April 24, 2024 • 47 mins
Join us on this enlightening episode of our podcast as Dr. Alyssa Hertz dives into the complexities of treating individuals with both Obsessive-Compulsive Disorder (OCD) and eating disorders. With her dual expertise, Dr. Hertz highlights the synergy between the treatment methodologies for these often co-existing conditions and provides clarity on the psychological underpinnings that they share. Listeners will gain valuable insights into effective therapeutic practices, the importance of integrated care, and the role of psychoeducation in treatment. This episode is packed with practical advice for clinicians, uplifting success stories, and essential resources for anyone navigating the landscape of OCD and eating disorders. Tune in to empower your understanding and treatment approaches for these challenging disorders.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Kira Yakubov Ploshansky (00:00):
Welcome back to Heal Your Roots Podcast,
cure Yakubov SHAN ski co hostand we have a very special guest
co host joining us today Dr. KiMangan, ll licensed
psychologist, and a very specialguest, Dr. Elissa hertz, also
licensed psychologist. Todaywe're going to talk about the
overlap between obsessivecompulsive disorder and eating
(00:21):
disorder. Ladies, thank you somuch for, for hosting and for
being a guest with us today.
Dr. Alyssa Hertz (00:27):
Thanks for having me.
Dr. Katie Manganello (00:29):
Yes, I'm so excited to have Alyssa on the
podcast with us Dr. Hertz. Funfact, we went to grad school
together. So this is my way ofbeing able to pull in my my
colleagues that have someoverlapping interests and some
cool stuff to share. So I'mreally excited.
Kira Yakubov Ploshansky (00:50):
So let's uh, we usually start each
episode kind of learning moreabout the practitioner. So if
you can share kind of yourbackground, what how you got
into mental health and yourspecific specialty? Sure.
Dr. Alyssa Hertz (01:03):
I wish I could say that it started by like, my
family was a psychologist orlike this strong desire to help
people. But I think for a whileI wanted to go into nursing
school because my mom and sisterwere but going to college, I had
no idea what I wanted to do. SoI took psychology courses, and
it kind of just stuck. I waslike, I'm good at talking to
(01:25):
people. And I'm good atlistening to people, this is the
perfect career choice. Butoverall, it really did start to
stick, I actually found it to bereally fascinating. And just
seeing all the different waysyou could actually use a
psychology degree to helppeople. You know, I think from a
really long time, I've alwayshad an interest in the eating
(01:47):
disorder route, I was justfascinated by it, just because
it's a little different, in myopinion than some other
presentations, right? Like, youdon't need to drink alcohol, or
you don't need to maybe engagein certain behaviors, but you
need food to live. And the factthat people just stopped eating
or kind of we're engaging thesereally dangerous behaviors stuck
(02:08):
out to me a lot. So I had lovedthat and took a lot of courses
in undergrad, my master'sprogram like Doctor degree. And
then I started having a lot ofcuriosity about OCD and ended up
at a training site with OCD andjust seeing a lot of overlap
between people with eatingdisorders, people with obsessive
(02:31):
compulsive OCD, and realizingthat there's a lot of symptom
similarity between the two ofthem. And I thought it could be
a special training opportunityand nice to be able to say that
something that I specialize inin both routes. So really, a lot
of my background and traininghas been working eating
(02:55):
disorders training in cognitivebehavioral therapy enhanced,
which is for eating disorders,and that family based therapy.
And then, on the other hand,doing a lot of training in
exposure and response preventiontreatment as well for OCD. And
then I found a job that actuallymarried the two together, and I
kind of never looked back fromthere.
Kira Yakubov Ploshansky (03:17):
That's awesome. That sounds really
cool. Yeah. And so can you sharea little bit about who you work
with now and the type ofpopulation I noticed the
overlap, but uh, do you seeclients only for one? Or they
have to have both? Or what doesthat kind of look like for you?
Yeah,
Dr. Alyssa Hertz (03:31):
yeah. So the practice I work for, we are kind
of bigger specialty was eatingdisorders. And we've recently
kind of branched out to startingto see OCD, anxiety related
disorders, PTSD, things likethat, again, just because we're
starting to paint this pictureof the two go together pretty
often. So we really, probablywithin the last couple of years,
(03:56):
have started branding ourselvesas a clinic that specializes in
the overlap between the two now,in order to be seen by one of
our practitioners, or you do nothave to have that comorbid
presentation. But it's kind ofjust like a nice option if you
are struggling with both. And Ithink there's a lot of times to
people don't understand thatit's one or the other. So having
(04:18):
someone that can relate to us asa part of, hey, you know, you
actually meet criteria for thisor you meet criteria for this
other thing. This is how it'simpacting your disorder. This is
how it's impacting yourpresentation. So yeah, I think
it just creates a kind of onestop shop for people to be able
to go to. And
Kira Yakubov Ploshansky (04:37):
so for the listeners who may not be as
familiar or may not know, canyou kind of share what eating
disorders are and some of thecommon subtypes?
Dr. Alyssa Hertz (04:45):
Yeah, of course. So eating disorders,
they're their psychiatricconditions that cause pretty
significant impairment insomeone's life. And I think if
we're looking at them more, Iguess, generally it's really
this just Intense preoccupationand fear with weight gain their
their body shape their weight inthis extreme desire to be able
(05:06):
to control these things. Andthey're, they're dangerous
eating disorders. They'rethey're very, very harmful
mentally and physically. Youknow, you could go on Google and
type in physical complicationsof eating disorders, and you're
gonna get a list. You know, someof them cardiovascular issues
like irregular heartbeats,people that have heart attacks,
(05:29):
GI issues. So when we're noteating enough, there's a lot of
kind of just like, not going tothe bathroom regularly, a lot of
GI distress. Substances abuse,people don't know how to cope
with it. So they're kind ofturning towards alcohol. But
probably I think, you know, theother part is, like the
suicidality piece. So eatingdisorders have highest suicide
(05:50):
rates than any other psychiatriccondition. So, you know, when
we're talking about treatingeating disorders, we're thinking
about this fast action approach,you know, we really need to get
people kind of quick intorecovery. Common types, there's,
there's a few you know, there'sseveral different eating
disorders, I think, probablywhat more people are familiar
(06:11):
with, or have at least heard atsome point in their life,
anorexia nervosa, bulimianervosa and binge eating
disorder. So anorexia is justthis really intense
preoccupation and fear aboutweight gain, their thoughts and
emotions that accompany foodrelated behaviors. This leads
(06:34):
the person to restrict, youknow, they're eating
significantly less amount ofcalories today, skipping a lot
of meals and snacks that peopleneed throughout the day. So
really the hallmark feature ofanorexia and I think, probably
what most people are familiarwith is that low body weight and
we're talking about not like oneor two pounds below and maybe
(06:56):
your growth chart by your it'sinappropriate for your
developmental level. And that'swhere we see a lot of those
complications start to come in.
And I think that's the pictureright? If you tell someone
anorexia, they're thinkingreally thin can see like, bone
structure. They don't look verywell. But there's also a binge
purging type as well, wherepeople are engaging in binge
(07:18):
episodes, which I'll explainengaging in purging episodes,
but really, it's that thatweight piece right, that is the
defining feature there foranorexia. Bulimia is someone who
repeated binge episodes. Sodifference between binging and
overeating, we're allsusceptible to overeating. You
(07:39):
know, Thanksgiving Super Bowl,parties, we all over eat from
time to time. Binge Eating isreally this unusual amount of
food that someone's eating in areally short period of time.
That characterizes it as abinge. A lot of the times I hear
people talk about, they can'tcontrol it, they've like blacked
(08:00):
out, during like an episode ofeating, they don't remember
consuming all of that food. Tomanage a lot of the
meaningfulness and distress thatcomes with the binge eating,
they do compensatory behaviors,which basically is just a way of
trying to get rid of everythingthat they ate. So we'll see self
induced vomiting, laxativeabuse, excessive exercise, and
(08:24):
those are kind of some of thecommon ones. And then the last
one, binge eating pretty similarto bulimia with the the binge
eating periods, but there's nocompensatory behavior. So
they're not trying to get rid ofthe food. And something
interesting in binge eating too,is, you typically aren't seeing
this intense preoccupation withlike weight shape and food as
(08:48):
you would with some of the otherones. But there's a lot of guilt
and shame that usually comeswith the binge eating, that a
person is experiencing. So thoseare probably the more common
ones that I would would say.
Yeah,
Dr. Katie Manganello (09:05):
Alyssa, you did a really good job of
explaining those. I am wonderingif you could talk a little bit
more to about like, bodydysmorphic disorder. I feel like
sometimes that kind of getslooped in there and is something
that other therapists maybedon't know as much about, like I
know that I didn't know as muchabout that until we started at
(09:25):
like the anxiety and OCDtreatment center. So do you want
to talk a little bit more aboutthat as well?
Dr. Alyssa Hertz (09:31):
Yeah, I think a lot of people they come into
treatment saying they have bodydysmorphic disorder, just
because there is this like, Idon't like my stomach or I don't
like my thighs or I don't likethis certain part about my body.
And, you know, again, thefunctionality of the two are a
lot different. This person istrying to lose weight, they're
(09:51):
trying to maintain a certainbody fat percentage or whatever
that looks like whereas someonewith Body Dysmorphia one it's
not just exclusive to maybe someof these more common areas like
die stomach, you know, there'susually not like a weight loss
component, it's usually thisperceived flaw whether it's real
or imagined, like, my nose lookstoo big and no one really
(10:15):
notices that or, you know, myshoulders are too broad. And I'm
thinking about, you know, whenwe're thinking about body
dysmorphia, there's a little bitof a functionality component
that's a lot different than, youknow, eating disorders. If we
boil these down, it comes downto weight loss and trying to
manage weight and this overcontrol like weight and shape.
(10:37):
Whereas Body Dysmorphia is alittle bit more global. It can
really be anything that a personperceives to be flawed.
Kira Yakubov Ploshansky (10:45):
So it sounds like it's super specific
of a body part versus like,overall, I'm not I'm unhappy
with how I look and I need tolose weight, whether that's
exercising like crazy cuttingcalories throwing up, right,
those kind of things, versuskind of it sounds like obsessing
over a particular body part.
Yes, correct.
Dr. Katie Manganello (11:04):
Right, which is like the perfect segue
into so some of the otherepisodes I have done with the
podcast, I talk a lot about OCD.
Yeah, I'm wondering if you canget your definition of OCD. And
then kind of after explaining alittle bit of the overlap
between eating disorders andOCD, and I feel like that body
(11:26):
dysmorphic disorder is kind oflike it that in the middle type
of things. So that's why Iwanted you to kind of talk about
that
Dr. Alyssa Hertz (11:35):
a little bit.
Yeah. Well, since you've goneover it a lot. I'll try not to
be overly contented about thesethings. But you know, OCD, the
two defining characteristics arethose obsessions and
compulsions. So obsessions arethe distressing on what thoughts
images, impulses, urges, that aperson that's experiencing? And
the major difference? You know,when we're thinking about we all
(11:57):
have disturbing thoughts, I'msure anyone can think of a time
they had a really weird thoughtthey're like, Oh, God. So you
know, if I'm having a thoughtof, I'm going to drive my car
off that bridge. I'm like, Thatwas weird. Like, I'm gonna
continue driving to work orwherever it is, I'm going where,
you know, the obsession alityfor someone with OCD is their
brain is kind of I describe itas like tagging that is, that's
(12:17):
dangerous. That's threatening.
What does that say about me? Whydid I have that thought? Does it
mean that I want to hurt myselfin some capacity, and it kind of
just gets stuck on a loop there.
The compulsive side then rightis a person's attempts to
neutralize or alleviate a lot ofthat distress and anxiety. So
that could be behavioral. So inthat example, I'm not going to
(12:39):
ever purchase anymore, I'm goingto take the long routes, I'm
going to have someone elsedrive, maybe it could be single
prayer over a bridge and whereit becomes cyclical, where it
becomes a little bit problematicfor people is, I say the prayer
when I go over the bridge, Ifeel better. So then I learned,
oh, all I have to do now is saya prayer in order to manage my
(13:01):
anxiety to get over the bridge.
And now I need to do it more andmore and more and more, and I
can't get over the bridgeanymore, without saying these
prayers. So essentially, theproblem here is the compulsions
negatively reinforced theobsessions, which essentially
means that person is gettingshort term relief. But as soon
(13:22):
as they encounter that triggeragain, or as soon as that thing
pops up into their head, again,they're kind of spinning, you
know, back into that cycle. Andit really boils down to this
concept of a person just hastrouble dealing with doubt,
uncertainty, and we're trying tohelp them learn that they can
handle some of those things. Sothe overlap, yes. So this is a
(13:44):
fun question. And I really am sohappy to talk about it. So you
know, just to start 41% ofpeople with eating disorders
also have an OCD diagnosis. Soit's not kind of just like this
small thing we're almost seeingabout like, half our people who
who have eating disorders, mostlikely are having some
undiagnosed or diagnosed eatingdisorder at the time. And think
(14:08):
what we're thinking about itright, the the core features of
both of them tend to be theseobsessions and compulsions. So I
will try to break it down in thebest way possible by an eating
disorders. Those obsessions are,you know about food, they're
about their weight, they'reabout their body image. So how
am I going to avoid eating toomuch when I'm at a party with
(14:29):
all of my friends? What if I eatthis slice of pizza over the
weekend and I gain you know, allof this weight? What happens if
I can't look in the mirrorbefore I go out somewhere? So
there's a lot of this justdistressing, repetitive thoughts
that happen in someone who whohas experienced an eating
disorder. The compulsivebehaviors depend on the disorder
(14:50):
a little bit, you know, someonewho is struggling with anorexia
might engage in a lot of likebody checking behaviors, they
might cut their food into areally small piece. says, you
know, things like that. Whereasin bulimia, we're seeing more of
that like purging behavior. Samefunction as OCD compulsions,
right? There's distress, there'suncertainty about body image and
(15:12):
certainty about food and how itcorrelates to weight. So I need
to do something in order to feelbetter, I need to do something
to prevent this catastrophicoutcome from happening. And we
kind of see that same thing inOCD. So an example to maybe lay
it out is what's give a personwho has OCD, they're leaving for
(15:34):
work and they're constantlychecking their purse for keys,
like is it there isn't there isthere take step closer the door,
let me check one more time aboutthe car luggage over time,
they're trying to alleviate thedoubt that there's the potential
that they left her keys in thehouse, they don't want to forget
they need to be to be certainabout that. In OCD, I'm sorry,
an eating disorders we're kindof seeing, you know, again, is,
(15:57):
I don't know if I can be certainthat this certain food won't
cause me to gain weight, I'mgonna avoid this certain food, I
need to, you know, only eat aspecific diet. And when we're
seeing that we're like, cool.
Okay, that definitely looks morecharacteristic of OCD, that
definitely looks morecharacteristic of eating
disorder, but it gets reallymuddied. So I'll give another
(16:17):
example. And it really helpexplain how when a person comes
in and gives you maybe just likea symptom, were having this kind
of expertise in both can helptease apart. So let's just say
someone comes in and they'retalking about cutting food into
small pieces. I think naturally,someone's like, probably eating
disorders, you know, they'recutting their food and swap
(16:38):
pieces. I've maybe heard thatsomewhere before. But it could
serve a lot. Yes, the thecutting of the small pieces of
food could be a way of slowingdown eating. So they can pull
quicker, it could be to appearlike, look, I eat more that's on
my plate. However, it also couldbe, I need to cut my food into
10 pieces to prevent my mom fromdying, I need to cut my food
(16:59):
into small pieces until it feelsjust right. So we're seeing this
kind of common symptom on thesurface level. But we need to
understand the functionality ofit as well. Because part of the
importance is that is thetreatment implications for that
as well. We can't applynecessarily the same treatment
(17:20):
to that symptom. So that's kindof where it can get a little bit
muddy than why it can be reallyhelpful to understand. Is this
kind of veering off into weightcontrol body image shape? Is
this kind of going into this, onpreventing this catastrophic
outcome, which maybe Haiti hastalked about this before? It's,
(17:41):
it doesn't make sense, I knowthat cutting my food into eight
pieces isn't actually going toprevent anything, but I feel
like I have to do it anyway.
Kira Yakubov Ploshansky (17:53):
So fascinating. I did not realize
that the overlap was sopervasive, and it makes me think
about, I mean, I know that inyour particular practice, I'm
sure there's a lot of therapistsor psychologists who have this
overlap, but I haven't heardreally it be that common for a
therapist to have bothspecialties, which is a little
concerning, but also, right,because if it's so pervasive,
(18:16):
and they're coming in for one orthe other, how, like, how does
that work? How do you commonlysee whether it's with other
therapists, or when clients arecoming in saying, you know, I
went in for initially an eatingdisorder and realize I have OCD
who my therapist can help me orvice versa?
Dr. Alyssa Hertz (18:32):
Yeah, I think it's tricky. I think a lot of
people get misdiagnosed. Youknow, either way misdiagnosed
with eating disorder, ormisdiagnosed with OCD. If a
person tend to think it's aneating disorder, or let's just
say it actually is a eatingdisorder, they're getting
referred out, like nine timesout of 10 people, people just
(18:53):
don't like touching eatingdisorders. But I think it's
either way, I think a providereither has to know a lot about
eating disorders to be able torule out the possibility that
this is OCD, like I understand,again, the functionality, I
understand the conceptualizationof eating disorders to say, this
definitely is hitting onsomething here and someone with
(19:14):
an OCD diagnosis, right, isneeds a provider to be able to
help them really distinguishbetween the two, when I gave
again, I think about thatexample, I gave it the food
cutting, if you don't know, tolook for underlying differences.
Well, we might get into a littlebit of a mess. They're not
saying someone can't help themand and work with maybe whatever
(19:38):
it is they're presenting, butyou're missing a whole other
piece of the disorder, possibly,or exacerbating, you know,
eating disorder behavior canexacerbate OCD and vice versa.
So it's, it's not that peoplecan't get help. I just think
when you have such a overlappingcommonality between again serve
(19:59):
squabble symptoms. It's a bigopportunity for something to get
math.
Dr. Katie Manganello (20:05):
Yeah, I think that carry back to what
you were saying with I feel likea big part of it that is worth
noting is that I mean, you couldmake that argument for a lot of
disorders because OCD has itsown, like comorbidities. I
always kind of explain I'm like,I've got in that camp, right?
Because there's, there's eatingdisorders, there's Autism
(20:26):
Spectrum Disorders, there'stics, threads, body focused,
repetitive behaviors, ADHDtrauma. So those are all kind of
lumped in with like, reallycommon comorbidity. So I think
that if you are going tosomebody who specializes in OCD,
they should, at least at thevery least be able to get to
(20:47):
that functionality, like Alyssasaying, and be able to at least
tease it apart and give you asolid diagnosis. And then, since
it's so common, I think like,for example, like obviously,
Alyssa specializes in eatingdisorders and OCD, I focus more
so on OCD and trauma relateddisorders. But I would say that
(21:08):
both of us also work a lot withADHD, right? Like, there's an
end. And we also like I couldwork with, you know, a level of
eating disorder as well. But ifit's something that's more
pervasive or intense, like thenit's maybe something that I
would say, Listen, maybe thiswould be a better kind of client
for you. So I think that if youhave a psychologist or somebody
who at least knows their theirdiagnostics well enough that at
(21:33):
least they'll be able to get agood diagnosis that can kind of
help move them forward.
Kira Yakubov Ploshansky (21:38):
Provide you clarify that? Because I do
think it's important. There areso many whom who were billed
comorbidities with a lot ofdisorders. And it sounds like
OCD is, it overlaps with somany, it's just kind of like the
topic or the theme, or what elseis kind of stuck on it that
they're obsessing over andhaving these compulsions over? I
mean, it sounds like yourclients have the best of both
(22:01):
worlds with you, which is reallygreat. And that you're able to
do both so well.
Dr. Alyssa Hertz (22:06):
Yeah, I mean, again, I think about a like a
one stop shop, essentially is,you know, it's frustrating
having to go to multipleproviders, I mean, I think we
can all get off big about whatwe've got to like our primary or
something, and they're like, youneed to follow up with this
person, this person, thisperson, and you're like, I don't
want to schedule all thisappointment, that's really
(22:26):
annoying. So it's nice to beable to kind of go to one spot
and be able to know that you'regetting a really good care for
both of those things. But I alsothink just from like,
motivation, financial, you know,finding someone who specializes
in things is pretty expensive.
And, you know, if you're tryingto say, go see this person
first, then go see this personor see two providers at the same
(22:48):
time. That's a lot of financialcommitment. That's a lot of
motivational commitment. Youknow, it's, it's doable, of
course, I don't want to givethat impression that it's not
doable. But I think withanything, I think we all like,
if I can have just a person thatdoes it all. Like that would be
great.
Dr. Katie Manganello (23:09):
Yeah, Alyssa, like when I mean, it's
not even, it's definitely moreof a burden on the individual
experiencing OCD, or an eatingdisorder, both. But I think it's
also it's a lot of extra legworkfor the therapist, because like
Alyssa and I both like I mean,we collaborate care with other
providers. And a lot of timesthey do, like somebody does come
(23:31):
in with somebody that they'veseen for a long time for
therapy, and they want to keepthat relationship for other
things. But like they're here tojust see us for just OCD. And
like we're, it's we take timeoutside of notes in you know,
everything to touch base withthe other providers and make
sure that that's consistent andthat it's on the same track. So
(23:53):
yeah, and I think that that'sanother reason why I love doing
the podcast and getting thisinformation out there so that it
can kind of It's my littlecontribution and getting more
people hopefully, in the knowabout this kind of stuff. So
there's less of all of that inthe long run.
Kira Yakubov Ploshansky (24:14):
And so since you treat both What are
some common therapies andtechniques and modalities that
you use for treating an overlapof the two, what do you
separate? Do you Do it allencompassing? Like what is your
kind of approach and style?
Dr. Alyssa Hertz (24:28):
Yeah, so I think the first thing is, the
two treatments have similarinterventions, but are
fundamentally different. So Ithink it'd be helpful to me
explain how they're differentand then also how they're
similar. You know, so for eatingdisorder treatment is an example
could be is I'm asking someone,okay, we're gonna go to a
(24:52):
restaurant and you're going topick out a food that you're
you're scared of something thatyou feel like it's going to
cause you weight, but thenafterwards, it might be good
distract yourself in some way gocall a friend, go watch your
favorite TV show send yourfavorite music, you know, don't
sit in this forever, you don'thave to, we're just kind of
asking you to get over that humpof anxiety. Whereas OCD, right,
(25:12):
we're not asking prettystructured, we're saying, You
know what, you're going to sitwith this distress, you're gonna
sit with this uncomfortabilityto learn that you can manage it.
And we're really asking someoneto lean into their fear a bit
more. So, you know, like, yeah,I might have not blown up the
candle, and my house is gonnaburn down, but I'm gonna day out
(25:33):
with my friends anyway. So whyit's important to know, again, I
think the treatments is you canaccidentally harm or exacerbate
symptoms on the other end. Andthis is where it kind of is
helpful. It also gets tricky, Ithink when you're working with
someone with both is theinterventions can be similar at
the same time as well. So familyinvolvement is huge on both
(25:57):
ends, we always love when whenfamily members or caregiver
providers are present with OCD,family based therapy, again,
it's treatment for adolescentswith anorexia, parents are
pretty much involved the wholeway through. And I think why why
caregiver involvement in generalis so important is because a lot
(26:17):
of accommodations are going on.
No one ever likes to see theirtheir loved one their child,
whoever it is in distress, sowe're just trying to take that
load off of them, we're tryingto take that burden off of them,
not realizing we're makingthings a little bit more
difficult for them. So eatingdisorder combinations might be
getting special groceries forthem, you know, not cooking with
(26:38):
butters, or things that havefat, but it could be cooking
with other things. Andunintentionally, we're kind of
increasing that power and eatingdisorder has over a person OCD
might be I'm not going to holdthe door for you. So you don't
have to a wash all your fruits,so you don't have to touch them.
So helping to reduce a lot ofthat family or family
(26:59):
accommodation is really helpinga person indirectly learn that
they can handle some of theseanxieties and challenges that
they're experiencing. So, youknow, I think that's a kind of
intervention that seen acrossthe board exposure. So it's a
big one, you know, primarystrategy for OCD work is doing
exposure work, we're saying,again, do the thing that scares
(27:22):
you the most, you know, we'regoing to help you get there. But
that is the best way to faceyour fears is to do this. And
we're in some respects doingthat, in eating disorder work to
we're asking people to see theirweight, sometimes it's the first
time they've ever seen theirweight, sometimes it's the first
time in a long time, we'reasking them to not weighed
themselves so much in and ofitself, that's an exposure.
(27:44):
We're asking them to eat foodsthat they've cut out of their
diet, or they're really scaredof because they think it's going
to gain weight. So the theexposure piece is really, really
helpful across a course in OCD,because that pretty much is the
treatment, but applying thatintervention over and so the
eating disorder work actuallyhas been really, really
beneficial for a lot of people.
(28:09):
And then I also think, just likethe hierarchy piece, too, is
you're gradually having thesepeople confront those things and
reduce certain behaviors thatare problematic in a way that,
in my opinion, fosters a lot ofself competence. You know,
you're tackling these things ata minimal anxiety rate and
(28:30):
you're feeling good about it,when you overcome it, you feel
like you could tackle that nextone. Definitely think it helps
with the motivational piece. Andby the time they get to that top
scary thing, which could bepetting a dog or gaining 30
pounds, it just doesn't feel soharmful or scary anymore. So I
definitely think having a lot ofcommon interventions is helpful,
(28:53):
but also can make it tricky atthe same time as when to apply
versus when to apply it as well.
Yeah. Yeah,
Dr. Katie Manganello (29:02):
that kind of segues into another question
that I was thinking about interms of like, what do you
think, are some of the mostchallenging aspects of treating
clients have both?
Dr. Alyssa Hertz (29:13):
Yeah, that's a that's a really good question. I
think one of the morechallenging aspects is actually
helping the person to understandtheir symptoms, you know, really
understanding I personallybelieve, spending a lot of time
on psychoeducation upfront, Idon't think there's any benefit
in here's what OCD is here. Butneither disorders like alright,
(29:33):
let's jump into treatment andlike, I want people to feel like
I know exactly how this works. Iknow exactly what this like
cycle looks like or, or what'shappening on this end. And I
think one of the challenges isreally helping a person start to
tease it apart on their own.
Really understanding okay, thisis definitely coming from eating
disorder mindset over here. Thisis coming from an OCD mindset
(29:56):
over here. I think The otherpieces is kind of what I just
said is when to apply thestrategies, you know, we might
say, again, practice deepbreathing or practice relaxation
strategies, eating disorder. Butif it's OCD, we don't practice
it. I think for kind of a saferroute, if I a person got sure
(30:18):
I'm just like, pretend it's OCD,then the worst case happens is
you sit with distress, you sitwith anxiety, it goes down
anyway, the outcome will prettymuch be the same if you're not
sure. But I think that's prettymuch the hardest part is I think
there's just a lot of, we needto understand your symptoms, we
need to know how they play outand like potentially where
(30:40):
they're coming from in order forus to effectively treat them
along the way.
Kira Yakubov Ploshansky (30:46):
So it sounds like a very thorough
beginning, right, like intakeprocess, understanding what's
going on for them what theirlife looks like, their family
made me think about an episodewith Katie, of how their family
can be involved. And it almostfeels like, you know,
counterintuitive of like, notenabling them, like doing things
outside of what would relievethat stress and anxiety so that
(31:07):
they can actually do it on theirown. So it sounds like a lot of
these things are are difficult,contradictory, but then also
kind of mesh well together aswell. Yes,
Dr. Alyssa Hertz (31:17):
yes. And that's hard to explain to people
is, this contradicts itself, andis anytime it works for
backwards. And they're kind ofjust like, white. But I think
once people really get the hangof it and start to again, learn
more about themselves and theirsymptoms and how they manifest
it becomes a little bit easieralong the way.
Kira Yakubov Ploshansky (31:39):
Do you have any success stories or kind
of being able to walk somebodywho has an overlap? And like,
what progress would look like?
Or what healing would look likefor them? If it's not someone in
specific?
Dr. Alyssa Hertz (31:51):
Yeah. So a while ago, I worked with someone
who came in for anorexia. And,you know, I think one thing I
should have mentioned is,regardless of what the person is
going through, if they areunderweight or mounters, that is
the top priority. You know, youjust can't do treatment, if
(32:12):
someone from a medicalstandpoint is is not healthy.
But also thinking about, ifyou've ever tried to do
something, when you're starving,it's not easy to concentrate,
it's not easy to take ininformation. So her and I really
worked on like that weightrestoration piece first getting
her to a healthier weight, so wecould engage in treatment, and a
(32:32):
lot of her, you know, symptomsfrom an OCD perspective, were
around fear that she could likeingest something that were would
like, change her bodycomposition and lead to all of
these like weight relatedchanges, she was kind of the
example I was leading into withlike, the cutting, there was
(32:54):
also like a piece of like, Ineed to cut certain foods in
order to prevent like choking,or like accidentally throwing up
because she was averse tothrowing up. We did a lot of
exposure work to like fearedfoods and stepping on the scale
and things like that. And Imean, I would say from start to
(33:14):
finish, it was definitely abumpy ride. This person had not
previously known that they hadan OCD diagnosis and having to
really go through a lot of that,not backward. But hey, there's
this other thing here that thatI think is actually making, you
know, the IDI center a littlebit worse, and potentially
(33:36):
exacerbating a lot of thesesymptoms, we really need to
tease this apart a little bitand treat the two more
simultaneously together. And Ithink that ended up opening up
like a whole different door forus, like treatment went so much
more smoothly. I'm talking aboutprobably for like, three to four
sessions. We were like, shouldwe be doing this anymore? Like I
(33:58):
think we're at a standstill,like what do we do here? And I
think for this person inparticular is we were totally
minimizing something else. Wedidn't realize this other thing
was going on and just kind ofhaving that extra knowledge and
being able to treat some ofthose OCD symptoms allowed one
some of the eating disorderbehavior to come down to some
(34:19):
degree as well. But we werealleviating a lot of stress and
anxiety on some other end. Butyeah, I mean, she well, I don't
see her anymore. I haven't heardfrom her. So I'm assuming that
she's doing really well and hasmoved on with things but it was
a really cool example and Ibring her up because she was the
(34:39):
first person I saw with OCD andeating disorders and that's
where I was like, oh, okay,these two really do coexist and
there's such a symptom overlaphere and not in the way again,
we're thinking about like OCDbehavior is over here and eating
disorders here but like a lot offood related OCD. 80 obsessions
(35:00):
and compulsions that made ittricky.
Kira Yakubov Ploshansky (35:05):
I bet that sounds Well, I'm glad you
were able to help her. And thatkind of sparked your interest
and inspiration into wanting todelve deeper into it.
Dr. Alyssa Hertz (35:13):
Yeah, it was a very interesting and fascinating
case.
Dr. Katie Manganello (35:18):
Was it? Do you feel like there's any common
misconceptions about OCD oreating disorders that you think
need to be addressed in thetherapy community?
Dr. Alyssa Hertz (35:28):
I think there's a lot of
Dr. Katie Manganello (35:31):
timing for sure. with OCD. Yeah,
Dr. Alyssa Hertz (35:32):
we could probably do a whole nother
Dr. Katie Manganello (35:37):
while this question could be a whole
episode,
Dr. Alyssa Hertz (35:40):
be a big one.
Yeah, I mean, these probably arerepeated. And these are probably
things that are very much outthere. But, you know, just the
idea that like OCD is beingcharacterized, this is
personality trader, this uniquequirk that people have, you
know, we hear it all the time ofso OCD. I'm so OCD for this. And
it minimizes, in my opinion,what someone with OCD is
(36:02):
actually going through, youknow, they're struggling,
they're suffering, some peopleare homebound, they can't leave
their houses or function ontheir own anymore. That's not
pleasant. You know, whensomething's describing, I'm so
OCD, it's usually I likecleaning until it's begun span,
or I like organizing until itlooks a certain way. And that's
different. But, you know, if youlike it, it's not a disorder.
(36:25):
You're enjoying engaging inthis. And I think, more than
anything, it's, it's just, Ican't imagine as a person if I
was struggling with OCD to hearpeople throw around that term,
so loosely, and knowing what thestruggle actually looks like. I
think the other the other bigone that comes up for me is what
(36:46):
OCD is, you. And I think thisgoes into why it can be so
missed, like most people aren'tactually getting treatment for
like 10 years when they haveOCD. Like there's a huge gap in
there. And there's probablyother reasons in there as well.
But you have the people come inand like why don't wash my hands
(37:07):
or I don't clean stuff for Idon't organize stuff. And really
helping people to understand OCDis so much more than just hand
washing or taking long showersor being overly clean. But we
have harm OCD, where people areafraid of hurting themselves or
other people or we havescrupulosity, and religious and
I know Katie did a wholewonderful podcast on that. And,
(37:29):
you know, OCD is really anythingthat you care about, if you care
about it, it's gonna go afterit. And I'm really helping
people to see like, it's, it'spretty broad. And that's why
people symptoms can be so allover the place when you're
working with them. But I thinkthose are probably two of my
biggest one, then I think inmore of the eating disorder
(37:49):
context, I think one of thebigger misconception is people
think that there's like a choiceand having an eating disorder,
where, really, it's not achoice. It's a, you know,
there's a lot of brainabnormalities that are
happening, people are kind ofborn with these abnormalities
that predispose them to eatingdisorders. And I have a great
(38:11):
example is I had a patient whowas just sick, like, blue or
something like that. And shejust lost a bunch of weight
because she was sick andcouldn't eat. And when she
recovered, she was anorexic. Allit took is her to lose too much
weight and then flip switched onin the brain. And she was in
treatment for anorexia. So, youknow, I highlight that as a, she
(38:33):
didn't choose to get sick. Andshe certainly didn't choose to
recover with now a whole anotherproblem on top of her. But
they're really, you know,difficult disorders. And I
always kind of lightly say, withmy patients, I'm like, there's a
good chance that you didn't wakeup one day, just say, I want an
(38:54):
eating disorder. I want to, youknow, really struggle with all
of this. It's just not somethingthat you ever hear. The other
one, I think that can be alittle disheartening to it is
parents think it's their fault.
It worked with parents all thetime. They're like I did
something, I caused this to somecapacity. I made a comment to
(39:17):
you know, back 10 years agoabout something and it's really
difficult to help parents reallyexternalize that, that eating
disorder from their childhoodand say, You didn't actually do
anything, you didn't cause thiseating disorder to happen. You
didn't do anything that madethis happen. It just
biologically predisposed, wehave environmental factors,
(39:41):
society, that could also be awhole nother podcast on society
and how it plays into eatingdisorders. And I think really
helping people understand thatthere's nothing you did or said
that cause someone to have aneating disorder. It's just kind
of a perfect combination, aperfect storm of all of these
factors that had come togetherto get your child sick. And
(40:05):
you're part of that likemedicine, if you will to helping
them get better rather than theproblem.
Dr. Katie Manganello (40:11):
I like that reframe. That's really
good. Yeah, yeah, part of thatmedicine. Another one that I
like was just thinking about asyou're talking to that really
bothers me is I think a lot ofpeople think that like, you
don't have an eating disorder,unless you're like, sick, then
like it, people in larger bodiescan also have eating disorders
(40:32):
as well. And like that can bereally harmful to people.
Absolutely.
Dr. Alyssa Hertz (40:36):
Again, when we probably close our eyes and
think about eating disorders, Ithink, everyone, I shouldn't say
everyone, a majority of peoplewould probably pick the anorexic
person. And treatment gap here,right is this is why people
don't often get treatment foreating disorders right away is
people with binge eatingdisorder, could be normal or
(41:00):
overweight, people with bulimiacould be average weight, a
little bit underweight, theycould be overweight. But because
we don't meet that stereotypicalidea of what an eating disorder
looks like, people are like, I'mfine, I'm not actually sick, or
no one's noticing, I could stillfit in all my clothes, I can
still do all the things that I'mdoing. It can mask itself,
(41:22):
you're still functioning, you'restill looking outwardly healthy,
but internally, you know,mentally you're you're
struggling, I think that's areally good one, it's still
really hard to break people awayfrom that misconception of
outwardly, what it looks likeit's a little bit silly it is to
just diagnose someone streetoutwardly to have you know, you
(41:45):
do or don't just because of yourbody composition.
Kira Yakubov Ploshansky (41:49):
Of that's such a great point. And
it sounds like just thinkingabout all these different
practitioners, right, like notknowing some of this or you
know, like quick snap judgments.
Is there any piece of advicethat you could give clinicians
who may not specialize in one oreither that can give them
something to kind of look for adifferentiate, just to kind of
stand out in that way?
Dr. Alyssa Hertz (42:13):
Yeah, I mean, definitely, like, ask all the
questions, Katie, and I, youknow, she mentioned
collaborating with otherproviders. And I think there's
more people out there that arewilling to help and help you
understand, because, after all,we all got into this field to
like, help people, we're tryingto get them through to the end
(42:34):
of that treatment, recoveryroad. And we want to be able to
provide any insights orresources or helpful stuff. So I
think, you know, connect withpeople in either community,
whether you are unsure if you'regoing to go into that route, or
you might end up working withpeople this way is just immerse
(42:54):
yourself into OCD eatingdisorder community, reach out to
people, I get emails for people,like undergrad schools or like
Training Master levels, andthey're like, Hey, I'm really
interested in this, like, canyou talk? And I'm like,
Absolutely, I would love tohelp. And there's so many free
(43:15):
webinars, talks, resources. Ifyou have the money, conferences,
just even just attending as aperson to walk through and learn
about all of these things.
There's so many opportunitiesout there that are accessible,
easy, affordable, for you to beable to learn a little bit more
about eating disorders or OCD.
(43:37):
And even you know, I'm attendinga free hour talk on the
comorbidities between the two,you know, it's just kind of
looking around and finding thoseopportunities and jumping on
them. What
Kira Yakubov Ploshansky (43:50):
a wealth of knowledge. Thank you
so much. This has been superinformative. Before we hop off,
are you can you share if there'sany resources for individuals
struggling with these things? Orany kind of tidbits or advice
for someone who might bestruggling with both of this?
Dr. Alyssa Hertz (44:07):
Yeah, I mean, I have definitely a bunch of
resources. And I'm going toselfishly plug the book that my
owners of the practice did, itis on how to treat comorbid,
eating disorders and OCD. It'sactually really, really helpful.
It goes through everything wetalked about, about what you
knew disorders are, what OCD is,what the treatment similarities,
(44:30):
differences are how to treatpeople case examples. It's a
really, really helpful book. Interms of resources for for
eating disorder community,there's the Academy for eating
disorders, which is great.
That's where a lot of theconferences come from. There's
huge networking events that youcould attend from there. There's
National Eating DisorderAssociation, Nida. They are
(44:51):
constantly doing events likewalks like I think they do a
eating disorder recovery walk inever. Every major city you know,
Throughout the year, and they'reconstantly doing advocacy or
volunteer opportunities to getinvolved. You know, so those are
feast is Another eating disorderwebsite for individuals who are
suffering with anorexia. Andwe're like a parent resource, I
(45:15):
think, to help them figure outhow to manage a child with an
eating disorder and just somehelpful resources there. And
then, of course, there's somereally good books. There's the
treatment manual for anorexia.
There's Chris fairbairns, CBT,manual for eating disorder. So
there's a lot out there on theOCD front, I think, the iocdf,
(45:41):
which is their big internationalwebpage for everything and
anything I pretty much alwaysrefer people there when they're
looking for resources or booksor anything. I'm like, here,
here here. I think there's a lotof good researchers and people
who have a lot of publishedbooks. There's John Grayson, who
(46:03):
has like one of my favoritebooks, freedom from OCD, that
was kind of like my trainingbook, if you will, to get into
OCD. There's Eric Stewart, whodoes a lot of research and
constantly doing studies forpeople. Eli Liebowitz, John
Abramowitz, John Hirschfeld,there's so many good people that
(46:26):
just keep pumping out a lot ofhelpful books and resources. So
it's pretty easy to find thatwhich is
Kira Yakubov Ploshansky (46:34):
we will definitely list all of these in
the show notes. That was Yeah,fantastic. Thank you. You have
so much knowledge and expertiseon this. I'm so happy you were
able to join us today. This wasincredible.
Dr. Alyssa Hertz (46:45):
I'm so happy you guys asked me to come this
is a lot of fun. So
Kira Yakubov Ploshansky (46:49):
if anybody wants to work with you,
fine. You can you share wherethey can get in touch with you.
Dr. Alyssa Hertz (46:54):
Yes, so I work for the Center for hope and
health. So easy enough to justkind of plug onto into Google.
There is phone number there's anemail I specifically work out of
in Texas for people who might beinterested in more that area,
(47:15):
but I also have a license thatallows me to practice across
state borders as well. Sowhether you're in New Jersey,
PA, Oklahoma, you know, whateverit might be is they can still
reach out to that number and ifthey're looking for resources or
treatment, that's how they canreach me. If
Kira Yakubov Ploshansky (47:35):
you've enjoyed this episode, please
like, share and subscribe. Liz,thank you so much for being on
Katie. Thanks for being our cohost. This was a phenomenal
episode to wrap
Welcome back to Heal Your Roots Podcast,
cure Yakubov SHAN ski co hostand we have a very special guest
co host joining us today Dr. KiMangan, ll licensed
psychologist, and a very specialguest, Dr. Elissa hertz, also
licensed psychologist. Todaywe're going to talk about the
overlap between obsessivecompulsive disorder and eating
(00:21):
disorder. Ladies, thank you somuch for, for hosting and for
being a guest with us today.
Dr. Alyssa Hertz (00:27):
Thanks for having me.
Dr. Katie Manganello (00:29):
Yes, I'm so excited to have Alyssa on the
podcast with us Dr. Hertz. Funfact, we went to grad school
together. So this is my way ofbeing able to pull in my my
colleagues that have someoverlapping interests and some
cool stuff to share. So I'mreally excited.
Kira Yakubov Ploshansky (00:50):
So let's uh, we usually start each
episode kind of learning moreabout the practitioner. So if
you can share kind of yourbackground, what how you got
into mental health and yourspecific specialty? Sure.
Dr. Alyssa Hertz (01:03):
I wish I could say that it started by like, my
family was a psychologist orlike this strong desire to help
people. But I think for a whileI wanted to go into nursing
school because my mom and sisterwere but going to college, I had
no idea what I wanted to do. SoI took psychology courses, and
it kind of just stuck. I waslike, I'm good at talking to
(01:25):
people. And I'm good atlistening to people, this is the
perfect career choice. Butoverall, it really did start to
stick, I actually found it to bereally fascinating. And just
seeing all the different waysyou could actually use a
psychology degree to helppeople. You know, I think from a
really long time, I've alwayshad an interest in the eating
(01:47):
disorder route, I was justfascinated by it, just because
it's a little different, in myopinion than some other
presentations, right? Like, youdon't need to drink alcohol, or
you don't need to maybe engagein certain behaviors, but you
need food to live. And the factthat people just stopped eating
or kind of we're engaging thesereally dangerous behaviors stuck
(02:08):
out to me a lot. So I had lovedthat and took a lot of courses
in undergrad, my master'sprogram like Doctor degree. And
then I started having a lot ofcuriosity about OCD and ended up
at a training site with OCD andjust seeing a lot of overlap
between people with eatingdisorders, people with obsessive
(02:31):
compulsive OCD, and realizingthat there's a lot of symptom
similarity between the two ofthem. And I thought it could be
a special training opportunityand nice to be able to say that
something that I specialize inin both routes. So really, a lot
of my background and traininghas been working eating
(02:55):
disorders training in cognitivebehavioral therapy enhanced,
which is for eating disorders,and that family based therapy.
And then, on the other hand,doing a lot of training in
exposure and response preventiontreatment as well for OCD. And
then I found a job that actuallymarried the two together, and I
kind of never looked back fromthere.
Kira Yakubov Ploshansky (03:17):
That's awesome. That sounds really
cool. Yeah. And so can you sharea little bit about who you work
with now and the type ofpopulation I noticed the
overlap, but uh, do you seeclients only for one? Or they
have to have both? Or what doesthat kind of look like for you?
Yeah,
Dr. Alyssa Hertz (03:31):
yeah. So the practice I work for, we are kind
of bigger specialty was eatingdisorders. And we've recently
kind of branched out to startingto see OCD, anxiety related
disorders, PTSD, things likethat, again, just because we're
starting to paint this pictureof the two go together pretty
often. So we really, probablywithin the last couple of years,
(03:56):
have started branding ourselvesas a clinic that specializes in
the overlap between the two now,in order to be seen by one of
our practitioners, or you do nothave to have that comorbid
presentation. But it's kind ofjust like a nice option if you
are struggling with both. And Ithink there's a lot of times to
people don't understand thatit's one or the other. So having
(04:18):
someone that can relate to us asa part of, hey, you know, you
actually meet criteria for thisor you meet criteria for this
other thing. This is how it'simpacting your disorder. This is
how it's impacting yourpresentation. So yeah, I think
it just creates a kind of onestop shop for people to be able
to go to. And
Kira Yakubov Ploshansky (04:37):
so for the listeners who may not be as
familiar or may not know, canyou kind of share what eating
disorders are and some of thecommon subtypes?
Dr. Alyssa Hertz (04:45):
Yeah, of course. So eating disorders,
they're their psychiatricconditions that cause pretty
significant impairment insomeone's life. And I think if
we're looking at them more, Iguess, generally it's really
this just Intense preoccupationand fear with weight gain their
their body shape their weight inthis extreme desire to be able
(05:06):
to control these things. Andthey're, they're dangerous
eating disorders. They'rethey're very, very harmful
mentally and physically. Youknow, you could go on Google and
type in physical complicationsof eating disorders, and you're
gonna get a list. You know, someof them cardiovascular issues
like irregular heartbeats,people that have heart attacks,
(05:29):
GI issues. So when we're noteating enough, there's a lot of
kind of just like, not going tothe bathroom regularly, a lot of
GI distress. Substances abuse,people don't know how to cope
with it. So they're kind ofturning towards alcohol. But
probably I think, you know, theother part is, like the
suicidality piece. So eatingdisorders have highest suicide
(05:50):
rates than any other psychiatriccondition. So, you know, when
we're talking about treatingeating disorders, we're thinking
about this fast action approach,you know, we really need to get
people kind of quick intorecovery. Common types, there's,
there's a few you know, there'sseveral different eating
disorders, I think, probablywhat more people are familiar
(06:11):
with, or have at least heard atsome point in their life,
anorexia nervosa, bulimianervosa and binge eating
disorder. So anorexia is justthis really intense
preoccupation and fear aboutweight gain, their thoughts and
emotions that accompany foodrelated behaviors. This leads
(06:34):
the person to restrict, youknow, they're eating
significantly less amount ofcalories today, skipping a lot
of meals and snacks that peopleneed throughout the day. So
really the hallmark feature ofanorexia and I think, probably
what most people are familiarwith is that low body weight and
we're talking about not like oneor two pounds below and maybe
(06:56):
your growth chart by your it'sinappropriate for your
developmental level. And that'swhere we see a lot of those
complications start to come in.
And I think that's the pictureright? If you tell someone
anorexia, they're thinkingreally thin can see like, bone
structure. They don't look verywell. But there's also a binge
purging type as well, wherepeople are engaging in binge
(07:18):
episodes, which I'll explainengaging in purging episodes,
but really, it's that thatweight piece right, that is the
defining feature there foranorexia. Bulimia is someone who
repeated binge episodes. Sodifference between binging and
overeating, we're allsusceptible to overeating. You
(07:39):
know, Thanksgiving Super Bowl,parties, we all over eat from
time to time. Binge Eating isreally this unusual amount of
food that someone's eating in areally short period of time.
That characterizes it as abinge. A lot of the times I hear
people talk about, they can'tcontrol it, they've like blacked
(08:00):
out, during like an episode ofeating, they don't remember
consuming all of that food. Tomanage a lot of the
meaningfulness and distress thatcomes with the binge eating,
they do compensatory behaviors,which basically is just a way of
trying to get rid of everythingthat they ate. So we'll see self
induced vomiting, laxativeabuse, excessive exercise, and
(08:24):
those are kind of some of thecommon ones. And then the last
one, binge eating pretty similarto bulimia with the the binge
eating periods, but there's nocompensatory behavior. So
they're not trying to get rid ofthe food. And something
interesting in binge eating too,is, you typically aren't seeing
this intense preoccupation withlike weight shape and food as
(08:48):
you would with some of the otherones. But there's a lot of guilt
and shame that usually comeswith the binge eating, that a
person is experiencing. So thoseare probably the more common
ones that I would would say.
Yeah,
Dr. Katie Manganello (09:05):
Alyssa, you did a really good job of
explaining those. I am wonderingif you could talk a little bit
more to about like, bodydysmorphic disorder. I feel like
sometimes that kind of getslooped in there and is something
that other therapists maybedon't know as much about, like I
know that I didn't know as muchabout that until we started at
(09:25):
like the anxiety and OCDtreatment center. So do you want
to talk a little bit more aboutthat as well?
Dr. Alyssa Hertz (09:31):
Yeah, I think a lot of people they come into
treatment saying they have bodydysmorphic disorder, just
because there is this like, Idon't like my stomach or I don't
like my thighs or I don't likethis certain part about my body.
And, you know, again, thefunctionality of the two are a
lot different. This person istrying to lose weight, they're
(09:51):
trying to maintain a certainbody fat percentage or whatever
that looks like whereas someonewith Body Dysmorphia one it's
not just exclusive to maybe someof these more common areas like
die stomach, you know, there'susually not like a weight loss
component, it's usually thisperceived flaw whether it's real
or imagined, like, my nose lookstoo big and no one really
(10:15):
notices that or, you know, myshoulders are too broad. And I'm
thinking about, you know, whenwe're thinking about body
dysmorphia, there's a little bitof a functionality component
that's a lot different than, youknow, eating disorders. If we
boil these down, it comes downto weight loss and trying to
manage weight and this overcontrol like weight and shape.
(10:37):
Whereas Body Dysmorphia is alittle bit more global. It can
really be anything that a personperceives to be flawed.
Kira Yakubov Ploshansky (10:45):
So it sounds like it's super specific
of a body part versus like,overall, I'm not I'm unhappy
with how I look and I need tolose weight, whether that's
exercising like crazy cuttingcalories throwing up, right,
those kind of things, versuskind of it sounds like obsessing
over a particular body part.
Yes, correct.
Dr. Katie Manganello (11:04):
Right, which is like the perfect segue
into so some of the otherepisodes I have done with the
podcast, I talk a lot about OCD.
Yeah, I'm wondering if you canget your definition of OCD. And
then kind of after explaining alittle bit of the overlap
between eating disorders andOCD, and I feel like that body
(11:26):
dysmorphic disorder is kind oflike it that in the middle type
of things. So that's why Iwanted you to kind of talk about
that
Dr. Alyssa Hertz (11:35):
a little bit.
Yeah. Well, since you've goneover it a lot. I'll try not to
be overly contented about thesethings. But you know, OCD, the
two defining characteristics arethose obsessions and
compulsions. So obsessions arethe distressing on what thoughts
images, impulses, urges, that aperson that's experiencing? And
the major difference? You know,when we're thinking about we all
(11:57):
have disturbing thoughts, I'msure anyone can think of a time
they had a really weird thoughtthey're like, Oh, God. So you
know, if I'm having a thoughtof, I'm going to drive my car
off that bridge. I'm like, Thatwas weird. Like, I'm gonna
continue driving to work orwherever it is, I'm going where,
you know, the obsession alityfor someone with OCD is their
brain is kind of I describe itas like tagging that is, that's
(12:17):
dangerous. That's threatening.
What does that say about me? Whydid I have that thought? Does it
mean that I want to hurt myselfin some capacity, and it kind of
just gets stuck on a loop there.
The compulsive side then rightis a person's attempts to
neutralize or alleviate a lot ofthat distress and anxiety. So
that could be behavioral. So inthat example, I'm not going to
(12:39):
ever purchase anymore, I'm goingto take the long routes, I'm
going to have someone elsedrive, maybe it could be single
prayer over a bridge and whereit becomes cyclical, where it
becomes a little bit problematicfor people is, I say the prayer
when I go over the bridge, Ifeel better. So then I learned,
oh, all I have to do now is saya prayer in order to manage my
(13:01):
anxiety to get over the bridge.
And now I need to do it more andmore and more and more, and I
can't get over the bridgeanymore, without saying these
prayers. So essentially, theproblem here is the compulsions
negatively reinforced theobsessions, which essentially
means that person is gettingshort term relief. But as soon
(13:22):
as they encounter that triggeragain, or as soon as that thing
pops up into their head, again,they're kind of spinning, you
know, back into that cycle. Andit really boils down to this
concept of a person just hastrouble dealing with doubt,
uncertainty, and we're trying tohelp them learn that they can
handle some of those things. Sothe overlap, yes. So this is a
(13:44):
fun question. And I really am sohappy to talk about it. So you
know, just to start 41% ofpeople with eating disorders
also have an OCD diagnosis. Soit's not kind of just like this
small thing we're almost seeingabout like, half our people who
who have eating disorders, mostlikely are having some
undiagnosed or diagnosed eatingdisorder at the time. And think
(14:08):
what we're thinking about itright, the the core features of
both of them tend to be theseobsessions and compulsions. So I
will try to break it down in thebest way possible by an eating
disorders. Those obsessions are,you know about food, they're
about their weight, they'reabout their body image. So how
am I going to avoid eating toomuch when I'm at a party with
(14:29):
all of my friends? What if I eatthis slice of pizza over the
weekend and I gain you know, allof this weight? What happens if
I can't look in the mirrorbefore I go out somewhere? So
there's a lot of this justdistressing, repetitive thoughts
that happen in someone who whohas experienced an eating
disorder. The compulsivebehaviors depend on the disorder
(14:50):
a little bit, you know, someonewho is struggling with anorexia
might engage in a lot of likebody checking behaviors, they
might cut their food into areally small piece. says, you
know, things like that. Whereasin bulimia, we're seeing more of
that like purging behavior. Samefunction as OCD compulsions,
right? There's distress, there'suncertainty about body image and
(15:12):
certainty about food and how itcorrelates to weight. So I need
to do something in order to feelbetter, I need to do something
to prevent this catastrophicoutcome from happening. And we
kind of see that same thing inOCD. So an example to maybe lay
it out is what's give a personwho has OCD, they're leaving for
(15:34):
work and they're constantlychecking their purse for keys,
like is it there isn't there isthere take step closer the door,
let me check one more time aboutthe car luggage over time,
they're trying to alleviate thedoubt that there's the potential
that they left her keys in thehouse, they don't want to forget
they need to be to be certainabout that. In OCD, I'm sorry,
an eating disorders we're kindof seeing, you know, again, is,
(15:57):
I don't know if I can be certainthat this certain food won't
cause me to gain weight, I'mgonna avoid this certain food, I
need to, you know, only eat aspecific diet. And when we're
seeing that we're like, cool.
Okay, that definitely looks morecharacteristic of OCD, that
definitely looks morecharacteristic of eating
disorder, but it gets reallymuddied. So I'll give another
(16:17):
example. And it really helpexplain how when a person comes
in and gives you maybe just likea symptom, were having this kind
of expertise in both can helptease apart. So let's just say
someone comes in and they'retalking about cutting food into
small pieces. I think naturally,someone's like, probably eating
disorders, you know, they'recutting their food and swap
(16:38):
pieces. I've maybe heard thatsomewhere before. But it could
serve a lot. Yes, the thecutting of the small pieces of
food could be a way of slowingdown eating. So they can pull
quicker, it could be to appearlike, look, I eat more that's on
my plate. However, it also couldbe, I need to cut my food into
10 pieces to prevent my mom fromdying, I need to cut my food
(16:59):
into small pieces until it feelsjust right. So we're seeing this
kind of common symptom on thesurface level. But we need to
understand the functionality ofit as well. Because part of the
importance is that is thetreatment implications for that
as well. We can't applynecessarily the same treatment
(17:20):
to that symptom. So that's kindof where it can get a little bit
muddy than why it can be reallyhelpful to understand. Is this
kind of veering off into weightcontrol body image shape? Is
this kind of going into this, onpreventing this catastrophic
outcome, which maybe Haiti hastalked about this before? It's,
(17:41):
it doesn't make sense, I knowthat cutting my food into eight
pieces isn't actually going toprevent anything, but I feel
like I have to do it anyway.
Kira Yakubov Ploshansky (17:53):
So fascinating. I did not realize
that the overlap was sopervasive, and it makes me think
about, I mean, I know that inyour particular practice, I'm
sure there's a lot of therapistsor psychologists who have this
overlap, but I haven't heardreally it be that common for a
therapist to have bothspecialties, which is a little
concerning, but also, right,because if it's so pervasive,
(18:16):
and they're coming in for one orthe other, how, like, how does
that work? How do you commonlysee whether it's with other
therapists, or when clients arecoming in saying, you know, I
went in for initially an eatingdisorder and realize I have OCD
who my therapist can help me orvice versa?
Dr. Alyssa Hertz (18:32):
Yeah, I think it's tricky. I think a lot of
people get misdiagnosed. Youknow, either way misdiagnosed
with eating disorder, ormisdiagnosed with OCD. If a
person tend to think it's aneating disorder, or let's just
say it actually is a eatingdisorder, they're getting
referred out, like nine timesout of 10 people, people just
(18:53):
don't like touching eatingdisorders. But I think it's
either way, I think a providereither has to know a lot about
eating disorders to be able torule out the possibility that
this is OCD, like I understand,again, the functionality, I
understand the conceptualizationof eating disorders to say, this
definitely is hitting onsomething here and someone with
(19:14):
an OCD diagnosis, right, isneeds a provider to be able to
help them really distinguishbetween the two, when I gave
again, I think about thatexample, I gave it the food
cutting, if you don't know, tolook for underlying differences.
Well, we might get into a littlebit of a mess. They're not
saying someone can't help themand and work with maybe whatever
(19:38):
it is they're presenting, butyou're missing a whole other
piece of the disorder, possibly,or exacerbating, you know,
eating disorder behavior canexacerbate OCD and vice versa.
So it's, it's not that peoplecan't get help. I just think
when you have such a overlappingcommonality between again serve
(19:59):
squabble symptoms. It's a bigopportunity for something to get
math.
Dr. Katie Manganello (20:05):
Yeah, I think that carry back to what
you were saying with I feel likea big part of it that is worth
noting is that I mean, you couldmake that argument for a lot of
disorders because OCD has itsown, like comorbidities. I
always kind of explain I'm like,I've got in that camp, right?
Because there's, there's eatingdisorders, there's Autism
(20:26):
Spectrum Disorders, there'stics, threads, body focused,
repetitive behaviors, ADHDtrauma. So those are all kind of
lumped in with like, reallycommon comorbidity. So I think
that if you are going tosomebody who specializes in OCD,
they should, at least at thevery least be able to get to
(20:47):
that functionality, like Alyssasaying, and be able to at least
tease it apart and give you asolid diagnosis. And then, since
it's so common, I think like,for example, like obviously,
Alyssa specializes in eatingdisorders and OCD, I focus more
so on OCD and trauma relateddisorders. But I would say that
(21:08):
both of us also work a lot withADHD, right? Like, there's an
end. And we also like I couldwork with, you know, a level of
eating disorder as well. But ifit's something that's more
pervasive or intense, like thenit's maybe something that I
would say, Listen, maybe thiswould be a better kind of client
for you. So I think that if youhave a psychologist or somebody
who at least knows their theirdiagnostics well enough that at
(21:33):
least they'll be able to get agood diagnosis that can kind of
help move them forward.
Kira Yakubov Ploshansky (21:38):
Provide you clarify that? Because I do
think it's important. There areso many whom who were billed
comorbidities with a lot ofdisorders. And it sounds like
OCD is, it overlaps with somany, it's just kind of like the
topic or the theme, or what elseis kind of stuck on it that
they're obsessing over andhaving these compulsions over? I
mean, it sounds like yourclients have the best of both
(22:01):
worlds with you, which is reallygreat. And that you're able to
do both so well.
Dr. Alyssa Hertz (22:06):
Yeah, I mean, again, I think about a like a
one stop shop, essentially is,you know, it's frustrating
having to go to multipleproviders, I mean, I think we
can all get off big about whatwe've got to like our primary or
something, and they're like, youneed to follow up with this
person, this person, thisperson, and you're like, I don't
want to schedule all thisappointment, that's really
(22:26):
annoying. So it's nice to beable to kind of go to one spot
and be able to know that you'regetting a really good care for
both of those things. But I alsothink just from like,
motivation, financial, you know,finding someone who specializes
in things is pretty expensive.
And, you know, if you're tryingto say, go see this person
first, then go see this personor see two providers at the same
(22:48):
time. That's a lot of financialcommitment. That's a lot of
motivational commitment. Youknow, it's, it's doable, of
course, I don't want to givethat impression that it's not
doable. But I think withanything, I think we all like,
if I can have just a person thatdoes it all. Like that would be
great.
Dr. Katie Manganello (23:09):
Yeah, Alyssa, like when I mean, it's
not even, it's definitely moreof a burden on the individual
experiencing OCD, or an eatingdisorder, both. But I think it's
also it's a lot of extra legworkfor the therapist, because like
Alyssa and I both like I mean,we collaborate care with other
providers. And a lot of timesthey do, like somebody does come
(23:31):
in with somebody that they'veseen for a long time for
therapy, and they want to keepthat relationship for other
things. But like they're here tojust see us for just OCD. And
like we're, it's we take timeoutside of notes in you know,
everything to touch base withthe other providers and make
sure that that's consistent andthat it's on the same track. So
(23:53):
yeah, and I think that that'sanother reason why I love doing
the podcast and getting thisinformation out there so that it
can kind of It's my littlecontribution and getting more
people hopefully, in the knowabout this kind of stuff. So
there's less of all of that inthe long run.
Kira Yakubov Ploshansky (24:14):
And so since you treat both What are
some common therapies andtechniques and modalities that
you use for treating an overlapof the two, what do you
separate? Do you Do it allencompassing? Like what is your
kind of approach and style?
Dr. Alyssa Hertz (24:28):
Yeah, so I think the first thing is, the
two treatments have similarinterventions, but are
fundamentally different. So Ithink it'd be helpful to me
explain how they're differentand then also how they're
similar. You know, so for eatingdisorder treatment is an example
could be is I'm asking someone,okay, we're gonna go to a
(24:52):
restaurant and you're going topick out a food that you're
you're scared of something thatyou feel like it's going to
cause you weight, but thenafterwards, it might be good
distract yourself in some way gocall a friend, go watch your
favorite TV show send yourfavorite music, you know, don't
sit in this forever, you don'thave to, we're just kind of
asking you to get over that humpof anxiety. Whereas OCD, right,
(25:12):
we're not asking prettystructured, we're saying, You
know what, you're going to sitwith this distress, you're gonna
sit with this uncomfortabilityto learn that you can manage it.
And we're really asking someoneto lean into their fear a bit
more. So, you know, like, yeah,I might have not blown up the
candle, and my house is gonnaburn down, but I'm gonna day out
(25:33):
with my friends anyway. So whyit's important to know, again, I
think the treatments is you canaccidentally harm or exacerbate
symptoms on the other end. Andthis is where it kind of is
helpful. It also gets tricky, Ithink when you're working with
someone with both is theinterventions can be similar at
the same time as well. So familyinvolvement is huge on both
(25:57):
ends, we always love when whenfamily members or caregiver
providers are present with OCD,family based therapy, again,
it's treatment for adolescentswith anorexia, parents are
pretty much involved the wholeway through. And I think why why
caregiver involvement in generalis so important is because a lot
(26:17):
of accommodations are going on.
No one ever likes to see theirtheir loved one their child,
whoever it is in distress, sowe're just trying to take that
load off of them, we're tryingto take that burden off of them,
not realizing we're makingthings a little bit more
difficult for them. So eatingdisorder combinations might be
getting special groceries forthem, you know, not cooking with
(26:38):
butters, or things that havefat, but it could be cooking
with other things. Andunintentionally, we're kind of
increasing that power and eatingdisorder has over a person OCD
might be I'm not going to holdthe door for you. So you don't
have to a wash all your fruits,so you don't have to touch them.
So helping to reduce a lot ofthat family or family
(26:59):
accommodation is really helpinga person indirectly learn that
they can handle some of theseanxieties and challenges that
they're experiencing. So, youknow, I think that's a kind of
intervention that seen acrossthe board exposure. So it's a
big one, you know, primarystrategy for OCD work is doing
exposure work, we're saying,again, do the thing that scares
(27:22):
you the most, you know, we'regoing to help you get there. But
that is the best way to faceyour fears is to do this. And
we're in some respects doingthat, in eating disorder work to
we're asking people to see theirweight, sometimes it's the first
time they've ever seen theirweight, sometimes it's the first
time in a long time, we'reasking them to not weighed
themselves so much in and ofitself, that's an exposure.
(27:44):
We're asking them to eat foodsthat they've cut out of their
diet, or they're really scaredof because they think it's going
to gain weight. So the theexposure piece is really, really
helpful across a course in OCD,because that pretty much is the
treatment, but applying thatintervention over and so the
eating disorder work actuallyhas been really, really
beneficial for a lot of people.
(28:09):
And then I also think, just likethe hierarchy piece, too, is
you're gradually having thesepeople confront those things and
reduce certain behaviors thatare problematic in a way that,
in my opinion, fosters a lot ofself competence. You know,
you're tackling these things ata minimal anxiety rate and
(28:30):
you're feeling good about it,when you overcome it, you feel
like you could tackle that nextone. Definitely think it helps
with the motivational piece. Andby the time they get to that top
scary thing, which could bepetting a dog or gaining 30
pounds, it just doesn't feel soharmful or scary anymore. So I
definitely think having a lot ofcommon interventions is helpful,
(28:53):
but also can make it tricky atthe same time as when to apply
versus when to apply it as well.
Yeah. Yeah,
Dr. Katie Manganello (29:02):
that kind of segues into another question
that I was thinking about interms of like, what do you
think, are some of the mostchallenging aspects of treating
clients have both?
Dr. Alyssa Hertz (29:13):
Yeah, that's a that's a really good question. I
think one of the morechallenging aspects is actually
helping the person to understandtheir symptoms, you know, really
understanding I personallybelieve, spending a lot of time
on psychoeducation upfront, Idon't think there's any benefit
in here's what OCD is here. Butneither disorders like alright,
(29:33):
let's jump into treatment andlike, I want people to feel like
I know exactly how this works. Iknow exactly what this like
cycle looks like or, or what'shappening on this end. And I
think one of the challenges isreally helping a person start to
tease it apart on their own.
Really understanding okay, thisis definitely coming from eating
disorder mindset over here. Thisis coming from an OCD mindset
(29:56):
over here. I think The otherpieces is kind of what I just
said is when to apply thestrategies, you know, we might
say, again, practice deepbreathing or practice relaxation
strategies, eating disorder. Butif it's OCD, we don't practice
it. I think for kind of a saferroute, if I a person got sure
(30:18):
I'm just like, pretend it's OCD,then the worst case happens is
you sit with distress, you sitwith anxiety, it goes down
anyway, the outcome will prettymuch be the same if you're not
sure. But I think that's prettymuch the hardest part is I think
there's just a lot of, we needto understand your symptoms, we
need to know how they play outand like potentially where
(30:40):
they're coming from in order forus to effectively treat them
along the way.
Kira Yakubov Ploshansky (30:46):
So it sounds like a very thorough
beginning, right, like intakeprocess, understanding what's
going on for them what theirlife looks like, their family
made me think about an episodewith Katie, of how their family
can be involved. And it almostfeels like, you know,
counterintuitive of like, notenabling them, like doing things
outside of what would relievethat stress and anxiety so that
(31:07):
they can actually do it on theirown. So it sounds like a lot of
these things are are difficult,contradictory, but then also
kind of mesh well together aswell. Yes,
Dr. Alyssa Hertz (31:17):
yes. And that's hard to explain to people
is, this contradicts itself, andis anytime it works for
backwards. And they're kind ofjust like, white. But I think
once people really get the hangof it and start to again, learn
more about themselves and theirsymptoms and how they manifest
it becomes a little bit easieralong the way.
Kira Yakubov Ploshansky (31:39):
Do you have any success stories or kind
of being able to walk somebodywho has an overlap? And like,
what progress would look like?
Or what healing would look likefor them? If it's not someone in
specific?
Dr. Alyssa Hertz (31:51):
Yeah. So a while ago, I worked with someone
who came in for anorexia. And,you know, I think one thing I
should have mentioned is,regardless of what the person is
going through, if they areunderweight or mounters, that is
the top priority. You know, youjust can't do treatment, if
(32:12):
someone from a medicalstandpoint is is not healthy.
But also thinking about, ifyou've ever tried to do
something, when you're starving,it's not easy to concentrate,
it's not easy to take ininformation. So her and I really
worked on like that weightrestoration piece first getting
her to a healthier weight, so wecould engage in treatment, and a
(32:32):
lot of her, you know, symptomsfrom an OCD perspective, were
around fear that she could likeingest something that were would
like, change her bodycomposition and lead to all of
these like weight relatedchanges, she was kind of the
example I was leading into withlike, the cutting, there was
(32:54):
also like a piece of like, Ineed to cut certain foods in
order to prevent like choking,or like accidentally throwing up
because she was averse tothrowing up. We did a lot of
exposure work to like fearedfoods and stepping on the scale
and things like that. And Imean, I would say from start to
(33:14):
finish, it was definitely abumpy ride. This person had not
previously known that they hadan OCD diagnosis and having to
really go through a lot of that,not backward. But hey, there's
this other thing here that thatI think is actually making, you
know, the IDI center a littlebit worse, and potentially
(33:36):
exacerbating a lot of thesesymptoms, we really need to
tease this apart a little bitand treat the two more
simultaneously together. And Ithink that ended up opening up
like a whole different door forus, like treatment went so much
more smoothly. I'm talking aboutprobably for like, three to four
sessions. We were like, shouldwe be doing this anymore? Like I
(33:58):
think we're at a standstill,like what do we do here? And I
think for this person inparticular is we were totally
minimizing something else. Wedidn't realize this other thing
was going on and just kind ofhaving that extra knowledge and
being able to treat some ofthose OCD symptoms allowed one
some of the eating disorderbehavior to come down to some
(34:19):
degree as well. But we werealleviating a lot of stress and
anxiety on some other end. Butyeah, I mean, she well, I don't
see her anymore. I haven't heardfrom her. So I'm assuming that
she's doing really well and hasmoved on with things but it was
a really cool example and Ibring her up because she was the
(34:39):
first person I saw with OCD andeating disorders and that's
where I was like, oh, okay,these two really do coexist and
there's such a symptom overlaphere and not in the way again,
we're thinking about like OCDbehavior is over here and eating
disorders here but like a lot offood related OCD. 80 obsessions
(35:00):
and compulsions that made ittricky.
Kira Yakubov Ploshansky (35:05):
I bet that sounds Well, I'm glad you
were able to help her. And thatkind of sparked your interest
and inspiration into wanting todelve deeper into it.
Dr. Alyssa Hertz (35:13):
Yeah, it was a very interesting and fascinating
case.
Dr. Katie Manganello (35:18):
Was it? Do you feel like there's any common
misconceptions about OCD oreating disorders that you think
need to be addressed in thetherapy community?
Dr. Alyssa Hertz (35:28):
I think there's a lot of
Dr. Katie Manganello (35:31):
timing for sure. with OCD. Yeah,
Dr. Alyssa Hertz (35:32):
we could probably do a whole nother
Dr. Katie Manganello (35:37):
while this question could be a whole
episode,
Dr. Alyssa Hertz (35:40):
be a big one.
Yeah, I mean, these probably arerepeated. And these are probably
things that are very much outthere. But, you know, just the
idea that like OCD is beingcharacterized, this is
personality trader, this uniquequirk that people have, you
know, we hear it all the time ofso OCD. I'm so OCD for this. And
it minimizes, in my opinion,what someone with OCD is
(36:02):
actually going through, youknow, they're struggling,
they're suffering, some peopleare homebound, they can't leave
their houses or function ontheir own anymore. That's not
pleasant. You know, whensomething's describing, I'm so
OCD, it's usually I likecleaning until it's begun span,
or I like organizing until itlooks a certain way. And that's
different. But, you know, if youlike it, it's not a disorder.
(36:25):
You're enjoying engaging inthis. And I think, more than
anything, it's, it's just, Ican't imagine as a person if I
was struggling with OCD to hearpeople throw around that term,
so loosely, and knowing what thestruggle actually looks like. I
think the other the other bigone that comes up for me is what
(36:46):
OCD is, you. And I think thisgoes into why it can be so
missed, like most people aren'tactually getting treatment for
like 10 years when they haveOCD. Like there's a huge gap in
there. And there's probablyother reasons in there as well.
But you have the people come inand like why don't wash my hands
(37:07):
or I don't clean stuff for Idon't organize stuff. And really
helping people to understand OCDis so much more than just hand
washing or taking long showersor being overly clean. But we
have harm OCD, where people areafraid of hurting themselves or
other people or we havescrupulosity, and religious and
I know Katie did a wholewonderful podcast on that. And,
(37:29):
you know, OCD is really anythingthat you care about, if you care
about it, it's gonna go afterit. And I'm really helping
people to see like, it's, it'spretty broad. And that's why
people symptoms can be so allover the place when you're
working with them. But I thinkthose are probably two of my
biggest one, then I think inmore of the eating disorder
(37:49):
context, I think one of thebigger misconception is people
think that there's like a choiceand having an eating disorder,
where, really, it's not achoice. It's a, you know,
there's a lot of brainabnormalities that are
happening, people are kind ofborn with these abnormalities
that predispose them to eatingdisorders. And I have a great
(38:11):
example is I had a patient whowas just sick, like, blue or
something like that. And shejust lost a bunch of weight
because she was sick andcouldn't eat. And when she
recovered, she was anorexic. Allit took is her to lose too much
weight and then flip switched onin the brain. And she was in
treatment for anorexia. So, youknow, I highlight that as a, she
(38:33):
didn't choose to get sick. Andshe certainly didn't choose to
recover with now a whole anotherproblem on top of her. But
they're really, you know,difficult disorders. And I
always kind of lightly say, withmy patients, I'm like, there's a
good chance that you didn't wakeup one day, just say, I want an
(38:54):
eating disorder. I want to, youknow, really struggle with all
of this. It's just not somethingthat you ever hear. The other
one, I think that can be alittle disheartening to it is
parents think it's their fault.
It worked with parents all thetime. They're like I did
something, I caused this to somecapacity. I made a comment to
(39:17):
you know, back 10 years agoabout something and it's really
difficult to help parents reallyexternalize that, that eating
disorder from their childhoodand say, You didn't actually do
anything, you didn't cause thiseating disorder to happen. You
didn't do anything that madethis happen. It just
biologically predisposed, wehave environmental factors,
(39:41):
society, that could also be awhole nother podcast on society
and how it plays into eatingdisorders. And I think really
helping people understand thatthere's nothing you did or said
that cause someone to have aneating disorder. It's just kind
of a perfect combination, aperfect storm of all of these
factors that had come togetherto get your child sick. And
(40:05):
you're part of that likemedicine, if you will to helping
them get better rather than theproblem.
Dr. Katie Manganello (40:11):
I like that reframe. That's really
good. Yeah, yeah, part of thatmedicine. Another one that I
like was just thinking about asyou're talking to that really
bothers me is I think a lot ofpeople think that like, you
don't have an eating disorder,unless you're like, sick, then
like it, people in larger bodiescan also have eating disorders
(40:32):
as well. And like that can bereally harmful to people.
Absolutely.
Dr. Alyssa Hertz (40:36):
Again, when we probably close our eyes and
think about eating disorders, Ithink, everyone, I shouldn't say
everyone, a majority of peoplewould probably pick the anorexic
person. And treatment gap here,right is this is why people
don't often get treatment foreating disorders right away is
people with binge eatingdisorder, could be normal or
(41:00):
overweight, people with bulimiacould be average weight, a
little bit underweight, theycould be overweight. But because
we don't meet that stereotypicalidea of what an eating disorder
looks like, people are like, I'mfine, I'm not actually sick, or
no one's noticing, I could stillfit in all my clothes, I can
still do all the things that I'mdoing. It can mask itself,
(41:22):
you're still functioning, you'restill looking outwardly healthy,
but internally, you know,mentally you're you're
struggling, I think that's areally good one, it's still
really hard to break people awayfrom that misconception of
outwardly, what it looks likeit's a little bit silly it is to
just diagnose someone streetoutwardly to have you know, you
(41:45):
do or don't just because of yourbody composition.
Kira Yakubov Ploshansky (41:49):
Of that's such a great point. And
it sounds like just thinkingabout all these different
practitioners, right, like notknowing some of this or you
know, like quick snap judgments.
Is there any piece of advicethat you could give clinicians
who may not specialize in one oreither that can give them
something to kind of look for adifferentiate, just to kind of
stand out in that way?
Dr. Alyssa Hertz (42:13):
Yeah, I mean, definitely, like, ask all the
questions, Katie, and I, youknow, she mentioned
collaborating with otherproviders. And I think there's
more people out there that arewilling to help and help you
understand, because, after all,we all got into this field to
like, help people, we're tryingto get them through to the end
(42:34):
of that treatment, recoveryroad. And we want to be able to
provide any insights orresources or helpful stuff. So I
think, you know, connect withpeople in either community,
whether you are unsure if you'regoing to go into that route, or
you might end up working withpeople this way is just immerse
(42:54):
yourself into OCD eatingdisorder community, reach out to
people, I get emails for people,like undergrad schools or like
Training Master levels, andthey're like, Hey, I'm really
interested in this, like, canyou talk? And I'm like,
Absolutely, I would love tohelp. And there's so many free
(43:15):
webinars, talks, resources. Ifyou have the money, conferences,
just even just attending as aperson to walk through and learn
about all of these things.
There's so many opportunitiesout there that are accessible,
easy, affordable, for you to beable to learn a little bit more
about eating disorders or OCD.
(43:37):
And even you know, I'm attendinga free hour talk on the
comorbidities between the two,you know, it's just kind of
looking around and finding thoseopportunities and jumping on
them. What
Kira Yakubov Ploshansky (43:50):
a wealth of knowledge. Thank you
so much. This has been superinformative. Before we hop off,
are you can you share if there'sany resources for individuals
struggling with these things? Orany kind of tidbits or advice
for someone who might bestruggling with both of this?
Dr. Alyssa Hertz (44:07):
Yeah, I mean, I have definitely a bunch of
resources. And I'm going toselfishly plug the book that my
owners of the practice did, itis on how to treat comorbid,
eating disorders and OCD. It'sactually really, really helpful.
It goes through everything wetalked about, about what you
knew disorders are, what OCD is,what the treatment similarities,
(44:30):
differences are how to treatpeople case examples. It's a
really, really helpful book. Interms of resources for for
eating disorder community,there's the Academy for eating
disorders, which is great.
That's where a lot of theconferences come from. There's
huge networking events that youcould attend from there. There's
National Eating DisorderAssociation, Nida. They are
(44:51):
constantly doing events likewalks like I think they do a
eating disorder recovery walk inever. Every major city you know,
Throughout the year, and they'reconstantly doing advocacy or
volunteer opportunities to getinvolved. You know, so those are
feast is Another eating disorderwebsite for individuals who are
suffering with anorexia. Andwe're like a parent resource, I
(45:15):
think, to help them figure outhow to manage a child with an
eating disorder and just somehelpful resources there. And
then, of course, there's somereally good books. There's the
treatment manual for anorexia.
There's Chris fairbairns, CBT,manual for eating disorder. So
there's a lot out there on theOCD front, I think, the iocdf,
(45:41):
which is their big internationalwebpage for everything and
anything I pretty much alwaysrefer people there when they're
looking for resources or booksor anything. I'm like, here,
here here. I think there's a lotof good researchers and people
who have a lot of publishedbooks. There's John Grayson, who
(46:03):
has like one of my favoritebooks, freedom from OCD, that
was kind of like my trainingbook, if you will, to get into
OCD. There's Eric Stewart, whodoes a lot of research and
constantly doing studies forpeople. Eli Liebowitz, John
Abramowitz, John Hirschfeld,there's so many good people that
(46:26):
just keep pumping out a lot ofhelpful books and resources. So
it's pretty easy to find thatwhich is
Kira Yakubov Ploshansky (46:34):
we will definitely list all of these in
the show notes. That was Yeah,fantastic. Thank you. You have
so much knowledge and expertiseon this. I'm so happy you were
able to join us today. This wasincredible.
Dr. Alyssa Hertz (46:45):
I'm so happy you guys asked me to come this
is a lot of fun. So
Kira Yakubov Ploshansky (46:49):
if anybody wants to work with you,
fine. You can you share wherethey can get in touch with you.
Dr. Alyssa Hertz (46:54):
Yes, so I work for the Center for hope and
health. So easy enough to justkind of plug onto into Google.
There is phone number there's anemail I specifically work out of
in Texas for people who might beinterested in more that area,
(47:15):
but I also have a license thatallows me to practice across
state borders as well. Sowhether you're in New Jersey,
PA, Oklahoma, you know, whateverit might be is they can still
reach out to that number and ifthey're looking for resources or
treatment, that's how they canreach me. If
Kira Yakubov Ploshansky (47:35):
you've enjoyed this episode, please
like, share and subscribe. Liz,thank you so much for being on
Katie. Thanks for being our cohost. This was a phenomenal
episode to wrap
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