Jackie is a psychology doctoral student completing her externship at an inpatient eating disorder treatment facility. She began her journey with us as an intern and now brings expertise to her work with clients struggling with food, body image, and nourishment issues.
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Thanks so much for joining me today, Jackie. Can you tell us a bit about your current work?
Of course, thanks for having me. I'm in a PsyD program—that's Doctor of Psychology—and my training facility this year is an inpatient unit for eating disorders at a hospital. Before I started my doctoral work, I actually began as an intern here at Expansive, which has been an amazing journey.
That's really intense work. Before we dive in, is there anything you'd like readers to know about your perspective?
Yes, I want to preface everything we discuss today by saying that I'm a trainee. I'm speaking from what I've learned in my experience thus far, but by no means am I an expert in this field.
Fair enough. So many of our clients at Expansive struggle with nourishment, feeding themselves, food issues, and body image. Let's start with a foundational question: What's the difference between an eating disorder and disordered eating?
Disordered eating is so prevalent in society. It's embedded into regular everyday conversations, and we see it everywhere. The major difference between disordered eating and an eating disorder is when it starts to impact your functionality. If it's influencing your social world—maybe you're avoiding a social gathering because you're afraid, nervous, or uncomfortable around the eating piece of it—that's significant. Or maybe it's impacting you mentally or emotionally. You're noticing changes in your ability to concentrate or regulate your emotions. Essentially, when it impacts your functionality, that's when it gets into disorder territory.
That makes a lot of sense. And disordered eating can include things like excessive thinking about food, over-awareness, monitoring, measuring. What are some other behaviors you see?
Behaviorally speaking, there can be avoidance of food, which doesn't necessarily need to connect to body image. There are diagnoses like ARFID—avoidant restrictive food intake disorder—which can sometimes come from a phobia. For example, if somebody had a really terrifying choking experience, they might not want to put food in their mouth for fear of perpetuating that sensation.
That's a whole other category I haven't really come across. Most of the time when I'm thinking about disordered eating, it's around body image. Our culture makes this so difficult—we're constantly bombarded with messages. We have to figure out how to live with all of that and develop a good relationship with ourselves and our ability to nourish ourselves lovingly.
Absolutely, yes.
Are there any major misconceptions about eating disorders?
I think one of them is exactly what you said—that eating disorders are only about body image and size. Although they very commonly are about that, I'll take this moment to highlight that within the eating disorder world, there's what's called the HAES model—H-A-E-S—which stands for Health At Every Size. It's an acknowledgement that eating disorders can revolve around body image and size, and they're also about so many other things outside of that sphere as well. There's this classic saying about how eating disorders are all about food and also not at all about food.
That's really interesting. Coming from a ballet background, I knew people with eating disorders, and I count myself as super lucky not to have gotten one. You're growing up in front of the mirror, constantly judging your body and how it's moving and what it looks like. I certainly have awareness—I get grumpy when my pants are too tight, things like that. I can relate to a lot of it and constantly work on the subtle ways I notice it in my life.
Yes, there are. And that actually speaks to another misconception about eating disorders—that these things we feel like are going to be with us forever are not always there forever. This idea that "I've paid so much attention to this and this has been with me my whole life. Who am I without this constant train of thought or this constant concern?" But eating disorders—you can recover from one and go on to live life without being so preoccupied by a lot of these things that feel really weighing on you on a day-to-day basis.
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Let's talk about how you work with someone in your regular clinical practice—not at the hospital, but someone who comes into the office struggling with restricting, binging, or binge-purge cycles. How do you begin to work with them?
I would start by trying to understand what their understanding is of what's going on with them. If someone comes in saying, "I'm really struggling with some sort of disordered eating, disordered thoughts around eating, disordered thoughts around my body," I really try to understand if they know where that's coming from. I want to get an understanding of exactly what those thoughts are. Is it a fear of actual physical discomfort? Because that's sometimes a presentation. Or is it a fear of your body changing in any capacity? It gets really interesting because sometimes you'll see that people really truly believe it's about one thing when, as we dig a little deeper, it actually ends up being about something else or a whole host of other things too.
At Expansive, we have a fair number of trans clients, and the body developing and changing can feel quite traumatic if you don't feel aligned with it.
Absolutely, yes.
I worked for a long time with a client who struggled with a binge-purge cycle. What made it really hard was that it was kind of her friend—a coping mechanism that had been her friend for a long time. She whittled it down to maybe once a month, so she felt it was manageable and therefore kind of okay. I struggled in the work with her, wanting her to have a fuller healing experience.
I think a lot of people think, "Well, I'm only doing it just a little bit," kind of like an alcoholic saying, "I'm only going to do it on the weekends." But it's still this internal shame we're carrying around.
Exactly.
A huge characteristic of eating disorders is that constant preoccupation with thinking about these things, even if you're only engaging in these behaviors every so often. So if we're working with a client who's presenting that way, maybe it's worth asking: "Okay, maybe you're only engaging in this behavior once a month, but how often are you thinking about it? What are you thinking about on a day-to-day basis? Are you waiting that whole month for that day you feel like you get to engage in that behavior?"
That makes me feel sad. Let's touch on the GLP-1 drugs for a minute, because that's such a big thing right now. I think there are positive aspects for some people, but also a lot of other considerations. What are your thoughts?
It's such a tricky topic. It's not a new medication, but the common usage for weight loss has really blown up in recent years, and I think there's still a lot to be learned about it. I think it's really tricky because if somebody starts a GLP-1 when it's medically advised and there are medical benefits to starting the medication at a certain point, there reaches another point where it surpasses that and no longer becomes medically beneficial. In fact, it can actually become medically detrimental and people can become pretty severely undernourished or malnourished.
It's really hard to see where that line exists because it's different for every body and every person. At one point it's medical advice, at another point it's against medical advice. It's just really hard to make that distinction.
I would imagine that for people who have tended to be heavier and then they try this and start losing weight—the attachment to that process, the attachment to being thinner. And we're dealing with body issues, so how thin is healthy thin? How do you maintain that? But I think it is an incredible drug in that it works with the mind. What I've heard people talk about is that they used to constantly think about food, and the drug relaxes that obsessive thinking, which must feel like a miracle for a lot of people.
Yes, the food chatter really just declines.
My last question: If somebody watching knows someone who's struggling with an eating disorder or very disordered eating, how can they support that person? There are different situations—one where you feel someone is struggling but they're not saying anything, and another where they've admitted to it. Like if you're living with someone who binges and purges, how do you support them and take care of yourself?
I don't know if these questions have a perfect answer, but that's such a hard situation to be in as someone who really cares for and loves someone precious and is also witnessing them struggle. That's a really hard situation when someone's struggling with anything, really. But when it comes to an eating disorder, so much of it does change. There is, unfortunately, a lot of shame that surrounds eating disorders. With anything that has a lot of shame attached to the behaviors and the things we're struggling with, it's really hard to confront, and it's really hard to have somebody come to you and ask you to confront it as well.
People can collude by not saying something. If I'm afraid that you have an eating disorder and I'm worried about you, one of the reasons I might not want to say anything is because I don't want to upset you or awaken the shame. But really, so often in these cases, love is leaning in a little bit and saying, "Listen, it seems as though you're struggling with this a little bit. I'm here for you."
I totally agree. Ultimately, what the person chooses to do—whether to seek help or not—does fall on them. In supporting someone to try to get there as best as possible, leaning in with care and respect and love is maybe the best course of action, as opposed to accidentally and unintentionally colluding.
Do you have any final thoughts as we wrap up?
One of the last things I was thinking is that the idea of imposter syndrome is really common in presentations of eating disorders. People might say, "Well, I'm not a certain body shape enough to constitute an eating disorder," or "I only engage in this behavior so many days a week, so I'm not sick enough to have an eating disorder," or "My friend does this, so I don't have an eating disorder either." There's a lot of that discounting and imposter syndrome when it comes to eating disorders.
So maybe one of the last things I wanted to share was that if anyone watching or listening is noticing behaviors or changes in the ways they're feeling or functioning, it's important to check in and maybe seek help. It doesn't have to be going to an inpatient hospital, but maybe just bringing it up with a loved one or asking a couple questions.
Or saying to their therapist, "I think I'd just like to take some time and explore my thoughts about this."
Exactly. Your therapist would love that.
Thank you so much, Jackie. I really appreciate you taking the time.
Of course. Thanks so much for having me.
If you're interested in starting therapy, check out our website to book a free consultation.
Let's talk about how you work with someone in your regular clinical practice—not at the hospital, but someone who comes into the office struggling with restricting, binging, or binge-purge cycles. How do you begin to work with them?
I would start by trying to understand what their understanding is of what's going on with them. If someone comes in saying, "I'm really struggling with some sort of disordered eating, disordered thoughts around eating, disordered thoughts around my body," I really try to understand if they know where that's coming from. I want to get an understanding of exactly what those thoughts are. Is it a fear of actual physical discomfort? Because that's sometimes a presentation. Or is it a fear of your body changing in any capacity? It gets really interesting because sometimes you'll see that people really truly believe it's about one thing when, as we dig a little deeper, it actually ends up being about something else or a whole host of other things too.
At Expansive, we have a fair number of trans clients, and the body developing and changing can feel quite traumatic if you don't feel aligned with it.
Absolutely, yes.
I worked for a long time with a client who struggled with a binge-purge cycle. What made it really hard was that it was kind of her friend—a coping mechanism that had been her friend for a long time. She whittled it down to maybe once a month, so she felt it was manageable and therefore kind of okay. I struggled in the work with her, wanting her to have a fuller healing experience.
I think a lot of people think, "Well, I'm only doing it just a little bit," kind of like an alcoholic saying, "I'm only going to do it on the weekends." But it's still this internal shame we're carrying around.
Exactly.
A huge characteristic of eating disorders is that constant preoccupation with thinking about these things, even if you're only engaging in these behaviors every so often. So if we're working with a client who's presenting that way, maybe it's worth asking: "Okay, maybe you're only engaging in this behavior once a month, but how often are you thinking about it? What are you thinking about on a day-to-day basis? Are you waiting that whole month for that day you feel like you get to engage in that behavior?"
That makes me feel sad. Let's touch on the GLP-1 drugs for a minute, because that's such a big thing right now. I think there are positive aspects for some people, but also a lot of other considerations. What are your thoughts?
It's such a tricky topic. It's not a new medication, but the common usage for weight loss has really blown up in recent years, and I think there's still a lot to be learned about it. I think it's really tricky because if somebody starts a GLP-1 when it's medically advised and there are medical benefits to starting the medication at a certain point, there reaches another point where it surpasses that and no longer becomes medically beneficial. In fact, it can actually become medically detrimental and people can become pretty severely undernourished or malnourished.
It's really hard to see where that line exists because it's different for every body and every person. At one point it's medical advice, at another point it's against medical advice. It's just really hard to make that distinction.
I would imagine that for people who have tended to be heavier and then they try this and start losing weight—the attachment to that process, the attachment to being thinner. And we're dealing with body issues, so how thin is healthy thin? How do you maintain that? But I think it is an incredible drug in that it works with the mind. What I've heard people talk about is that they used to constantly think about food, and the drug relaxes that obsessive thinking, which must feel like a miracle for a lot of people.
Yes, the food chatter really just declines.
My last question: If somebody watching knows someone who's struggling with an eating disorder or very disordered eating, how can they support that person? There are different situations—one where you feel someone is struggling but they're not saying anything, and another where they've admitted to it. Like if you're living with someone who binges and purges, how do you support them and take care of yourself?
I don't know if these questions have a perfect answer, but that's such a hard situation to be in as someone who really cares for and loves someone precious and is also witnessing them struggle. That's a really hard situation when someone's struggling with anything, really. But when it comes to an eating disorder, so much of it does change. There is, unfortunately, a lot of shame that surrounds eating disorders. With anything that has a lot of shame attached to the behaviors and the things we're struggling with, it's really hard to confront, and it's really hard to have somebody come to you and ask you to confront it as well.
People can collude by not saying something. If I'm afraid that you have an eating disorder and I'm worried about you, one of the reasons I might not want to say anything is because I don't want to upset you or awaken the shame. But really, so often in these cases, love is leaning in a little bit and saying, "Listen, it seems as though you're struggling with this a little bit. I'm here for you."
I totally agree. Ultimately, what the person chooses to do—whether to seek help or not—does fall on them. In supporting someone to try to get there as best as possible, leaning in with care and respect and love is maybe the best course of action, as opposed to accidentally and unintentionally colluding.
Do you have any final thoughts as we wrap up?
One of the last things I was thinking is that the idea of imposter syndrome is really common in presentations of eating disorders. People might say, "Well, I'm not a certain body shape enough to constitute an eating disorder," or "I only engage in this behavior so many days a week, so I'm not sick enough to have an eating disorder," or "My friend does this, so I don't have an eating disorder either." There's a lot of that discounting and imposter syndrome when it comes to eating disorders.
So maybe one of the last things I wanted to share was that if anyone watching or listening is noticing behaviors or changes in the ways they're feeling or functioning, it's important to check in and maybe seek help. It doesn't have to be going to an inpatient hospital, but maybe just bringing it up with a loved one or asking a couple questions.
Or saying to their therapist, "I think I'd just like to take some time and explore my thoughts about this."
Exactly. Your therapist would love that.
Thank you so much, Jackie. I really appreciate you taking the time.
Of course. Thanks so much for having me.
If you're interested in starting therapy, check out our website to book a free consultation.
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