Dr. Karen Nelson is joined by Patti Witt, LMFT here at Melrose. Karen and Patti will talk about Depression and anxiety - and the impact they can have on eating disorders and eating disorder recovery.
Dr. Karen Nelson is joined by Patti Witt, LMFT here at Melrose. Karen and Patti will talk about Depression and anxiety - and the impact they can have on eating disorders and eating disorder recovery.
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. Together, we will discuss anxiety and depression, and the impact these two can have when combined with an eating disorder. Now, before I begin, I invite you to take a deep breath. and join me in this space.
Patti, welcome back to the podcast.
Patti Witt - Thank you.
Dr. Karen Nelson - This is our third time? So happy to have you here [00:01:00] with me. My dear friend, Patti, and lovely colleague is back with us today, talking about this really important conversation. You know the drill, though. Before I get started, could you introduce yourself and tell us about your role here at Melrose?
Patti Witt - I'm Patti Witt. I'm a licensed marriage and family therapist and I work at the Burnsville, Minnesota office in the outpatient setting.
Dr. Karen Nelson - Wonderful. So Patty and I have had the joy of working together for the past several years. We do a lot of, kind of, collaboration and consultation. One of the many best things about being a therapist is that all my friends are therapists. And so I have the joy of being able to just really get to know Patty. And we do a lot of consultation, not only about, you know, our patients, but also just our lives as well. Let's maybe just start talking about this idea of depression and anxiety. What comes up for you as I bring up kind of those two diagnoses?
Patti Witt - You know, I guess what happens for me is I [00:02:00] feel like when you talk about anxiety, things go up.
Dr. Karen Nelson - Yes.
Patti Witt - And depression, your feelings or your body goes down.
Dr. Karen Nelson - How else might you even describe it to a patient if they're struggling to know, do I have anxiety? Might I be depressed?
Patti Witt - You know, ask them to go into their body. What are they feeling in their body? Because a lot of times your body will give you the clues about, you know, are you anxious? Is your heart pounding? Are your hands tingling? Can you sit still? Are you able to focus? Depression, it might be a similar thing. Are you able to focus? Maybe not, but maybe you feel kind of like heavy. You feel blah. You don't have many feelings. You feel kind of dead inside. And so they can be similar, but there are certainly differences.
Dr. Karen Nelson - I think that's a really tangible way for people to kind of connect in, with, do I have potential anxiety or do I have depression? I think a lot of times what I notice, Patty, [00:03:00] in around mental health is we talk about topics, but we often don't explain them. And so people can be like, oh, yeah, I feel anxious. Sometimes. Well, does that mean I have anxiety?
Patti Witt - Well, there's situational anxiety, like driving in today, felt a little bit anxious.
Dr. Karen Nelson - Same girl, right?
Patti Witt - But I don't feel that all the time. So there's situational anxiety, but then there's also anxiety where it's pretty much the mainstay of my life. I also have clients that after working with me, they realized, you know what? I think I am an anxious person, or I think I have anxiety, but they live with it and it feels normal to them.
Dr. Karen Nelson - So we actually do have a lot of statistics about general mental health disorders. There's actually some statistics that say there are estimates that show about 60 percent of those with anxiety also have symptoms of depression. And so in therapy, we'll use the word co-occurring, meaning like two disorders go together. How do you make sense of that, [00:04:00] that those disorders often co-occur?
Patti Witt – Well, if you think about eating disorders, most of the time, there's co-occurring disorders that go with them. And so if you have an eating disorder, it's likely that you might have anxiety and it's unlikely you may have depression and it's likely you may have both.
Dr. Karen Nelson - That's right. Absolutely. I kind of joke with my patients sometimes. I say, anxiety and depression, they're like first cousins. They're just kind of in the same family. They hang out together. Their symptoms can inform one another or trigger one another, right? Do you notice that with patients?
Patti Witt - One of the ways that I see both occurring is if a person is using symptoms, anxiety might be driving them to use symptoms, but afterwards then they might notice that depression comes up from using symptoms. I rarely see an eating disorder without a co-occurring diagnosis. I probably see that every time I see a client.
Dr. Karen Nelson - That's [00:05:00] right.
Patti Witt -Yeah.
Dr. Karen Nelson - That's right. It's just really common to have other mental health issues with the eating disorder. We're going to be doing a lot of exploration of how those three kind of inform each other. How depression and anxiety obviously are standalone diagnoses, but what we noticed doing eating disorder work is that they show up very frequently as a triad, or sometimes people will only have depression and an eating disorder. Or only generalized anxiety and an eating disorder.
Patti Witt - Again, when you think about anxiety or depression, a lot of times it shows up in the body. That's the first time or the first sign that something's wrong, a headache, a stomach ache. I can't go to school because I have a stomach ache. So parents, you know, maybe that aren't familiar with mental health symptoms will see physical symptoms, bring their kid in, and then the doctor can recognize that maybe something else is going on.
Dr. Karen Nelson - Absolutely. Do you think that's also true for [00:06:00] adults that, you know, sometimes adults will present in a doctor's office because I have this nagging stomach ache and I don't know, what have you noticed?
Patti Witt - Oh, sure. You know, think of, you know, tight shoulders, holding your body in a certain pose for anxiety, your shoulders up by your ears, stomach aches, lower back pain, lots of different ways that anxiety and stress can affect us.
Dr. Karen Nelson - Let's maybe kind of break it down a little bit and spend some time talking about both of them. Thinking about depression, what do you look for as a therapist?
Patti Witt - I look for when they come in, how do they sit? What does that look like? I listen to the tone of their voice. I listen to the words, the stories that they tell me. How their week went. I look at their eyes. Are they looking at me? Not that everybody needs to look at their therapist, but a lot of times it's downcast. They're slumped a little bit. There's not very much energy in the room.
Dr. Karen Nelson - That's right. Absolutely. Because [00:07:00] depression and anxiety show up in our body. What would you say, or how may you describe what life might be like for someone who's depressed or what have patients described for you?
Patti Witt - Patients have described when you go outside, you don't see colors.
Dr. Karen Nelson - Oh, good one.
Patti Witt - It's really hard to get out of bed. It's hard to be motivated. You want to be with friends, but when you're with friends, you aren't really having fun. There's not a spark there. It's hard to go to work. It's hard to sleep sometimes, or sometimes I want, that's all they want to do is sleep.
Dr. Karen Nelson - That's right.
Patti Witt - And so it's just, even as I'm talking about it, I can feel it in my body. My hands are getting really heavy, and so a lot of times in session, I start to feel what they feel.
Dr. Karen Nelson - Agreed.
Patti Witt - And so that's sometimes how I can feel what is going on with them.
Dr. Karen Nelson - Kind of the vibe in the room, almost. Absolutely. Well, and it's so interesting, you know, as I was hearing you kind of describe [00:08:00] some of the experiences that your patients were sharing, those really are kind of the diagnostic characteristics, big fancy words, is, we look for a collection of experiences to then diagnose someone. And we also look for duration. How long is this happening? And then we look for like impact on other functioning. So, how does this get in the way of other functioning? Because in and of themselves, right, there may be times where I'm sad and I don't want to hang out with friends. And, if that's been happening for six months to a year, okay, maybe we got to look at that.
Patti Witt - Right. So in children, I just want to point out that the depression might show up differently. May show up as anger, may show up as behavior problems.
Dr. Karen Nelson - That's right. Agitation.
Patti Witt - Agitation.
Dr. Karen Nelson - You bet. Yeah. Irritability is kind of the word that I'll use for parents. Right. So they might not have kind of that, quote, classic depressed mood, they just may be [00:09:00] more agitated, ticked off. Yeah, I'm upset about something. Let's maybe talk about some risk factors for depression, thoughts on that, or what comes up for you?
Patti Witt - Trauma can create depression, genetics has an effect a lot of times, unresolved grief.
Dr. Karen Nelson - Sometimes the way that I make sense of the world. We talk about maybe sometimes people have like more of a depressive personality, we just know, and I'm so glad you brought up, not only genetics, but just like how I grow up in my household. If there's someone in my house who's struggling with a depression, that deeply impacts the kid.
Patti Witt - Absolutely. So if you have a parent that can't meet your needs or struggles to regulate their own child, what will happen is that child will then have to figure out a way to manage their own feelings. And so sometimes what will happen is if they're not sure [00:10:00] how to manage their feelings, they might take a cue from their parents.
Dr. Karen Nelson - I'm glad that you brought that up. We just know that past experiences deeply inform how I make sense of the world.
Patti Witt - And so as we've spoken before, core beliefs can drive depression. So if you have negative core beliefs about yourself, one of the things that may happen is you may believe that you are not worthy of love or you may believe that you are stupid. Who wouldn't have symptoms of depression or feel a little bit depressed with that's your worldview.
Dr. Karen Nelson - 100 % And again, we just know that people who have gone through adverse life events, so really traumatic or hard things, are more likely to develop depression. Like you said, it kind of makes sense. If I have these bad things happen to me, and it's how I start to making sense of the world, it makes - we just really understand how it impacts my outlook.
Patti Witt - Right. So if those [00:11:00] things happen over and over, then how will I ever have it be any way different?
Dr. Karen Nelson - Well, and I think sometimes it's not just life events like we were talking about. We know that brain chemistry impacts experiences of depression. How might you talk to a patient if they are maybe a little resistant or uncertain if medication management may be the kind of appropriate course for them or in conjunction with therapy? How have you had those discussions?
Patti Witt - I actually encourage them to meet with a psychiatrist to actually talk about that…
Dr. Karen Nelson - Yes!
Patti Witt - …because the psychiatrists will give them options and talk about the possibilities of how this may help them. And then research does show that psychotherapy and medication is the gold standard. Not always, but a high percentage actually really encourages that.
Dr. Karen Nelson - And I think it's one of the benefits, you know, at Melrose, we have a multidisciplinary team, which is just big words for, we have [00:12:00] various providers that can support our patients. And so I have the same response. If a patient is really struggling with depression, I'll make that referral. Go, let's talk to an expert. Talk to an expert.
Patti Witt - For sure.
Dr. Karen Nelson - Do you think sometimes people take it personally, like, it's my fault that I have a depression?
Patti Witt - Or there's something wrong with me? There's something wrong with me that I'm depressed because, again, our society is pull yourselves up from the bootstraps…
Dr. Karen Nelson - That’s right.
Patti Witt - …and if you could just change the way you think or get up and do something, you wouldn't be depressed. Which, I guess is part of working on depression is like getting up and having a schedule, etc., but if you do have brain chemistry needs, then medication is the way to go.
Dr. Karen Nelson - And so sometimes people may have, again, their core belief of, I'm failing, I'm screwing this up.
Patti Witt - Well, when you don't have depression, it can be really difficult to [00:13:00] understand somebody's experience. And so they may not even understand that they're minimizing or making somebody feel less than. But the person that does have depression, a lot of times will look within and wonder, is this possible?
Dr. Karen Nelson - Even more self doubt, which then can even kind of intensify those feelings of depression. So kind of that shame. I can't do this right, there's something wrong with me. If maybe my family and friends don't really understand it, or say it's all my fault or within my control, those are some pretty big feelings to try and manage.
Patti Witt - Right. Or it's all in my head.
Dr. Karen Nelson - Good One.
Patti Witt - What does that even mean?
Dr. Karen Nelson - I don't know. And then, let's connect in the eating disorder. Let's imagine that I have - I try and share with my family and friends that I'm struggling with a depression. I get the message, pull myself up by the bootstraps, figure it out, just don't be sad. Well, I'm probably gonna want to try and do [00:14:00] something to potentially manage that emotion, hello, eating disorder.
Patti Witt - Hello, eating disorder. And the eating disorder is right there waiting.
Dr. Karen Nelson - That's right. That's right. It wants to, again, I mean, I think I say it literally a hundred times a day, no one wants to feel bad, right? You and I have never met a patient, and I can honestly say I have never met a patient that has walked into my office and said, I hope I have the worst day of my life today, Karen. No, of course not. We may have patients that think, I deserve to have a bad day.
Patti Witt - For sure. Yeah.
Dr. Karen Nelson - But, it makes sense that as humans, of course I don't want to feel bad.
Patti Witt - Well, if you think about binge eating disorder, or bulimia, one of the ways to not be able to feel anything, or think anything, is to use food. And then on the opposite end, anorexia, one of the ways to not think about anything is to have a very tight schedule of restriction. And then you can't, you don't really [00:15:00] need to feel anything for a while. And so it kind of helps manage all different kinds of eating disorders.
Dr. Karen Nelson - That's right. Absolutely. Because we say it all the time, right? Eating disorders are not about food. We just know that. They're about emotion.
Patti Witt -That's right.
Dr. Karen Nelson - And so, hey, if I feel really sad and overwhelmed, number one, of course, I want to feel better, and number two, I got to figure out what to do. The eating disorder says, hey, I know what to do. Binge. Purge. Numb out. Restrict. Let's transition and talk about anxiety. Tell me kind of initial thoughts on that, as I even just mentioned that word, what comes up.
Patti Witt - So, for me, anxiety is a little bit more understandable, or sometimes I am able to help people move through it, because there's not that possible brain chemistry connection. And so, many times, anxiety, you can help people to, like, in the moment, bring [00:16:00] their body, you know, down a little bit. It's a little bit harder with depression to bring their body up.
Dr. Karen Nelson - That's right. Examples?
Patti Witt - If somebody is, you know, very anxious and is wiggling in their chair, tapping their foot, can't sit still, moving around, maybe moving around my office, touching things, you know, one of the ways to help them is to do some mindfulness exercise to get them in their body, because part of it, they're not, they don't want to be in their body.
Dr. Karen Nelson - That's right.
Patti Witt - And so to bring them into their body, a big breath, put your feet on the ground, something to help them kind of ground themselves into the office.
Dr. Karen Nelson - For sure. And the cool thing is, I totally agree with you, anxiety feels like I can tangibly help the person in the moment manage it.
Patti Witt - Yeah.
Dr. Karen Nelson - Right. Because as a therapist, you and I talk about how we can see it. It's because it's very apparent to us. And so [00:17:00] other skills that you might, or I don't know, what else might you do with a patient if you're kind of noticing they're jiggling around or the leg tap is a big one for me, you know, that that's really common where people kind of bounce their leg.They'll sit on the, very edge of the chair. That's another one. Yeah.
Patti Witt - So sometimes I say what, you know, what's going through your mind right now, what's happening up there.
Dr. Karen Nelson - Yeah.
Patti Witt - And a lot of times they don't know because there's thoughts flying around. And so even knowing what's going on up there kind of helps me to see where they are.
Dr. Karen Nelson - I think another thing, sometimes I'll ask that question, kind of what's going on and they'll be like, nothing. It's just, it's typical Tuesday, Karen, what are you talking about? And so then we'll direct our attention together into their body. What do you feel? I feel fine. Slow down. That's my favorite thing to say, slow down. What do you feel? Right? And then it's like, uh oh, it's getting real in here, Karen. What's happening?
Patti Witt - Right, because many times they don't want to go into their [00:18:00] body. That's a dangerous place to go.
Dr. Karen Nelson - So we'll lead them there. We'll help them. We're with you.
Patti Witt - When I recognize anxiety I know that part of my job is to help with the repair. And the repair is me actually giving that client what they need in the moment. Attention. A soft voice. Understanding. Reassurance. Validation. It makes sense that you would feel this way. It's going to be okay. We can work through it. And then they can, they can start to like receive what they didn't get as a child. And then eventually, if we continue to do this work together, I'm hoping that they will take on the part of the repair. I'm okay because I can manage this for myself.
Dr. Karen Nelson - So we know that anxiety as well as depression can start in childhood and adolescence and parents can be really effective in potentially helping their [00:19:00] kids learn how to manage or even name or acknowledge some of that emotion. What have you noticed as a therapist of how a parent can be potentially supportive to a child who's experiencing big failings?
Patti Witt -So if parents are able to help a child understand their emotion, what can happen is the emotion will go up, the parent will give the child what they need, and then the emotion can return to baseline. If a child has a household where emotions aren't tolerated well, then what happens is their emotion goes up, and it goes up, and it goes up, and it hangs around for a while. And then eventually we'll recede and the child then has to learn, what am I going to do with this? How do I manage this on my own? The things that parents can help children with, manage emotions with, are exactly what you said, naming them. They can help comfort them when they have emotion. They can give them reassurance, validation, [00:20:00] attention, safety. And if a child gets that when they're having difficult emotions, what they will learn is I'm okay because somebody will take care of me. And then as they become adults, they start to do that for themselves and they learn I'm okay, because I will take care of me.
Dr. Karen Nelson - Nice. So what happens if maybe I am a kid, who I, maybe I didn't have an adult that was there to comfort me or to kind of help me learn how to manage emotion?
Patti Witt - Probably you're going to use something else to help you manage emotions, which could be food or lack of food. And then it's, you're going to be a more anxious child, because if you don't have somebody helping you through life's difficult situations or difficult emotions, you may not know what to do with this, and it just stays in your body. Then you become an anxious adult too.
Dr. Karen Nelson - Good point. Well, and that becomes a really powerful pathway that the eating disorder can potentially [00:21:00] then start to develop, right? If I don't really know how to manage or regulate my emotions, it makes sense. I want to figure out how to do that.
Patti Witt - Oh, for sure. And children don't have very many opportunities or options, food is one of them.
Dr. Karen Nelson - So either, like you had mentioned, I'll binge or overeat, maybe I'll even binge and purge, or I'll do some significant restriction.
Patti Witt - Right. And so that gives them a pattern or a pathway of how to manage this.
Dr. Karen Nelson - If a patient didn't get it from a parent, the repair work in therapy is, as the therapist, we initially can do some of that nurturance for them, and then we're kind of handing over the ownership of being able to soothe and comfort their own self.
Patti Witt - Absolutely. So this is what it looks like for the client to do this. To notice that there's an emotion that I'm feeling and to name it, and it's probably coming from back there somewhere. If it doesn't make sense why I'm feeling this, it’s probably coming [00:22:00] from back there…
Dr. Karen Nelson - What's back there?
Patti Witt - …back there in my childhood, something from back there is getting activated. I think it might feel like anxiety. It might feel like sadness. And then the next step is for the adult you to lend your body to that younger self. Because a lot of times when you feel anxious or depressed, your body also feels anxious or depressed. So, as an adult, you sit up, you put your feet on the floor. Doing it right now.
Dr. Karen Nelson - That's right.
Patti Witt - You put your arms down, because if you're anxious or you're depressed, you're typically not going to be sitting calmly. And so it kind of says there's nothing bad going on right now if you can sit like this. And then the fourth thing that I encourage people to do is to ask yourself, what do I need for myself in this moment to feel a little bit less anxious, a little bit less sad. I might need reassurance. I might need [00:23:00] validation. I might need comfort. And if I can give myself a little bit of validation or reassurance, like it's going to be okay, I can get through this, what might happen is your anxiety might come down a little bit. Your depression might come down a little bit. And then you might be able to get through the moment without using negative symptoms.
Dr. Karen Nelson - Absolutely. So being able to do that kind of self validation or self nurturing becomes a skill to eventually then avoid or not needing to use the eating disorder, because again, the eating disorder is trying to manage the emotion. But what we're doing in therapy is we're helping the patient, number one, even identify the emotion.
Patti Witt - Right.
Dr. Karen Nelson - And then work to kind of soothe it or calm it.
Patti Witt - Yeah, so we're doing something externally for them. Eventually we want them to be able to internally do this work.
Dr. Karen Nelson - That's right. I think it is important to note that [00:24:00] researchers don't know exactly what causes anxiety disorders. That it could be a combination of things. So you and I were talking about, you know, potentially a genetic component or like a family history, life experiences, but we do know that it often is kind of an accumulation of things.
Patti Witt - Very well, I mean, actually that was really well said. You know, it's an accumulation of things and so we don't know the exact cause, but a lot of times as we explore a client's life, we can start to see where possibly where these things come from.
Dr. Karen Nelson - For sure. Well and I like that, those examples that you were bringing, right, you know, if I grew up in a household where maybe I didn't have someone to help me soothe or nurture those emotions, or I had a traumatic experience, those become kind of the building blocks that may eventually lead to a diagnosis of an anxiety disorder later in life. As we were describing potentially some of the [00:25:00] differences between depression and anxiety, anxiety can feel really scary for our patients. And their bodies can, they can feel really overwhelmed in their bodies. I mean, many of our patients arrive to us and, you know, will share, oh, I've absolutely have a panic attack. Can we take a minute and maybe talk about, you know, what are some of the things we look for as therapists to identify if someone's had a panic attack?
Patti Witt - Usually they tell you that it feels like they're going to die.
Dr. Karen Nelson - That's it. That's it. Body sensations like, you know, should we list them? I don't know. Heart rate, right? Heart rate goes way up. Feels like I can't breathe.
Patti Witt - Feels like, sometimes feels like I can't walk. Feels like my vision goes. I feel like I'm numb. That's right. Well, I think, again, people will present in emergency rooms and like you said, it can feel, it's absolutely [00:26:00] terrifying. Maybe my brain is racing, but it's very physical. It's showing up in their body. Emotion lives in our body, right?
Patti Witt - Absolutely. And so one of the ways to calm your body down or a false way to calm your body down is to use symptoms. I mean, think about exercise. A lot of times my clients will say, when I'm exercising, I'm not feeling or thinking anything. And so I just keep going. When I'm binging, I'm not feeling anything. I may not be thinking about anything, so I keep going. When I am restricting, I have a clear schedule, I have a clear pattern, so I really don't have to think about anything else.
Dr. Karen Nelson - That's right.
Patti Witt - I don't have to feel anything.
Dr. Karen Nelson - Good point. And who, again, who wants to feel overwhelmed in their body? How would you guide a patient through managing a panic attack?
Patti Witt - Actually, [00:27:00] one of the first things to do is for them to, you know, to say this to themselves, I think I'm having a panic attack, because naming naming what might be going on is a way for them to know they're not going to die. This won't kill them. When it shows up into my office, you know, it's different than when they're on their own. We're going to walk them through it. It looks like you are having some panic, so I notice that you're not breathing, so I'm going to have you take a breath if you can. If you can't, let's stand up and put our arms up in the air, which of course, there's my arms up in the air.
Dr. Karen Nelson - That’s right, we're pantomiming it.
Patti Witt - Right. So we do some movement, you know, we walk around the room, I reassure them it's going to be okay.
Dr. Karen Nelson - That's right.
Patti Witt - Once again, I'm offering reassurance. Validation that yes, this is really scary, but I'm here with you. That's right. Nothing bad's gonna happen. And then you start to see them ratchet down, calm down.
Dr. Karen Nelson - Right. Their breathing starts to kind of return to [00:28:00] normal.
Patti Witt - Yeah.
Dr. Karen Nelson - Another thing that I will do is have someone, the fancy words that we might use in therapy is called grounding. Oftentimes when someone's having a panic attack, their brain is racing and they're thinking about 17,000 things at once. And it can feel really scary. So grounding just kind of is fancy words for bringing your attention right into the here and now. We talked about it on a previous podcast. Look around the room, you know, name five things you can see, four things you can touch. Kind of helping them get right into this room rather than being in that racy, scary space in their brain. All feelings come in waves, even panic. It will come in a wave. And we appreciate and understand how intense it is, and you can do it. Like, we're going to flow through it. As we're talking about these general mental health issues of depression and anxiety, is it ever normal to feel anxious or depressed?
Patti Witt - Well, absolutely. As, again, as I was driving in, I was feeling a little bit anxious.
Dr. Karen Nelson - That's right. [00:29:00]
Patti Witt - Because I don't have any papers in front of me, right. I just am responding to things and so it would be natural for a person to be anxious about a test or getting married or, you know, a sporting event.
Dr. Karen Nelson - A new baby, a new job.
Patti Witt - Absolutely. And depression, you know, like when my cat died earlier this year, you know, I wasn't as up as I usually am. So depression can be, of course these things could be normal.
Dr. Karen Nelson - For sure.
Patti Witt - Like you said, though, it's like, how long is it lasting? Am I able to like have, you know, start to have times where I'm feeling less depressed? Am I able to enjoy things? So it's kind of, you know, it is working with your therapist to figure out is this quote normal, or is this moving into something that I need to be more aware of?
Dr. Karen Nelson - For sure. Because again, the goal or [00:30:00] expectation of therapy should never be to eradicate emotion. It's how do we tolerate emotion? So what’s normal? I mean we want you to have the wide range of emotion because remember, emotion just gives us info, right?
Patti Witt - It's like some data, right?
Dr. Karen Nelson - Right. Could you imagine, like, going to a friend's wedding and feeling no happiness or maybe a little sadness? Right. Like, how blah.
Patti Witt - Right. So even coming into therapy can be anxiety producing.
Dr. Karen Nelson - Yes.
Patti Witt - And so, again, we discern whether is this something that you always feel or you feel most of the time, or are you anxious for some reason coming into therapy?
Dr. Karen Nelson - So as we're talking about just the connection between general mental health disorders and in eating disorders, again, we just know that they often show up together. We just know that eating disorders can have some kind of perfectionistic tendencies, right? A lot of our patients have a desire to be kind of perfect or want things to go just right. The [00:31:00] way that this can show up for patients and what I noticed, especially with some of my patients who are in college is that desire for perfection. I want to do well. Maybe I am exhausted and overwhelmed with all of my schooling. I'm feeling kind of anxious that I'm not going to get good grades. I'm feeling maybe really panicky. Once again, I don't want to feel that panic. And so then I may, which I often notice they'll use the eating disorders, to manage that anxiety. They'll restrict. Potentially they'll overexercise. Sometimes patients will engage in binge purge behavior where they're feeling really anxious or even sad. So they'll binge, then they feel guilty, then they'll purge. And that cycle just continues.
Patti Witt - And sometimes what happens is we turn it toward our bodies. We want, you know, if things aren't going well, in other places in our lives, well, at least we can control what we look like, what we put in our bodies. And so now it becomes about [00:32:00] body image, how, you know, instead of being upset about or worried about grades or being perfect in different places, we actually want now our bodies to be perfect. And so that can be a huge stress. And because it's really hard to tell our bodies what to do.
Dr. Karen Nelson - And so those just become examples of how the emotion just deeply impacts, urges around the eating disorder. And so part of the work is learning how to manage the emotion without utilizing the eating disorder to manage it, quite frankly, developing other skills.
Patti Witt - Right. And then also managing your thoughts.
Dr. Karen Nelson - Yeah.
Patti Witt - Because if you think about it, your thoughts are going to create emotions.
Dr. Karen Nelson - Tell us.
Patti Witt - So if your thoughts are creating emotions, and these emotions are things like shame or anxiety or depression, there's where you use the eating disorder to manage the emotions, right? But it's really maybe starting [00:33:00] to figure out these thoughts. What are the thoughts? Because sometimes the thoughts are, they don't make sense when you say them out loud…
Dr. Karen Nelson - Oh good point.
Patti Witt - … or maybe you are, they're perfectionistic thoughts, or they're all or none thinking. Or you just can't win.
Dr. Karen Nelson - Good Point.
Patti Witt - And so we got to figure out, okay, what are these thoughts? And then are they, do they really make sense?
Dr. Karen Nelson - And working to kind of manage them, working on the eating disorder behaviors, but then also working to manage depression and anxiety, that becomes part of the therapy, right? We're not only just focusing on the eating disorder behavior, right?
Patti Witt - Well, sometimes when a client comes in, we aren't, sometimes we don't talk much about the eating disorder behaviors. Sometimes we talk more about depression, anxiety, other emotions. How are you managing? What does it feel like? Because we know that again, eating disorders aren't about food.
Dr. Karen Nelson - That's right.
Patti Witt - It's about emotions.
Dr. Karen Nelson - You got it. For sure.
Patti Witt - Many times, you know, when I say that, you know, I get an eye roll. [00:34:00]
Dr. Karen Nelson - Why do you think that or what comes out?
Patti Witt - You know, I think that people don't really want it to be about emotions. I don't want to feel shame. I don't want to feel anxious. I don't want to feel depressed. I don't want to feel it in here. I don't want you to see me feel this.
Dr. Karen Nelson - That's right.
Patti Witt - Because it feels really shameful to feel these things.
Dr. Karen Nelson - Well, and I think that can be sometimes the myth is we only, the way that we treat eating disorders is to just, you know, do a food plan and then they'll miraculously go away. If I can just, if I can just figure out how to eat just right, then maybe I won't feel anxious and depressed. That's a myth.
Patti Witt - That's a myth. And if we do that, we are like going along with that myth.
Dr. Karen Nelson - That's right. And so kind of back to that conversation that we were, we were having, the eating disorder almost becomes like a management way to, I don't know, it becomes a way to manage depression and anxiety.
Patti Witt - Right. And, and so you're just doing the best you can.
Dr. Karen Nelson - Yeah. [00:35:00]
Patti Witt - You know, eating disorders aren't like evil.
Dr. Karen Nelson - That’s right.
Patti Witt - It's just a way to help you manage something that you don't know how else to manage.
Dr. Karen Nelson - For sure.
Patti Witt - And we just want to work on figuring other ways to do it.
Dr. Karen Nelson - For sure. And that we want to be real clear, like you're saying, you're not wrong or bad or messed up for having an eating disorder. Actually, you're just trying to solve your problem. That aspect of being very mindful, working with your dietician to develop a plan and consistency around food. Sometimes, as we were talking, emotion shows up in our body, and so people are like, well, I don't feel hungry. I feel anxious. So I, the way that I've learned how to manage that is I just skip meals.
Patti Witt - Right.
Dr. Karen Nelson - And so we want to work to act opposite from that.
Patti Witt - Right. Because your body actually would like you to nourish it.
Dr. Karen Nelson - That's right.
Patti Witt - And so if you're If you have a habit of ignoring it, your hunger cues might be diminished, but your body still needs the food.
Dr. Karen Nelson - Good point. Good point. And again, if I'm not eating [00:36:00] consistently, it can increase the experience of an emotion, meaning I can feel even more anxious if I'm not eating regularly.
Patti Witt - Right. And so you might think that the emotion is causing…
Dr. Karen Nelson - Yeah.
Patti Witt - …the problem, but it's really you not nourishing your body.
Dr. Karen Nelson - For sure. So that skill is just really important of having consistent eating. And so that's a good example of, as an eating disorder therapist, we're, we're working to kind of address things at the same time. Right?
Patti Witt - Yes.
Dr. Karen Nelson - We're saying, hey, we got to be eating consistently, but we're also going to give you skills on how to think about your thoughts or name feelings. We're doing that in conjunction with, or that's just part of the therapy.
Patti Witt - Yeah. Sometimes I check in with my clients about, you know, have you eaten anything today?
Dr. Karen Nelson - Yeah.
Patti Witt - You know, what, what are you, what's going on there? Because when they come into therapy, that may actually impede the work that we do together.
Dr. Karen Nelson - Good point. Right. And so we may, [00:37:00] you know, offer a snack. I can, I offer to eat with patients at times. Let's share a snack together. For friends and family members, you know, these diagnoses can be challenging to navigate. And again, it can feel kind of scary to hear a diagnosis of a family member of an eating disorder or depression or anxiety. Any thoughts on that? Or how might you talk to family members about supporting their loved one with an eating disorder and depression and anxiety?
Patti Witt - You know, I would first validate the friends and family members that this can be a struggle within the family or between, you know, the friendships, because depression and anxiety can be really difficult to manage. However, this person, your loved one, isn't doing this on purpose. And so kindness, understanding, but getting your own needs met are really important.
Dr. Karen Nelson - Very good. And so, we often just want to send the message of hope and nurturance. Recovery is [00:38:00] very possible.
Patti Witt - It sure is.
Dr. Karen Nelson - And, well, we're just here for you.
Patti Witt - Yep.
Dr. Karen Nelson - Well, Patti, I can't thank you enough. This has been just a joy to have this conversation. I appreciate your wisdom.
Patti Witt - Thanks for asking me. I love being here with you.
Dr. Karen Nelson - We'd love to hear your feedback on our episodes, the topics we cover, and anything you'd like to hear me discuss on the show. Our email address is melrose at parknicollet.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.
To learn more about Melrose Center, please visit melroseheals.com.
Melrose Heals, a conversation about eating disorders, was made possible by generous donations to the Park Nicollet Foundation.