Driving the Conversation Around Eating Disorders in Teens and Adults: Understanding the Mental Health Component Ashley Ariail-Bloomberg Fellow,Licensed Counselor, Eating Disorder Specialist

This week is National Eating Disorder Association(NEDA) Awareness week .

Introduction:

• Highlighting the prevalence and seriousness of eating disorders
• Discussing the importance of addressing the mental health component of these disorders

Eating Disorders as a Mental Health Issue:

• Defining eating disorders and their impact on mental health
• Addressing common misconceptions and stereotypes about who can develop eating disorders

The Impact on Individuals and Families:

• Discussing the emotional and physical toll of eating disorders
• Highlighting the importance of early detection and intervention

The Role of Language:

• The impact of societal language around food and body image on eating disorders
• Addressing ways to promote healthy language and attitudes

Addressing Eating Disorders in Teens and Adults:

• Highlighting the unique challenges of addressing eating disorders in different age groups
• Discussing treatment options and resources available

Preventing Eating Disorders:

• The importance of promoting positive body image and healthy relationships with food
• Strategies for preventing the development of eating disorders

Supporting Individuals and Families:

• Discussing ways to support individuals and families affected by eating disorders
• Highlighting the importance of access to resources and support groups

Conclusion:

• Recap of the key takeaways and the importance of addressing eating disorders as a mental health issue
• Encouragement to continue the conversation and promote awareness and understanding.

Eating disorder is a mental health issues not just a manifestation of body or food challenges. Eating disorders can be typecast as afflicting teenage girls or by income level. It has a significant impact on the individual and family and can have extreme consequences, not a matter to be taken lightly. As a society, our language around food and body is very important.

Ashley Ariail is a Bloomberg Fellow, a  licensed counselor, and an eating disorder specialist from Children's Hospital, Plano.  She works with children and teens and families as they work through eating disorder issues and body image issues as well.  She's a

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(00:22):
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(00:42):
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It's a perspective.
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Hello everyone.
Welcome to today's podcast.
This is our series on health andwe are talking about mental
health, I have Ashley Ariailwith us, who's a licensed
counselor and also an eatingdisorder specialist.
Ashley works with children andteens and families as they work

(01:05):
through eating disorder issuesand around body image issues as
well.
She's a passionate advocatedoing outreach programs in the
community and across the boardwith schools as well.
Ashley, welcome.
I'm really looking forward totoday's conversation.

Ashley (01:19):
Thank you for having me.

Sirisha (01:20):
To get started, how did you get into this field?
Can you walk us through yourbackground, what you do
currently?

Ashley (01:27):
Yes.
I started out at children'shealth and I was in our
behavioral psych unit where wewere treating, everything we're
treating suicidality,non-suicidal, self-injury and
then that was the only place atthe time to treat eating
disorders.
That's where I was first exposedto treating them.
That's not something that mostcounseling programs offer a lot

(01:51):
of input on.
You have, one class perhaps oneating disorders as part of
psychopathology, and then that'sit.
So my career started atchildren's health and then later
children's built an entireprogram out in Plano, and so I'm
now with children's medicalcenter Plano.
We have a 12 bed unit to treatkids inpatient, and then we also

(02:13):
have a partial hospitalizationprogram and an IOP program, or
the kids go home at the end ofthe day, but we're still
providing services for eithermost of the day or half day.

Sirisha (02:24):
Obviously you work in a children's hospital, but is that
the demographic that is mostimpacted, and when do you start
to see manifestations of eatingdisorder usually?

Ashley (02:31):
So most eating disorders develop in adolescence, and the
tricky thing is, do you catch itin adolescents or not?
So even when you have an adultpresentation of an eating
disorder where it's identified,let's say you're in your
twenties or thirties, mostpeople can go back to sometime
in their preteen or adolescentyears.

(02:51):
I will say in the past, I'vebeen at children's for 12 years,
I have seen kids come in youngerand I have seen kids as young as
seven or eight.
So most of the eating disordersdevelop in the younger ages, and
we're really lucky that we havea lot of programs now that are
catching it at those youngerages before it gets to adulthood

(03:12):
where it's very difficult.

Sirisha (03:15):
So what usually are the reasons for it?
We've seen a lot of coverage insocial media now about body
shaming, body issues and justInstagram and so many pictures,
I think that creates this imagethat people aspire to, which is
not necessarily normal.
So what can we do to detect thatearly on?

Ashley (03:36):
It's a great question, it's a question every parent
asks us when I get there becausethey say, what could we have
done to prevent this?
What is the root cause of this?
And the frustrating answer isthat we're not always, really
sure.
So we go by thebio-psycho-social model.
So what we would say,biologically speaking, obviously
some people have apredisposition in their family,

(03:57):
so someone in the family mayhave an eating disorder, but
they may not.
Similar to people with thecancer diagnosis, sometimes you
can trace that back in thefamily, sometimes this is the
first person.
And so we look at it biology, wealso look at temperament.
It can be different depending onthe different diagnoses.
Most of our kids are highlyperfectionistic.

(04:17):
They're very smart.
They're very rule following andthey're very compliant and
they're usually fairly aware ofother people's feelings, and
they're very compassionatetowards others, but not
necessarily compassionate tothemselves.
Then you have, their socialenvironment.
This, happened to me in highschool.
I did not develop an eatingdisorder, but I had friends who
spent their lunch, restrictingtheir lunch and only drinking a

(04:40):
diet soda and talking abouttheir weight and disparaging
their bodies.
So it could come from friends,honestly.
One of the reasons I am a bigadvocate is that I do feel,
unfortunately there are adultsin kids' lives that say things.
So I do know at school, even myI have a seven year old daughter
and a four year old daughter.
My seven year old, we've runinto two instances, even at her

(05:03):
age where she has been told atschool that food is not good for
you.
And she is very assertive andshe raised her hand and she
said, my motto,"which is allfood is good food", and we do
say in variety and moderation,but she just raised her hand and
assertively told them.
So I do think, sometimes inschools, depending on athletics,
it could be coaches.

(05:24):
Sometimes it's the pediatricianthe kid goes in and the
pediatrician says,"Hey, theyneed to watch their weight" and
the kid hears that.
Sometimes parents are dietingthemselves and then obviously
social media.
The impact of COVID is somethingthat we're continuing to study
because kids screen timeinitially, when kids were home
from school in the beginning ofMarch 20 20, they were on their

(05:48):
phones a lot more as theyweren't doing social activities
and so obviously, Fair tiktokers talkers and influencers
and YouTubers and all of thesethings where people are putting
their diets out there, theirexercise routines.
So we just call it the perfectstorm.
That a kid may be going througha difficult time in their life,
whether it's a move or they'velost a family member or they're

(06:11):
being bullied.
Then they may have, some ofthese psych social stressors and
it culminates in the developmentof an eating disorder.
And that is a very frustratinganswer for most of our parents,
because they really want toknow, what is the one thing that
caused it, and we can't alwaysgive that to them, but I would

(06:31):
say that those are the biggestfactors.

Sirisha (06:34):
It's not surprising, especially when you're talking
about a dollar since then, thepeer group has a much bigger
influence than the adults in thelife.
So they are taking their cuesand learning from their friends
and now social media is thatpeer group as well, so there's a
lot of influence coming fromthere.
I think it's saddening anddisheartening when you hear that
your seven year old is hearingthis at school, and that ties

(06:57):
into where you said you see itstarting at eight and nine year
olds, they're already hearingthe conversation.
Before we deep dive, do you seeteenage girls

Ashley (07:05):
Prior to COVID children's would have a eating
disorder symposium each yearwhere we would cover different
topics.
I think that what most peoplethink of is it is an adolescent
wealthy girl.
That this happens for people,who maybe have the luxury of an
open access to food and then arejust really choosing not to, and

(07:26):
I think one of the things that Ilike about working at children's
where we see all demographics iswe see males and females.
I would say, at the highest I'veseen our unit split is about 40,
60 with 40% male.
That's not always the case.
I will say we see kids from allsocioeconomic statuses.
So sometimes we have kids whoare food insecure, where that

(07:47):
may have played a role in theirrestriction.
We see kids from all religions,all ethnicities, we see kids
across gender identity andsexual orientation.
A lot of the times students intheir programs have to
interview, therapists in thefield and they will ask me,
what's the typical eatingdisorder, and again I say, I
can't really tell you.

Sirisha (08:08):
I think it's a disorder with no specificity and I'm glad
you're sharing that becauseanyone can have it or anyone can
manifest symptoms.
So what are the types of eatingdisorders and what are the
symptoms for someone to detectit?

Ashley (08:21):
The most common one that people seem to be familiar with
and perhaps is portrayed themost in some of the movies and
the TV shows is anorexianervosa.
You will typically see a kidrestricting and which means not
eating.
Now, some people think, okay.
If I see my kid eat at all, Isee my kid eat dinner at home,

(08:42):
so they can't possibly haveanorexia, but that kid may have
skipped breakfast, cause somekids don't eat breakfast.
They may have then skipped theirlunch at school, they may have
not had a snack on athletics andthen that dinner, that may be
not that big, but not that smallcould be their only meals a day
and they could still be droppingweight and getting to a point
where the it's very dangerousand they're in the hospital.

(09:04):
So what anorexia is it is arestrictive pattern of behavior.
So where someone is not intakingenough calories to support their
weight, they are losing weight.
It used to the DSM is how we do,all of the disorders.
and so there was a change madein the fifth edition.
It used to say you had to beunder 85% of your ideal body

(09:26):
weight.
So whatever the weight for yourgender, age and height that you
should be, you had to be under85% of that.
They have taken that off and Ithink that's really important,
but it is basically that you areunder your expected weight or
you have dropped weight.
For kids who are gaining andgrowing, like my seven year old
should be gaining every year andgrowing.
Anorexia nervosa in a youngerkid, because it looked like they

(09:47):
haven't lost weight, but theyhave failed to gain in a year,
which would be troublesome.
Or it could look like someonehas begun to lose weight and is
now underweight.
It has to come with apreoccupation with weight and
shapes.
There has to be this drive forthinness or this drive for
sometimes with the males.

(10:08):
It's not necessarily drive forthinness, but it's a drive for a
certain body aesthetic.
So it could be that they quoteunquote, want to look muscular.
So we would still fall that adrive for thinness, even though
that maybe like waiflike modelbody, isn't what they're after.
And it usually comes with bodydistortions where the person as
they are losing weight orfailing to gain and grow, they

(10:29):
do not see themselves asunderweight.
They see themselves as either anaverage weight or sometimes see
themselves as overweight.
So for anorexia nervosa that isthe primary presentation, but
then bulimia nervosa is whereyou're seeing kids who sometimes
they're underweight, but most ofthe time, their average weight
could possibly be overweight.

(10:51):
Those are the kids that aregoing through patterns of binge
eating and purging behaviors andso they're eating more than what
we would consider a normalamount of food in a specific
amount of time.
Stereotypically again in themovies, it's like they ate a tub
of ice cream or they ate a wholebag of chips.
The interesting thing that a lotof the anti diet dieticians, who

(11:14):
there's a ton of them that Icould tell you about they're
coming out and they're there.
They're using social mediapositively.
They're using tech talk andInstagram positively to say,
Hey, most people who are Benji.
Actually that binge-eatingoftentimes follows restriction.
So kids will try to restrict andrestrict your body's built to
override that and get you, getfood into you.
And so some kids can't gothrough that restriction and

(11:36):
we'll flip into the bingeeating, then they will feel
guilty and they will purge.
Purging could be emphasis.
It could be a flax.
It is, it could be use ofdiuretics or it could be the
kids.
Who binge eat and then they willrun or exercise, for an hour to
get those calories off.

(11:57):
And so those kids.
It can be very dangerous.
I think most people focus onanorexia nervosa because their
weight is so low for the kids.
With bulimia nervosa, theirelectrolyte levels are often
very off and that can be verydangerous.
All of us know, potassium,phosphorus, magnesium, when
you're purging, those things canbe very off and it can be very

(12:21):
life-threatening.
We have a diagnosis calledotherwise specified feeding and
eating disorder where you havesymptoms of anorexia or bulimia.
But you're not meeting maybelike the clinical criteria.
So sometimes we see kids come inwho are not quite at the
threshold for that diagnosis.
And so it's otherwise specifiedfeeding and eating disorder.
And then the other thing wetreat that I think people are

(12:43):
not as familiar with is avoidantrestrictive food intake
disorder.
We do have, I would say, when wehave the really young kids Most
of the time, that's thediagnosis.
Although I have seen young kidswith a, what we would call a
traditional eating disorder.
So our fit avoidant, restrictivefood intake disorder is not
weight or shape driven.

(13:03):
Those kids do not have concernsabout calories.
They are not worried about anyof that.
What they have had is either atraumatic event.
So they may have choked and nowbe afraid to eat certain foods.
They may have we've had kidsthat they had the flu, they
threw up.
Now they're terrified ofthrowing up.
They don't want to intake food.
We have kids who have medicalconditions.
They may have.

(13:23):
GI issues.
They may have severe foodallergies and now they're afraid
to eat because it causes thempain or they could have an
anaphylactic reaction a bunch ofdifferent ways that you could
get to ARFID.
But the key component is thatthey have a restricted pattern
of eating that is impactingtheir kind of normal weight and
growth trajectory, or they havelost weight, but there are no

(13:46):
body distortions and no drivefor thinness.
Then there is binge eatingdisorder.
Children's does not treat that.
That is not my specialty, butthat is where people have binge
eating, but they do not have anypurging behaviors.

Sirisha (14:01):
So what as parents, family members, community
surrounding these children orteenagers, what can we do?
What are the signs we would lookfor and how do we integrate.

Ashley (14:11):
Before I could answer as a professional, now that I'm a
mom I'm recognizing a lot ofways you can intervene.
I always tell this story.
So when my daughter is inkindergarten, she's in virtual
kindergarten and the PE teacherhad sent home home these
activities, and one of them wasyou need to karate squat good

(14:32):
foods and you need to karatechop bad foods.
And my daughter, let me tellyou, my family knows the only F
word in our family is fat,right?
And so she said, wait, mom,they're saying chicken nuggets
are bad..
They're saying pizza's bad food.
No food is bad food, all food isgood food for your body, and I
said, yes and so I cut off thevideo.

(14:53):
I said, we're not doing this.
I emailed the coach.
And I said, if there is any kindof nutrition advice that's
coming towards my child, shewill not be participating in
that.
That is reserved for licenseddieticians, registered
dieticians.
And the coach was very nice andunderstanding when I explained
my specialty.
Again with this other comment, Ithink for parents, when you

(15:15):
begin to hear those things atwhatever age, you may hear them.
My daughter is very young, youmay not hear them later.
I think you can just talk toyour kid very openly.
And some of these things,aren't, it's not an eating
disorder.
There are kids who, inadolescents are like maybe I'm
not eating a dessert three timesa day.
Is that unhealthy?

(15:36):
No, but I think you do have towatch those trends because what
I hear a lot from parents is mykid decided to be healthy.
And they cut out desserts andparents are like, okay, that's
fine.
Do I want my kids having sugarat seven 30 right before bed?
No, I don't.
But we also don't, there's nofood that's off limit in our

(15:56):
house.
It starts with desserts and thenkids will move into,"okay I'm
not going to have chips, I'm notgoing to have fast food, I'm
never eating fried here, there'sno more pizza".
So I would just keep an ear outand do some kids, maybe change
their food intake and it's notdangerous.
But I think parents usually, Iwould say there, there is a

(16:16):
warning bell and it's hard totrain yourself to look out for
it because one thing I'm verypassionate about is our society
has really, I think, demonizedand weaponized food.
I think everybody has somethingthat's wrong with food and
people are making a lot of moneyoff of Tik TOK and I'm not going
to call out any store chain inparticular.

(16:38):
I'm not saying you shouldn't buyorganic food, but again, there
are billions of dollars in thehealth and wellness industry
being made by labeling foods asclean or dirty or safe or
unsafe.
And it's also, and one of thethings I'm really passionate
about, it's an equity issue.
So they're demonizing foods thatsome families need because that

(17:02):
may be all they have access to.
Or if you're a single workingmother, you may have to stop by
Chick-fil-A and that's the onlything you can get your kid and
fast food.
Doesn't have to be bad food.
So I would look out for that.
I would look out for kidsskipping meals.
Obviously I would look out forkids exercising more, more than

(17:22):
you would expect.
So for instance, a kid who hassoccer practice, I played
soccer, right?
I did not have the energy to gorunning after I had already
spent an hour and a half soccer.
So we have parents who have saidthey had, track practice, then
they're still running, or thenthey're still doing crunches.
Or they get really upset if theymiss one day of working out.
If you have a kid who's workingout and they're injured, but

(17:44):
they're so worried about gettingout of shape that they're
pushing or injury, that's alsosomething.
And because we're in Texas andTexas is a very sports focused
state, I think we do see thatcome up.
Wearing really baggy clotheskids, ironically, that lose this
weight, don't want anybody tosee it.
They are satisfied by seeing it,but they want to hide it from

(18:05):
people.
And I know sometimes the stylesgoing away from these oversize,
extra large t-shirts andleggings, but if you see your
kid wearing baggy clothing orlayers in the summer, these kids
are cold because they don't havebody fat and so they'll be
wearing a sweatshirt in likeJune when it's 90 degrees
outside.

(18:25):
So I would say those things.
And then one of the things Ithink, in mental health we've
always talked about family mealsare so important.
They're actually reallyprotective against a variety of
different mental healthdisorders and so if you're
having family meals, just payingattention to you as your kid
eating or just pushing theirfood around if you see maybe
some of these other signs, juststart to pay attention to

(18:46):
record.

Sirisha (18:48):
I think it's very subtle signals sometimes, you
have to be aware.
You have to be cognizant andit's a slow change or a slow
drift in the conversation.
So you're talking about what thekids are saying, but as parents,
you made this comment, all foodis good food and how we address
it, how we talk about ourselves,how we talk about our own eating
habits.
What do we do at home?
How should we be talking aboutourselves or our conversation

(19:12):
and our relationship with foodas well?

Ashley (19:14):
I think that, and this is the question I get from
parents the most, what can I donow?
And so as a woman, I am, 38 nowand I would say my metabolism
changed at about 35.
I think that we just have to bereally kind to our bodies.
I do not disparage my body.
If I have gained weight, I'm notgoing to talk about that in
front of my kids.

(19:34):
If maybe I'm going to eat I'mItalian., I love food.
I've never had an eatingdisorder and I really do try to
live by the motto" all food isgood food".
I do recognize as we are notteenagers, we are not gaining
and growing.
We have different caloric needsthan our kids, right?
So there are certain things, mykids can have an ice cream every
single day after school.
I really don't call attention tothat, I don't say I can't have

(19:56):
this.
I'm not going to or when I doworkouts at home during COVID, I
have a weight routine and theysaid why are you doing that?
I said I have to be strongenough to pick you up.
One of my daughters, we were inSanta Fe, she caught knee on a
cactus and so I had to carry herdown a mountain.
So I say remember the time mommyhad to carry you back down the
mountain when we were hiking, Ihave to be strong.

(20:16):
So I don't focus on weight loss,I focus on strength and, I want
my body to live a long time andI want my body to be able to do
the things that I like to do.
I do play soccer at 30 and Idon't play soccer to manage my
weight.
I play soccer because it's veryfun and I enjoy something my
kids play.
So I focus on any activity isn'tabout punishment for eating this

(20:39):
or,'oh, Thanksgiving', so now Ibetter work out tomorrow.
Just I stay away fromtying foodto exercise.
I stay away from any disparagingremarks about my body.
I definitely do not comment ontheir bodies and then I think,
my kids, we talk about proteinis to build your muscles,
carbohydrates are for yourbrain.

(20:59):
There's vitamins in fruits andvegetables that your body needs
and then dairy is for your bonesto make your bones really
strong.
You can only store calcium tillage 30, that's a very big,
important thing for bone healthis to get in those dairies and
so that's how we talk aboutfoods.
Even at the hospital, we callthem meats, milks, grains,

(21:20):
fruits, and vegetables.
So when I talked to my kids, Ifthey're trying to eat a cookie
after they've already hadcookies and then they've already
had maybe, spaghetti, I'll say,Hey, you need some protein.
And so I don't talk to themabout healthier, unhealthy.
I really tell them we have toeat out of all of those five

(21:40):
food groups in the day becausethose, they each have something
your body needs.
And I will tell you even my fouryear old understands that.
I don't think you can do anydamage by talking about these
five food groups and all food isgood food.
I don't think kids are going tobinge eat ice cream because you
say all food is good food.
The caveat for older kids is invariety and moderation.

(22:00):
I think we all know we can't eatMcDonald's every day of the
week, but I will tell you wehave pizza night every Friday,
and no one in our family isoverweight from that and so I
think we have to de-stigmatizewhat society says is if you eat
this will drastically impactyour weight.
That's not true and we havereally good dieticians who work
with families on these foodmyths.

(22:22):
A lot of families do have a lotof anxiety about the way that
we're weight restoring theirkids in treatment and the types
of foods we're exposing them to.
And based on the anxiety I haveseen in the families, I
recognize that this is a problemin our society.
There's a dietician.
I follow her, her name isdietician Anna, and she says,
our body is our earth, it's theonly body we will get.

(22:45):
So for people, who are worriedabout protecting the earth, like
this earth is only earth wehave, right, we need to treat it
kindly.
Same thing for your body, yourbody is the only body that you
have and if you don't treat itwith kindness or respect, you
can't get another one.
And so I really, think that thekids that I counsel that, that

(23:06):
resonates with them, that it isthe only form they're going to
have and being kind to it isvery important.

Sirisha (23:14):
Two things come to mind when you're saying this, kids
are also well aware of having awhole plate, like the five food
groups you're talking aboutbecause there have been times
when I've gone out, especiallyduring vacation offered my kids
to start with dessert.
For some reason, they don't seemto still want to start with
dessert or ice cream at the mealand rather have dinner first,
but that's a choice they make,right, it's not restrictive as

(23:35):
you speak.

Ashley (23:36):
My daughter loves vegetables she loves carrot
sticks and she doesn't, we'veoffered ranch for the carrot
sticks, she eats them plain.
I personally don't understandthat, she also eats a wide
variety of other things.
So I'm not very worried aboutit, for her snack if she chose
carrot sticks.
That's great.
Kids may move towards dessert,salt to your sweet food, and I

(23:58):
think as long as it's not thatfood, they're not associating it
with something negative andsaying, I don't want dessert
because this, but they justmaybe don't want something
sweet.
I think that's fine.
And it is, and they get to makethose choices as long as they're
out of health.

Sirisha (24:14):
Yes.
The other comment you made wasabout the earth suit.
I had one of these forwards, Isaw this comment, which actually
ties it well for someone who's anumbers person.
If your body was number one andyou added all the zeros after it
be it wealth to be it education,be it everything that you're
trying to aspire to, you canremove all those zeros and still
have the one, but if you removethe one, the zeros have no

(24:35):
meaning.

Ashley (24:37):
So it's a different

Sirisha (24:38):
station, you get one body and you have to take care
of it

Ashley (24:42):
off it I would almost say nothing matters if you
don't.
We talk to kids about this, Ifyou're in eating disorder
treatment, because we're tryingto save your life.
How are you going to college?
How are you hanging out withyour friends?
How are you going to prom withyour boyfriend?
If you're a parent, how are youtaking care of your kids?
Because you may end up being intreatment and away from them,

(25:03):
or, we've had people who havelost a kid, teenagers have lost
their jobs, but I work withother clinicians who work with
adults, They have lost theirjobs because they were in
treatment and asset for so long.
So I agree with you, this thingwill steal everything and I
think that the biggestmisconception that I have seen
is that, the teenagers that wehave, and I've treated a couple

(25:28):
of adults in private practicebefore children's they really
think that they can control theeating disorder and that they
can have just enough restrictiveeating or just enough bingeing
and purging that it will get inthe way of their life.
That is not the case, it willeventually overtake the person,
there is no middle ground witheating disorders.

Sirisha (25:49):
When you practice children's, you're working with
the whole family I as anindividual might have an eating
disorder, but it's really afamily dynamic that sets it up
and I think it goes toeverything you've been talking
about, right?
The dinner table conversations,how you talk about yourself, how
you treat yourself What doesthat intervention that families
do?
And I'm also very interested inlearning, we talking about young
children and teenagers, theyhave siblings.

(26:09):
So what impact does it have onthe siblings in specific and how
can we have that conversationwith them?
Because they're much closer thanage, much closer to them, right?
It's a different relationshipbetween a parent and a child and
a sibling and a child.

Ashley (26:21):
One of the biggest things that we say to the
parents when they come inbecause a lot of the times, what
did I do?
And we work really hard to sayyou didn't do anything again.
And there's social media,there's friends, or, if a parent
did go on a diet and did loseweight, there are people whose
parents dieted their whole livesthat don't have eating
disorders.
So we try really to shift themfrom like a blame of themselves

(26:44):
or others and into, Hey, you areour biggest source of support as
we restore healing.
Pediatrics for adolescents andyounger kids family-based
treatment where the family aspart of treatment and we do
family therapy.
That is the gold standard ofcare.
In addition to what we call amultidisciplinary team, meaning

(27:05):
there's a therapist, dietician,nurses, doctors everybody's
working together.
Family therapy is structured sothat parents can learn about the
eating disorder, cause I don'tsee a lot of parents that are
coming in with a lot ofknowledge.
It's a lot about helping parentsset limits on the eating
disorder.
So parents have become veryafraid of upsetting their child

(27:26):
because these kids who beforehad been very compliant, very
rule following are all of asudden lying.
They may be yelling, they may behiding food or throwing food and
so the parents come in andthink, okay if I push on the kid
at all, I'm setting them backand we really have to coach
parents that no, we've got tonip this in the bud, we've got

(27:47):
to get on top of this.
We have to make sure that thelimits are there and the biggest
thing with eating disorders, wedo not threaten or bribe or
guilt or negotiate for ourprogram.
Specifically we haveexpectations of the patient for,
how many meals they need to beeating and if they eat them,
that's great.

(28:08):
They get certain privileges thatthey want and if they're not
eating and they're notnourishing their body, they're
not getting certain privileges.
And so sometimes the kids comeback and they say you're
punishing me for having thisdisorder, but I tell them,"Was
what if I didn't show up at workfor two weeks?
Like I didn't tell my managerdidn't show up, didn't do my

(28:31):
job.
Would it be punishment that Ididn't get my paycheck?
Or did I make the decision tonot show up.
No one can make me go to work,no one can force me out of my
house every into work, I makethat decision because I have
chosen to have a job and I'vechosen to get a paycheck.
If I ceased to do those things,I won't get those other things

(28:51):
and so we teach the kids a lotthat, Hey, we're removing the
stress.
Because a lot of times parentsare they're desperate, they are
scared.
Can you imagine, this is alife-threatening disorder.
Parents have said, I'll buy youa ticket to New York if you eat,
we'll go on a cruise or it couldbe something smaller, like a
board game or a video game, orthey have guilted their kid,

(29:13):
don't you know, there's kidsstarving in other country, or
they've yelled at their kids inmoments of stress and
frustration.
I think every parent probablyhas raised their voice at their
kid.
I have, but none of thosestrategies work, the kid really
has to decide to make thisdecision.
However, I tell parents, if yourkid was failing out of school,
there may be some naturalconsequences, right?
They may have to go to tutoringor they may have to go to summer

(29:35):
school, or you may not let themgo to all of their
extracurricular activities, ifthey have F in every subject.
Even sports teams, you can'tplay if you don't have certain
grades.
So there are naturalconsequences and we do have
families enforce those naturalconsequences.
When a kid is not eating anddoing what they need to do,
there will be either privilegesthey get or privileges that they

(29:55):
don't get, or naturalconsequences and building the
distress tolerance in the familyso that the family can handle
that pushback from the eatingdisorder externalizing, the
eating disorder is somethingelse we do.
We talk about there's your kidand there's the eating disorder.
We don't think that there's somesort of split personality, but

(30:17):
for most of our kids there's aclear timeline where the family
says, I know when this eatingdisorder started and the
behaviors changed.
My kid was never screaming at meabout food before, my kid wasn't
lying to me before that and sowe'll say,'Hey parents, you can
be very mad at the eatingdisorder.
You can be so frustrated, we'regoing to choose to externalize

(30:38):
that so that you can talk aboutyour frustration with the eating
disorder, without the kidfeeling like you were mad
specifically at them, because wedo understand that this is a
mental illness and this is notsomething that kids just
voluntarily are choosing to doin order to be defiant'.
It very much feels outside oftheir control until, they can
get the support.

(30:59):
To overcome it and we talk withparents.
One of the phrases I always sayto parents.
I say to parents, you can't dothis for them, but they can't do
it without you.
And the parents also are asource of encouragement and
motivation and helping the kidscope.
When they see their kiddistressed, being able to come
in and provide eitherencouragement, calm, Parents

(31:21):
then learn about their copingskills and we'll practice coping
skills with their child.
And then we also talk about thefamily dynamics, are there
disruptions or barriers totreatment, has the family gotten
away from communicating?
Is there, to your point aboutsiblings or is there another
sibling, who maybe needs a lotof attention in the family and
this kid has gotten used to notasking parents for some is there

(31:43):
conflict between parents where'stheir conflict between siblings,
where that is creating morestress for the kid with the
eating disorder?
Yes.
We want to address that anddecrease the stress in the
house.
I could probably talk foreverbut that's basically what we're
doing is we're educating thefamily.
We're identifying barriers athome to recovery and identifying

(32:03):
stressors and then we are verymuch building up parents and
their knowledge and teachingthem all of the skills that we
as a program have so that whenthe kid leaves the program, we
don't want them dependent on us.
We want them going out and beingsuccessful after they leave us.

Sirisha (32:21):
I think it's a perception change, right, for
anyone listening to this orlearning about it.
Eating disorders we very muchthink of it as body and body
issues, but to your point, it'salso mental health issue.
It's not really so much just aphysical appearance thing, but
really that part of it andfamilies, it is a stressor for
everyone going through thisexperience.
So how do we learn to cope withit, get knowledge around it and

(32:45):
learn to share that as well.
And even when there are familiesgoing through this they are
going to have meetings withfriends, go for Thanksgiving
with there family, so makingeveryone else in your community,
around you aware of it so thatyou can still have the
conversation, but not talk aboutfood and others.
Say you're visiting yourgrandparents, are you visiting
your aunts and uncles or justfriends, family.

(33:06):
So how do you have thatconversation around that?
And just normalizing it in away.
And the other part of it that Ithought you were mentioning as
just, as a parent you do feelthe guilt.
You feel that blame, and I'mglad you addressed that because
parenting is challenging.
And you're always going toquestion yourself whether you

(33:29):
made the right thing, especiallywhen you denied something or,
when you went through a certainthing.
So it's hard enough to dowithout having that guilt and
blame because you have toseparate that from what you are
going through at this point,because you have to help your
child, enable the change and asa family unit come together to
figure out how to do it and not.
And I think the sibling part, Ialso was wondering the other

(33:50):
way, as the person who is goingthrough an eating disorder,
sometimes the other siblingmight also get less attention,
but how to make sure that theyare part of it, because that is
also a stressor for anotherchild.
So they're going to any otherincident or trauma that they can
themselves itself feelmarginalized, that they should
somehow be included in thisdiscussion and just other things

(34:10):
and have a say in everythingthat's

Ashley (34:13):
going through.
Going on.
Yes.
And, I feel like everyconversation I have, I feel like
I have to talk about COVID and,I'm ready for, when it's safe
for us to be able to relax someof the restrictions.
That we have.
Children's has a two visitorpolicy right now because we
treat medically fragile kids,both on the eating disorder unit
and in other areas.

(34:33):
So siblings haven't beenallowed, before we would have
siblings in family therapy, andI've had parents who have really
wanted the siblings and forexactly the reason that you
said, where they have said thishas impacted all of us, siblings
very worried, we're worried theymight develop an eating
disorder.
They're worried they're going totrigger their sibling by saying

(34:53):
something, as simple as, oh, Iwent to soccer practice today.
The eating disorder hears thatand is why do they get to
exercise and I don't.
I've also had parents that said,I don't want my nine or 10 year
old in, because I don't thinkthey understand and I always
tell them, I think that they do,they have a high capability to
understand, and they've alsobeen seeing the behaviors.
And so I would like for them tobe here because they have

(35:16):
observed what's going on at homeand I bet they know more than
you think they do and so thathas been one of the downfalls of
COVID is the sibling component.
I do think though that we havetried really hard to have
parents have those conversationswith their kids and bring their
kids into the loop.
And also to explain the biggestthing is, siblings are not

(35:37):
responsible for the child whohas the eating disorder.
And sometimes kids feel thatthey need to follow their
sibling around the house andmake sure they're not exercising
or purging, or sometimes parentsmistakenly think, maybe an older
sibling 15,16 is the one who canmake sure that the child eats.

(35:58):
And I say, no, I really don'tkids end up in a parent role, I
want to make sure that theyunderstand that they are still
in a sibling role.
They can support, there's lotsof age, appropriate ways for
them to support their brother orsister, but they do not have to
be in a parent role ofsupervising and I do think
that's very helpful.
Those conversations are veryhelpful for the sibling and then

(36:20):
we refer them to outpatientfamily therapy after treatment.
And I tell the parents, this islike crisis time, partials or
inpatient, your outpatientfamily therapist will be
addressing how this stay in thistreatment has impacted the whole
family and what steps goingforward, need to be addressed.

(36:43):
So to your point, how siblingsare feeling and how it's changed
their family system, how it'schanged their family dynamics at
the outpatient level of care, werecommend three to six months of
family therapy to address all ofthese changes and how the family
is functioning in this new modeland in this new way, and to
identify, If maybe there hasbeen a negative impact, like you

(37:06):
said, where siblings feel leftout or they feel like they don't
have enough time with parents.

Sirisha (37:12):
So that's right.
Children's obviously here inPlano has a dedicated program,
right, but people around theworld, you don't have access to
resources.
You may not know where to go, ifyou'll figure it out that you
need the help, what is the bestway to get access to resources?
Is there like a helpline.
I was watching in February,there's actually a national
eating disorder awareness week.

(37:33):
Is there helplines for otherthings, is there a way to access
resources?

Ashley (37:37):
So you're talking about a NEDA, which is the national
eating disorder association, sothey have actually parent
booklets on their website ortoolkits.
They have parent tool kits, Whatto lookout for, it even goes
through if your kid's gettinghospitalized, how do you talk to
insurance?
How do you get them in?
It's great.
They also have teacher toolkits.
I have had teachers and coachesreach out to me before where

(38:00):
we've come to speak to theschool.
But again, if you're someonethat you don't live in DFW and
you want those resources.
There are other resources onNEDA for people that may be in a
kid's life that are not there.
I am part of, I adapt theinternational association for
eating disorder professionalsand so there is a place where
you can search for people whoare what we call CEDS certified,

(38:21):
which is certified eatingdisorder specialist.
I'm also a certified eatingdisorder specialist supervisor
and so you can search on theirpsychology today.
You can usually type in eatingdisorder specialty to get
resources, for therapists andthen there is another one and
it's called the Texas eatingdisorder association.

(38:42):
It used to be called the Elisaproject, but it's now called
Texas eating disorderassociation.
So if you're in the state ofTexas, they have a lot of very
good resources.
I will put out a plug we're notthe only eating disorder place
in DFW and there are nationaleating disorder places.
So for instance, eating recoverycenter is also in Plano, they
treat kids and adults, Centerfor Discoveries also in Plano,

(39:05):
they treat adolescents andadults.
So if you're in a differentstate there are other national
places that are specific eatingdisorder programs.
Ours is in a children'shospital, embedded in a
children's hospital.
They have residential levels ofcare where people can go for up
to three months and then theyusually do have inpatient,
partial and IOP programs as welland so I would never, deter

(39:28):
someone from seeking thoseresources.
I think we all have a passionfor treating this disorder.
I think we because we're ahospital, we get a lot of very
medically complex kids and whenwe are full, we refer out to
those facilities

Sirisha (39:45):
and we spend a lot of time talking about kids, but you
also refer to adults.
So what should adults be doingdifferently?
What kind of treatment?
How can we help them?

Ashley (39:52):
Adults are a little bit trickier because kids, they
don't have the ability to sayI'm not going to treatment.
They maybe could protest, butthe parent ultimately is able to
sign them into treatment.
I think the biggest thing is tostill involve their family.
So whether.
It's a college aged kid, parentsmay still have some leverage.
They may still be financiallysupporting that kid.

(40:14):
For adults, that are married,the spouses are included.
They still will do familytherapy.
The research on it is a littlebit different, it may not be
quote unquote evidence-basedtreatment, but including the
family and the spouse is alwaysimportant.
And sometimes the children, Iwould say, if you see signs of
an eating disorder, myrecommendation is to see your

(40:38):
pediatrician and, possibly adietician.
The pediatrician will usuallysay, Hey, yes, this is
concerning and then refer you toa dietician to monitor the
weight.
Those are the people who reallyneed to build the meal plan and
be the ones in charge of that,therapists do not do that.
And even our physicians on unit,they're not the ones building
the meal plan, it's thedietician and then also of

(41:01):
course, I would say, see atherapist, bare minimum
therapist and dietician.
For adults, I would say the samething.
You could start with anoutpatient therapist and a
dietician to monitor your weightand make sure it's safe and then
those people will normallyrecognize if a step up in level
of care is needed, where withall the outpatient intervention
it's still not, enough and ifthe person isn't safe, they will

(41:25):
then refer them to a facilityand help you get connected.
Most everyone I know that worksin this field is very aware of
resources because it's such adangerous disease.

Sirisha (41:37):
Actually, this is a very important topic.
There's so much to talk aboutand I'm sure if we spend time,
we could talk about the types oftreatment and inpatient and
outpatient therapy and othertreatments available as we
discuss it.
Is there anything else youwanted to share before I ask you
the final two questions?

Ashley (41:57):
My biggest thing would be, don't be afraid to talk to
your kid.
As part of treating eatingdisorders, we do treat a lot of
kids who, have suicidal ideationor non-suicidal self-injury and
in the education for thosethings, the biggest thing is
don't be afraid to ask your kid,if you think your kid's having
thoughts of suicide orself-harm, you can not hurt them

(42:18):
by asking.
And I would say the exact samething for eating disorders.
You are not going to dosomething wrong by expressing
your concern.
I do think you should go youknow.
gently, but straight at it andbe very clear about what you've
noticed and what your concernsare.
I think, to be very patient andto be very empathic, but to

(42:39):
address it.
And for parents to know it issomething that can escalate very
quickly.
So it's not something that wewant to wait on.
The disease will usually,progress slowly, but then once
it gets going, it's like asnowball downhill.
And so I think parents,oftentimes I hear them say, I
wish I had done somethingearlier, I didn't anticipate it

(43:02):
going south this quickly.
And so just not to be afraid, Ithink in general, as a mental
health clinician, I think we'rereally good at talking about
medical issues, but we're notvery good at talking about
mental health.
People get really squirmy aboutit and uncomfortable and so my
biggest advice would be to tryto put yourself in a good space
to be as comfortable as you canbe and just to be very open

(43:24):
about anything related to mentalhealth and that as calm as
you're able to be, that alsohelps, others.
If they need to disclosesomething to you, they'll be
able to do that, if they feellike it's a non-judgemental and
safe space.

Sirisha (43:38):
That's very important like you said, we do feel
squirmy talking about mentalhealth and asking if someone is
going through an eating disorderissue or having suicidal
tendencies or ideation.
We hesitate to discuss it orbring it up because we think
that will generate the idea,generate the thought.
But what you're saying is, thatis not going to be the trigger.
If you're just going to speak toit, that to find out if there's

(43:58):
some thoughts going on, so youcan catch it early nip it, like
you said earlier on to intervenebefore it starts to escalate
very fast, go out of control atthat point.
Yeah.
So this is a question I ask allmy guests.
What advice would you give you a21 year old self for your career
in life?

Ashley (44:21):
Perseverance, most people have run into something.
I remember mine was grad schoolwas fine, but there's all
there's these 3000 hours youhave to get after becoming a
counselor and sometimes it'sharder to get those.
I remember doubting myself a lotand I wish I adjust and I did
persevere smear.
I am.
But I think just maybeconfidence that it will, if you

(44:45):
love something.
Keep your confidence thatthere's a reason that you
started the process and followit out to the end.
Don't jump ship when it getshard persevere through it,
because, I have a career nowthat we love what we do.
We love our coworkers.
We are passionate about the carethat we give.
And I would hate to think that Icould have missed out on this

(45:06):
just because it was hard for afew years.
Like confidence in your dreams.
Like I know that sounds likevery cliche, but keep going even
when it's hard, if you're, ifyour gut intuition tells you,
this is the thing you'resupposed to do, not as if you
can always defer your career,but that inner knowing follow
that inner knowing that'stelling you, this is what you're
called to and just keep pushingthrough.

Sirisha (45:27):
You're saying believe in yourself and follow your
inner compass because there areother things to be had, like the
relationships, the community,the outreach, just think back,
you're having You did it foryourself, but you are having
this huge impact now in whatyou're doing and even this
discussion we are having, I'mlearning from it.
Hopefully others will get tohear and listen and help
themselves and others as welland just spread the message.

(45:51):
What is the one word you woulduse to describe yourself?

Ashley (46:00):
That's actually very hard to boil that down into one
word.
And I would say bold probably.

Sirisha (46:09):
I can totally see that from what I know of you, which
is good.
So thank you, Ashley.
This was very informative andI'm so glad we got to talk about
this because I have only read alittle bit.
There's a lot of discussionaround it and the most important
thing that I took away from thisconversation.

(46:30):
So a couple of things is it isnot just a physical man
gestation, but really a mentalhealth issue.
And it's separate from theidentity of the person and how
you as a community of family cansupport the discussion that we
are having to enable them toaddress it.
And just talking about it earlyon, like we talked about it
right.
And directly asking them isbetter than thinking that's

(46:50):
going to be the seed of an idea.
Go down that fat.
If they're thinking about it,they've already thought about
it.
There's nothing you by asking,you're going to change that you
might as well address it andhave treatment go through early.
So I'm so glad we got to chatwith you and share your immense
knowledge.
And thank you so much.

Ashley (47:09):
Thank you for having me.
I really appreciateopportunities like this.
I think that this is such adelicate subject that I hear
parents all the time say I wishthere were more resources and so
I think when people like you,invite people like me to discuss
this and you're reaching a wideraudience than I reaching, in the
hospital, I'm just reallygrateful for that.

(47:30):
I hope you enjoyed today'sepisode June and every other
Wednesday to catch the nextepisode.
If you think a friend maybenefit from this, please share
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please like subscribe and leaveus a review on your favorite
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All the resources we talkedabout are also available on my
website, women carrier inlife.com I would love to hear

(47:51):
from you about your stories andyour journey.
You can reach me on my.
Twitter, Instagram or Gmail atwomen carrier in life until next
time, this is Trisha signingoff.
Remember there are infinitepossibilities to drive, change
and carrier in life, which willyou choose to make a reality
today?