March 27, 2021 • 28 mins
Megan Mikhail is a research student who looks to understand what exactly causes eating disorders. In this episode, she shares the latest in research relating to what causes them, but also what factors best treat them
Megan is a PHD student in the clinical psychology program at Michigan State University. Megan’s research looks at the interaction between biological and environmental risk for disordered eating- with particular focus on the role of emotions in disordered eating, and eating disorders in disadvantaged populations.
Megan’s Research:
https://orcid.org/0000-0001-9262-3683
Contact Megan: https://msutwinstudies.com/megan-m
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Episode Transcript
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Speaker 1 (00:00):
I won't lend my body out out everything that I'm
made do. Won't spend my life trying to change. I'm
learning a love who I am, I get, I'm strong,
I feel free, I know who every part of me.
It's beautiful and I will always out way. If you
(00:24):
feel it with your eyes in the air, She'll love
to the boom. I am there, say good day and
did you and die out? Welcome back outway, fam Today
it's just me. Amy is not here, sadly we miss her,
but I'm here with a very special guest named Megan.
And Meghan is a PhD student in clinical psychology, and
(00:48):
Megan is doing amazing work that you're going to be
so stoked to learn about. Megan's research broadly includes the
interactions between biological and environmental risk for distort eating, particularly
kind of translating that now into a little bit more
human how our emotions play a role in disordered eating
and eating disorders in disadvantage and marginalized communities. Megan is
(01:12):
super passionate about integrating the research and clinical practice to
advanced care for people with eating disorders, especially those who
have been underserved. So you're doing awesome work because you're
helping us understand how eating disorders and disordered eating come
to be. Right. Yeah, well, thank you so much. And
you know, I just want to say I think you
(01:32):
all are doing really awesome work to kind of talking
about eating disorders and getting that information out there. So
thank you so much for having me. Thank you. I mean,
our podcast is about a year old actually, but the
past year it has become increasingly easy to get people
to listen because we are talking about diet culture so
much in the media and disrupting a lot of media
(01:55):
norms even from body size to color to ability. You know,
all these things are being disrupted in such a beautiful
way that a lot of people understand how toxic the
skinny mindset is, if you will. But what people don't
know about eating disorders is that it's not just the
drive to be thin. It can be caused by as
(02:16):
you know, a multi fectoral you know, situation. And I
love what you're focusing on. So let's kind of just
start with your story. How did you get into this work? Sure,
so this work is pretty personal for me. So I
was diagnosed with anorexia when I was actually about eleven
um and I struggled a lot with disordered eating all
through my teenage years and into my twenties UM, both
(02:38):
anorexia and kind of binge eating, and for a long time,
I think it was a source of shame for me. UM.
So eating disorders weren't really something that we're talked about
in my family, UM. I think in part because you know,
I come from a mixed ethnic background and my dad's
a first generation American, my mom is Mexican American, and
it just wasn't something that was necessarily talked about in
(02:59):
their families either. So for a long time, I didn't
really understand, you know, why this was something that I
struggled with, UM and why it was so hard for me.
And that made me really interested in kind of getting
involved in research and figuring out why this is something
people go through and what are all the reasons that
can contribute to it. So one of the things that
we know is that eating disorders are really closely related
(03:19):
to other kinds of disorders moved off in things like
anxiety or depression, and that's actually something that kind of
runs in my family and that I've dealt with all
my life. And I think that really helped me understand
how my eating disorder and disordered eating behaviors were kind
of functioning in a way to help me regulate my
anxiety and my emotions. So that was really personally helpful
to me and also made me want to just learn
(03:41):
more about that and kind of get that information out
there for other people who might be struggling with it. Well,
thank you for sharing a bit of your personal story.
I definitely relate to anxiety and depression being kind of
like known in my family, but eating disordered disordered eating
being territory that my family didn't know about. But what's
interesting is you said you've got diagno knows at age eleven,
(04:02):
So we get a lot of moms listening who are
concerned about their child's well being. Did a parents step
in when you were eleven to, you know, say something's
going on? You know, there seems to be some sort
of conversation was happening for you? What was that like? Definitely? So,
I think what we often see with adolescence, and we
see this with adults too, is that sometimes kiddos might
not know that something is wrong, um, and I think
(04:24):
that was definitely the case for me. So when I
was that young, I didn't really necessarily realize that I
had a problem. So it's definitely my parents who noticed
that I wasn't kind of eating the way that I should,
or I was exercising too much. So I was doing
cross country back then, but I would do kind of
even extra exercise beyond that. So I think it was
my parents noticing that and kind of getting me into
(04:44):
the doctor that was actually really important for me getting
help then and doing a little bit better. So I
definitely say if parents are kind of noticing that kids
are struggling with that, or not eating like they used to,
or seem kind of anxious around food um, or maybe
exercising more than kind of makes sense, or for reasons
that not just like for fun um, those are definitely
reasons to kind of seek help into getting that diagnosis
(05:05):
at that age feel validating, shameful. Were you aware of
that diagnosis personally as at age eleven? Yeah, So I
got into treatment actually around age twelve, so about a
year after I really started developing those serious symptoms, so
I was pretty aware of it. I went to like
an outpatient treatment program with my parents. Um so they
were doing something called FBT. So I don't know if
(05:27):
you're familiar with that, but it's a family based treatment.
I was actually really lucky to get that because it's
one of the most evidence based treatments for young kiddos,
and in that treatment, parents are actually really involved in
helping kids eat and kind of feel better in that way.
So I was aware of it, and I think, as
you kind of mentioned, they think a lot of shame
did come along with it, because it wasn't really something
(05:49):
that I felt like I could talk about with other
people or in school. It's a very secretive thing and
it was kind of like a family secret for a
long time that that was something I experienced, and I
didn't actually even start sort of talking about it or
telling my friends about it until I was in my twenties,
um because I was worried about what people would think
or if people would judge me or think that I
was just obsessed with my appearance, if they kind of
(06:11):
learned that about me. So it's really freeing when I
finally did start to talk about it with people and
realize that people can be really accepting of it, and
also a lot of other people had gone through and
experienced similar things, even if they hadn't necessarily gotten a
diagnosis at that young age or at any age. Yeah,
I think that speaks to so many, whether it's a
mental illness or anything. Really is like we all kind
(06:33):
of run around with these deep seated secrets that we think,
you know, if people knew we would be we wouldn't
belong or we'd be judged, or there'd be shame, And
like every single one of us is running around with
a different little seed of shame. And then you know,
over a decade went by for you before you found
your voice to speak about it. And it sounds like
by doing so, you know your friends or your your colleagues,
(06:55):
maybe we're like, oh well me too, me too, me too,
And suddenly you know you're it's kind of just like
a big relief to let that air out of the
balloon and deflate and relax and say, Okay, you're not broken,
or we're all a little bit broken, and that's that's okay, right,
That's like being a human is exactly? Was that huge
(07:15):
for your healing to be able to talk about something
like that so young? I yeah, I definitely was. Um.
I have a friend who once said to me, like
sunlight is the best disinfectant, and I think that's a
really nice thing, because, like you're saying, I think we
all carry around things that we feel ashamed of or
feel like we're the only person struggling with it. And
when it's something that's a deep secret that you're not
(07:36):
sharing with anyone else, it's really easy for those feelings
of guilt and shame to build up and you just
kind of feel worse and worse about it um and
I think it even makes it harder to change those
behaviors if you're having disordered eating behaviors or other kinds
of challenges. But once you start talking about it, you
realize that you know it's okay, and other people are
going through similar things. And so as part of my training,
(07:58):
I also see therapy clients, and I think what I've
realized is everyone has these things that they think they're
the only one that they that experienced something like that,
But usually I had someone else tell me that exact
same thing like a week ago. So I think none
of us are really as alone as we think. And
when we kind of discovered that, or personally, when I
discovered that, it definitely was very freeing and allowed me
(08:20):
to let go of a lot of the guilt and
shame I've been carrying around. That's awesome, and it clearly
I think by doing so allowed you to do the
amazing work that you're doing. So let's kind of dive
into that work. When did you realize that anxiety or
depression could be related to eating disorders? That's a great question.
So I think I sort of realized it some through
(08:41):
my own experience and kind of realizing that there were
times when I was engaging in certain behaviors because it
helped me feel calmer, help me feel better. But their
research literature is actually pretty consistent about it as well.
So the research shows that among people with eating disorders
and disordered eating, they're really high levels of anxiety in depression,
with a lot of research showing that more than half
(09:03):
of people who struggle with eating disorders also struggle with
anxiety and depression. Um, so there's a really strong link
in their research, and part of the reason seems to
be related to biology. So we know that eating disorders
obviously are affected by the socio cultural context that we
live in, but they're also affected by your underlying genetic
risk for developing an eating disorder. And we see that
(09:26):
the genes that contribute to eating disorders also contribute to
things like anxiety and depression. So I was trained by
as a biologist in my undergrad and that's how I
sort of started getting interested in learning about genetic contributions
to things UM, and started learning about the overlap that exists. Well,
that must really take away the shame and for anybody
who maybe wants to kind of like, let's boil that down.
(09:47):
I think what you're saying is we have genes and
the environment could turn those genes on or off, possibly
the environment being anything around you. And if you have
that gene and you're predisposed is to a factor that
turns that gene on. I think I'm not getting this
completely scientifically right. You're doing it really right. Yeah, then
(10:07):
kind of very so I'm oversimplifying it. But outcomes the
eating disorder behavior or the anxiety or the depression, etcetera.
So that's so interesting. Would you say that, UM, And
I don't know if you could really boil this down,
but would you say that anxiety slash depression leads to
a eating disorder or would you say an eating disorder
leads to anxiety and depression or back and forth, back
(10:28):
and forth, That's a really excellent question, and it's one
that I think is still being debated in the research literature.
And I think what you're saying about the back and
forth is probably a big part of it, because what
we know is that when people aren't getting enough to eat,
that actually affects their brain as well in ways that
can increase risk for anxiety and depression. So there probably
is kind of a circular nature to it. Where people
(10:50):
are engaging and disordered eating, it kind of affects their
body and also their self image in a way that
can increase anxiety and depression, and then disordered eating behaviors
can kind of be used as a way to manage
those symptoms as well. But the research does show that
often anxiety is what shows up first for people. Um
So people might have anxiety when they're younger, like when
they're in childhood, and then later developed disordered eating. So
(11:14):
that's the way it often seems to go, but definitely
not for everyone. That makes sense in your research, do
you distinguish between disordered eating and eating disorders or I
know when I was in undergrad I was interested in
learning about eating disorders and disordered eating because I was
silently suffering with my own and wanted to learn more,
although I couldn't put that into words, and I remember
(11:36):
that I couldn't find any research that spoke to kind
of what I was dealing with, which was more disordered
eating than eating disorders such as an axia, bolimia, you know,
eating disorders not otherwise specified even didn't really speak to
what I was going through. Has the research expanded to
encompass more broad definition of eating disorders. I think it has.
(11:57):
I think there's still work to be done, but I
think increasedly people recognize that most people who struggle with
disordered eating are kind of having an experience like you described,
so they don't neatly fit into a box of one
of those diagnoses, but they may still be struggling with
their eating or body image um and still suffering distress
from it. And so what we think now is that
(12:19):
disordered eating kind of exists on a spectrum um. So
you might have people that have these very severe disorders
that manifest in specific ways, but then there are a
lot of other people out there who are really struggling
with disordered eating symptoms in a way that might not
fit that diagnosis. But it's still really important to address
and when it comes to research and finding people to
(12:41):
conduct research on, are we bringing more people into the
mix who don't neatly fit into anorexia bulimia. Yeah. So, actually,
almost all of our research is conducted with people from
the community and the general population. So at Michigan State University,
we are really lucky to have population based twin registry
(13:02):
and um I won't go into all the details of that,
but having twins is really helpeful for getting at some
of those genetic components to things like disordered eating, and
in the general population we see the kind of the
whole spectrum. So there are some people who might say
that they never struggle with disordered eating or body image,
and then there are some people who have struggled with
it really severely, and then kind of everyone in between.
(13:25):
Um So, in our research, we think it's really important
to capture that whole variability because even people who are
not meeting criteria for a diagnosis, you know, might still
be struggling and in need of help. One of the
things that you research is specifically is our ability to
emotionally regulate and how that plays a role in eating
disorders and disordered eating. Can you define emotional regulation or
(13:50):
emotional disregulation? Maybe both for us? I think of emotion
regulation as being kind of how you manage and respond
to your emotions. So sometimes people might have an emotion,
but they might respond to that by criticizing themselves for
how they feel or trying to suppress that emotion and
not show it to other people. And we generally think
of those as not very helpful ways to respond to
(14:12):
emotions because they tend to make the emotion more intense
or lead to other kinds of behaviors like disordered eating. Um.
But there are other ways that people sometimes manage their emotions,
one of them being just accepting how you feel and
kind of listening to what that emotion is telling you,
which is actually kind of one of the most adaptive
ways to respond, as well as just kind of thinking
differently about the situation or maybe doing something to distract
(14:35):
yourself or change the situation. And those are ways that
often one can listen to on one's emotions and respond
to them in a way that's less likely to lead
to kind of feeling worse down the line. And our
emotional regulation skills learned genetic both. So I think that's
a question that the science actually hasn't fully answered, but
they are definitely not a hundred percent genetic or even
(14:58):
mostly genetic. I it's say because some of the things
that we actually do to treat disordered eating and also
things like anxiety and depression actually often involved teaching people
how to pay attention to their emotions and regulate them
more effectively. So that kind of starts with mindfulness and
being aware of what it is that you're feeling, and
also being aware that your emotions are kind of there
(15:20):
to help you as opposed to hurt you, and then
figuring out different ways to kind of engage in self
soothing techniques or problem solving techniques so that you can
manage those emotions without trying to turn them off with
things like disordered eating behaviors. Yeah, so what I'm hearing,
and I was kind of applying my own personal story here,
which is I had no emotional regulation skills growing up,
(15:42):
which I think a lot of people don't, and everything
that I've learned has been learned. I've you know, mindfulness
is a huge part of my journey, and I teach
what I call modern mindful eating to my students in
a program called Fork the Noise. And what I find
most amazing being about the work that I do is
when students apply it, it bleeds into the rest of
(16:05):
their life. So we start with the food and then
it turns into regular life or sometimes my students have
an easier time applying the mindfulness concept to life, and
then it comes back to the food because you have
this expanded, less reactive, less cyclical reaction to your negative
thoughts or even your thoughts in general. And I kind
(16:25):
of picture in a circle like if my my brain
was going one way in one direction one day, it
stopped and it started going in the other direction, and
the first way didn't serve me, in the second way
really did. But I don't know always how to put
that into words. So do you find that, you know,
working with a therapist is the best way to learn
emotional regulation and things like that. Yeah, So I'm a
(16:49):
big fan of therapy. I always think that if you
think you can benefit from therapy, and often even if
you don't think you can, you can. Um. So I
think therapy can be a really helpful of resource for
using these and learning these kinds of skills, especially therapy
that's focused on things like mindfulness or um. Dialectical behavior therapy,
which is sometimes called DBT, has been shown to be
(17:12):
helpful for people with eating disorders in terms of recognizing
and learning to regulate their emotions. And I think a
therapist can also be really helpful in helping you learn
to accept your emotions and not judge them as much
or judge yourself for having them, because they think it
can be really easy to get into the trap of
thinking you should feel differently, or you're a bad person
(17:32):
if you feel guilty or angry or sad, and really
that's not true because we all experience those emotions, and
so being able to learn that those emotions are natural
and okay, I think is an important part of the process.
And your research keeps showing us that this emotional regulation
plays a role in the development of disordered eating and
(17:53):
eating disorders. Yeah, so, um, there's been a lot of
research looking at that across time. So what you see
is that when people have a hard time regulating their
emotions or a kind of prone to anxiety or depression
like we were talking about earlier, that kind of sets
them up for being at higher risk for disordered eating
down the line. And what we see is that when
(18:14):
people get treatment and learn kind of how to manage
their emotions more effectively than their disordered eating tends to
go down, as well as their symptoms of anxiety and depression. So,
like you were talking about, it can kind of generalize
to multiple things, and especially a lot of research has
been conducted with people who might experience binge eating or
other kinds of disregulated eating. We're often that kind of
(18:34):
eating can be triggered by really intense negative emotions, and
the thinking is that when you have that behavior, it
might help you feel better temporarily, but often people afterwards
um will feel sort of guilty or ashamed, and it
can lead to sort of a vicious cycle, though definitely
plays an important role, and then more anxiety, more shame,
(18:55):
more feelings like you need to you know, usually restrict,
which leads to another binge and then before or you
know what, you're in that cycle exactly. So it's pretty
cool because your research isn't just looking for what causes
eating disorders. You're also looking for not just the cause,
but how to escape it or break the cycle. Right, Yeah,
what would you say most of your research is focused on?
(19:17):
That's a good question. So I think that I often
kind of think about those things as being a little
bit interchangeable in terms of like what causes it and
what maintains it. They can sometimes be different, but often
the things that started off can be the things that
sort of keep it going. So my research focuses on
kind of how emotions can play a role in any
part of that. So in getting started with disordered eating,
(19:39):
um in terms of anxiety and depression contributing to that,
but also why eating disorders or disordered eating might continue.
And you know, I think it's kind of complicated sometimes
to disentangle what kind of first and what came second.
So we use special research designs to do things like that,
like having longitudinal studies where we track people over time.
(19:59):
M some of our research looks at that to kind
of see like what came first and what came second.
But I think when you have people who are struggling
with disordered eating, like the most important thing I guess
is trying to figure out how to help them feel
better once they're in that situation. So I hope is
that by researching kind of how emotions contribute, we can
sort of develop better treatments to help people who might
(20:22):
be experiencing eating disorders. An alway has quite the range
of listeners when it comes to age, probably sixteen year olds,
I'm sure we have, but a lot of our listeners
who write in are fifty sixty seventy, and they feel
like it's too late for them, And they'll ask us,
(20:44):
you know, do I have a chance at this? And
I personally think they do. But I'd love to know
if your research looks at populations who are perhaps forty
six seventy. Even so, my research hasn't looked at that specifically.
We have tended to focus on younger populations just because
of some other aspects of our research. But I think,
(21:05):
you know, to what your listeners would say, I think,
you know, there's no evidence that it's ever too late
for someone to be helped with something like, no matter
the age of the person coming in, whether they're really
young or whether they're kind of more advanced in life, like,
people can always kind of benefit from help, and like
it's never too late to change or to start to
feel better. So all the research that we have shows
(21:27):
that the treatments that work for people who are in
their twenties should also work really well for people who
are in their fifties and older, although obviously some aspects
of a person's life might be different at that time.
So I think, you know, no matter what a person's age,
there's definitely hope for them to recover. That's awesome. Thank
you for sharing that. And tell us a little bit
about eating disorders and the prevalence in disadvantaged or marginalized populations.
(21:50):
What are we seeing they're compared to I don't know
the right word, their regular populations. Now that doesn't sound right, Yeah,
I think more advantaged populations. Yeah, yeah, So that's kind
of the other arm of my research, and I think
of them as being related because people who are disadvantaged
or marginalized, who are experiencing discrimination or poverty, there under
(22:11):
a lot of stress. Right, So if we think that
being under a lot of stress and experiencing a lot
of negative emotions can be a risk factor for eating disorders,
then it makes sense that people who are experiencing that
kind of stress um or those kinds of negative emotions
might also be at higher risk um And for a
long time, I think there have been stereotypes out there
(22:32):
about who eating disorders effects. So usually it's a thin,
young white female individual. And what we know now and
also you know, I think this resonates with what you
said about your listeners, is that that just is not
true that eating disorders occur in all kinds of people
of all racial and ethnic backgrounds and ages and socioeconomic
status is and what their research increasingly shows is actually
(22:56):
that belonging to a disadvantaged or marginalized group can really
increase your risk. So one of the places that that
shows up is food insecurity, and this probably makes sense,
like if you can't get enough food to eat and
you're also experiencing other stressors that go along with poverty,
your chances of experiencing and eating disorder are actually a
(23:17):
lot higher on both at that time and then if
you experience that as a child later on in life.
So those that's kind of what their research is showing.
And for people who experience things like discrimination because of
their race or their sexual orientation, the risk is actually
higher for those people as well. And there's some research
showing that it may be actually that discrimination per se,
(23:37):
that it is increasing their stress and increasing their risk.
So the risk factor is the discrimination. Exactly, how can
we help those communities who are most in need. What
can we in the advantage communities due to help those
struggling with disordered eating and eating disorders in disadvantaged populations.
So I think one thing that's really important is awareness
(23:59):
because going back to those stereotypes, um, and it's really unfortunate,
but the research shows that even clinicians or people who
work with people with eating disorders might hold some of
those stereotypes, even potentially without being aware of them. So
just being aware that someone who might not look like
the eating disorder stereotype might be suffering from an eating disorder,
(24:20):
I think is really important. And kind of related to that,
I think making sure that services are available and accessible
to people is really important. So often, for example, a
person might have Medicaid insurance and there are not a
lot of therapists who take that kind of insurance. So
I think increasing availability and making sure that people who
may not have the financial resources to pay out of pocket,
(24:42):
for example, can still access services and access care is
really important. A lot of public health initiatives need to
be changed so that these people in these communities have
access to mental health care exactly. Yeah, I think that
there can be a lot of barriers for accessing treatment
even for people who are advantaged in many ways, especially
(25:04):
when it comes to eating disorders. So you can imagine
that if someone doesn't have very many resources or connections
to mental health services, it might be even harder. I
think increasing awareness and also increasing access is kind of
what's most important to help people get the assistance that
they might need. And when it comes to kind of
going back out to your work relating to anxiety and depression,
(25:27):
do you study how the variables change when a person
is put on medication like an anti anxiety medication or
an antidepressant. Yeah, so we don't study that directly, but
there is some research on it. So the research suggests
that medication can actually really help some people with disordered
eating with some caveats. So sometimes when people are really
(25:49):
underweight or engaging in a lot of disordered eating behaviors,
it actually changes their biochemistry so that the medications don't
work quite as well in their brain as they otherwise would.
So sometimes the first step is really helping the person's
body kind of get back to a more stabilized place
where their brain and their biochemistry is functioning maybe more typically,
(26:11):
and then the medications can be helpful for things like
depression and anxiety that might be fueling eating disorders, so
it's kind of a dual barrel approach there. That's probably
why it's so important to be working with a team
that includes a therapist, oftentimes a dietitian to make sure
that you are eating enough that your brain is getting
all the nutrients that it needs so that the medications
(26:33):
can be dosed properly and changed accordingly, but knowing that
they are kind of working as they should be exactly exactly.
I think eating disorders are really complicated, and they involve
our minds but also our bodies, and so making sure
that we're sort of taking care of all those aspects
of it is really critical just kind of give people
the best opportunity to achieve recovery and just feel better
(26:56):
in life. And I think you hit the nail on
the head, which is eating disorders are complicated, and most
people don't understand that. Even people with eating disorders don't
understand that. They feel frustrated that they can't just recover,
that they can't just eat the food or not binge
on the food, or not compensate for the food. But
what you're doing is so important because it's really assessing
(27:20):
all the variables and kind of showing, you know, us public,
that there's so many more pieces to the public that
doesn't meet the eye. So your work is so important
and Amy and I want to thank you for doing
it and for sharing it with us, and for also
sharing your personal story today. We really appreciate it. Yeah,
thank you so much, um, and thank you again for
(27:40):
having me and for doing this and sharing this information
with people out there. It's really great. Do you have
social media or anything where anybody can go find you
or you stay under the radar and we can just
maybe read your research? Can we link anything in the
show notes to show off the amazing work you're doing. Yes,
So I'm a nerd and I have no social media,
we like, uh, I do have um like a research page.
(28:03):
I can definitely send you the link to that so
you can take a look at some of the research
articles that I've worked on. That'll be awesome. We have
tons of like nutrition students and social work students who
I'm sure would also just be interested to just read
the amazing papers that I got to take a look
at before this episode. And you're really doing amazing work.
So thank you so much for your time, Megan, thank you.
I really appreciate it.
I won't lend my body out out everything that I'm
made do. Won't spend my life trying to change. I'm
learning a love who I am, I get, I'm strong,
I feel free, I know who every part of me.
It's beautiful and I will always out way. If you
(00:24):
feel it with your eyes in the air, She'll love
to the boom. I am there, say good day and
did you and die out? Welcome back outway, fam Today
it's just me. Amy is not here, sadly we miss her,
but I'm here with a very special guest named Megan.
And Meghan is a PhD student in clinical psychology, and
(00:48):
Megan is doing amazing work that you're going to be
so stoked to learn about. Megan's research broadly includes the
interactions between biological and environmental risk for distort eating, particularly
kind of translating that now into a little bit more
human how our emotions play a role in disordered eating
and eating disorders in disadvantage and marginalized communities. Megan is
(01:12):
super passionate about integrating the research and clinical practice to
advanced care for people with eating disorders, especially those who
have been underserved. So you're doing awesome work because you're
helping us understand how eating disorders and disordered eating come
to be. Right. Yeah, well, thank you so much. And
you know, I just want to say I think you
(01:32):
all are doing really awesome work to kind of talking
about eating disorders and getting that information out there. So
thank you so much for having me. Thank you. I mean,
our podcast is about a year old actually, but the
past year it has become increasingly easy to get people
to listen because we are talking about diet culture so
much in the media and disrupting a lot of media
(01:55):
norms even from body size to color to ability. You know,
all these things are being disrupted in such a beautiful
way that a lot of people understand how toxic the
skinny mindset is, if you will. But what people don't
know about eating disorders is that it's not just the
drive to be thin. It can be caused by as
(02:16):
you know, a multi fectoral you know, situation. And I
love what you're focusing on. So let's kind of just
start with your story. How did you get into this work? Sure,
so this work is pretty personal for me. So I
was diagnosed with anorexia when I was actually about eleven
um and I struggled a lot with disordered eating all
through my teenage years and into my twenties UM, both
(02:38):
anorexia and kind of binge eating, and for a long time,
I think it was a source of shame for me. UM.
So eating disorders weren't really something that we're talked about
in my family, UM. I think in part because you know,
I come from a mixed ethnic background and my dad's
a first generation American, my mom is Mexican American, and
it just wasn't something that was necessarily talked about in
(02:59):
their families either. So for a long time, I didn't
really understand, you know, why this was something that I
struggled with, UM and why it was so hard for me.
And that made me really interested in kind of getting
involved in research and figuring out why this is something
people go through and what are all the reasons that
can contribute to it. So one of the things that
we know is that eating disorders are really closely related
(03:19):
to other kinds of disorders moved off in things like
anxiety or depression, and that's actually something that kind of
runs in my family and that I've dealt with all
my life. And I think that really helped me understand
how my eating disorder and disordered eating behaviors were kind
of functioning in a way to help me regulate my
anxiety and my emotions. So that was really personally helpful
to me and also made me want to just learn
(03:41):
more about that and kind of get that information out
there for other people who might be struggling with it. Well,
thank you for sharing a bit of your personal story.
I definitely relate to anxiety and depression being kind of
like known in my family, but eating disordered disordered eating
being territory that my family didn't know about. But what's
interesting is you said you've got diagno knows at age eleven,
(04:02):
So we get a lot of moms listening who are
concerned about their child's well being. Did a parents step
in when you were eleven to, you know, say something's
going on? You know, there seems to be some sort
of conversation was happening for you? What was that like? Definitely? So,
I think what we often see with adolescence, and we
see this with adults too, is that sometimes kiddos might
not know that something is wrong, um, and I think
(04:24):
that was definitely the case for me. So when I
was that young, I didn't really necessarily realize that I
had a problem. So it's definitely my parents who noticed
that I wasn't kind of eating the way that I should,
or I was exercising too much. So I was doing
cross country back then, but I would do kind of
even extra exercise beyond that. So I think it was
my parents noticing that and kind of getting me into
(04:44):
the doctor that was actually really important for me getting
help then and doing a little bit better. So I
definitely say if parents are kind of noticing that kids
are struggling with that, or not eating like they used to,
or seem kind of anxious around food um, or maybe
exercising more than kind of makes sense, or for reasons
that not just like for fun um, those are definitely
reasons to kind of seek help into getting that diagnosis
(05:05):
at that age feel validating, shameful. Were you aware of
that diagnosis personally as at age eleven? Yeah, So I
got into treatment actually around age twelve, so about a
year after I really started developing those serious symptoms, so
I was pretty aware of it. I went to like
an outpatient treatment program with my parents. Um so they
were doing something called FBT. So I don't know if
(05:27):
you're familiar with that, but it's a family based treatment.
I was actually really lucky to get that because it's
one of the most evidence based treatments for young kiddos,
and in that treatment, parents are actually really involved in
helping kids eat and kind of feel better in that way.
So I was aware of it, and I think, as
you kind of mentioned, they think a lot of shame
did come along with it, because it wasn't really something
(05:49):
that I felt like I could talk about with other
people or in school. It's a very secretive thing and
it was kind of like a family secret for a
long time that that was something I experienced, and I
didn't actually even start sort of talking about it or
telling my friends about it until I was in my twenties,
um because I was worried about what people would think
or if people would judge me or think that I
was just obsessed with my appearance, if they kind of
(06:11):
learned that about me. So it's really freeing when I
finally did start to talk about it with people and
realize that people can be really accepting of it, and
also a lot of other people had gone through and
experienced similar things, even if they hadn't necessarily gotten a
diagnosis at that young age or at any age. Yeah,
I think that speaks to so many, whether it's a
mental illness or anything. Really is like we all kind
(06:33):
of run around with these deep seated secrets that we think,
you know, if people knew we would be we wouldn't
belong or we'd be judged, or there'd be shame, And
like every single one of us is running around with
a different little seed of shame. And then you know,
over a decade went by for you before you found
your voice to speak about it. And it sounds like
by doing so, you know your friends or your your colleagues,
(06:55):
maybe we're like, oh well me too, me too, me too,
And suddenly you know you're it's kind of just like
a big relief to let that air out of the
balloon and deflate and relax and say, Okay, you're not broken,
or we're all a little bit broken, and that's that's okay, right,
That's like being a human is exactly? Was that huge
(07:15):
for your healing to be able to talk about something
like that so young? I yeah, I definitely was. Um.
I have a friend who once said to me, like
sunlight is the best disinfectant, and I think that's a
really nice thing, because, like you're saying, I think we
all carry around things that we feel ashamed of or
feel like we're the only person struggling with it. And
when it's something that's a deep secret that you're not
(07:36):
sharing with anyone else, it's really easy for those feelings
of guilt and shame to build up and you just
kind of feel worse and worse about it um and
I think it even makes it harder to change those
behaviors if you're having disordered eating behaviors or other kinds
of challenges. But once you start talking about it, you
realize that you know it's okay, and other people are
going through similar things. And so as part of my training,
(07:58):
I also see therapy clients, and I think what I've
realized is everyone has these things that they think they're
the only one that they that experienced something like that,
But usually I had someone else tell me that exact
same thing like a week ago. So I think none
of us are really as alone as we think. And
when we kind of discovered that, or personally, when I
discovered that, it definitely was very freeing and allowed me
(08:20):
to let go of a lot of the guilt and
shame I've been carrying around. That's awesome, and it clearly
I think by doing so allowed you to do the
amazing work that you're doing. So let's kind of dive
into that work. When did you realize that anxiety or
depression could be related to eating disorders? That's a great question.
So I think I sort of realized it some through
(08:41):
my own experience and kind of realizing that there were
times when I was engaging in certain behaviors because it
helped me feel calmer, help me feel better. But their
research literature is actually pretty consistent about it as well.
So the research shows that among people with eating disorders
and disordered eating, they're really high levels of anxiety in depression,
with a lot of research showing that more than half
(09:03):
of people who struggle with eating disorders also struggle with
anxiety and depression. Um, so there's a really strong link
in their research, and part of the reason seems to
be related to biology. So we know that eating disorders
obviously are affected by the socio cultural context that we
live in, but they're also affected by your underlying genetic
risk for developing an eating disorder. And we see that
(09:26):
the genes that contribute to eating disorders also contribute to
things like anxiety and depression. So I was trained by
as a biologist in my undergrad and that's how I
sort of started getting interested in learning about genetic contributions
to things UM, and started learning about the overlap that exists. Well,
that must really take away the shame and for anybody
who maybe wants to kind of like, let's boil that down.
(09:47):
I think what you're saying is we have genes and
the environment could turn those genes on or off, possibly
the environment being anything around you. And if you have
that gene and you're predisposed is to a factor that
turns that gene on. I think I'm not getting this
completely scientifically right. You're doing it really right. Yeah, then
(10:07):
kind of very so I'm oversimplifying it. But outcomes the
eating disorder behavior or the anxiety or the depression, etcetera.
So that's so interesting. Would you say that, UM, And
I don't know if you could really boil this down,
but would you say that anxiety slash depression leads to
a eating disorder or would you say an eating disorder
leads to anxiety and depression or back and forth, back
(10:28):
and forth, That's a really excellent question, and it's one
that I think is still being debated in the research literature.
And I think what you're saying about the back and
forth is probably a big part of it, because what
we know is that when people aren't getting enough to eat,
that actually affects their brain as well in ways that
can increase risk for anxiety and depression. So there probably
is kind of a circular nature to it. Where people
(10:50):
are engaging and disordered eating, it kind of affects their
body and also their self image in a way that
can increase anxiety and depression, and then disordered eating behaviors
can kind of be used as a way to manage
those symptoms as well. But the research does show that
often anxiety is what shows up first for people. Um
So people might have anxiety when they're younger, like when
they're in childhood, and then later developed disordered eating. So
(11:14):
that's the way it often seems to go, but definitely
not for everyone. That makes sense in your research, do
you distinguish between disordered eating and eating disorders or I
know when I was in undergrad I was interested in
learning about eating disorders and disordered eating because I was
silently suffering with my own and wanted to learn more,
although I couldn't put that into words, and I remember
(11:36):
that I couldn't find any research that spoke to kind
of what I was dealing with, which was more disordered
eating than eating disorders such as an axia, bolimia, you know,
eating disorders not otherwise specified even didn't really speak to
what I was going through. Has the research expanded to
encompass more broad definition of eating disorders. I think it has.
(11:57):
I think there's still work to be done, but I
think increasedly people recognize that most people who struggle with
disordered eating are kind of having an experience like you described,
so they don't neatly fit into a box of one
of those diagnoses, but they may still be struggling with
their eating or body image um and still suffering distress
from it. And so what we think now is that
(12:19):
disordered eating kind of exists on a spectrum um. So
you might have people that have these very severe disorders
that manifest in specific ways, but then there are a
lot of other people out there who are really struggling
with disordered eating symptoms in a way that might not
fit that diagnosis. But it's still really important to address
and when it comes to research and finding people to
(12:41):
conduct research on, are we bringing more people into the
mix who don't neatly fit into anorexia bulimia. Yeah. So, actually,
almost all of our research is conducted with people from
the community and the general population. So at Michigan State University,
we are really lucky to have population based twin registry
(13:02):
and um I won't go into all the details of that,
but having twins is really helpeful for getting at some
of those genetic components to things like disordered eating, and
in the general population we see the kind of the
whole spectrum. So there are some people who might say
that they never struggle with disordered eating or body image,
and then there are some people who have struggled with
it really severely, and then kind of everyone in between.
(13:25):
Um So, in our research, we think it's really important
to capture that whole variability because even people who are
not meeting criteria for a diagnosis, you know, might still
be struggling and in need of help. One of the
things that you research is specifically is our ability to
emotionally regulate and how that plays a role in eating
disorders and disordered eating. Can you define emotional regulation or
(13:50):
emotional disregulation? Maybe both for us? I think of emotion
regulation as being kind of how you manage and respond
to your emotions. So sometimes people might have an emotion,
but they might respond to that by criticizing themselves for
how they feel or trying to suppress that emotion and
not show it to other people. And we generally think
of those as not very helpful ways to respond to
(14:12):
emotions because they tend to make the emotion more intense
or lead to other kinds of behaviors like disordered eating. Um.
But there are other ways that people sometimes manage their emotions,
one of them being just accepting how you feel and
kind of listening to what that emotion is telling you,
which is actually kind of one of the most adaptive
ways to respond, as well as just kind of thinking
differently about the situation or maybe doing something to distract
(14:35):
yourself or change the situation. And those are ways that
often one can listen to on one's emotions and respond
to them in a way that's less likely to lead
to kind of feeling worse down the line. And our
emotional regulation skills learned genetic both. So I think that's
a question that the science actually hasn't fully answered, but
they are definitely not a hundred percent genetic or even
(14:58):
mostly genetic. I it's say because some of the things
that we actually do to treat disordered eating and also
things like anxiety and depression actually often involved teaching people
how to pay attention to their emotions and regulate them
more effectively. So that kind of starts with mindfulness and
being aware of what it is that you're feeling, and
also being aware that your emotions are kind of there
(15:20):
to help you as opposed to hurt you, and then
figuring out different ways to kind of engage in self
soothing techniques or problem solving techniques so that you can
manage those emotions without trying to turn them off with
things like disordered eating behaviors. Yeah, so what I'm hearing,
and I was kind of applying my own personal story here,
which is I had no emotional regulation skills growing up,
(15:42):
which I think a lot of people don't, and everything
that I've learned has been learned. I've you know, mindfulness
is a huge part of my journey, and I teach
what I call modern mindful eating to my students in
a program called Fork the Noise. And what I find
most amazing being about the work that I do is
when students apply it, it bleeds into the rest of
(16:05):
their life. So we start with the food and then
it turns into regular life or sometimes my students have
an easier time applying the mindfulness concept to life, and
then it comes back to the food because you have
this expanded, less reactive, less cyclical reaction to your negative
thoughts or even your thoughts in general. And I kind
(16:25):
of picture in a circle like if my my brain
was going one way in one direction one day, it
stopped and it started going in the other direction, and
the first way didn't serve me, in the second way
really did. But I don't know always how to put
that into words. So do you find that, you know,
working with a therapist is the best way to learn
emotional regulation and things like that. Yeah, So I'm a
(16:49):
big fan of therapy. I always think that if you
think you can benefit from therapy, and often even if
you don't think you can, you can. Um. So I
think therapy can be a really helpful of resource for
using these and learning these kinds of skills, especially therapy
that's focused on things like mindfulness or um. Dialectical behavior therapy,
which is sometimes called DBT, has been shown to be
(17:12):
helpful for people with eating disorders in terms of recognizing
and learning to regulate their emotions. And I think a
therapist can also be really helpful in helping you learn
to accept your emotions and not judge them as much
or judge yourself for having them, because they think it
can be really easy to get into the trap of
thinking you should feel differently, or you're a bad person
(17:32):
if you feel guilty or angry or sad, and really
that's not true because we all experience those emotions, and
so being able to learn that those emotions are natural
and okay, I think is an important part of the process.
And your research keeps showing us that this emotional regulation
plays a role in the development of disordered eating and
(17:53):
eating disorders. Yeah, so, um, there's been a lot of
research looking at that across time. So what you see
is that when people have a hard time regulating their
emotions or a kind of prone to anxiety or depression
like we were talking about earlier, that kind of sets
them up for being at higher risk for disordered eating
down the line. And what we see is that when
(18:14):
people get treatment and learn kind of how to manage
their emotions more effectively than their disordered eating tends to
go down, as well as their symptoms of anxiety and depression. So,
like you were talking about, it can kind of generalize
to multiple things, and especially a lot of research has
been conducted with people who might experience binge eating or
other kinds of disregulated eating. We're often that kind of
(18:34):
eating can be triggered by really intense negative emotions, and
the thinking is that when you have that behavior, it
might help you feel better temporarily, but often people afterwards
um will feel sort of guilty or ashamed, and it
can lead to sort of a vicious cycle, though definitely
plays an important role, and then more anxiety, more shame,
(18:55):
more feelings like you need to you know, usually restrict,
which leads to another binge and then before or you
know what, you're in that cycle exactly. So it's pretty
cool because your research isn't just looking for what causes
eating disorders. You're also looking for not just the cause,
but how to escape it or break the cycle. Right, Yeah,
what would you say most of your research is focused on?
(19:17):
That's a good question. So I think that I often
kind of think about those things as being a little
bit interchangeable in terms of like what causes it and
what maintains it. They can sometimes be different, but often
the things that started off can be the things that
sort of keep it going. So my research focuses on
kind of how emotions can play a role in any
part of that. So in getting started with disordered eating,
(19:39):
um in terms of anxiety and depression contributing to that,
but also why eating disorders or disordered eating might continue.
And you know, I think it's kind of complicated sometimes
to disentangle what kind of first and what came second.
So we use special research designs to do things like that,
like having longitudinal studies where we track people over time.
(19:59):
M some of our research looks at that to kind
of see like what came first and what came second.
But I think when you have people who are struggling
with disordered eating, like the most important thing I guess
is trying to figure out how to help them feel
better once they're in that situation. So I hope is
that by researching kind of how emotions contribute, we can
sort of develop better treatments to help people who might
(20:22):
be experiencing eating disorders. An alway has quite the range
of listeners when it comes to age, probably sixteen year olds,
I'm sure we have, but a lot of our listeners
who write in are fifty sixty seventy, and they feel
like it's too late for them, And they'll ask us,
(20:44):
you know, do I have a chance at this? And
I personally think they do. But I'd love to know
if your research looks at populations who are perhaps forty
six seventy. Even so, my research hasn't looked at that specifically.
We have tended to focus on younger populations just because
of some other aspects of our research. But I think,
(21:05):
you know, to what your listeners would say, I think,
you know, there's no evidence that it's ever too late
for someone to be helped with something like, no matter
the age of the person coming in, whether they're really
young or whether they're kind of more advanced in life, like,
people can always kind of benefit from help, and like
it's never too late to change or to start to
feel better. So all the research that we have shows
(21:27):
that the treatments that work for people who are in
their twenties should also work really well for people who
are in their fifties and older, although obviously some aspects
of a person's life might be different at that time.
So I think, you know, no matter what a person's age,
there's definitely hope for them to recover. That's awesome. Thank
you for sharing that. And tell us a little bit
about eating disorders and the prevalence in disadvantaged or marginalized populations.
(21:50):
What are we seeing they're compared to I don't know
the right word, their regular populations. Now that doesn't sound right, Yeah,
I think more advantaged populations. Yeah, yeah, So that's kind
of the other arm of my research, and I think
of them as being related because people who are disadvantaged
or marginalized, who are experiencing discrimination or poverty, there under
(22:11):
a lot of stress. Right, So if we think that
being under a lot of stress and experiencing a lot
of negative emotions can be a risk factor for eating disorders,
then it makes sense that people who are experiencing that
kind of stress um or those kinds of negative emotions
might also be at higher risk um And for a
long time, I think there have been stereotypes out there
(22:32):
about who eating disorders effects. So usually it's a thin,
young white female individual. And what we know now and
also you know, I think this resonates with what you
said about your listeners, is that that just is not
true that eating disorders occur in all kinds of people
of all racial and ethnic backgrounds and ages and socioeconomic
status is and what their research increasingly shows is actually
(22:56):
that belonging to a disadvantaged or marginalized group can really
increase your risk. So one of the places that that
shows up is food insecurity, and this probably makes sense,
like if you can't get enough food to eat and
you're also experiencing other stressors that go along with poverty,
your chances of experiencing and eating disorder are actually a
(23:17):
lot higher on both at that time and then if
you experience that as a child later on in life.
So those that's kind of what their research is showing.
And for people who experience things like discrimination because of
their race or their sexual orientation, the risk is actually
higher for those people as well. And there's some research
showing that it may be actually that discrimination per se,
(23:37):
that it is increasing their stress and increasing their risk.
So the risk factor is the discrimination. Exactly, how can
we help those communities who are most in need. What
can we in the advantage communities due to help those
struggling with disordered eating and eating disorders in disadvantaged populations.
So I think one thing that's really important is awareness
(23:59):
because going back to those stereotypes, um, and it's really unfortunate,
but the research shows that even clinicians or people who
work with people with eating disorders might hold some of
those stereotypes, even potentially without being aware of them. So
just being aware that someone who might not look like
the eating disorder stereotype might be suffering from an eating disorder,
(24:20):
I think is really important. And kind of related to that,
I think making sure that services are available and accessible
to people is really important. So often, for example, a
person might have Medicaid insurance and there are not a
lot of therapists who take that kind of insurance. So
I think increasing availability and making sure that people who
may not have the financial resources to pay out of pocket,
(24:42):
for example, can still access services and access care is
really important. A lot of public health initiatives need to
be changed so that these people in these communities have
access to mental health care exactly. Yeah, I think that
there can be a lot of barriers for accessing treatment
even for people who are advantaged in many ways, especially
(25:04):
when it comes to eating disorders. So you can imagine
that if someone doesn't have very many resources or connections
to mental health services, it might be even harder. I
think increasing awareness and also increasing access is kind of
what's most important to help people get the assistance that
they might need. And when it comes to kind of
going back out to your work relating to anxiety and depression,
(25:27):
do you study how the variables change when a person
is put on medication like an anti anxiety medication or
an antidepressant. Yeah, so we don't study that directly, but
there is some research on it. So the research suggests
that medication can actually really help some people with disordered
eating with some caveats. So sometimes when people are really
(25:49):
underweight or engaging in a lot of disordered eating behaviors,
it actually changes their biochemistry so that the medications don't
work quite as well in their brain as they otherwise would.
So sometimes the first step is really helping the person's
body kind of get back to a more stabilized place
where their brain and their biochemistry is functioning maybe more typically,
(26:11):
and then the medications can be helpful for things like
depression and anxiety that might be fueling eating disorders, so
it's kind of a dual barrel approach there. That's probably
why it's so important to be working with a team
that includes a therapist, oftentimes a dietitian to make sure
that you are eating enough that your brain is getting
all the nutrients that it needs so that the medications
(26:33):
can be dosed properly and changed accordingly, but knowing that
they are kind of working as they should be exactly exactly.
I think eating disorders are really complicated, and they involve
our minds but also our bodies, and so making sure
that we're sort of taking care of all those aspects
of it is really critical just kind of give people
the best opportunity to achieve recovery and just feel better
(26:56):
in life. And I think you hit the nail on
the head, which is eating disorders are complicated, and most
people don't understand that. Even people with eating disorders don't
understand that. They feel frustrated that they can't just recover,
that they can't just eat the food or not binge
on the food, or not compensate for the food. But
what you're doing is so important because it's really assessing
(27:20):
all the variables and kind of showing, you know, us public,
that there's so many more pieces to the public that
doesn't meet the eye. So your work is so important
and Amy and I want to thank you for doing
it and for sharing it with us, and for also
sharing your personal story today. We really appreciate it. Yeah,
thank you so much, um, and thank you again for
(27:40):
having me and for doing this and sharing this information
with people out there. It's really great. Do you have
social media or anything where anybody can go find you
or you stay under the radar and we can just
maybe read your research? Can we link anything in the
show notes to show off the amazing work you're doing. Yes,
So I'm a nerd and I have no social media,
we like, uh, I do have um like a research page.
(28:03):
I can definitely send you the link to that so
you can take a look at some of the research
articles that I've worked on. That'll be awesome. We have
tons of like nutrition students and social work students who
I'm sure would also just be interested to just read
the amazing papers that I got to take a look
at before this episode. And you're really doing amazing work.
So thank you so much for your time, Megan, thank you.
I really appreciate it.
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Amy Brown
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