On today’s episode, Dr. Karen Nelson is joined by Dr. Andrea Zuellig to discuss how eating disorders have changed in the past 20 years.
On today’s episode, Dr. Karen Nelson is joined by Dr. Andrea Zuellig to discuss how eating disorders have changed in the past 20 years.
Click here for a transcript of this episode.
[00:00:00] Dr. Karen Nelson: 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 Dr. Andrea Zuellig to discuss how eating disorders have changed in the past 20 years. We've learned so much more about this disease, the various ways an eating disorder can present itself, how treatment has evolved, and how it can impact a wide variety of people. Now, before I begin, I invite you to take a deep breath and join me in this space.
So today, first [00:01:00] of all, Andrea, welcome back to the podcast. I'm so excited to have you here with me today.
Dr. Andrea Zuellig: Thank you. Thank you. Thank you. I'm so excited to be back. It's – I love being on this podcast with you. You're amazing. And I just love everything that you've done for our community. And I think that this podcast is just incredible. It's brought so much to so many people.
Dr. Karen Nelson: Amazing. Today, you and I are going to be talking about kind of the evolution of eating disorders over the past 20 years. You and I, we will name ourselves as ‘seasoned therapists.’ Which just means we have some experience in this, right?
Dr. Andrea Zuellig: Yeah, yeah.
Dr. Karen Nelson: We've seen some things. And so I'm excited for our conversation to help our listeners just get some information about kind of the evolution of what the disorder has done, maybe populations that it seems to be impacting. That's what we're going to be talking about today. Before we get started, you know the drill. I would love it if you could introduce yourself and [00:02:00] remind our listeners about your role here at Melrose.
Dr. Andrea Zuellig: Alright, so my name is Andrea Zuellig. I am a clinical psychologist and I'm also a higher level of care therapist at Melrose. I work in the inpatient program, the residential program, and the partial-day treatment program. I'm also the clinical lead for the binge eating disorder program. I started at the Eating Disorders Institute.It was called EDI then, before it became Melrose.
I started there in 2003. So, I've worked with people with eating disorders for a little bit over 20 years now, which amazes me and makes me feel elderly.
Dr. Karen Nelson: Stop.
Dr. Andrea Zuellig: And as you said, Karen, we have seen some stuff.
Dr. Karen Nelson: We have seen some stuff. So, being that higher level of care therapist, just for clarity, Andrea sees patients who are inpatient. And I, by specialty, I see patients in an outpatient setting, meaning they come to me usually once a week, once every other week. As [00:03:00] an inpatient therapist, you're with them on that day-to-day basis as they're moving through that more intensive care.
Dr. Andrea Zuellig: Exactly.
Dr. Karen Nelson: And so, just a lot of experience in eating disorders over these past 20 years, right? Um, seasoned, wise, experienced, right? Those are words that we're going to use. It just means that you've seen a lot.
You really have, for sure. I mean, this is a giant question. So I'm not quite sure how I would answer this, so I'm going to ask you.
Dr. Andrea Zuellig: Great.
Dr. Karen Nelson: How do you think eating disorders have changed? I mean, even just kind of anecdotally, from your experience as a practitioner, what have you noticed –
Dr. Andrea Zuellig: Ugh,
Dr. Karen Nelson: …potentially evolve?
Dr. Andrea Zuellig: So much, and it's interesting because every – I feel like, once every couple of weeks a bunch of us on the inpatient staff will say, ‘Oh my God, do you remember back in the early 2000s when all we had was this? And now all of a sudden all of this stuff is happening? And wow, it's just completely different.’
And I feel like the whole field has had to [00:04:00] change from it. I think there are – the major differences that I see I feel like are wrapped into I guess three categories. Which I'm going to immediately forget these, so please remind me. But one, the patient population has changed dramatically. Two, the type of treatments that we know have evolved and have changed and become better.
And I think that in another 20 years – which, oh my god. If I'm still here, we'll talk again about this.
Dr. Karen Nelson: That's right.
Dr. Andrea Zuellig: And say, ‘Guess what? Remember when we used to do this? Now we do this. It's completely different.’ You know, science is changing. We're learning more and more about eating disorders every day.
And the things that we did 20 years ago, we don't really do anymore. The things that we'll do 20 years from now, maybe we'll do, who knows. But things are changing and getting better. And then the third thing, I think, is just the world. The world is so different. [00:05:00] And I think that we've had to accommodate to changes in the world and what we've known. And so it's really interesting.
Dr. Karen Nelson: I love how you kind of clearly define some of those nuances that you're noticing have changed in just the evolution of eating disorders. Let's maybe jump in. Let's maybe dissect that idea of just kind of the population. And when you say that, help us know what that means.
Dr. Andrea Zuellig: Sure. I'm thinking age, gender, sexual identification, gender identification, race, culture. All of those aspects, and all of those aspects have changed dramatically.
Dr. Karen Nelson: Tell us, what have you noticed?
Dr. Andrea Zuellig: So when I started out at what was then called EDI, the Eating Disorders Institute, I was an outpatient therapist then and was for many years. And the typical patient was always Caucasian female who was probably between the ages of 15 and 20.
I think my first 13-year-old, I was nervous because I was thinking, ‘Oh [00:06:00] my gosh, you know, 13. That's so young. Do I involve the parents? Do I not? Oh my gosh, what do I do with that?’ And now we're seeing six-year-olds.
Dr. Karen Nelson: Right.
Dr. Andrea Zuellig: So, big change.
Dr. Karen Nelson: Do you think it's trending younger?
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: Tell me, what do you notice?
Dr. Andrea Zuellig: It's trending younger and it's trending older.
Dr. Karen Nelson: Oh, so both ends of the spectrum.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: You can really see it.
Dr. Andrea Zuellig: Yes. Yes. It's not unusual for us to see, what we call ‘Peds’ – pediatric kids. So kids that are as young as five, six, who, the tendency is that they often have ARFID, which is more of the picky, selective eating. But we are also seeing kids with full-blown anorexia nervosa, or traits of that, body image issues, feeling fat, not wanting to be perceived as being overweight and really cutting out foods because of that.
Dr. Karen Nelson: Absolutely. So those cultural messages seemed to kind of [00:07:00] trend in this, as a culture we're talking more about diet and exercise and the age of kid that's being impacted seem to trend downward.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: We're having patients refer to us, you know in childhood, quite frankly.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: You know, 7, 8, 910. Have you noticed any shifts in how parents are receiving the messages about care for their kids in the treatment of an eating disorder? Have you noticed any shifts there?
Dr. Andrea Zuellig: I have. I think that parents have more concerns about the nutrition messages. It's very, very hard to be a parent nowadays. Where we get so many conflicting messages every single hour, it seems like, on what's good for you, what's healthy, what's nutritious, what you should be feeding your kids, what you shouldn't.
There's so much pressure. And I think that particularly as our culture has gotten so much more obsessed with organic food, sugars, [00:08:00] fats, high protein, you know, all the messages there. I feel like when our dieticians, who are all very, very well-educated and trained, give parents the advice, ‘Okay, here are portion sizes, here are the types of foods that you should be giving your child and all foods fit.’
And you know, maybe more caloric and more fat and more sugar than maybe you've been giving them. I think that some parents understandably get very anxious and they might go to a well-known supposed-expert in the field. I'm talking about Dr. Google.
Dr. Karen Nelson: That's right.
Dr. Andrea Zuellig: Our friend. And by the way, I don't know about any of you, but anytime I go on Google – Dr. Google, basically, as I call it – Google will tell me I'm dying, okay?
Dr. Karen Nelson: Of course
Dr. Andrea Zuellig: I put in anything. I put in, I have a headache. Okay, I'm dying. You know, something – I have a stomachache, I'm dying. So think of what these poor parents get when [00:09:00] they start Googling up nutrition and what's helpful for children and teens. nd so they're going to be freaking out.
So, you know, I would really, on the one hand – parents. I'm a parent, I have so much empathy for all of you. On the other hand, please, please, please trust us. We are all experts in this field. We have worked a very long time in this field, the majority of us. And particularly our dieticians, they know their stuff.
I would trust them with anything. And whatever information they're telling you, it's legit. And if I took my child to a cardiologist, I'm taking him to the cardiologist for a reason, and I'm going to trust what the cardiologist has to say because I know that they are a specialist in this field. And I would just really urge parents to please try to [00:10:00] trust the experts, try to trust us over what Google may say, what certain articles may say, fitness magazines will say, because there's a lot of inaccurate and actually unhealthy advice out there.
Dr. Karen Nelson: Such a good point. And I think that also brings up one of the things that we talk about a lot in treatment is the importance of support, but the support of the supporters.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: Right? That, you know, it makes sense as a parent if my kid is going through eating disorder treatment and maybe I'm getting this meal plan with foods that I don't even personally eat as a parent.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: Or I might be afraid of. Wow, am I going to have a lot of emotion about that? Let's get you connected with support.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: We have a Parents in Support of Others group. Maybe you can talk to, you know, the therapist. Potentially you may want to find your own therapist as a parent to just manage some [00:11:00] of that emotion.
Because, you bet, this is a lot to try and manage. And like you said it best: We're the experts, and so we would never misdirect you.
Dr. Andrea Zuellig: Yes, I'm a little bit biased being a therapist myself, but I really feel like any parent that has a child with an eating disorder should probably get their own therapist.
Dr. Karen Nelson: Agreed.
Dr. Andrea Zuellig: Because they would really benefit from that because it is, it's rough.
Dr. Karen Nelson: That's right. And you deserve support. And you deserve support.
Dr. Andrea Zuellig: Yes. Yes.
Dr. Karen Nelson: I like that. You also made this really interesting comment that you are noticing kind of the opposite end of the continuum. Some older populations are being impacted. Thoughts on that?
Dr. Andrea Zuellig: I think it's a combination of things. We're seeing people who have hadan eating disorder when they were young and then for various reasons they relapse. And there's a lot of research showing that – I'm just thinking of, women actually right now. But women who [00:12:00] maybe they had an eating disorder when they were in their teens. They recovered or recovered somewhat. They kind of held it together, did okay, went through some years. And then all of a sudden their kids are out of the house, they're looking at retirement and basically, they're having a bit of a crisis. And it goes into what they put into their body.
Dr. Karen Nelson: Actually, it was one of the podcasts that we did. Amanda Delsman and I talked about eating disorders in women over 40
Dr. Andrea Zuellig: Yeah.
Dr. Karen Nelson: And how important it is. What's interesting is that sometimes the cultural messages doesn't keep up with the real time reality of what's happening in eating disorder treatment. And so the cultural message might still be ‘eating disorders affect Caucasian women in their teens.’
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: And what we know – and that's the importance of having these conversations – is that is false. And I've also noticed in my practice as an outpatient therapist people who [00:13:00] either were undiagnosed, maybe they were struggling with an eating disorder, but it went undiagnosed for maybe much of their adult life.
And now, because there is more awareness or understanding, they are finally accessing treatment.
Dr. Andrea Zuellig: Yeah.
Dr. Karen Nelson: And I think that's so powerful to know that healing can happen at any age, at any time. You don't time out of eligibility. We want people to really know that.
AZ; Absolutely. And I think. You know, the other piece of this too is that our culture is hopefully getting more body positive. On the other hand, you know, we're bombarded by all these messages about obesity and about health and what health is like and that health is physical, you know, and based on appearance. And so therefore, like if you look at somebody and they're, they're skinny, then they must be healthy. And if you look at somebody and they're overweight, they must not be healthy. Where, that's not the case at all.
So, weight often [00:14:00] – definitely not always, but often – doesn't have a whole lot to do with health. So I think it's also very difficult for people as they age. Particularly women. And I can say this as a 51-year-old woman: Menopause is no joke. You know, body changes happen and you have no control over that.
And that can be very, very difficult for anybody that is living in this society. And I think that there's so much that's still out there. This is like my passionate issue right now about aging. Not being allowed to age and not being allowed to age gracefully.
Dr. Karen Nelson: That’s right.
Dr. Andrea Zuellig: You know. That we're still supposed to look like we do when we're 25 and there's a lot out there about women feeling invisible, becoming invisible in many ways and feeling like they've lost importance and power and meaning. And all of those [00:15:00] things are just –open the door to disordered eating practices.
Dr. Karen Nelson: Well, and I think, too, kind of this classic conceptualization of an eating disorder is often about kind of the illusion of control. And so all those things that you point to, right? ‘My body feels out of control. Maybe I don't feel seen in the same way. Maybe I feel somewhat invisible.’
The way that I almost instantly can feel powerful as I have control over my eating. Or I'm going to the gym. And then how confusing it feels because I might get praise for that.
Dr. Andrea Zuellig: Mhmm.
Dr. Karen Nelson: And again, we want to acknowledge we're not demonizing, you know, kind of quote ‘healthy behaviors’ and taking care of yourself.
Dr. Andrea Zuellig: No, not at all.
Dr. Karen Nelson: But there is a space where it shifts into obsessive, maybe even risky behaviors that we want to address.
Dr. Andrea Zuellig: Yes. Absolutely. And there is that fine line that people get into when healthy eating becomes unhealthy eating. And when healthy exercise and healthy movement becomes [00:16:00] unhealthy exercise. What about that ratio between, like, men and women, or just different genders that we're noticing? Has that shifted?
Dr. Andrea Zuellig: Yes. We saw very few men. The men that we did see, I feel at that time they tended to be younger men, usually college age. But definitely not younger than that usually. And they tended to have bulimia. There was still an enormous stigma against men having eating disorders. And so, we saw very few men.
I think the shift there has been enormous. Just enormous. We're seeing eating disorders in young boys. We're seeing adult men come in of all ages who have either identified for the first time that they've had an eating disorder or who have had an eating disorder for many years and are just now seeking treatment.
Dr. Karen Nelson: I mean, we talk a lot about when [00:17:00] we do kind of learning presentations for, you know, people in the community. One of the things that we talk a lot about at Melrose is what the research tells us. Current research is that eating disorders do not discriminate.
Dr. Andrea Zuellig: Absolutely.
Dr. Karen Nelson: They do not discriminate around age or race, sexual identity, other cultural identities. That they are absolutely present through all of those spaces. And having the ability to identify and appreciate that anyone potentially can be impacted and that help is available for all.
Dr. Andrea Zuellig: Absolutely.
Dr. Karen Nelson: For sure.
AZ; Absolutely.
Dr. Karen Nelson: What do you think about just your kind of anecdotal experience of people who may identify with the LGBTQ community and their being able to access treatment? What do you think about that?
Dr. Andrea Zuellig: That also has changed substantially over the past 20 years. And, you know, my hope is that as there's more [00:18:00] awareness, acceptance. Acceptance of the LGBTQ+ community, and also people's awareness of eating disorders. That they are getting more assistance and more help.
We see that, unfortunately, for a lot of our people who are trans, it really does affect their body image and body type, and that really does play a part in eating. And that has been a huge shift for us, and I think that's been extremely helpful for us to educate ourselves and learn so much more about this community and their needs, and how helping with acceptance of gender identity and being able to identify with a gender that was not the body that you were born in is incredibly helpful for people. [00:19:00] And actually can really, really help with recovery from their eating disorder along with other tools in gender-affirming care.
Dr. Karen Nelson: Well, I think it's something that we'll talk about as we continue this conversation, just as a care community: Us learning and doing research, right, of how maybe these different groups are impacted, the types of treatments that we might want to make sure we're bringing to them as they're working to recover from an eating disorder. I think that there's more and more data and research that is being done. You know, maybe 20 years ago, there was maybe zero-to-no information about the trans community and eating disorders. And now, again, this kind of awareness and commitment to make sure that we truly are doing inclusive care and we want to be gathering and holding space for all people who may be struggling.
Well, let's maybe transition and talk a little bit about some of the changes that you have noticed in diagnoses and [00:20:00] treatment. But one of the things that you had kind of shared is this addition of two particular diagnoses in eating disorders. One, ARFED: avoidant restrictive food intake disorder, and then BED, which is binge eating disorder.
Those were both added to the DSM in 2013. What have you noticed just in kind of presentation of those disorders and what you have watched in kind of patient population around that?
Dr. Andrea Zuellig: Sure. So this is very exciting to me being the lead of BED. So going back 20 years, our most common diagnosis that we gave, and in fact up until I think 2013, was eating disorder NOS, which is called ‘eating disorder not otherwise specified.’
Now the corresponding diagnosis for that is known as OSFED, which is ‘other specified feeding or eating disorder.’ But what eating disorder NOS was, was basically the category where people didn't fit [00:21:00] neatly into anorexia and they didn't fit neatly into bulimia. And so they must have eating disorder, NOS. Just about everybody had eating disorder, NOS.
Dr. Karen Nelson: That's right. It kind of became a catch all category.
Dr. Andrea Zuellig: Yeah. Yeah. Yeah. And because the diagnostic criteria for anorexia was incredibly strict, the diagnostic criteria for bulimia was very strict. And what we know now is that binge eating disorder comprises really the majority of eating disorder diagnosis, really.
And so one of the things that we see now, that actually we did know back then, but we couldn't diagnose it, we couldn’t name it, we couldn't put a label on it, was that, really BED is our most common diagnosis.
Dr. Karen Nelson: I do a lot of initial assessments, and as I'm working to diagnose someone, as I'm helping them understand this constellation of symptoms, it can feel validating [00:22:00] to know like, ‘Oh, other people have this.’
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: ‘This isn't just me like, quote, “being weird with food.”’ Another common symptom that people will bring up is so much shame that I can't control it.
Dr. Andrea Zuellig: Control it.
Dr. Karen Nelson: That’s right.
Dr. Andrea Zuellig: And that is actually one of the criteria of the disorder.
Dr. Karen Nelson: Absolutely. And there’s –
Dr. Andrea Zuellig: And it's not a moral failing.
Dr. Karen Nelson: Yes! Oh, I'm so glad you said that because a lot of people, there's this shame perspective. Like, well, if I had more willpower or if I, you know, just did this particular diet, better, I'd get this under control. And it can feel validating to, number one, know that this is a real life thing. It is a treatable condition, and there's evidence-based treatment for it. That feels so exciting. What do you notice about that expression of ARFID? How have you noticed that present?
Dr. Andrea Zuellig: We have so many patients right now with ARFID. And again, I think that ARFID was something that was out there and people did not recognize it [00:23:00] and we had a lot of kids that went to feeding clinics. They still do, which is great, fantastic treatment, really helpful. They never really had a diagnosis for that and they were called ‘picky eaters.’
And for a while the phrase went around ‘selective eating.’ It's not defined by body image, there's no body image issues or just basically normal body image issues like the rest of us. But there's not an attempt to restrict food to lose weight. But what happens is that the person has an aversion to lots of foods or certain types of foods, and so their repertoire of foods that they will eat can be very narrow. o the point that it ends up causing nutritional deficiencies, at times low weight, at times not. But it can become a problem with social things, lots of arguments at meals, and we see it mostly with kids, but we also see quite a few adults that have this as well, that [00:24:00] have had this since childhood, and it's never been addressed.
Dr. Karen Nelson: And I, again, you know, having that place to understand that this is a diagnosable and treatable condition.
Dr. Andrea Zuellig: Definitely. The CBT for ARFID, which is excellent and very, very helpful.
Dr. Karen Nelson: Tell us what CBT is.
Dr. Andrea Zuellig: So CBT is Cognitive Behavioral Therapy. So it's the idea of challenging behaviors, challenging thoughts, and that really can change actions and exposure to certain foods, exposure to scary foods, and being able to, in the case of ARFID, the person being able to eat more. And being able to widen their repertoire of foods.
They may always end up being somewhat of a picky eater, but ideally they'll be able to eat foods from each food group and have some nutritional balance there.
Dr. Karen Nelson: Absolutely. Other changes that you've noticed in treatment over time or just maybe, you know, perspectives that have changed? [00:25:00]
Dr. Andrea Zuellig: Oh, sure. I mean, I feel like eating disorders has been the category that has kind of dropped through the cracks. But is so severe that so many people have not known how to treat it.
I think that there's more research coming out all the time about how to treat eating disorders. We have family based therapy, which, you know, was developed since I started working at EDI. And that's been totally different in how we involve families. I think in the late 1990s, early 2000s, we would not involve parents at all, actually, even with the younger teens.
It was all individual therapy. How do you do this? How do you eat more? Now we're really recognizing the power that the family has, how much it affects the parents, how much it affects the whole family, and how the parents or guardians or other people in the kid's life, how that can be such [00:26:00] an integral part.
Dr. Karen Nelson: What do you think about – even just as I'm reading these words, a lot of emotions coming up for me – the war on obesity.
Dr. Andrea Zuellig: Oh God.
Dr. Karen Nelson: I had to. You know I had to ask you. Andrea is the clinical lead around the binge eating disorder program. And so, you know, we do know that a higher percentage of people who are diagnosed with binge eating may fall into the overweight or obese category. And so we sometimes hear, you know, patients say like, you know, I'm overweight and the only option is for me to lose weight. I don't know. What do you think about that?
Dr. Andrea Zuellig: This is so tricky. This is so tricky. And there are, I think, so many elements into this, I think. I guess my question is, does there have to be a war against obesity?
Dr. Karen Nelson: I know.
Dr. Andrea Zuellig: Can't we just talk about it?
Dr. Karen Nelson: Yeah, yeah.
Dr. Andrea Zuellig: Can't we have just like a [00:27:00] conversation and maybe some interventions? I mean, does it have to be a war?
Dr. Karen Nelson: Good point.
Dr. Andrea Zuellig: Anytime I hear this talk about like a war against obesity, I always cringe inside, as I know that you do too. Because it, it feels so judgmental. It feels so judgy. It feels so icky. And it's very, very interesting because I almost feel like if there wasn't such a war against obesity, maybe people would be less obese.
Dr. Karen Nelson: Wow, good point.
Dr. Andrea Zuellig: You know, I think that, you know, we have a lot of evidence showing that when people restrict, they're much more likely to overeat or binge. And that diets don't work. And that the more that people engage in these behaviors, that they tend to actually gain back weight and more weight. I wonder if instead if society actually changed its attitudes toward weight and [00:28:00] bodies in general and was more accepting of biodiversity, maybe we wouldn't have so many issues.
Dr. Karen Nelson: That's right. Well, and I like that you brought up, you know, even just those – kind of the way it's maybe phrased in our culture. This like war on obesity. The other thought that comes into my brain is, well, what's an acceptable body?
Dr. Andrea Zuellig: Right.
Dr. Karen Nelson: You know, I mean, if the only acceptable body is a slender, you know, muscular type body. Well, no wonder I'm going to feel overwhelmed and potentially shamed if my body naturally might not look like that.
Dr. Andrea Zuellig: Exactly. And if your body doesn't naturally look like that, then you're more likely to diet.
Dr. Karen Nelson: That's right.
Dr. Andrea Zuellig: And what we know about diets is that people tend to gain the weight back within a year and they tend to gain more.
Dr. Karen Nelson: More. For sure.
Dr. Andrea Zuellig: And the more that you do that, the more weight you will gain. And so really, What is causing the obesity? I mean, to me. I mean, there are a lot of [00:29:00] theories on this. You know, it's genetics, it's types of foods, it's whatever, it's people being less active. And I'm sure that it's incredibly multifactorial. But, we know that one thing does not help, and that is negative attitudes towards people who have larger body sizes.
Dr. Karen Nelson: Absolutely. And kind of that myth. You know, we've talked about it before on the podcast. This myth that I can kind of trick biology, and if I just cut out sugar, I'm magically going to, you know, make my body into what this culture tells me I should have.
Dr. Andrea Zuellig: Yes. Yes.
Dr. Karen Nelson: And that's just not, right.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: That's just not the way it works. It's interesting that you were talking about this kind of cultural message about body and weight. Any other cultural messages that you've noticed have potentially impacted the increase of eating disorder diagnosis.
Dr. Andrea Zuellig: I just can't get over how much society changes. In many ways [00:30:00] the idealized body changes, but there's always this underlying theme of thinner is better, which is so destructive.
Dr. Karen Nelson: Well, and don't you think it even transcends thinner is better? Thinner is more likable.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: Like, I'm going to be accepted. Like, the way that I get more friends, or the way that I get more likes or clicks, or the way that I just belong.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: Is through shifting my body. There is very direct correlational data that suggests the more time our teens – or quite frankly us – are looking at social media, the increased risk we have for depression and anxiety. And it just makes sense. And one thing that I talk a lot about with my patients is the difference between logic and emotion. And logically, I might be able to get on board with, I get it, a Snapchat filter isn't real. But man, emotion isn't logical. And when I'm flipping through [00:31:00] and looking at all my friends with the latest filter, and if I don't look like that, logic might not show up in that moment. And emotion might, and I might feel really bad.
And then what do we know about eating disorders? They manage emotion!
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: And so then the eating disorder will potentially get triggered, or there's a risk to use the eating disorder to manage that emotion.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: And so we start to see the pattern develop. And my patients share those comments with me again and again.
AZ; I feel like, Karen, I feel like you nailed all of my concerns about the last 10 years in one word: filter. Filter.
Dr. Karen Nelson: The filter. You got it.
Dr. Andrea Zuellig: Where, I remember the filters used to be, ‘Oh, it was a funny little cat and the whiskers and blah, blah, blah. And, you know, and people still do that in the elf hats and they're great.’ And now, all these people are using filters to make themselves look younger and better. And, and I'm like, why are we using these filters? Why can't we just be [00:32:00] ourselves?
Dr. Karen Nelson: That's right. That's right. Absolutely. I think also, you know, some of the changes that we've just noticed kind of culturally or these world changes that have happened over the past, you know, 20 to 10 years. I think more of our kids and more adults, it just seems like more people are anxious. The just kind of general mental health has shifted. Or what do you think about that?
Dr. Andrea Zuellig: Yes, a lot more anxiety, depression, a lot more – a lot more social anxiety. Which I do not think that social media has helped with at all. Because if you know that you can always be on display or targeted anytime at all, or the amount of like, fear of missing out. Where you see, you know, your whole neighborhood is having a block party except for you.
Dr. Karen Nelson: Exactly!
Dr. Andrea Zuellig: And I wasn't invited. Maybe I didn't even want to go, but now I know I'm not invited.
Dr. Karen Nelson: But now I really wanted to go. I know. [00:33:00] It's like so real though.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: It's so real. Because again, logic is an emotion. And so my emotion-brain, I can feel super left out. I can feel rejected. I can feel shamed. And I, I mean. All of that triggers so much emotion and eating disorders, if nothing else – I was talking with someone yesterday – it is an emotion manager.
Dr. Andrea Zuellig: Yes.
Dr. Karen Nelson: Not the best one. We may want you to, and we're going to recommend you choose another way to manage emotion. But the eating disorder can make you feel really powerful at times. Or it can distract you from some of that discomfort that you may feel.
Dr. Andrea Zuellig: Absolutely. For sure.
Dr. Karen Nelson: Well, any potential messages, you know, as we've kind of talked about some of these shifts that we've noticed over time? What messages would you want our listening audience to hear about just messages of hope or recovery or resilience as you've kind of watched some of these [00:34:00] things change in eating disorders? Any messages of hope for them, of some of the positives that you've noticed?
Dr. Andrea Zuellig: Oh, absolutely. I mean, we still see recovery all the time. We see that people are more severe and they are still recovering.
Dr. Karen Nelson: Ooh, so good. That's it.
Dr. Andrea Zuellig: And we see that families are stepping up. You know, families are pulling it together. Families are doing what they need to do and that's fantastic because our families have been through a lot.
Dr. Karen Nelson: Absolutely. Absolutely.
Dr. Andrea Zuellig: And that they always have our support.
Dr. Karen Nelson: And I think that definitely is the message we want to send today. You know, hearing this conversation, it might feel a little overwhelming like, ‘Wow, so many things have changed and there's, you know, so many parts that potentially can impact it.’ And we want to say we understand that. We get that, we see that, and there's always a possibility for recovery, and we watch it happen every day.
Dr. Andrea Zuellig: The other part too is, [00:35:00] is that we are still – one of the things I think is very helpful and hopeful is that overall, I believe that recovery rates are better with eating disorders than they were 20 years ago, as people are learning more and more about the use of various different treatments.
You know, again, like what we talked about in the last 20 years, it's been CBTE, FBT, DBT, temperament based therapy. Lots of different things, doing also treatment for PTSD at the same time, if somebody has a trauma history. Recovery rates are getting better all the time. And we will continue to see that over the years as research develops in this area.
Dr. Karen Nelson: I love that. Well, any – I guess one final question that I have for you today, Andrea. What would you hope that listeners maybe take away from this conversation or any kind of lasting comments that you'd [00:36:00] like to make?
Dr. Andrea Zuellig: There's always hope that, like we've talked about, that people always can recover and that we're making more and more strides every day in this field. And that we're seeing it.
Dr. Karen Nelson: That's right.
Dr. Andrea Zuellig: We've seen enormous change over the past 20 years. And there is still positive change.
Dr. Karen Nelson: Very much so. Well, Andrea, I can't thank you enough. I've just so enjoyed sitting with you in real life. As my kids say, ‘in real life.’ To sit with you in real life. You are a delight. I just appreciate your wisdom.
Dr. Andrea Zuellig: Oh, thank you so much. Thanks for having me.
Dr. Karen Nelson: Absolutely.
If you or a loved one are suffering from an eating disorder, we're here to help. Call 9 5 2 9 9 3 6 2 0 0 to schedule an appointment and begin the journey towards healing and recovery. To learn more about Melrose Center, please visit [00:37:00]melroseheals.com.
Melrose Heals: A Conversation About Eating Disorders was made possible by generous donations to the Park Nicollet Foundation.