. And I think that's important for people to realize, too, it can mean that you're sleeping less, too.
Dr. Karen Nelson 18:10
Good point. What might be some symptoms of anxiety?
Dr. Karen Boortz 18:14
I think feeling worried or on edge... sort of wound like a rubber band a lot of times and it's a continuum. So I think some worry and planning is necessary. I am a planner. So I like to say that it's helpful and beneficial in a lot of ways. But everything is a continuum and I think when you notice that it's something that's impacting you and, the challenge is when you worry about things, you're living as if they're happening today.
Dr. Karen Nelson 18:45
For sure. What might be some symptoms of depression?
Dr. Karen Boortz 18:48
Changes in appetite, not having been interested in the things that you were interested in before. Not feeling pleasure or happiness, especially from things that used to feel enjoyable before. Just not feeling like yourself sometimes. Certainly, ever kind of walking in the realm of being better off not being around and I think sometimes people get scared to say that, but those are normal thoughts, too. And they help other people understand what's going on and again, help you to understand that too. But it can kind of feel dark and lonely and and sad a lot.
Dr. Karen Nelson 19:26
For sure. Again, that aspect of shame might come in. I don't want to tell someone that I'm struggling or I'm having these negative thoughts.
Dr. Karen Boortz 19:33
Right.
Dr. Karen Nelson 19:33
How might anxiety and depression show up in someone who is struggling with an eating disorder?
Dr. Karen Boortz 19:40
So I think you know, the eating disorder is kind of like this loud voice or horn going on. And if you can imagine what life would be like with all this chatter and never feeling like you can do enough, and sort of having these voices... I mean, that's stressful to be around all the time and it can be draining and wear you out and look a lot like depression. It can make activities and things not enjoyable anymore when you're constantly worried about that. And then certainly just the worry and stress that goes along with eating disorders is really big.
Dr. Karen Nelson 20:14
So you can be diagnosed with both an eating disorder and anxiety and depression.
Dr. Karen Boortz 20:18
Yeah, and I think we see a variety of people who, you know, it might be primary, the mental health, it might be mostly the depression and anxiety and the eating disorder came along next as a coping means. And sometimes it's the opposite, that it's really about the eating disorder, and the mental health stuff came along with it, too. And I think sometimes there's a misconception that, like, if I fix the depression or anxiety that sometimes those have less stigma these days than the eating disorder. So if I just fixed those, the eating disorder will go away. But it becomes its own entity and really needs to be addressed, too.
Dr. Karen Nelson 20:58
What are some things a person with an eating disorder can do to continue their recovery during this pandemic, in this difficult time?
Dr. Karen Boortz 21:05
Yeah, I think staying connected to people, talking about things. You know, focusing on little goals and challenges, and focusing on those pros and cons. Trying to remember what life was like without the eating disorder. I think sometimes people can't even remember how they used to enjoy things or what that was like, and really trying to keep that image in mind. And, again, evaluating sort of the values of am I spending the time and mental energy on the things that matter to me? And just looking at that, sometimes reflecting on it... So it might be journaling, it might be looking at those pieces.
Dr. Karen Nelson 21:43
Tell me about community and how that might be important to recovery.
Dr. Karen Boortz 21:47
Yeah, I think, you know, the eating disorder is such a loud voice for people. And it is, you know, we're leaving them alone with the devil, in some ways, 23 hours a day, even on a therapy day, right? That's a day they got treatment. And so no matter what good advice they can get, I think it's really hard to then leave and have this other voice that's telling them something different. And so the more voices that we can have, that counteract that eating disorder, and that have a different message is really important and relying on those people. Because again, it's one of those weird illnesses where we don't know if we want to get better. And some days we do, and then some days that all goes out the window. And so how do people... What do people do on the days they're not as sure? And sometimes that's really about community and people supporting them, and helping them to make different choices on those hard days, too.
Dr. Karen Nelson 22:44
How can friends and family support a loved one with an eating disorder during this pandemic?
Dr. Karen Boortz 22:49
You know, I think there's a variety of ways and it's so individual to each person. And I think trying to understand... get them talking... help them to understand... help them to see the pros and cons, and to get the help that they need. And then really trying to work with those providers to understand for that person. For some people, it may be pushing more food, for some people, it might not be talking about the food at all. I think it's so varied, but I think it's about encouraging them to get the help and to at least start seeking that out, and Talking.
Dr. Karen Nelson 23:23
Absolutely. That aspect that we hit on before of have in start the conversation.
Dr. Karen Boortz 23:30
Yeah.
Dr. Karen Nelson 23:30
Like, we're not going to assume that it's just going to get better if we don't talk about it, it often probably gets more intense.
Dr. Karen Boortz 23:36
Yeah, absolutely. And there's a narrative that I'm not that sick, then. Or I don't have that big of a problem if people aren't saying anything. Or, you know, all those other judgments that go along with that.
Dr. Karen Nelson 23:47
I think another aspect... we do have a support group here for friends and family who may have someone who's struggling with an eating disorder. But that aspect that I heard you mention, a family just getting involved.
Dr. Karen Boortz 23:59
Yeah.
Dr. Karen Nelson 23:59
Understanding the therapy that they're doing... maybe learning some DBT skills, and encouraging their loved one who's struggling you know, to maybe use skills or do a distract with someone.
Dr. Karen Boortz 24:11
Yeah. Yeah. And I think... being okay with getting the feedback of what's helpful and not helpful. I think sometimes we can be so quick to be defensive, or to want to explain why that might be why I said this, why did this, or defend... but I think knowing you're never going to understand that eating disorder brain. And so you can ask too, you can ask what would be helpful; you don't have to know it or figure it out. And often they may not know initially. I think if you keep kind of prompting them to give you that information, they will think about it and might have some ideas too.
Dr. Karen Nelson 24:49
Absolutely. I love that. Just again, continuing that conversation. And oftentimes my patients are pretty quick to tell me what they don't like...
Dr. Karen Boortz 24:59
Yeah. Or certainly know it when you give them the wrong thing. [Overlapping].
Dr. Karen Nelson 25:03
That's right. That's right. But like you said, start there.
Dr. Karen Boortz 25:06
Yeah.
Dr. Karen Nelson 25:06
Not helpful mom, when you... you know, are whatever.
Dr. Karen Boortz 25:10
Yeah.
Dr. Karen Nelson 25:11
Right and acknowledging, "Gosh, when we sat on the couch and watched, you know, Ted Lasso and had popcorn like that was really fun."
Dr. Karen Boortz 25:19
Yeah.
Dr. Karen Nelson 25:19
Let's do that again.
Dr. Karen Boortz 25:20
Yeah, often it's about distractions. It's about, you know, not distracting in a way that means that we don't have to do the food, we don't have to address the problem, but that we don't have to focus on a ton. And that we can recognize that that can be really difficult. And that might not make sense. I think just understanding that it's not rational. A lot of times people want to logic a loved one into like, having it go away. I think knowing that eating disorders are so illogical, it doesn't make any sense. And so you can share your logic with them sometimes, but it's probably not gonna sink in. And there's probably different ways that you need to find to help.
Dr. Karen Nelson 26:00
That's right. I talk to people a lot about I can't assume even if it's my most loved family or friend, I can't assume they can read my mind.
Dr. Karen Boortz 26:08
Yeah. And especially when that person doesn't know in that moment what they want, how are you going to figure out what they want or need?
Dr. Karen Boortz 26:14
And so they need to kind of do some of that work to think about what... what you can give them because like we already said, I mean, you will know what you don't want.
Dr. Karen Nelson 26:14
That's right.
Dr. Karen Nelson 26:23
That's right. Very, very, very true. Telehealth has been wonderful during this time, as it allows people to, you know, see their therapist potentially from the comfort of their own home or you know, maybe they're there at work. But can you tell me why this might not always be ideal for someone who is struggling with an eating disorder?
Dr. Karen Boortz 26:42
Yeah, I think it's really important sometimes for professionals to just get eyes on somebody and see how they're doing. See how in real time there seem to be feeling I think you lose a lot of context over the phone in terms of how somebody's mood is, how they... what they bring to the table. You know what I think... there's a lot of looking at what that realistically looks like for their body right now. And I think there can be a lot of hiding and misleading of that sometimes in telehealth for eating disorders. Eating disorders are sneaky.
Dr. Karen Nelson 27:17
That's right. That's right.
Dr. Karen Boortz 27:19
And it's not... I think the challenge for loved ones is, like we talked about with chemical dependencies- it seems behavioral. It seems like they're doing it on purpose. It seems like they're doing something to be hurtful. But, you know, it's just we know, that's part of the deal, that it's... you know, often eating disorders are gonna see what they can get away with. And it's not about the individual, it's about the eating disorder, and that just being such a strong pull for them, that it's hard to be open sometimes to share what's really going on. [Overlapping].
Dr. Karen Nelson 27:49
For sure. Very true. Absolutely. [Overlapping]. I think acknowledging that while telehealth may be an option, that it also may be encouraged or even required from your treatment team that you'll be seen in person, because like you said, that it can be real sneaky.
Dr. Karen Boortz 28:05
Yeah.
Dr. Karen Nelson 28:05
And so yeah.
Dr. Karen Boortz 28:06
And you know, the pros and cons of it are in terms of your weight, that doesn't always lie to us on where things are at sometimes, too. And so while we don't want to surround the treatment with what the weight is a you know, it is an important factor and can be, you know, can help us to understand what's going on. And as part of the picture that is important for us, too.
Dr. Karen Nelson 28:33
Absolutely. Isolation and anxiety, and uncertainty can all contribute to an eating disorder. What might be the best way to manage all of those?
Dr. Karen Boortz 28:47
You know, I think it is to try to remember what you do have control over and what you don't sometimes. You know, we do things on radical acceptance and on accepting some things and that doesn't mean you, you have to like it. I think that can be confusing for people that I'm allowing permission or especially people who have been passive in the past. I think there's a difference between being okay with something and also accepting like, this is where things are today. I think trying to understand what's on the table, what's the goals? What are the things that you can do to improve things in this moment, and today and trying to not get ahead of yourself. Or look back too much.
Dr. Karen Nelson 29:30
Absolutely. So really accepting things where they are today, right? Kind of being in the moment... almost that mindfulness piece that we were talking about.
Dr. Karen Boortz 29:39
Yeah. And it doesn't have to, it might not be that way forever, but today it is for whatever reason, right? Today, I'm struggling. Today, these things are happening. It isn't going to be forever, things will change. But today, here's what I have to do to try to manage that. And then just really little habits, you know. Really little things that might seem silly or feel silly or be little, can make such a difference, too. Just five minutes outside. Take the steps once we get into the habit, a lot of times it's easier to sort of do more for ourselves, but it might just be brushing your teeth... like what are little goals that are achievable in that day that would make a difference for you?
Dr. Karen Nelson 30:19
Very good point. What do you hope our listeners take from our conversation today?
Dr. Karen Boortz 30:24
Well, that Karens are awesome.
Dr. Karen Nelson 30:26
Uh, yeah. [Laughs]. We have totally proved it.
Dr. Karen Boortz 30:31
No, I think mostly there's that like... ask somebody. Talk to somebody. Encourage the conversations. Know you're not alone. And I think, always go check it out. Get more information from people who know this field and can help you consider if we can be helpful, what your options are, and you can consider them more what you would like to do.
Dr. Karen Nelson 30:55
I love that. Continue the conversation.
Dr. Karen Boortz 30:58
Yeah.
Dr. Karen Nelson 30:58
And recovery is possible.
Dr. Karen Boortz 31:00
There you go.
Dr. Karen Nelson 31:01
That's right. Well, Karen, thank you so much for joining me today. It's been such a joy talking with you about this really important topic of eating disorders during a pandemic.
Dr. Karen Boortz 31:10
Yeah, I think it's been really hard for people and it's good to have as many resources out there and just to let them know that their healing's possible and the help's out there. I know it's trickier to find, but we're here.
Dr. Karen Nelson 31:23
[Piano Music] That's it for today. Thanks for joining me. We've covered a lot. So I encourage you to let it settle and filter in. And as I tell my patients at the end of every session: Take notice. Pay attention, and we'll take it as it comes. I'll talk to you next time. Melrose Heals, a conversation about eating disorders, was made possible by generous donations to the Park Nicolet Foundation. [Music fades].