July 14, 2025 • 42 mins
Shattering misconceptions about eating disorders leads us to a profound realization: these complex conditions aren't about control—they're about safety. This conversation with Jennifer Stanger, a therapeutic consultant specializing in eating disorder treatment and intervention, reveals why traditional approaches often fail and what truly works for lasting recovery.
Drawing from both personal and professional experience, Jennifer explains how eating disorder treatment lags behind other behavioral health fields in addressing co-occurring conditions. While substance use treatment has evolved to integrate mental health approaches, eating disorder programs often work in isolation, treating symptoms without addressing underlying trauma, anxiety, depression, and family dynamics.
We dive deep into the neurological impacts, discussing how eating disorders impair the frontal cortex similar to substance use disorders, making rational decision-making nearly impossible. Our discussion brings clarity to recovery challenges, particularly the rarely-discussed physical and psychological distress of weight restoration. Join the conversation as we uncover better approaches to healing.
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Episode Transcript
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Speaker 1 (00:00):
Hello folks, thanks for joining us today again on
Head Inside Mental Health,featuring conversations about
mental health and substance usetreatment, with experts from
across the country sharing theirthoughts and insights on the
world of behavioral health care.
Broadcasting on WPVM 1037, thevoice of Asheville independent
commercial free radio, I am ToddWeatherly, your host,
(00:22):
therapeutic consultant andbehavioral health expert.
Joining us today is mycolleague and compatriot, and
now a friend of mine for over adecade, jennifer Stanger.
Jennifer is a member of theStuckersmith and Weatherly
consulting team, specializing inlong-term care management and
eating disorder treatment andcare, as well as intervention.
(00:44):
Jennifer initially entered thetreatment and recovery field
through marketing and businessdevelopment roles, where I met
her, but later transitioned toworking with programs as a
recovery coach and programmanager, later evolving into
therapeutic consulting, crisisintervention and long-term case
management.
She thrives on working withcomplex dynamics of families and
individuals in need oftreatment and support services,
(01:04):
with her own personal recoverystory, being trained in the
ARISE intervention model, aprominent and internationally
recognized invitational methoddeveloped by Dr Judith Landau.
Jennifer specializes ininterventions for both eating
and substance use disorders.
She is also skilled inaddressing the complexities of
severe and persistent mentalhealth conditions, guiding
(01:25):
families and loved ones throughcare planning and navigating the
challenges that come along witha path to long-term recovery.
Jennifer has a bachelor'sdegree in business admin from
Liberty University, but, withover 15 years in the behavioral
health field, her extensiveexperience has earned her
credentials as a qualifiedmental health and substance
abuse prevention professional,as well as a certified life
(01:45):
coach with the InternationalAssociation of Professional
Career College.
When she's not working, jenniferis a marathon runner.
And was it the New YorkMarathon or the Boston Marathon?
Which one did you run recently?
Speaker 2 (01:55):
Boston Marathon.
Speaker 1 (01:56):
Ran the Boston.
Marathon recently Finished it.
She's a fitness instructor andcoach at the local YMCA and
certified cat herder when shehas time enough to be at home.
But you know, jennifer, firstof all, welcome to the show.
Speaker 2 (02:11):
Thank you so much.
Thanks for having me.
That was all a mouthful.
I know the introduction.
Speaker 1 (02:15):
Well, the thing that I think you know you and I were
going to talk about today focusin on working with those
struggling with eating disorder.
Just had Dr Wendy Oliver Pyatton the show.
Speaker 2 (02:27):
Yes.
Speaker 1 (02:27):
So she's fabulous.
She's fabulous and we talked alot.
We spent more time on themental health side but talking
about how oftentimes eatingdisorder programs, while they do
a very good job of managingwhat is ultimately the the
logistical science of managingan eating disorder calorie
counts and, and you know, weightand blood, blood counts and the
(02:51):
whole you know there's a lot ofscience that goes in just
managing an eating disorder.
But then a person you knowstarts to eat regularly and then
they they may have cleared outthe crisis of eating disorder
and then they've got all themental health stuff that starts
to show up and if they dischargeat that time they end up
cycling back through becausethey haven't addressed the
(03:12):
underlying trauma or issues thatare going on and everything
else.
What's your take on all that?
Like, tell me about the coremessage behind national
awareness, national eatingdisorder awareness, and your
thoughts about how the world isworking with individuals who
suffer from that condition.
Speaker 2 (03:30):
Yeah, I mean I think the awareness piece it's
something that's increased, butI feel like the the eating
disorder industry still lacksbehind in both knowledge,
understanding, treatment like itjust lacks behind from
substance use and mental health.
Speaker 1 (03:52):
Substance use was in that category for a while too.
Right, I mean like they had tocatch up.
You still have substance useprograms out there that are not
doing as well with the mentalhealth piece, but they've had to
catch up a lot.
Do you feel like eatingdisorder is kind of behind them?
Speaker 2 (04:08):
Well, it's way behind .
It's way behind.
I mean I think you even justrealize that.
You know, when we talk aboutco-occurring disorders, everyone
you immediately think mentalhealth and substance use.
Wouldn't eating disorder,mental health be co-occurring or
eating disorder substance usebe co-occurring?
But we don't.
We don't even I mean ourverbiage around it doesn't even
(04:28):
recognize that that the eatingdisorder in another diagnosis is
still going to be aco-occurring piece.
And I think when we look at thetreatment programs out there,
we don't see the co-occurring.
We don't see co-occurringprograms addressing eating
disorders and substance use,eating disorders and mental
(04:50):
health.
We have a few.
I mean, thank goodness GallantHope is down there in South
Florida that is reallyaddressing the mental health and
the eating disorders but wedon't see the duly licensed,
true co-occurring treatmentcenters for eating disorders and
substance use and eatingdisorders and mental health.
Yeah, they're so closelyrelated.
Speaker 1 (05:11):
One of the things that they've done that is
changing, I think, is insubstance uses.
You know, the substance usefield again is ahead of the mark
on this Mental health suffersfrom the same problem they don't
address substance.
I feel like mental healthprograms may address diet,
exercise, lifestyle and foodintake a little better, uh, than
(05:35):
than substance use field doesbut definitely you know it used
to be done where you have to.
Let's solve this problem.
You got a substance use problem.
You got a mental health problem.
You got an eating disorderproblem.
You could have all three yeslet's solve this problem and
then we solve that problem.
We're going to go over here andsolve this problem and now
we're walking into the worldwhere we realize that
(05:56):
co-occurring disorders needco-occurring treatment.
Yeah, you got to work with themboth at the same time because
they're not separable, andexactly you know in your mind
and I know that you work a lotwith these programs and and and
are able to not only dotreatment, placement, but also
the case management and advocacythat goes as part of
(06:17):
therapeutic consulting what'sthe difference between?
What's the difference between aprogram that does, you know,
kind of exclusively eatingdisorder and in a bit of a silo
approach, and a program thatdoes true co-occurring
programming for eating disorders?
What, like what's thedifference between those two
programs in your mind?
Speaker 2 (06:38):
yeah, I mean I I think there's a piece with um
staffing definitely that has theability.
You know the ability to be ableto work with both and to be
able to address both.
You know, I mean, when youthink about majority of the
programs are treating eatingdisorders in a silo and kind of
(07:00):
what you were talking aboutearlier eating disorder, I think
I think the reason eatingdisorders are so complex is
because there's so manydifferent components that are
pulled into it.
You're not going to have anindividual with an eating
disorder that doesn't have somesort of underlying trauma issues
.
Speaker 1 (07:20):
Family dynamics.
Speaker 2 (07:23):
Exactly right.
But you also have this medicalcomplexity that you were talking
about earlier, and so you knowthat's a little bit different, I
guess.
If you think about that, insome comparisons it's it's kind
of like.
It's kind of like the detoxside of substance use, but with
eating disorders it'ssignificantly longer.
We're not talking about justlike a 7 to 10 day period, but
(07:47):
there's all these medical acuitypieces that need to be observed
and monitored around the eatingdisorder as well, and so
there's medical complexity.
There is the mental health sideof things, there's the food.
There's the food and theregulation side of things, and
then there's these underlyingissues, and so much of an eating
(08:09):
disorder program ispredominantly addressing medical
and food related issues, and sowhat lacks is getting down to
the why, right?
So I think you know, if I'mtalking to somebody who is
dealing with substance use, oneof the things I'm going to ask
(08:33):
them is well, what does drinkingdo for you?
Right, because it's donesomething positive, it's helped
you deal and cope in some way,right?
So what is that substance usedoing for you, right?
And so that should be the samequestion that's being asked to.
(08:57):
The eating disorder is likewhat is this doing for you right
, there's a positive piece to it.
There once was a positive piece, and then it's taken over and
it's become somethingsignificantly more.
So you can't address the eatingdisorder in a lasting way
without addressing like, well,what was it doing?
Speaker 1 (09:19):
Because that's starting to identify that those
core issues that are going downbelow the eating disorder well,
it's funny you say that becausethere dr andrew while wrote a
book called the marriage of sunand moon and he kind of lists
this, you know, over hundreds ofyears there are all these
things that that people havedone to alter their mind from
(09:42):
drinking alcohol to to likeexcessive eating of mangoes, to
use of substances andpsychedelics and things like
that.
And one of the things that hetalks about is is the act of
purging, because purgingvomiting triggers a region in
(10:02):
the brain that causes endorphinrelease.
Speaker 2 (10:06):
Yes.
Speaker 1 (10:07):
Yep, and and just like, and self-harm.
Self-harm is another one youknow.
Speaker 2 (10:11):
Yes.
Speaker 1 (10:12):
You set yourself, the body goes into.
You know you might go into mildshock.
We wouldn't identify the shockbecause it's not a major injury,
but the body goes through thisprocess and it releases
endorphins and there's a reliefon the other side of being hurt
that you experience and itbecomes you know, what we refer
to commonly as this processaddiction, where a person not
(10:35):
only experiences the relief, butthey've got this way that they
do it.
You know, I eat this and then Ipurge or what have you that I
purge or what have you, butthere's this method to the
madness that causes relief andthen you throw OCD in there and
this person kind of gets lockedinto the way that they do this,
(10:56):
the way that they hide it.
And it's really kind offascinating to me what the brain
does with this material.
And one of the things that youknow you've just I guess it was
last year or year before the youyou received the, you went and
did the arise training.
Um, I'd like to talk a littlebit more about that.
(11:16):
But specific to eating disorder, how do you intervene, like,
with all this stuff kind ofgoing on, co-occurring
conditions and a mashup of allthis symptomology, like how do
you intervene with a personwho's suffering from eating
disorder?
What's that look like?
Because I think it's differentthan you do with substance use
it is.
Speaker 2 (11:37):
Um, I think that with I think the challenge with
intervening with eatingdisorders is that there is a
deeper, greater sense ofpersonalization.
By personalization I mean, likeyour core identity being
connected to it, and so if I saysomething to the person about
(11:59):
like hey, I feel concerned foryou.
This is what I'm seeing and I'mworried.
There's more of aninternalization piece, like it
becomes more shame based andthere's a greater likelihood of
the defense mechanisms going up,even more so than with
substance use, if that makessense because it's.
(12:22):
It's almost more personal, likeI'm saying something that's
even more personal and justsaying hey, I'm concerned about
your drinking and some of thesebehaviors and things that you're
doing while you're drinking.
When we're talking about theeating disorder, individuals
with eating disorders are moreprone to take that on as an
identity, more so than someonewith a substance use Right, so I
(12:46):
can start almost strugglingwith an eating disorder.
I almost become that identityversus.
I don't think we see that asmuch with the substance use
Right, like it's still more of abehavioral type thing.
Speaker 1 (12:59):
I mean, you see it in mental health as well,
especially with things likepersonality disorder and
depression and anxiety.
But you know, the thing aboutthink about substance use is
that, okay, I can quit asubstance, I can't quit eating
yes, yes you know, and, and Ithink, the biggest challenge the
(13:20):
way that I eat, what I eat andhow I and how I really you know,
if you talk to anybody who does, I know that you do this too
like fitness and nutritionmanagement and those kinds of
things.
There's this identity with theway that I eat from like my
childhood and the things thatare favorites to me.
And and comfort foods a greattime I had with a family member
(13:41):
or whoever that this foodrevolved around.
Maybe from the South, I canidentify with that a lot, but at
any rate I mean I think anybodycan but the you know, with an
eating disorder you're talkingabout this person's.
You know what they put intotheir body and all of that stuff
that's attached to it, which alot of times is, you know,
(14:02):
trauma and shaming and otherthings that you know.
The family dynamics that existwith eating disorder are a lot
around weight and body image.
Speaker 2 (14:11):
Yeah.
Speaker 1 (14:12):
There's, you know, one of the co-occurring
disorders with eating disordercorrect me if I'm wrong is body
dysmorphia, which is, like youknow, a person who's 110 pounds
feels like they're fat.
Speaker 2 (14:38):
Mm-hmm, and that's you know, it's not normal,
that's not accurate.
They've got a misinvolutionalkind of view of themselves, so
kind of.
I mean we see a lot of timeswith, like mental health and
other sorts of things, where wejust start kind of overusing the
term in a way that's not reallyappropriate, because true body
dysmorphia, it's almost like adelusion disorder, right, my
brain is not seeing things inreality and I think what we
(15:09):
started using it more is kind ofin just this like generalized
sense of like I'm not really fat, but I think I am, and so you
know, everyone, you know or Ishouldn't say everyone but most
people with an eating disorderare going to struggle with body
image in some way and that's anormal component.
Speaker 1 (15:22):
It's not, I mean yeah , I don't like who I am.
Speaker 2 (15:26):
Yeah, exactly Exactly .
That is something that I thinkmost people struggle with in
some way, shape or form.
Right Like, I wish this wasdifferent about myself.
And so there's this, there isthis you know commonality and
eating disorders, that I have asomewhat distorted perception of
myself and what my body lookslike, and then there's body
dysmorphia right.
(15:47):
Right, which is the only way Ican describe it is it's.
It's, it's almost like more oflike a thought component, you're
like the brain is not able toactually see.
It's seeing something differentthan what somebody else would
see, right, and so I think we'vekind of overgeneralized the use
(16:09):
of the term when there reallyis a significant brain
disconnect, when we're talkingabout body dysmorphia.
Speaker 1 (16:21):
And then there's a difference between two terms and
I don't think most peopleunderstand, which is the
difference between dysmorphiaand dysphoria.
Yes, and you know dysphoria,and if we're going to give it an
example, I just had Dr MichaelGurian on the show, who's a
gender expert and this is usedwith individuals who you know
(16:46):
they're born female but theyreally feel like they are a male
and that's that's.
That's sex dysphoria, genderdysphoria Gender is a societal
construct.
Sex is a science term, so thisis sex dysphoria.
I, I'm a, I'm a, I was born afemale, I have female parts, but
(17:09):
I feel like a male and I wantto make a transition to that.
Yes, Versus gender dysphoria,which is where we find the
identity of a person being on aspectrum.
Then, if we move from there, wego into dysmorphia, and
dysmorphia is a clinical termthat is about a disorder and
(17:32):
that's the person who looks atthemselves at 105 pounds in the
mirror and believes that they'refat and they need to lose
weight.
That's dysmorphia.
Yeah, and it leads to and itleads to these things that are
very unhealthy, and psychiatricconditions and eating disorders
that person's probably their BMIis so low they end up going to
the hospital.
So when you run into that backto this question about
(17:56):
intervening it lives with youpersonally You're shoving your
walking up into somebody's life,all up in their face
essentially, but the ARISE modelis an invitational model face
essentially.
But you know, the arise modelis a is an invitational model.
You know, ideally, a person torealize that they need help, um,
and that you're there as aresource for them to find it.
(18:18):
What does that look like?
What does that like?
Give us a, give us a case youknow, if you've got one that you
can share, give us somethingthat you know, a person that
you've worked with or, uh, acase that's come to you, that
you walk through these piecesand this is what it looked like
for that individual, like whatare the features to doing
intervention?
Speaker 2 (18:38):
Well, it's much more.
You know the interventionitself, you're really taking a
much more conversationalapproach, and so you're creating
a safe space.
So I think that's one of thebiggest things about eating
disorders is because one thing Ilike can't talk about eating
disorders without not saying howmuch I hate when we say that
(19:01):
eating disorders and anorexiaare about control right they're
not about control, it's aboutsafety.
Speaker 1 (19:09):
Right, they're not about control, it's about safety
.
So why is it they say it'sabout control?
What is like?
What is it?
So yeah?
Speaker 2 (19:16):
So I think the conversations around eating
disorders being about control, Ithink comes from all the
rituals that come out of it,Right?
So you and you were talkingabout that a little bit right.
Oh, these OCD, and I actuallyexactly so.
I think that there's a lot ofcomponents about eating
disorders and especiallyanorexia, that almost almost
more parallel OCD, because itbecomes very ritualistic.
(19:39):
Right, I only, I can only eatthat.
You know, nine, 12 and 5 PM.
I can only eat, you know, 700calories at each meal.
I have to use two packets ofpepper and, um, I'm going to
measure out my amount of foodand I eat, or I drink exactly 24
ounces of water.
There's all these very I cut my, I'm going to cut my piece of
(20:03):
meat into 24, even pieces, andso we say, wow, like this is,
this is control.
Because now if somebody comesin and says, hey, you can't do
that, I'm going to get upset,right.
Speaker 1 (20:15):
Right.
Speaker 2 (20:17):
But when you think about why?
So this goes back to the likewhat's it doing for you?
What are these rituals doingfor you?
Yeah, what relief are?
Speaker 1 (20:27):
they giving you.
Speaker 2 (20:29):
Yeah, so somebody who has OCD.
What does you know what iscounting the tiles on the
ceiling doing for you?
What is you know checking thelights three times doing for you
?
Speaker 1 (20:44):
What is?
Cutting the stake into 24pieces to do for you right.
Speaker 2 (20:48):
Yes, it's not the control.
Externally it looks likecontrol, but internally it feels
like safety.
Right, so I've created thissafe environment for myself.
So the eating disorder becomesthis bubble of safety, and the
reason I don't want somebody tointerrupt these rituals and this
(21:09):
routine and what I feel like Ihave to do is because that feels
like an intrusion, it feelsunsafe.
So I've created this safe spacearound myself and everything I
do now is to protect that.
So when you're coming into andpart of that is also what makes
it more personal and why aperson's going to have the
(21:30):
strong response to trying tospeak into it because you're
breaching on my area of safety.
Speaker 1 (21:36):
Right, right, and so when you think about it in that
context.
When you walk into thatperson's life to intervene
because it's gotten unsafe,right yeah, like how, how do you
?
What's the delicate way inwhich you walk into that aspect
(21:56):
of a person's life when you gotto intervene there at the
beginning of their recoveryjourney?
Um, what does that?
What does that look like?
Speaker 2 (22:49):
So being able to match their tone, their is
almost a greater connection thanwith other diagnoses.
Speaker 1 (22:56):
Um to be able to connect and have a very
compassionate conversation andso you know, in an intervention
dynamic we want to, other day Iwas actually speaking to the Bar
Association here locallyyesterday and somebody asked me
about intervention and I waslike, first of all I don't
really like the word because itlooks like what it does on TV.
(23:19):
And while there's a model outthere that's like that, that's
confrontive and you know lettersto family members and
overwhelming a person with allthis kind of like.
We think you need help, um, andthat can't there.
There are times when it works,um, but with the clientele,
(23:40):
especially the clientele you andI work with you know, for
intervening on someone not onlywith substitutes but pretty
significant eating disorder oreating disorder and or mental
health condition or both, andlikely they have both, because
the truth is you don't have a,you don't have a eating disorder
or a substance use conditionfor which you need residential
(24:01):
treatment.
That doesn't come, that is notaccompanied by a mental health
condition, like it doesn't exist.
Speaker 2 (24:07):
Absolutely.
Speaker 1 (24:09):
You know, this compassion and this approach
style and everything else thatyou're talking about is is
pretty critical and key.
I think the the interventionstyle model also gets in a hurry
.
We got to go in and this personis going to come with me right
now.
There's this window, whereasyou're talking about a, you know
, between invitational approach,but you know between
invitational approach, but youknow, even a rise methodology
(24:31):
doesn't necessarily, isn'tnecessarily answering all the
questions that I know you runinto with a person with severe,
you know, thought disorder orthey have severe eating disorder
.
You've got this personaljourney Like what was it like
for you?
How did you?
I know it informs the way thatyou do what you do, like yeah it
was a little.
If you're willing to give us alittle bit about your recovery
(24:52):
story.
Speaker 2 (24:53):
Yeah Well, I think one of the biggest challenges,
kind of like what you're saying,like how do you go into that
conversation with somebody withan eating disorder and this this
just came up this week at theYMCA actually and uh, a member
that's I feel concerned over andhave no, this significant
(25:14):
weight loss and the biggestchallenge is, uh, that's how to
say something.
Right, like you, you want tohow do you say something?
You want to say something andthe reality is is there's?
There's just nothing that youcan say that's going to come out
well, um and and I think that'sone of the pieces that's so
(25:37):
difficult um is trying to figureout, and that's something I
know from experience there'sjust no way to speak into it and
express concerns.
Yeah exactly the person who'sreceiving this is going to be
like.
Oh my God, thank you so muchfor saying something Right.
(25:57):
It's just not.
You know it's, it's not goingto happen.
And I think, gosh, I my ownjourney to you know cause I
struggled with alcohol use aswell as the eating disorder, and
so when we talk about thisco-occurring piece not uncommon,
as we know no, it's absolutelynot and it's not.
(26:20):
I think people think of them ascontradictory, and here's one
thing I will tell you about aneating disorder is it is a
walking contradiction.
It does not.
It makes sense in my brain.
It does not make sense toanyone else who is looking at it
seeing it From the outside, nothaving it right and trying to
understand it right, Becauseyou're like you're restricting
your calories, You're losingweight, but you're okay drinking
(26:44):
calories Like that doesn't makesense to me, alcohol's got a
lot of calories, right.
Yeah, it's exactly, exactly.
And yet somehow we come up withthis rationalization and the
rules, the rules or therationalization, in my own brain
.
It can make sense and I canremember at one point in time
(27:08):
when I did identify gee, maybeI'm drinking too much.
And I stopped drinking for acouple days and I started to
lose weight, more weight, and Iwas already underweight and my
brain said, wow, see, this iswhy I need a drink is because if
I don't drink and now I'm goingto, I now I'm losing too much
(27:30):
weight.
That's going to make peoplemore concerned.
So, like my disordered, myalcoholic eating disorder, brain
rationalized that's.
That is why you need tocontinue to drink, because it
keeps you at this, still a lowconcerning weight, but better
than it dropping down low.
(27:51):
You know what I mean.
So, like it kind of like has.
This justification doesn't makesense to anyone else and you
also have to keep in mind youknow we talk about the impact
that substance use has on thefrontal cortex and the
significant impact that eatingdisorders are the same.
If you look at CT scans ofeating disorders and substance
use or mental health, they'reall very, very similar, they're
(28:14):
impacting similar regions of thebrain right.
Yes, that frontal cortex.
It's significantly impaired andso my ability with a severe
eating disorder, my ability tomake well thought out decisions
is is completely impaired.
So you know, when you'retalking to parents of somebody
(28:35):
with a, you know a mental health, significant mental health, and
you're like hey, look like weknow you want to try to
understand why they're behavingin this way and you just can't
rationalize.
Speaker 1 (28:46):
Like we're not.
Speaker 2 (28:47):
your brain is not going to be able to make sense
out of this, but the same isreally true with what's
happening in that eatingdisorder brain.
Speaker 1 (28:53):
I don't.
Yeah, it's like I don't.
Whoever the family members areright, I'm not asking you to
think this makes sense.
It doesn't make sense, but itmakes sense to them for a series
of reasons.
And we've got to find thischicken in the armor.
There's this place wherethey're vulnerable to realizing
(29:16):
something is going wrong, andpart of the work I know from my
side it sounds like it's verysimilar is to find where that is
.
But you know, the other pieceis that you've got this lived
experience.
I do not.
I can walk in and say all kindsof things that make sense,
right, that doesn't make aperson realize that they need to
(29:36):
get help.
You know, if you're workingwith somebody who suffers from
and we tell families this allthe time, I know for a fact you
and I together suffers from andwe tell families this all the
time, I know for a fact, you andI together.
But you know you got somebodywho suffers from thought
disorders, like you're not goingto negotiate with thought
disorder or psychosis.
Speaker 2 (29:52):
Exactly.
Speaker 1 (29:52):
It's not participating in a reality that
you can understand.
What you can do is ignoreeverything that doesn't make any
sense and follow their line oflogic, and somewhere in there is
something that they want.
Speaker 2 (30:07):
Yep.
Speaker 1 (30:08):
And if they want that , you know I want to have a job
or have a girlfriend or have alife or live independently or
any of these.
You know, things that everybodywants.
Somewhere in there is somethingthat's normal that they want.
Yeah, Well, sounds like youwant this and if you want that,
you probably going to have toaddress some of these other
(30:28):
things, because right now, whatyou're doing is not working
right.
Speaker 2 (30:32):
Exactly.
Speaker 1 (30:34):
Now, with a person with thought disorder, it's very
difficult to even get that faralong in it and they may end up
in the hospital or arrested orall kinds of other things.
But for a person with an eatingdisorder you know from what
you're saying it sounds likethere are a couple of things
going on.
One is they're trying to.
They've got anxiety.
They probably suffer fromdepression.
(30:54):
There's probably deep traumaand they are.
They have engaged in a, aprocess, a lifestyle that it
causes them to stay away from,abate the anxiety, control the
environment so that they don'tcome into places where they feel
unsafe.
And then all of a sudden you'regoing to walk in and you can't
(31:19):
just go blowing that up.
Speaker 2 (31:22):
Yeah.
Speaker 1 (31:23):
This is we're going to.
We're going, we're gonna, we'regonna chip away at it.
We're gonna scratch at thesurface with this person and and
gently help them realize, whichyou can't do in a moment.
You know that exactly.
It doesn't happen in a moment.
It happens.
It happens when the personknows who you are, realizes they
can trust you, knows that youhave a shared experiences, so
(31:46):
you have these.
You know what we would calltherapeutic alliances with this
person yes, ready walking intothe situation and then you know,
I kind of I look at it this wayyou, you stand, you stand still
but still available and waitfor them to come to you, a
little bit like, yeah, like youknow, the scared creature in the
cave, it's like, hey, I got alittle something I think you
(32:06):
want.
Why don't you come out, justlet's talk a little come out, a
little bit um, and then ideally,you know, somewhere along in
that process they can gettreatment, and treatment is, you
know, being surrounded byclinical professionals and teams
of support and 24-hoursupervision and all these pieces
that help that person managethe process.
Now, the other vulnerable spotthat I like to talk about, and I
(32:29):
know that you have a lot ofexperience with, is the other
side of treatment is, you know,okay, they've gotten past the
crisis, they've gone throughsome treatment.
Speaker 2 (32:37):
What comes next?
Speaker 1 (32:39):
What comes next Like what is?
The?
What is the?
What is the transition out of?
Out of residential treatment,out of crisis, essentially, and
some of the care that goes alongwith that?
What is that?
What is coming back home beingindependent?
What does that look like for aperson?
Speaker 2 (32:54):
who suffers from eating disorder yeah.
So I think honestly, I thinkthat's again that's one of the
most challenging areas foreating disorders and I think we
also just don't have, we lacktransitional programs.
Speaker 1 (33:10):
Oh yeah, yeah, you have a lot for substance use,
right?
Speaker 2 (33:14):
Yes, you really lack that transitional programming
that supports an eating disorderand all of our sober livings,
mental health, transitionalprograms.
We can have someone who's had ahistory of eating disorder, but
you know they're.
And even when they say you knowsecondary eating disorder but
(33:36):
they're not equipped to dealwith someone who's coming out of
residential.
Coming out of residential isway too fragile and I think you
know, talking from my experiencewith it.
I think one of the areas thatwe don't talk about enough with
eating disorders is that placeof frailty as you come out of a
(33:59):
residential program and I thinkone of the things that people
don't realize.
It's all taught from myexperience and that was going
into residential significantlyunderweight and so one of the
primary things that they'redoing is weight restoration.
Okay, Right.
And.
Speaker 1 (34:17):
The science part right.
Speaker 2 (34:18):
Yes, yes, the science and the medical part and weight
restoration is not comfortable,right?
So I think we have people, wehave someone who's like a normal
weight and likes their food.
They're like well, that'sfantastic.
Like you're telling me, I getto eat these.
Like extra calories, like youknow.
Like, like you have to do this.
Like great, like that soundswonderful, right, but right.
(34:40):
But when you've been soseverely malnourished, your body
is in freak out mode, so you'readding these calories to your
body.
Yes, and so when you're going inand you have consumed, on a
regular basis for a long periodof time, significantly lower
(35:04):
calories than your averageperson would need in order to
just maintain weight, the body'sfreaking out at very little
calories, just to begin with.
And so they're watching andthey're monitoring and they're
upping the calories, but thebody's continuing to freak out.
(35:26):
It doesn't know what to do witheverything.
The metabolism actually shutsdown because what your body is
saying is oh my God, you'regiving me food.
Hold on to it, don't process it, because I don't know when
you're going to give this to meagain, because that's what it's
been used to, right?
Speaker 1 (35:45):
Wow.
Speaker 2 (35:46):
And so what's going to happen is, as your body
starts to gain weight andespecially as a female, you're
going to gain all of yourinitial weight in the stomach
area.
Your body knows to protect yourvital organs and your
reproductive organs.
Speaker 1 (36:04):
So you're talking about it gives calories to the
place where they're showing up,right.
Speaker 2 (36:09):
Yeah, yeah, so here's so, yeah, exactly, exactly.
So here's this person whoalready struggles with body
image of a severely low weightand now all my weight gain is
starting in the stomach area.
Speaker 1 (36:23):
Oh, my gosh.
Speaker 2 (36:25):
And so what people don't realize, I mean one.
It's incredibly uncomfortable.
Like your, your, your bodydoesn't know what to do with it.
All you feel is this distensionin this incredible fullness.
Internally, you're not.
It's not you're.
You're probably constipated,right, your body's just not
(36:46):
operating properly and even onceyou reach a normal weight,
where you've gained weight isnot.
It doesn't look normal.
Um, so it takes about a yearfor the weight that you gain to
really evenly distributenormally throughout the body,
(37:09):
and so again you talk about whathappens.
You're in a residential program,say.
You're in a residential programfor 60 days.
You discharge.
The biggest challenge that Ialways faced was I physically
feel uncomfortable, I hate theway I look and don't even try to
tell me that you know, youdon't, you know.
(37:31):
Don't try to do the whole likeI can barely I literally have
gained.
I have, we would call it thepooch right.
Like you, gain this big poochright in your stomach area and
the thing is, I know how to makeit go away.
I feel physically uncomfortable.
I know exactly how to make thisgo away.
Speaker 1 (37:51):
I can make it go away within a day.
Speaker 2 (37:53):
Yes, to go right back to those eating disorder
behaviors, and so to me, that'sone of those biggest challenges
is you're discharging the personat the most vulnerable state,
where not only are they stillthis emotional wreck, like
they're physically a wreck, andso then you just go right back
(38:14):
into your daily life and try tomaintain that recovery piece and
try to continue to eat in thisway.
That's only adding to thisphysical discomfort that you're
in, and so that was for me, isit never took long I mean, it
was always a matter of weeksbefore I just returned right
(38:35):
back to those behaviors.
Speaker 1 (38:37):
Yeah, well, and it sounds like, for the transition
piece, something that you knowwe've used you as a person who
does this, but even a person is,you know, ideally they used you
as a person who does this, buteven a person is, you know,
ideally they're returning to anenvironment that's got some
supports, whether it's you knowa supported living group
environment though there are notmany of those for eating
disorder but at the very leastlike a good therapist.
(38:58):
If there are medications, a goodpsychiatrist and a recovery
coach, that's.
You know, you and I, we harp onthis.
I know all the time with fanslike get a recovery coach.
You know, you and I, we harp onthis.
I know all the time with fanslike get a recovery coach
program.
They're in doesn't have one.
Get one to be involved, getsomebody who can walk and talk
with them, can show up for themin person, can see how they're
doing, can determine whether ornot they're kind of reengaging
(39:21):
in some of these old patternsand need more support.
That that person is really isreally, really critical to their
recovery.
And it's a role I know thatyou've played many times for a
lot of different people.
I like using you for thatbecause I think your personal
experience causes you to beattentive in ways that others
may not be.
Speaker 2 (39:42):
Yeah.
Speaker 1 (39:42):
So I'm really grateful for you as a person who
is on our team and I'm gratefulthat you agreed to come on the
show today.
Jennifer, thanks so much fortalking with us about eating
disorder and you know we'llprobably get you back on the
show so we can talk some moreabout intervention.
But this has been Head InsideMental Health on WPBM 1037, the
(40:03):
Voice of Asheville Our guesttoday, jennifer.
Speaker 2 (41:21):
Stanger.
Jennifer, thanks for being onthe show.
Thanks, todd.
I need a little help.
I found a little help, thankyou.
I don't need your love.
Send me a.
Send me a.
I don't need your love.
Send me a.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
(41:43):
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
Speaker 1 (42:01):
Find my way home.
Hello folks, thanks for joining us today again on
Head Inside Mental Health,featuring conversations about
mental health and substance usetreatment, with experts from
across the country sharing theirthoughts and insights on the
world of behavioral health care.
Broadcasting on WPVM 1037, thevoice of Asheville independent
commercial free radio, I am ToddWeatherly, your host,
(00:22):
therapeutic consultant andbehavioral health expert.
Joining us today is mycolleague and compatriot, and
now a friend of mine for over adecade, jennifer Stanger.
Jennifer is a member of theStuckersmith and Weatherly
consulting team, specializing inlong-term care management and
eating disorder treatment andcare, as well as intervention.
(00:44):
Jennifer initially entered thetreatment and recovery field
through marketing and businessdevelopment roles, where I met
her, but later transitioned toworking with programs as a
recovery coach and programmanager, later evolving into
therapeutic consulting, crisisintervention and long-term case
management.
She thrives on working withcomplex dynamics of families and
individuals in need oftreatment and support services,
(01:04):
with her own personal recoverystory, being trained in the
ARISE intervention model, aprominent and internationally
recognized invitational methoddeveloped by Dr Judith Landau.
Jennifer specializes ininterventions for both eating
and substance use disorders.
She is also skilled inaddressing the complexities of
severe and persistent mentalhealth conditions, guiding
(01:25):
families and loved ones throughcare planning and navigating the
challenges that come along witha path to long-term recovery.
Jennifer has a bachelor'sdegree in business admin from
Liberty University, but, withover 15 years in the behavioral
health field, her extensiveexperience has earned her
credentials as a qualifiedmental health and substance
abuse prevention professional,as well as a certified life
(01:45):
coach with the InternationalAssociation of Professional
Career College.
When she's not working, jenniferis a marathon runner.
And was it the New YorkMarathon or the Boston Marathon?
Which one did you run recently?
Speaker 2 (01:55):
Boston Marathon.
Speaker 1 (01:56):
Ran the Boston.
Marathon recently Finished it.
She's a fitness instructor andcoach at the local YMCA and
certified cat herder when shehas time enough to be at home.
But you know, jennifer, firstof all, welcome to the show.
Speaker 2 (02:11):
Thank you so much.
Thanks for having me.
That was all a mouthful.
I know the introduction.
Speaker 1 (02:15):
Well, the thing that I think you know you and I were
going to talk about today focusin on working with those
struggling with eating disorder.
Just had Dr Wendy Oliver Pyatton the show.
Speaker 2 (02:27):
Yes.
Speaker 1 (02:27):
So she's fabulous.
She's fabulous and we talked alot.
We spent more time on themental health side but talking
about how oftentimes eatingdisorder programs, while they do
a very good job of managingwhat is ultimately the the
logistical science of managingan eating disorder calorie
counts and, and you know, weightand blood, blood counts and the
(02:51):
whole you know there's a lot ofscience that goes in just
managing an eating disorder.
But then a person you knowstarts to eat regularly and then
they they may have cleared outthe crisis of eating disorder
and then they've got all themental health stuff that starts
to show up and if they dischargeat that time they end up
cycling back through becausethey haven't addressed the
(03:12):
underlying trauma or issues thatare going on and everything
else.
What's your take on all that?
Like, tell me about the coremessage behind national
awareness, national eatingdisorder awareness, and your
thoughts about how the world isworking with individuals who
suffer from that condition.
Speaker 2 (03:30):
Yeah, I mean I think the awareness piece it's
something that's increased, butI feel like the the eating
disorder industry still lacksbehind in both knowledge,
understanding, treatment like itjust lacks behind from
substance use and mental health.
Speaker 1 (03:52):
Substance use was in that category for a while too.
Right, I mean like they had tocatch up.
You still have substance useprograms out there that are not
doing as well with the mentalhealth piece, but they've had to
catch up a lot.
Do you feel like eatingdisorder is kind of behind them?
Speaker 2 (04:08):
Well, it's way behind .
It's way behind.
I mean I think you even justrealize that.
You know, when we talk aboutco-occurring disorders, everyone
you immediately think mentalhealth and substance use.
Wouldn't eating disorder,mental health be co-occurring or
eating disorder substance usebe co-occurring?
But we don't.
We don't even I mean ourverbiage around it doesn't even
(04:28):
recognize that that the eatingdisorder in another diagnosis is
still going to be aco-occurring piece.
And I think when we look at thetreatment programs out there,
we don't see the co-occurring.
We don't see co-occurringprograms addressing eating
disorders and substance use,eating disorders and mental
(04:50):
health.
We have a few.
I mean, thank goodness GallantHope is down there in South
Florida that is reallyaddressing the mental health and
the eating disorders but wedon't see the duly licensed,
true co-occurring treatmentcenters for eating disorders and
substance use and eatingdisorders and mental health.
Yeah, they're so closelyrelated.
Speaker 1 (05:11):
One of the things that they've done that is
changing, I think, is insubstance uses.
You know, the substance usefield again is ahead of the mark
on this Mental health suffersfrom the same problem they don't
address substance.
I feel like mental healthprograms may address diet,
exercise, lifestyle and foodintake a little better, uh, than
(05:35):
than substance use field doesbut definitely you know it used
to be done where you have to.
Let's solve this problem.
You got a substance use problem.
You got a mental health problem.
You got an eating disorderproblem.
You could have all three yeslet's solve this problem and
then we solve that problem.
We're going to go over here andsolve this problem and now
we're walking into the worldwhere we realize that
(05:56):
co-occurring disorders needco-occurring treatment.
Yeah, you got to work with themboth at the same time because
they're not separable, andexactly you know in your mind
and I know that you work a lotwith these programs and and and
are able to not only dotreatment, placement, but also
the case management and advocacythat goes as part of
(06:17):
therapeutic consulting what'sthe difference between?
What's the difference between aprogram that does, you know,
kind of exclusively eatingdisorder and in a bit of a silo
approach, and a program thatdoes true co-occurring
programming for eating disorders?
What, like what's thedifference between those two
programs in your mind?
Speaker 2 (06:38):
yeah, I mean I I think there's a piece with um
staffing definitely that has theability.
You know the ability to be ableto work with both and to be
able to address both.
You know, I mean, when youthink about majority of the
programs are treating eatingdisorders in a silo and kind of
(07:00):
what you were talking aboutearlier eating disorder, I think
I think the reason eatingdisorders are so complex is
because there's so manydifferent components that are
pulled into it.
You're not going to have anindividual with an eating
disorder that doesn't have somesort of underlying trauma issues
.
Speaker 1 (07:20):
Family dynamics.
Speaker 2 (07:23):
Exactly right.
But you also have this medicalcomplexity that you were talking
about earlier, and so you knowthat's a little bit different, I
guess.
If you think about that, insome comparisons it's it's kind
of like.
It's kind of like the detoxside of substance use, but with
eating disorders it'ssignificantly longer.
We're not talking about justlike a 7 to 10 day period, but
(07:47):
there's all these medical acuitypieces that need to be observed
and monitored around the eatingdisorder as well, and so
there's medical complexity.
There is the mental health sideof things, there's the food.
There's the food and theregulation side of things, and
then there's these underlyingissues, and so much of an eating
(08:09):
disorder program ispredominantly addressing medical
and food related issues, and sowhat lacks is getting down to
the why, right?
So I think you know, if I'mtalking to somebody who is
dealing with substance use, oneof the things I'm going to ask
(08:33):
them is well, what does drinkingdo for you?
Right, because it's donesomething positive, it's helped
you deal and cope in some way,right?
So what is that substance usedoing for you, right?
And so that should be the samequestion that's being asked to.
(08:57):
The eating disorder is likewhat is this doing for you right
, there's a positive piece to it.
There once was a positive piece, and then it's taken over and
it's become somethingsignificantly more.
So you can't address the eatingdisorder in a lasting way
without addressing like, well,what was it doing?
Speaker 1 (09:19):
Because that's starting to identify that those
core issues that are going downbelow the eating disorder well,
it's funny you say that becausethere dr andrew while wrote a
book called the marriage of sunand moon and he kind of lists
this, you know, over hundreds ofyears there are all these
things that that people havedone to alter their mind from
(09:42):
drinking alcohol to to likeexcessive eating of mangoes, to
use of substances andpsychedelics and things like
that.
And one of the things that hetalks about is is the act of
purging, because purgingvomiting triggers a region in
(10:02):
the brain that causes endorphinrelease.
Speaker 2 (10:06):
Yes.
Speaker 1 (10:07):
Yep, and and just like, and self-harm.
Self-harm is another one youknow.
Speaker 2 (10:11):
Yes.
Speaker 1 (10:12):
You set yourself, the body goes into.
You know you might go into mildshock.
We wouldn't identify the shockbecause it's not a major injury,
but the body goes through thisprocess and it releases
endorphins and there's a reliefon the other side of being hurt
that you experience and itbecomes you know, what we refer
to commonly as this processaddiction, where a person not
(10:35):
only experiences the relief, butthey've got this way that they
do it.
You know, I eat this and then Ipurge or what have you that I
purge or what have you, butthere's this method to the
madness that causes relief andthen you throw OCD in there and
this person kind of gets lockedinto the way that they do this,
(10:56):
the way that they hide it.
And it's really kind offascinating to me what the brain
does with this material.
And one of the things that youknow you've just I guess it was
last year or year before the youyou received the, you went and
did the arise training.
Um, I'd like to talk a littlebit more about that.
(11:16):
But specific to eating disorder, how do you intervene, like,
with all this stuff kind ofgoing on, co-occurring
conditions and a mashup of allthis symptomology, like how do
you intervene with a personwho's suffering from eating
disorder?
What's that look like?
Because I think it's differentthan you do with substance use
it is.
Speaker 2 (11:37):
Um, I think that with I think the challenge with
intervening with eatingdisorders is that there is a
deeper, greater sense ofpersonalization.
By personalization I mean, likeyour core identity being
connected to it, and so if I saysomething to the person about
(11:59):
like hey, I feel concerned foryou.
This is what I'm seeing and I'mworried.
There's more of aninternalization piece, like it
becomes more shame based andthere's a greater likelihood of
the defense mechanisms going up,even more so than with
substance use, if that makessense because it's.
(12:22):
It's almost more personal, likeI'm saying something that's
even more personal and justsaying hey, I'm concerned about
your drinking and some of thesebehaviors and things that you're
doing while you're drinking.
When we're talking about theeating disorder, individuals
with eating disorders are moreprone to take that on as an
identity, more so than someonewith a substance use Right, so I
(12:46):
can start almost strugglingwith an eating disorder.
I almost become that identityversus.
I don't think we see that asmuch with the substance use
Right, like it's still more of abehavioral type thing.
Speaker 1 (12:59):
I mean, you see it in mental health as well,
especially with things likepersonality disorder and
depression and anxiety.
But you know, the thing aboutthink about substance use is
that, okay, I can quit asubstance, I can't quit eating
yes, yes you know, and, and Ithink, the biggest challenge the
(13:20):
way that I eat, what I eat andhow I and how I really you know,
if you talk to anybody who does, I know that you do this too
like fitness and nutritionmanagement and those kinds of
things.
There's this identity with theway that I eat from like my
childhood and the things thatare favorites to me.
And and comfort foods a greattime I had with a family member
(13:41):
or whoever that this foodrevolved around.
Maybe from the South, I canidentify with that a lot, but at
any rate I mean I think anybodycan but the you know, with an
eating disorder you're talkingabout this person's.
You know what they put intotheir body and all of that stuff
that's attached to it, which alot of times is, you know,
(14:02):
trauma and shaming and otherthings that you know.
The family dynamics that existwith eating disorder are a lot
around weight and body image.
Speaker 2 (14:11):
Yeah.
Speaker 1 (14:12):
There's, you know, one of the co-occurring
disorders with eating disordercorrect me if I'm wrong is body
dysmorphia, which is, like youknow, a person who's 110 pounds
feels like they're fat.
Speaker 2 (14:38):
Mm-hmm, and that's you know, it's not normal,
that's not accurate.
They've got a misinvolutionalkind of view of themselves, so
kind of.
I mean we see a lot of timeswith, like mental health and
other sorts of things, where wejust start kind of overusing the
term in a way that's not reallyappropriate, because true body
dysmorphia, it's almost like adelusion disorder, right, my
brain is not seeing things inreality and I think what we
(15:09):
started using it more is kind ofin just this like generalized
sense of like I'm not really fat, but I think I am, and so you
know, everyone, you know or Ishouldn't say everyone but most
people with an eating disorderare going to struggle with body
image in some way and that's anormal component.
Speaker 1 (15:22):
It's not, I mean yeah , I don't like who I am.
Speaker 2 (15:26):
Yeah, exactly Exactly .
That is something that I thinkmost people struggle with in
some way, shape or form.
Right Like, I wish this wasdifferent about myself.
And so there's this, there isthis you know commonality and
eating disorders, that I have asomewhat distorted perception of
myself and what my body lookslike, and then there's body
dysmorphia right.
(15:47):
Right, which is the only way Ican describe it is it's.
It's, it's almost like more oflike a thought component, you're
like the brain is not able toactually see.
It's seeing something differentthan what somebody else would
see, right, and so I think we'vekind of overgeneralized the use
(16:09):
of the term when there reallyis a significant brain
disconnect, when we're talkingabout body dysmorphia.
Speaker 1 (16:21):
And then there's a difference between two terms and
I don't think most peopleunderstand, which is the
difference between dysmorphiaand dysphoria.
Yes, and you know dysphoria,and if we're going to give it an
example, I just had Dr MichaelGurian on the show, who's a
gender expert and this is usedwith individuals who you know
(16:46):
they're born female but theyreally feel like they are a male
and that's that's.
That's sex dysphoria, genderdysphoria Gender is a societal
construct.
Sex is a science term, so thisis sex dysphoria.
I, I'm a, I'm a, I was born afemale, I have female parts, but
(17:09):
I feel like a male and I wantto make a transition to that.
Yes, Versus gender dysphoria,which is where we find the
identity of a person being on aspectrum.
Then, if we move from there, wego into dysmorphia, and
dysmorphia is a clinical termthat is about a disorder and
(17:32):
that's the person who looks atthemselves at 105 pounds in the
mirror and believes that they'refat and they need to lose
weight.
That's dysmorphia.
Yeah, and it leads to and itleads to these things that are
very unhealthy, and psychiatricconditions and eating disorders
that person's probably their BMIis so low they end up going to
the hospital.
So when you run into that backto this question about
(17:56):
intervening it lives with youpersonally You're shoving your
walking up into somebody's life,all up in their face
essentially, but the ARISE modelis an invitational model face
essentially.
But you know, the arise modelis a is an invitational model.
You know, ideally, a person torealize that they need help, um,
and that you're there as aresource for them to find it.
(18:18):
What does that look like?
What does that like?
Give us a, give us a case youknow, if you've got one that you
can share, give us somethingthat you know, a person that
you've worked with or, uh, acase that's come to you, that
you walk through these piecesand this is what it looked like
for that individual, like whatare the features to doing
intervention?
Speaker 2 (18:38):
Well, it's much more.
You know the interventionitself, you're really taking a
much more conversationalapproach, and so you're creating
a safe space.
So I think that's one of thebiggest things about eating
disorders is because one thing Ilike can't talk about eating
disorders without not saying howmuch I hate when we say that
(19:01):
eating disorders and anorexiaare about control right they're
not about control, it's aboutsafety.
Speaker 1 (19:09):
Right, they're not about control, it's about safety
.
So why is it they say it'sabout control?
What is like?
What is it?
So yeah?
Speaker 2 (19:16):
So I think the conversations around eating
disorders being about control, Ithink comes from all the
rituals that come out of it,Right?
So you and you were talkingabout that a little bit right.
Oh, these OCD, and I actuallyexactly so.
I think that there's a lot ofcomponents about eating
disorders and especiallyanorexia, that almost almost
more parallel OCD, because itbecomes very ritualistic.
(19:39):
Right, I only, I can only eatthat.
You know, nine, 12 and 5 PM.
I can only eat, you know, 700calories at each meal.
I have to use two packets ofpepper and, um, I'm going to
measure out my amount of foodand I eat, or I drink exactly 24
ounces of water.
There's all these very I cut my, I'm going to cut my piece of
(20:03):
meat into 24, even pieces, andso we say, wow, like this is,
this is control.
Because now if somebody comesin and says, hey, you can't do
that, I'm going to get upset,right.
Speaker 1 (20:15):
Right.
Speaker 2 (20:17):
But when you think about why?
So this goes back to the likewhat's it doing for you?
What are these rituals doingfor you?
Yeah, what relief are?
Speaker 1 (20:27):
they giving you.
Speaker 2 (20:29):
Yeah, so somebody who has OCD.
What does you know what iscounting the tiles on the
ceiling doing for you?
What is you know checking thelights three times doing for you
?
Speaker 1 (20:44):
What is?
Cutting the stake into 24pieces to do for you right.
Speaker 2 (20:48):
Yes, it's not the control.
Externally it looks likecontrol, but internally it feels
like safety.
Right, so I've created thissafe environment for myself.
So the eating disorder becomesthis bubble of safety, and the
reason I don't want somebody tointerrupt these rituals and this
(21:09):
routine and what I feel like Ihave to do is because that feels
like an intrusion, it feelsunsafe.
So I've created this safe spacearound myself and everything I
do now is to protect that.
So when you're coming into andpart of that is also what makes
it more personal and why aperson's going to have the
(21:30):
strong response to trying tospeak into it because you're
breaching on my area of safety.
Speaker 1 (21:36):
Right, right, and so when you think about it in that
context.
When you walk into thatperson's life to intervene
because it's gotten unsafe,right yeah, like how, how do you
?
What's the delicate way inwhich you walk into that aspect
(21:56):
of a person's life when you gotto intervene there at the
beginning of their recoveryjourney?
Um, what does that?
What does that look like?
Speaker 2 (22:49):
So being able to match their tone, their is
almost a greater connection thanwith other diagnoses.
Speaker 1 (22:56):
Um to be able to connect and have a very
compassionate conversation andso you know, in an intervention
dynamic we want to, other day Iwas actually speaking to the Bar
Association here locallyyesterday and somebody asked me
about intervention and I waslike, first of all I don't
really like the word because itlooks like what it does on TV.
(23:19):
And while there's a model outthere that's like that, that's
confrontive and you know lettersto family members and
overwhelming a person with allthis kind of like.
We think you need help, um, andthat can't there.
There are times when it works,um, but with the clientele,
(23:40):
especially the clientele you andI work with you know, for
intervening on someone not onlywith substitutes but pretty
significant eating disorder oreating disorder and or mental
health condition or both, andlikely they have both, because
the truth is you don't have a,you don't have a eating disorder
or a substance use conditionfor which you need residential
(24:01):
treatment.
That doesn't come, that is notaccompanied by a mental health
condition, like it doesn't exist.
Speaker 2 (24:07):
Absolutely.
Speaker 1 (24:09):
You know, this compassion and this approach
style and everything else thatyou're talking about is is
pretty critical and key.
I think the the interventionstyle model also gets in a hurry
.
We got to go in and this personis going to come with me right
now.
There's this window, whereasyou're talking about a, you know
, between invitational approach,but you know between
invitational approach, but youknow, even a rise methodology
(24:31):
doesn't necessarily, isn'tnecessarily answering all the
questions that I know you runinto with a person with severe,
you know, thought disorder orthey have severe eating disorder
.
You've got this personaljourney Like what was it like
for you?
How did you?
I know it informs the way thatyou do what you do, like yeah it
was a little.
If you're willing to give us alittle bit about your recovery
(24:52):
story.
Speaker 2 (24:53):
Yeah Well, I think one of the biggest challenges,
kind of like what you're saying,like how do you go into that
conversation with somebody withan eating disorder and this this
just came up this week at theYMCA actually and uh, a member
that's I feel concerned over andhave no, this significant
(25:14):
weight loss and the biggestchallenge is, uh, that's how to
say something.
Right, like you, you want tohow do you say something?
You want to say something andthe reality is is there's?
There's just nothing that youcan say that's going to come out
well, um and and I think that'sone of the pieces that's so
(25:37):
difficult um is trying to figureout, and that's something I
know from experience there'sjust no way to speak into it and
express concerns.
Yeah exactly the person who'sreceiving this is going to be
like.
Oh my God, thank you so muchfor saying something Right.
(25:57):
It's just not.
You know it's, it's not goingto happen.
And I think, gosh, I my ownjourney to you know cause I
struggled with alcohol use aswell as the eating disorder, and
so when we talk about thisco-occurring piece not uncommon,
as we know no, it's absolutelynot and it's not.
(26:20):
I think people think of them ascontradictory, and here's one
thing I will tell you about aneating disorder is it is a
walking contradiction.
It does not.
It makes sense in my brain.
It does not make sense toanyone else who is looking at it
seeing it From the outside, nothaving it right and trying to
understand it right, Becauseyou're like you're restricting
your calories, You're losingweight, but you're okay drinking
(26:44):
calories Like that doesn't makesense to me, alcohol's got a
lot of calories, right.
Yeah, it's exactly, exactly.
And yet somehow we come up withthis rationalization and the
rules, the rules or therationalization, in my own brain
.
It can make sense and I canremember at one point in time
(27:08):
when I did identify gee, maybeI'm drinking too much.
And I stopped drinking for acouple days and I started to
lose weight, more weight, and Iwas already underweight and my
brain said, wow, see, this iswhy I need a drink is because if
I don't drink and now I'm goingto, I now I'm losing too much
(27:30):
weight.
That's going to make peoplemore concerned.
So, like my disordered, myalcoholic eating disorder, brain
rationalized that's.
That is why you need tocontinue to drink, because it
keeps you at this, still a lowconcerning weight, but better
than it dropping down low.
(27:51):
You know what I mean.
So, like it kind of like has.
This justification doesn't makesense to anyone else and you
also have to keep in mind youknow we talk about the impact
that substance use has on thefrontal cortex and the
significant impact that eatingdisorders are the same.
If you look at CT scans ofeating disorders and substance
use or mental health, they'reall very, very similar, they're
(28:14):
impacting similar regions of thebrain right.
Yes, that frontal cortex.
It's significantly impaired andso my ability with a severe
eating disorder, my ability tomake well thought out decisions
is is completely impaired.
So you know, when you'retalking to parents of somebody
(28:35):
with a, you know a mental health, significant mental health, and
you're like hey, look like weknow you want to try to
understand why they're behavingin this way and you just can't
rationalize.
Speaker 1 (28:46):
Like we're not.
Speaker 2 (28:47):
your brain is not going to be able to make sense
out of this, but the same isreally true with what's
happening in that eatingdisorder brain.
Speaker 1 (28:53):
I don't.
Yeah, it's like I don't.
Whoever the family members areright, I'm not asking you to
think this makes sense.
It doesn't make sense, but itmakes sense to them for a series
of reasons.
And we've got to find thischicken in the armor.
There's this place wherethey're vulnerable to realizing
(29:16):
something is going wrong, andpart of the work I know from my
side it sounds like it's verysimilar is to find where that is
.
But you know, the other pieceis that you've got this lived
experience.
I do not.
I can walk in and say all kindsof things that make sense,
right, that doesn't make aperson realize that they need to
(29:36):
get help.
You know, if you're workingwith somebody who suffers from
and we tell families this allthe time, I know for a fact you
and I together suffers from andwe tell families this all the
time, I know for a fact, you andI together.
But you know you got somebodywho suffers from thought
disorders, like you're not goingto negotiate with thought
disorder or psychosis.
Speaker 2 (29:52):
Exactly.
Speaker 1 (29:52):
It's not participating in a reality that
you can understand.
What you can do is ignoreeverything that doesn't make any
sense and follow their line oflogic, and somewhere in there is
something that they want.
Speaker 2 (30:07):
Yep.
Speaker 1 (30:08):
And if they want that , you know I want to have a job
or have a girlfriend or have alife or live independently or
any of these.
You know, things that everybodywants.
Somewhere in there is somethingthat's normal that they want.
Yeah, Well, sounds like youwant this and if you want that,
you probably going to have toaddress some of these other
(30:28):
things, because right now, whatyou're doing is not working
right.
Speaker 2 (30:32):
Exactly.
Speaker 1 (30:34):
Now, with a person with thought disorder, it's very
difficult to even get that faralong in it and they may end up
in the hospital or arrested orall kinds of other things.
But for a person with an eatingdisorder you know from what
you're saying it sounds likethere are a couple of things
going on.
One is they're trying to.
They've got anxiety.
They probably suffer fromdepression.
(30:54):
There's probably deep traumaand they are.
They have engaged in a, aprocess, a lifestyle that it
causes them to stay away from,abate the anxiety, control the
environment so that they don'tcome into places where they feel
unsafe.
And then all of a sudden you'regoing to walk in and you can't
(31:19):
just go blowing that up.
Speaker 2 (31:22):
Yeah.
Speaker 1 (31:23):
This is we're going to.
We're going, we're gonna, we'regonna chip away at it.
We're gonna scratch at thesurface with this person and and
gently help them realize, whichyou can't do in a moment.
You know that exactly.
It doesn't happen in a moment.
It happens.
It happens when the personknows who you are, realizes they
can trust you, knows that youhave a shared experiences, so
(31:46):
you have these.
You know what we would calltherapeutic alliances with this
person yes, ready walking intothe situation and then you know,
I kind of I look at it this wayyou, you stand, you stand still
but still available and waitfor them to come to you, a
little bit like, yeah, like youknow, the scared creature in the
cave, it's like, hey, I got alittle something I think you
(32:06):
want.
Why don't you come out, justlet's talk a little come out, a
little bit um, and then ideally,you know, somewhere along in
that process they can gettreatment, and treatment is, you
know, being surrounded byclinical professionals and teams
of support and 24-hoursupervision and all these pieces
that help that person managethe process.
Now, the other vulnerable spotthat I like to talk about, and I
(32:29):
know that you have a lot ofexperience with, is the other
side of treatment is, you know,okay, they've gotten past the
crisis, they've gone throughsome treatment.
Speaker 2 (32:37):
What comes next?
Speaker 1 (32:39):
What comes next Like what is?
The?
What is the?
What is the transition out of?
Out of residential treatment,out of crisis, essentially, and
some of the care that goes alongwith that?
What is that?
What is coming back home beingindependent?
What does that look like for aperson?
Speaker 2 (32:54):
who suffers from eating disorder yeah.
So I think honestly, I thinkthat's again that's one of the
most challenging areas foreating disorders and I think we
also just don't have, we lacktransitional programs.
Speaker 1 (33:10):
Oh yeah, yeah, you have a lot for substance use,
right?
Speaker 2 (33:14):
Yes, you really lack that transitional programming
that supports an eating disorderand all of our sober livings,
mental health, transitionalprograms.
We can have someone who's had ahistory of eating disorder, but
you know they're.
And even when they say you knowsecondary eating disorder but
(33:36):
they're not equipped to dealwith someone who's coming out of
residential.
Coming out of residential isway too fragile and I think you
know, talking from my experiencewith it.
I think one of the areas thatwe don't talk about enough with
eating disorders is that placeof frailty as you come out of a
(33:59):
residential program and I thinkone of the things that people
don't realize.
It's all taught from myexperience and that was going
into residential significantlyunderweight and so one of the
primary things that they'redoing is weight restoration.
Okay, Right.
And.
Speaker 1 (34:17):
The science part right.
Speaker 2 (34:18):
Yes, yes, the science and the medical part and weight
restoration is not comfortable,right?
So I think we have people, wehave someone who's like a normal
weight and likes their food.
They're like well, that'sfantastic.
Like you're telling me, I getto eat these.
Like extra calories, like youknow.
Like, like you have to do this.
Like great, like that soundswonderful, right, but right.
(34:40):
But when you've been soseverely malnourished, your body
is in freak out mode, so you'readding these calories to your
body.
Yes, and so when you're going inand you have consumed, on a
regular basis for a long periodof time, significantly lower
(35:04):
calories than your averageperson would need in order to
just maintain weight, the body'sfreaking out at very little
calories, just to begin with.
And so they're watching andthey're monitoring and they're
upping the calories, but thebody's continuing to freak out.
(35:26):
It doesn't know what to do witheverything.
The metabolism actually shutsdown because what your body is
saying is oh my God, you'regiving me food.
Hold on to it, don't process it, because I don't know when
you're going to give this to meagain, because that's what it's
been used to, right?
Speaker 1 (35:45):
Wow.
Speaker 2 (35:46):
And so what's going to happen is, as your body
starts to gain weight andespecially as a female, you're
going to gain all of yourinitial weight in the stomach
area.
Your body knows to protect yourvital organs and your
reproductive organs.
Speaker 1 (36:04):
So you're talking about it gives calories to the
place where they're showing up,right.
Speaker 2 (36:09):
Yeah, yeah, so here's so, yeah, exactly, exactly.
So here's this person whoalready struggles with body
image of a severely low weightand now all my weight gain is
starting in the stomach area.
Speaker 1 (36:23):
Oh, my gosh.
Speaker 2 (36:25):
And so what people don't realize, I mean one.
It's incredibly uncomfortable.
Like your, your, your bodydoesn't know what to do with it.
All you feel is this distensionin this incredible fullness.
Internally, you're not.
It's not you're.
You're probably constipated,right, your body's just not
(36:46):
operating properly and even onceyou reach a normal weight,
where you've gained weight isnot.
It doesn't look normal.
Um, so it takes about a yearfor the weight that you gain to
really evenly distributenormally throughout the body,
(37:09):
and so again you talk about whathappens.
You're in a residential program,say.
You're in a residential programfor 60 days.
You discharge.
The biggest challenge that Ialways faced was I physically
feel uncomfortable, I hate theway I look and don't even try to
tell me that you know, youdon't, you know.
(37:31):
Don't try to do the whole likeI can barely I literally have
gained.
I have, we would call it thepooch right.
Like you, gain this big poochright in your stomach area and
the thing is, I know how to makeit go away.
I feel physically uncomfortable.
I know exactly how to make thisgo away.
Speaker 1 (37:51):
I can make it go away within a day.
Speaker 2 (37:53):
Yes, to go right back to those eating disorder
behaviors, and so to me, that'sone of those biggest challenges
is you're discharging the personat the most vulnerable state,
where not only are they stillthis emotional wreck, like
they're physically a wreck, andso then you just go right back
(38:14):
into your daily life and try tomaintain that recovery piece and
try to continue to eat in thisway.
That's only adding to thisphysical discomfort that you're
in, and so that was for me, isit never took long I mean, it
was always a matter of weeksbefore I just returned right
(38:35):
back to those behaviors.
Speaker 1 (38:37):
Yeah, well, and it sounds like, for the transition
piece, something that you knowwe've used you as a person who
does this, but even a person is,you know, ideally they used you
as a person who does this, buteven a person is, you know,
ideally they're returning to anenvironment that's got some
supports, whether it's you knowa supported living group
environment though there are notmany of those for eating
disorder but at the very leastlike a good therapist.
(38:58):
If there are medications, a goodpsychiatrist and a recovery
coach, that's.
You know, you and I, we harp onthis.
I know all the time with fanslike get a recovery coach.
You know, you and I, we harp onthis.
I know all the time with fanslike get a recovery coach
program.
They're in doesn't have one.
Get one to be involved, getsomebody who can walk and talk
with them, can show up for themin person, can see how they're
doing, can determine whether ornot they're kind of reengaging
(39:21):
in some of these old patternsand need more support.
That that person is really isreally, really critical to their
recovery.
And it's a role I know thatyou've played many times for a
lot of different people.
I like using you for thatbecause I think your personal
experience causes you to beattentive in ways that others
may not be.
Speaker 2 (39:42):
Yeah.
Speaker 1 (39:42):
So I'm really grateful for you as a person who
is on our team and I'm gratefulthat you agreed to come on the
show today.
Jennifer, thanks so much fortalking with us about eating
disorder and you know we'llprobably get you back on the
show so we can talk some moreabout intervention.
But this has been Head InsideMental Health on WPBM 1037, the
(40:03):
Voice of Asheville Our guesttoday, jennifer.
Speaker 2 (41:21):
Stanger.
Jennifer, thanks for being onthe show.
Thanks, todd.
I need a little help.
I found a little help, thankyou.
I don't need your love.
Send me a.
Send me a.
I don't need your love.
Send me a.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
(41:43):
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
Speaker 1 (42:01):
Find my way home.
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