Transcription:
The Road to Recovery: An Overview of Eating Disorders and Treatment Options

Cheryl Martin: Are you worried that a child or loved one may have an eating disorder or you are secretly engaging in unhealthy eating habits to keep your weight under control? Well, coming up next, a closer look at eating disorders and how to overcome them.

This is my Maimo Med Talk. I'm Cheryl Martin. And with me this episode is psychiatrist, Dr. Carlisdania Mendoza, with the Maimonides Community Mental Health Center. Doctor, I'm so glad you're on to discuss this important topic.

Dr. Carlisdania Mendoza: Thank you so much for having me, Cheryl. I'm excited to talk to you and your audience about eating disorders today.

Cheryl Martin: So, what are the most common eating disorders?

Dr. Carlisdania Mendoza: I like to think about eating disorders from what we call a transdiagnostic approach, and it actually focuses on what do they have in common. And the most important feature of eating disorders, which I consider to be cognitive disorders, is that self-evaluation or self-worth is unduly influenced by the person's weight or body shape. And so while most people can have some level of dissatisfaction with their body, and this is quite common in modern society, certain people and individuals mainly base their sense of worth on their body and their weight and go through very, very extreme lengths to try to control their weight.

And so when we talk about the most common diagnoses, these would be anorexia nervosa in which the person controls weight by extreme restriction, sometimes starvation, prolonged starvation; bulimia nervosa in which a person has episodes of binge eating, which can be followed by vomiting or use of laxative in order to get rid of excessive calories. And the other more common eating disorder is binge eating disorder where the person can have these episodes of binge eating, usually after diets or trying to restrict, they feel unable to stop eating for certain periods of time.

Cheryl Martin: You talked about a connection with body image and self-worth. To what extent does social media play in this when we have more images through TikTok, Instagram, Twitter? Have we seen an uptick, let's say, with eating disorders?

Dr. Carlisdania Mendoza: Well, actually, eating disorders have been around for a really long time, dating back to 3rd, 4th centuries. Anorexia was first described by that name in the 1600s. So, they're not quite a modern phenomena. But as you pointed out, we are bombarded with this idea of perfection and of looking perfect, of portraying ourselves in a certain way on video, on Instagram. And so, this can lead to an increase in body dissatisfaction and certainly an increase in what we call diet culture with individuals making attempts to control the way they look.

And we have seen in the last few decades an increase in diagnosis of eating disorders. But we think that that's more related to decreased stigma and more people being more willing to talk about it, and us as a society and even as a field in psychiatry paying more attention to people's eating habits and disordered eating.

Cheryl Martin: So for a parent or a friend, what would be some of the red flags to them that would indicate an eating disorder, some early indicators?

Dr. Carlisdania Mendoza: I'm glad you asked that question because it's very important to detect disordered eating behaviors early. The earlier we detect them, the easier it is to treat and the better the prognosis, which is how well the person will do.

And so, the things to look out for in ourselves or friends, family, in our children are extreme restrictions. So after a period of maintaining weight, losing weight in a short period of time, not eating. So, people might make excuses to not sit at the dinner table, and try to distract others from not noticing that they're not eating. Those are big things. Sometimes if you notice that your child or friend always goes to the bathroom after a meal, that could be concerning for purging behaviors. And more globally, in general, if people are talking a lot about their weight, talking critically about themselves, weighing themselves often, body checking, spending lots of time looking at themselves in the mirror, those are the things to look out for as concerning signs that there could be an eating disorder at play.

Cheryl Martin: Have you found that the longer a person has had an eating disorder, that they're not able to see themselves clearly as they are? So, they may be, let's say 70 or 80 pounds, but they don't see themselves as severely underweight?

Dr. Carlisdania Mendoza: Absolutely. So, this is the core feature of anorexia nervosa, is despite the person having a very low weight to the point where they might have needed medical intervention, medical hospitalization, despite these consequences, the person continues to be obsessed with restricting their eating and continues to be obsessed with losing more and more weight.

Cheryl Martin: So when they look in the mirror, they don't see themselves clearly?

Dr. Carlisdania Mendoza: It's a little bit more complicated than that. I think many patients with anorexia nervosa, part of them can see that their body is small and they don't necessarily feel that their body looks good when it looks so small, yet they have a difficult time letting go of the control of weight. And so, it's much less about the way it looks reflected back to them, and it's much more about using control of weight as a way to deal with stress or interpersonal distress, to the point where it could erode healthy relationships and make the person become very isolated and kind of lose a sense of what is healthy.

Cheryl Martin: Is there a particular age group or gender that's most at risk?

Dr. Carlisdania Mendoza: Definitely, we see that eating disorders that are much more common among women, and this is especially true for anorexia nervosa, where it's about 10 times more likely to be diagnosed in women or young girls. Usually, it starts to develop in adolescence. So, it can be as early as 11, 12, 13, 14 years old. And more commonly, they're diagnosed in the late teens, early 20s. But they can develop at any age really.

Cheryl Martin: How serious are eating disorders and how do they impact one's health in the long run?

Dr. Carlisdania Mendoza: They're incredibly, incredibly serious. And there's a lot of information out about how being overweight or being large impacts your health. But actually, being underweight can be even worse for you and more serious in the short term. And so, patients who aren't eating enough to meet their nutritional needs can be at risk for a host of problems, the most serious being abnormal heart rhythms that can lead to their death or things more chronic in the long run, like having weak bones or osteoporosis. Those are from the most extreme to something that's a little more common.

Cheryl Martin: So, at what point should a person seek medical help or their loved ones encouraging them? When should that happen?

Dr. Carlisdania Mendoza: Ideally, that would happen as early as possible. Even if you may have a little bit of a concern that something is going on, it's best to address your family member, friend, your child from a non-judgmental point of view, and share what you're concerned about. Stay away from labeling their body or calling them names. And be mindful to not be critical of other people's bodies. But if you are concerned, open up the conversation about how they're feeling about themselves or that you've noticed that they haven't been eating. And at first, it's okay to introduce the person to the idea of just seeing a psychiatrist, of getting some mental healthcare in general and open up the conversation that way. For someone who's severely malnourished, who's very, very small, who you're more imminently concerned about, then the best way to approach that is to bring someone to the emergency room and have them medically evaluated.

Cheryl Martin: What if the person resists all your attempts to reach out?

Dr. Carlisdania Mendoza: Well, like anything else, if you're very, very concerned, there are resources available to us here in New York, like calling Mobile Crisis Center who can evaluate and make recommendations for the person. But most likely, what will be helpful is, again, taking that non-judgmental approach, not quitting, and continuing to try to speak with the person, share your concern and try to show that you are trying to help, and helping that person get the care that they need. The most important part is to not give up and to continue to try to get them to help.

Cheryl Martin: Dr. Mendoza, are there treatments and approaches that are effective?

Dr. Carlisdania Mendoza: Absolutely. So, sometimes eating disorders gets stigmatized as disorders that can be incredibly hard to treat. While this is true, there are treatments that are available and it depends on what eating disorder the person has, what behaviors they're engaging in.

And so for someone who is having trouble eating and maintaining body weight, usually, they can be a part of a residential treatment program where their mealtimes can be observed, they can meet with a dietician, they can get group therapy, 24/7 monitoring by nursing staff. And for people who are less severe, maybe engaging in some purging behaviors and binging, they can be treated on an outpatient basis with either some medications which can be used to treat illnesses that co-occur with eating disorders like depression and anxiety, and with several different psychotherapeutic techniques, including cognitive behavioral therapy, which has been shown to be very helpful for bulimia nervosa and binge eating; interpersonal therapy, psychodynamic therapy or family-based therapy, which is particularly helpful for children who have eating disorders.

Cheryl Martin: So, there are success stories then of those who were seriously engaged in eating disorders and they were able to turn the page and return to a normal, healthy eating regimen?

Dr. Carlisdania Mendoza: Absolutely, absolutely. There's a lot of hope and it fuels really my passion and interest in eating disorders. I can think of a young female patient I had during my residency training that was engaging in purging behaviors on a daily basis, throwing up after dinner, secretly hiding it from her friends and family. And through cognitive behavioral therapy, she was able to stop the behaviors and identify that her purging and her vomiting was very closely linked to a traumatic experience that she had in adolescence. And once she was able to make the connection and enrich her life and relationships and decrease her sense of shame around her experience and around these behaviors, she was able to achieve remission from bulimia.

Cheryl Martin: Well, what are some healthy strategies to nourish our bodies so we don't get to that point? In other words, what can parents do to help their children develop healthy eating behaviors?

Dr. Carlisdania Mendoza: Well, I'm glad you asked that because eating is important, not just in the context of eating disorders, but just in general, in order to maintain a healthy life, right? Food is medicine. Eating is how we take care of our bodies. And so, taking a healthier, non-judgmental approach to managing your eating can be very helpful, not only for people with eating disorders, but for everyone. Trying to reduce stigma around weight can be very helpful. And the key thing to remember is that weight is only one piece of the health puzzle, and there are many other things that are important in fitness and longevity and overall wellbeing.

Cheryl Martin: Do you recommend that the parents talk to their children about self-image?

Dr. Carlisdania Mendoza: Absolutely. Absolutely. And especially as you mentioned with the social media conversation, and social media being so prevalent actually gives us an opportunity to speak with children about what they see, how they're seeing it. And although they are getting so much influence from the media that they consume, the most influential environment is the environment in the home. And so, modeling healthy behaviors, healthy relationships with ourselves, with our bodies is the best way to help prevent some of these issues from developing and also, once they develop, help prevent them from getting worse.

Cheryl Martin: It's obvious that you are passionate about this topic. So, what led you to pursue a career as a psychiatrist with this area as one of your specialties?

Dr. Carlisdania Mendoza: I was actually very interested in how people develop a sense of self. And I linked up with a researcher at UT Southwestern Psychiatry Department, Dr. Carrie McAdams, who was studying sense of self as it related to eating disorders. And I just became so interested in how eating disorders develop and how managing identity and enriching relationships and developing a healthy sense of self is key in helping people heal from the damage that eating disorders can cause.

Cheryl Martin: That's great. Well, Dr. Carlisdania Mendoza, thank you so much for educating us on eating disorders and also what recovery can look like. Very, very helpful.

Dr. Carlisdania Mendoza: Thank you for having me.

Cheryl Martin: To make an appointment, call 718-283-7864. That's 718-283-7864. And for more information, go to maimo.org. That's M-A-I-M-O.org. If you found this information helpful, please share it with others on your social media and thanks for listening to my Maimo Med Talk.