On today's episode, Dr. Karen Nelson is joined by Patti Witt, licensed Marriage and Family therapist here at Melrose. Karen and Patti will discuss Trauma - what it looks like, how it is stored in the body and how trauma can intersect with Eating Disorders.
On today's episode, Dr. Karen Nelson is joined by Patti Witt, licensed Marriage and Family therapist here at Melrose. Karen and Patti will discuss Trauma - what it looks like, how it is stored in the body and how trauma can intersect with Eating Disorders.
For a transcript of this episode click here.
Dr. Karen Nelson: [00:00:00] 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. A podcast designed to explore, discuss, and understand eating disorders and mental health.
On today's episode, I'm joined by Patti Witt, Licensed Marriage and Family Therapist here at Melrose. Patti and I will discuss trauma, what it looks like, how it is stored in the body, and how trauma can intersect with eating disorders. Now, before I begin, I invite you to take a deep breath and join me in this space.
Well, welcome to the podcast, Patti. So happy to have you here with me. Before we get [00:01:00]started, I would love it if you could introduce yourself and tell us about your role here at Melrose.
Patti Witt: My name is Patti Witt, and I am a licensed marriage and family therapist, and I primarily see clients in the outpatient setting.
Dr. Karen Nelson: You know, we're going to be talking today about trauma, and you know, I think we use that word a lot in kind of everyday discussions, right? People might be familiar with the acronym PTSD or Post-Traumatic Stress Disorder. We'll talk about that as we move through our discussion today. But sometimes it can be confusing to understand. Like, what is trauma? Like, is there a particular definition of trauma that we use in therapy? Or maybe help us understand how you as a therapist conceptualize trauma.
Patti Witt: So, a lot of my clients ask me that very question, ‘Do I have trauma?’ or ‘I don't have trauma.’ And so that can take them a [00:02:00] while to accept that what they went through has had a lasting effect on them, a negative event that overwhelmed them and they don't see it sometimes as a cause of where they might be in their life now.
Dr. Karen Nelson: Absolutely. So, it really is a subjective experience, right?
Patti Witt: Absolutely. Because what might be traumatic to you might not be traumatic to me, depending on the context or the circumstances surrounding it.
Dr. Karen Nelson: Oh, it's so important. Absolutely. And how lovely to be in the therapy experience and you as the therapist to validate that. Like this is your experience and if it felt impactful to you, well then it is. Just period, right? Like we don't have to look for qualifiers or ‘Yes, buts.’ A lot of our clients do that. ‘Well, yes, but –’ you know – ‘other worse things might happen to other people.
Patti Witt: Oh, I hear that a lot too.
Dr. Karen Nelson: Right.
Patti Witt: You know, it's not [00:03:00] traumatic because so many other people have experienced it worse.
Dr. Karen Nelson: Yeah.
Patti Witt: And I tell them, that's part of a trauma response is that you're disconnected from how it impacted you.
Dr. Karen Nelson: I'd love it if we could continue to explore that idea of how sometimes people may minimize their own experience. And you were mentioning how that in and of itself can be a trauma response. So tell us a little more about that or, or how that might show up.
Patti Witt: Or it could also be a protective response.
Dr. Karen Nelson: Tell us. Yeah.
Patti Witt: If you minimize it, like ‘That wasn't that bad,’ or ‘That's happened to other people and that, you know, it's not a big deal.’ That's a protective factor for you because then you don't have to really go there or pay attention to it.
Dr. Karen Nelson: Absolutely.
Patti Witt: And so, so many clients will, again, [00:04:00] minimize it. And when they do that, well, the act of minimizing it actually is connected to the symptom use. Let's continue to define, you know, we were talking about trauma is defined as negative event or an event that creates just negative long lasting experiences for someone. What could be a traumatic event in someone's life? I would love it if you could maybe give us some examples of what that might look like.
Patti Witt: Okay. So there's one-time events like a car crash or being in a fire or somebody dying. Those are one-time events that can be really traumatic. There's also traumatic events that happen, that occur over and over. Being bullied.
Dr. Karen Nelson: Yes. Oh my gosh.
Patti Witt: Racism. Being, as a child, being put in situations where you have no power?
Dr. Karen Nelson: Well, I think, you know, what I'm really connecting with [00:05:00] and I think what we explore in therapy with our clients is, again, their experience of the event. And so patients may say, ‘Well, yeah, I was bullied, but everybody gets bullied.’ But that doesn't mean that your experience is any less important or real. So to summarize, the trauma can be a one-time event or it can be something that happens over time, correct?
Patti Witt: Absolutely. The other piece of it is: What were your support system? What was your support system like during the traumatic event? So if a child was bullied and the teacher notices and steps in and helps manage it, or if the child goes home and talks to the parent and the parent steps in and manages it and talks to the child about what it's like, then [00:06:00] trauma may not be so impactful. If a child is bullied and nobody notices or nobody does anything about them or they don't talk about it – because a lot of times trauma is connected to shame. Because what happens with trauma is, you know, it's always – typically – people are always going to think it's their fault. They've done something wrong or they've done something to deserve it. And so if nobody like helps them understand the truth of that, which it is not true, then what happens is that shame is now the forefront of trauma.
Dr. Karen Nelson: Such a beautiful description. Well, and I think something that has always helped me as a therapist kind of conceptualize trauma: You know, trauma is an experience that creates a feeling of helplessness, right? It's [00:07:00] associated with, like you said, I love that you bring up shame. We're going to talk a lot about that experience. There may be like pain, physical pain that's attached to that traumatic experience, feeling confused, uncertain. So a lot of overwhelming thoughts come in when a traumatic experience has happened.
Patti Witt: Overwhelming thoughts and overwhelming emotions –
Dr. Karen Nelson: That’s it.
Patti Witt: And overwhelming body sensations.
Dr. Karen Nelson: I love that. Yep. Absolutely. Because our body is in the trauma. So, it's panicking. It's reacting. Let's talk about fight or flight. People may have heard that term before. Often associated with trauma, when we are really triggered or feeling overwhelmed, our body might go into fight or flight. Tell us a little bit about your experience of, you know, helping patients know what fight or flight is or what is fight or flight?
Patti Witt: Well, you know, fight or flight [00:08:00] is a trauma response that occurs without you thinking about it. And so, many times when there is a trauma, your body and your brain are reacting together to protect you, to do the best thing to get you out of that situation. And so fight or flight is connected to pushing back, getting away, fighting. Which is another thing that happens in trauma that happens naturally without you thinking about it. Because if there's a tiger in the room, like you open the door and there's a tiger, you don't want to think, ‘Is this tiger a nice tiger, or is it a fake tiger?’
Dr. Karen Nelson: That’s right. We're not assessing.
Patti Witt: No, you want your thinking brain to shut down and like run or slam the door or go into collapse or fight, whatever your best option is to stay alive.
Dr. Karen Nelson: I like that you identified that aspect of, we may [00:09:00] label it fight or flight, but there's another equally important component to that of being freeze, fight, flight, or freeze. And any one of those three components, like you said, our brain naturally is doing it to protect us. Let's talk about, how can trauma show up in a person's life, or what might that look like?
Patti Witt: So many times the client will come in and say things like, ‘There's just something wrong with me.’ They can't identify it, but, ‘There's just something wrong with me. I'm not a good person. I'm not, you know, a worthwhile person.’ Or that shows up in their life and in who they choose to be with, their different choices in life, it shows up in extreme busyness so that they don't have to, like, think about what might happen to them. ADHD, attention deficit disorder, high anxiety, low, [00:10:00] you know, zoning out all the time. Jeez, there's so many ways it shows up.
Dr. Karen Nelson: There’s so many ways.
Patti Witt: Because again, it's so subjective. Each person that walks in, you're going to see it a little bit differently. Low self esteem a lot of times is how it shows up. A low sense of worthiness is a lot of times what comes out. Eating disorders, any kind of addiction typically connected to past trauma.
Dr. Karen Nelson: And so people may be, again, if they've had a one-time traumatic event. So if someone, you know, unfortunately, if they've been raped, or if they've been physically assaulted one time, they may be able to point to that one event. But as you and I are exploring and explaining, again, sometimes the trauma feels almost more subtle or it's not a one time event. And so people feel confused as to, ‘Why do I feel [00:11:00] this way?’ And so as a therapist, we're helping to explore those past experiences to help understand how they're showing up with us, right?
Patti Witt: Right. So it's connecting what happened in the past to the behaviors and how you feel about yourself right now.
Dr. Karen Nelson: Oh, perfect. That's perfect. Absolutely. So the story just becomes so important, right? We want to hear the story. We also call it the narrative, is the fancy word, which just means we want to know the story of who you are and those experiences are deeply impactful and so they show up in our behavior currently. Like you said, eating disorder behavior, that may be a way to numb out or not feel the pain from past trauma.
Patti Witt: Right. So I think my job or your job as a therapist is to connect the dots for them because a lot of people don't understand how this back here might actually be affecting this right now.
Dr. Karen Nelson: Absolutely.
Patti Witt: And sometimes [00:12:00] in doing that, putting things into context, it starts to make sense and you can see people's relief that actually there's a reason that I'm feeling this way. I'm not crazy.
Dr. Karen Nelson: That's right.
Patti Witt: Because they're not crazy.
Dr. Karen Nelson: Of course not.
Patti Witt: Because really, when you look at what they went through, you know, maybe during their childhood and adolescence, and what they're going through now, it's absolutely connected.
Dr. Karen Nelson: So that is important to understand the story. So if I was maybe bullied as a kid and I arrive now in adulthood where I'm busy all the time or I'm struggling in relationships, I worry that people are unsafe or they're going to hurt me. That is how it shows up in your current life. And as a therapist, we're circling back to understand the story of, ‘I wonder why we may be fearful of relationships currently.’ It kind of helps us [00:13:00] understand the story. One of the things I talk a lot about with my clients who've experienced trauma is this idea of hypervigilance, extra awareness, basically. That if I've experienced trauma in my past, I'm going to, in the present, look for anything that even remotely is similar to that previous traumatic experience. So I may over-interpret kind of benign or neutral cues from people. So that's some big clunky words, right? What that basically just means. Let's use an example of bullying or where I've had a lot of distress in friendship. If I have a worldview that people are unsafe and they will hurt me, I may look for, quote, evidence in current relationships to almost, again, protect myself to not engage in relationships. Because of course I don't want to be hurt. Do you notice experiences like that with clients of working to protect [00:14:00] themselves?
Patti Witt: Oh, such a common occurrence. Because you're looking at the present through your past eyes.
Dr. Karen Nelson: Oh, I love that.
Patti Witt: Right. So that's your filter is that the world is dangerous. People are dangerous. I'm going to get hurt. Something bad's going to happen. And that's your filter.
Dr. Karen Nelson: That's right.
Patti Witt: And so even though your adult brain may understand that this person, my friend, is not going to hurt me. You know, there's many, many examples of that. There's still a part of you that doesn't believe that could ever be true. And so that happens in therapy also, is that, you know, while I may prove to be a very trustworthy person, somebody may – part of that person is looking at me like, eventually you're going to hurt me just like everybody else has.
Dr. Karen Nelson: Let's talk about how trauma can be related to Post-Traumatic Stress Disorder. Does [00:15:00] all trauma create post traumatic stress disorder?
Patti Witt: Absolutely not. No. PTSD has a set of criteria that have to be met for that diagnosis to be given to a client. Can you give us some examples of what might it look like if I've had a traumatic experience and I have been diagnosed with PTSD? What might be some of the symptoms that I might be experiencing?
Patti Witt: Hypervigilance. Another one might be intrusive thoughts. So, you know, thinking, you know, things just intrude during your regular day that are connected to the trauma. Nightmares. Thinking that the world isn't, doesn't feel real or that you don't feel real in the world. So dissociation where you lose time zoning out, which, you know, can be a – dissociation, we all do this [00:16:00] every day. You know, it's things like I'm driving down the road and I get somewhere and I'm like, ‘Well, wait a minute, who just drove the car?’ That's dissociation.
Dr. Karen Nelson: Yeah.
Patti Witt: But there's other kinds of dissociation where you kind of are gone longer and you don't like what happened the last couple hours. So those are some of the things that we can see. Losing trust in the world or in yourself.
Dr. Karen Nelson: I mean, I think that those characteristics people can really start to identify with, right? Like, ‘Oh yeah, maybe, maybe I do notice some of these things,’ and that can be some really interesting talking points to bring to your therapist. We were talking about symptoms of Post Traumatic Stress Disorder. One of those symptoms can be kind of, you know, over-awareness, hyper-awareness. People may also experience body changes, right? Like maybe fast breathing, or it may be associated with panic attacks. Help us know what – [00:17:00] does your body change when you're maybe re-experiencing trauma or you feeling scared or stressed? Tell us about that.
Patti Witt: I'm thinking that so many people now have heard that the body remembers trauma.
Dr. Karen Nelson: Yeah.
Patti Witt: And the symptoms that a person experiences through their life in their body many times it's connected to trauma, because their body is remembering and protecting itself in some way or reliving it. So, like you said, difficulty breathing, a fast heartbeat, any kind of stressful reaction, like, your shoulders living up by your ears. Stomach ache. A stomach ache is a big one because you know, a person having a hurt stomach is connected to so many traumas, and it's also connected to shame. The feeling of shame a lot of times is having a stomach ache.
Dr. Karen Nelson: That's right. Attached to – I think about anxiety too, how it all just, you know, we [00:18:00] start to see how they're all just kind of connecting, right? And we're going to weave in how then the eating disorder shows up also as a way to kind of manage all of that discomfort. So our body can hurt. We can have a lot of tension. You know, maybe our heart's racing, right? Kind of these physical experiences of almost like a panic attack. Are there things that we can do to help our body calm down in those moments?
Patti Witt: Absolutely. So if you are having, if your body is what they call hyper-aroused, so a panic attack, you feel like you're out of control, you're extremely anxious. There are ways to bring your body back into what we call the window of tolerance, where you can think and feel and tolerate your emotional distress. So it doesn't mean that when you're in the window of tolerance, you don't have feelings. You can feel, you know, agitated, you can feel scared, you can feel sad. [00:19:00] But at some point, you might go out of the window of tolerance, where you really can't get back into what – a lot of times people think control, right, which is a trigger-ish word, but back into where you feel you can, you know, think and act skillfully. When you can't do that, you can do things like change your breathing or notice your breathing or do a breathing pattern. Like breathing in for a count of seven and breathing out for a count of eight. Things like, you can also do things like grounding your feet sitting up, which I'm doing right now, putting your feet on the ground and putting your shoulders and your back against the chair, which is reminding your body, if you can do something like that, you can't be in danger because that's not a danger pose. If you're sitting up straight and you put your shoulders down.
Dr. Karen Nelson: I absolutely love it. So we use the [00:20:00] word grounding, which is just kind of fancy words to bring you back into the present moment, right? Because when we're panicky, our brain is flying all over the place, we are breathing shifts and changes.
Breathing becomes our biggest avenue to re-regulate. And I think that experience of re-regulating with your therapist is a really important experience to gain some confidence and competence, that I can feel really big things and I also can be safe. Well, let's talk about, we've been having this discussion around, you know, what is trauma? How does someone experience trauma? Let's start helping our listeners understand the intersection between trauma and eating disorders. So tell us how that might show up. If someone has experienced trauma, [00:21:00] how might an eating disorder show up for them?
Patti Witt: So, if you think of the symptoms of trauma, what happens is, there's the fight and the flight and the freeze and the submit. So, actually, the flight is connected to eating disorders. It's a way to get out of your own life or get out of your own head or get away from your feelings. So, a person can use eating disorder symptoms to help manage trauma symptoms.
Dr. Karen Nelson: Absolutely. Absolutely. Once again, no one wants to hurt. They just don't. And if I've experienced this traumatic event or long-term trauma, prolonged trauma that brings up all this emotion and distress, of course I don't want to feel that. And so the eating disorder, she just sits right outside the door. She just waits until all that distress shows up. She knocks on the door and says, ;Hey. Why don't you –’ and we can fill in the blank as [00:22:00] far as what the symptom looks like. I might binge, purge, restrict, overexercise. Right? I mean, does that resonate for you, what you see with your patients?
Patti Witt: Absolutely, except the eating disorder to me is not outside the door.
Dr. Karen Nelson: Oh, good point.
Patti Witt: It's sitting next to them.
Dr. Karen Nelson: That's right. That's a good description.
Patti Witt: Like, I am your friend.
Dr. Karen Nelson: I am your friend.
Patti Witt: I'm going to help you.
Dr. Karen Nelson: Good point.
Patti Witt: Because, you know, so many times people demonize the eating disorder. But a lot of times I say the eating disorder is a misguided attempt – you know, if we think of it as a part of yourself – it's a misguided attempt to help you regulate yourself, your world, your life.
Dr. Karen Nelson: Because once again, I don't want to hurt. And so if I can engage in this behavior and not hurt for even a moment, I'm going to do that.
Patti Witt: Yes.
Dr. Karen Nelson: The reality is we only have so much energy and attention in our brain. And so if my brain is being really triggered by a past traumatic event and [00:23:00] I shift that attention to focusing on calories or restricting, focusing on you know, planning out a binge or when I'm going to purge, then I don't have to be in the mind of almost like re-suffering from that past traumatic event.
Patti Witt: Yes. It's a way of disconnecting from the past.
Dr. Karen Nelson: You got it.
Patti Witt: But the unfortunate thing is that you're also disconnecting from the now.
Dr. Karen Nelson: Good point, absolutely. Not only disconnecting from the now and engaging in eating disorder behaviors, we know, right, is just really risky. So let's maybe explore. If someone, let's use the example of someone who's experienced trauma and may be engaging or has also been given the diagnosis of anorexia. I would love it if you could maybe help our listeners know how that might come to be or, or how they are using anorexia behaviors to manage those symptoms of trauma.
Patti Witt: So, [00:24:00] most people actually do connect anorexia with control. And if I wasn't able to control what happened, you know, what has happened to me, this is a way for me to have absolute control. I control what I look like. I control what I put in my mouth. I can control the calories. I can really be in control of my world. And of course, you know, when you don't have an eating disorder, you're looking at it like, no, actually this, you're out of control. But it doesn't feel that way. It feels like, ‘I am in control, things are good, I am managing.’
Dr. Karen Nelson: Again, if we kind of go back to that idea that the trauma creates emotion and experiences that may feel overwhelming – hence, out of control, right? I feel out of control with my emotion – then the eating disorder is a way to kind of control the emotion? Or what would you say?
Patti Witt: Well, it's absolutely a way to not feel [00:25:00]anything. You know, it's a way to you know, focus on, don't look at, don't open that door. Stay in the room, never open that door. And so you stay in the room and your world actually becomes very, very, very narrow.
Dr. Karen Nelson: The research does tell us that there is a high incidence of patients who have been diagnosed with eating disorders also carry a diagnosis of PTSD or Post Traumatic Stress Disorder or indicate that they do have a history of trauma. So we do know that many people who are struggling with eating disorders also inherently have this experience with trauma in their background.
Patti Witt: And I just want to bring up another type of trauma that could be connected and that's attachment trauma.
Dr. Karen Nelson: Tell us.
Patti Witt: So when you have attachment trauma, you, it is like you are – you learn that it's not safe to be attached to other people. You didn't have safe [00:26:00] attachments or meaningful attachments as a child. And so you can only, you have to kind of pull into yourself. And so you do want to disconnect from the world. That feels safer. And so this kind of attachment trauma actually can be connected to all different types of eating disorder. But a lot of times when you have attachment trauma, you are not aware of the damage that's going on with an eating disorder. You're not attached to yourself either.
Dr. Karen Nelson: So, let's talk about some interventions that might be used for someone who's been diagnosed with both PTSD and an eating disorder. And just as a side note I'm using the word intervention, another word that we might use is like ‘treatment for.’ So, sometimes we use the word interventions as therapists, like what interventions are we using? Another way to talk about that is also different treatments for PTSD and eating disorders.
Patti Witt: One of the most important interventions is connection with your [00:27:00] therapist and building trust and showing up, you know, showing up and paying attention. And so I know that that's not a technique, but I just want to say that sometimes people get this idea that trauma therapy involves an intervention. And sometimes it does, but a lot of times it's, you know, coming into therapy week after week. Learning to trust somebody. Learning that this person's not going to hurt me, that this person's not going to make fun of me, that this person's not going to think I'm stupid, that they're on my side. And so, if you didn't have that growing up, then that repair, that's part of the repair of trauma therapy. There are other interventions such as EMDR.
Dr. Karen Nelson: Oh my gosh. I know. You go first. Eye movement –
Patti Witt: Eye Movement Desensitization Reprocessing.
Dr. Karen Nelson: You did it. We get a medal. Nobody ever says the long words you [00:28:00] guys, so everyone just says EMDR in kind of therapy lingo. So I'm glad you remembered what the DR meant, because I didn't.
Patti Witt: So you're taking a memory. Or you're taking a piece of, you know, a piece of a memory and you're reprocessing it. Or you're processing it for the first time, actually, and you're using eye movement or bilateral eye stimulation to move through this.
Dr. Karen Nelson: This is kind of where I geek out, you guys. The brain is really, really cool and amazing. And we talk a lot about kind of the emotion side of our brain and the logic side of our brain. And one of the ways to kind of understand what happens in trauma is that the traumatic experience gets kind of stuck on one side of our brain, the emotion side of our brain. And so we need to kind of help that experience move to the logical side of our brain, not to minimize or discount the emotion, [00:29:00] but to help us understand and tolerate the event in a different way. So that's the magic of why EMDR works. There's another type of therapy called ART, Accelerated Resolution Therapy.
Patti Witt: Good job.
Dr. Karen Nelson: I knew that one. Where basically, we're just having people move their eyes and remember an event and we're reprocessing it with them. There's a lot of other steps, right? I mean, so I don't want to minimize it down to that. But it really is about moving the memory from one side of the brain to the other with the assistance of a skilled therapist.
Patti Witt: Or another way to think about it, your thinking brain helping to put it into context, right? So your thinking brain or your left brain is helping your right brain to understand it. Because when you understand it as a child, children have different ways of thinking. Their brains, up until the age of about 11, [00:30:00] are mostly concerned with, you know, the emotional growth. And then after 11, then they start to be able to use more of their left brain, their thinking brain, putting things into context. If you had trauma as a young child, you didn't really have the context. Your brain was very black and white and very feeling oriented, so it's stored quite a bit different than when you have a trauma as an adult. So in EMDR or ART, your left brain, your thinking brain is actually helping – crosses over – and helping your emotion brain, like, make sense of it.
Dr. Karen Nelson: Very good point. And those therapies, again, you know, we want to be very clear. Those are very specialized therapies. We have therapists here at Melrose that are trained in those techniques. It's a collaboration between the patient and the therapist to determine what type of therapy is going to best help them. There's all different types of intervention. I [00:31:00] love, and I want to acknowledge, that place of the importance of connection between the therapist and the patient.
Patti Witt: My experience is when I go out to like, get my client, my body and my eyes and the way I look at them is already telling them, I am happy to see you. And I am, I'm happy to see them. And who doesn't love that? And we all need to feel that somebody's happy to see us. And that is a huge part of connection is that I'm happy to see you through my eyes. I'm looking at them with fondness, with love, with compassion, with empathy. And if they are able to meet my eyes and see that, that's a part of the healing process right there.
Dr. Karen Nelson: Oh, it's so. It can be a really unique and new experience for some of our clients to be just genuinely cared for because our [00:32:00] experience as their therapist can almost kind of mirror. Right? Like if someone – you're right. I mean, the reality is that we're human beings and we're therapists. So we're real good at feels, right? Like I tell people, like, I'm just going to feel it. Like I just am. It's who I am. Right? It's who we are. But I love that you're saying that because when we become emotional, again, not inappropriately emotional, but when we just validate that, wow, what you just shared with me was so impactful and I have emotion, many times our patients are looking at us and saying, ‘It's okay that I feel that way then. Maybe I felt that way on the inside, but I've never expressed it on the outside because I've been minimized or shamed or too afraid.’
Patti Witt: Right. I'm telling you, this is a big deal. I'm not saying get over it, you know, Oh, I can't believe you're feeling that way. I'm saying this is a big deal.
Dr. Karen Nelson: That's right.
Patti Witt: And I'm glad you told me.
Dr. Karen Nelson: [00:33:00] So good. Mm hmm. If someone has been diagnosed with an eating disorder and trauma in their background, what support may they need from family and friends?
Patti Witt: Well, I think that first of all, that they have to allow themselves to have support because sometimes what happens is asking for support or asking for help feels – these are trigger words – needy, like you're too much, you know, those types of words. And so, even acknowledging that it would be helpful to reach out and ask. So we, I do a lot of work about how do you ask for help? How do you, you know, what kind of support do you need, but how do you, like, move toward that support? Because in our culture, it's like, ‘Pull yourselves up from the bootstraps,’ right? And so there's this vision that you should just be able to get through [00:34:00] it. You know, why are you complaining? Just get through it. And I hear that a lot: Just get through it. Well, that's what you've done all your whole life. Just get through it. Just get through it. Just get through it. And now here your therapist saying you don't have to just get through it. You can reach out and get support, and that can be a really new concept.
Dr. Karen Nelson: That's right. Well, and how scary it can be to ask for support if I've literally never done it or I've been shamed for asking.
Patti Witt: Oh, the word shame. Exactly.
Dr. Karen Nelson: The shame word. For sure. Tell us about how our patients may experience shame around that so they have maybe like a dialogue that I shouldn't ask for support.
Patti Witt: I shouldn't be so needy. I should – anytime you hear the word should, or ought to, it usually involves shame. And you know, we can experience shame in much different – our reactions to shame can be similar or very different. So there's something called the [00:35:00] shame compass. And it's just a compass of like different ways that people respond to shame. One can be you can attack yourself. You know, with words or behaviors. ‘I shouldn't have done that. You're stupid. Why did you do that? Everybody hates you.’ So it's all these negative ways of, you know, cutting yourself, harming yourself.
Dr. Karen Nelson: Using the eating disorder.
Patti Witt: Using the eating disorder. So you can attack others. And so this is when somebody says something to you and even if they don't mean to shame you, you can feel the shame, but then attack them. You can, then in another way, you can isolate yourself, you can turn away, you can – isolate yourself is a big one. You, you know, you go off on your own to lick your wounds as it were. And then the opposite side is that you turn to the eating disorder for comfort. You turn [00:36:00] to drugs and alcohol for comfort. You turn to something to numb yourself out. And in the middle of the compass is rumination.
Dr. Karen Nelson: Oh.
Patti Witt: Where you ruminate over and over and over about what has occurred and then you get stuck.
Dr. Karen Nelson: Really stuck. For sure. Yeah. And so we can just – I mean, what a beautiful example. Do you have a handout of that? And can I get one by Monday? So good.
Patti Witt: I wish I could credit it. I just heard it, looked it up and I've been using it for years, but it –
Dr. Karen Nelson: Oh, it's so good.
Patti Witt: So you can look up the shame compass and –
Dr. Karen Nelson: I will be Googling that. That's right. I mean, shame. I mean, that's what we say at the beginning of the podcast: Eating disorders live in secrecy and shame.
Patti Witt: Absolutely.
Dr. Karen Nelson: So Patty, as we're finishing up today, is there anything I haven't asked you that you'd like to say?
Patti Witt: You know, before the podcast, I looked up a little bit about how do I help somebody that has trauma, [00:37:00] because a lot of times when you, I mean, it's so prevalent that you are going to come across somebody that has had traumatic experiences. And so I googled it and came up with all these ideas about. how do I help somebody? And there's things to do or things to not do, things that you can say. And one of the the top ones was listen, just listen and you don't even have to make a comment or you can make a comment like, ‘That sounds hard’ or ‘I'm glad you told me/’ And just listening without having to have a response. Because so much of the time we want to fix things and so we don't want to say things like, ‘That happened a long time. You know, why aren't you over that now? It's not a big deal.’ It really invalidates the person that has trauma. And so it's kind of like, listen. Listen without having to have a response.
Dr. Karen Nelson: It's perfect. [00:38:00]Patty, I can't thank you enough. This has been so, so amazing to have this conversation with you today.
Patti Witt: Yeah. You're lovely too. What am I looking at you with? My love.
Dr. Karen Nelson: That's it. Yeah.
Patti Witt: My love and connection eyes.
Dr. Karen Nelson: I know.
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.
To learn more about Melrose Center, please visit MelroseHeals.com. If you or a loved one are suffering from an eating disorder, we're here to help. Call 952 993 6200 to schedule an appointment and begin the journey towards healing and recovery.
Melrose Heals: A Conversation About Eating Disorders, was made possible by generous donations to the Park [00:39:00] Nicollet Foundation.