Treatment for Eating Disorders - Sabino Recovery

A Wise Mind Presented By Sabino Recovery S1 Ep5

Podcast, host Sam Zimmer is joined by Dr. Laura Riss, a clinical psychologist, practicing out of Atlanta, GA, specializing in areas of eating disorders and survivors of abuse and trauma. The two discuss eating disorders and the intersection between trauma and eating disorders.

Dr. Laura M Riss, PsyD Bio:

Dr. Laura Riss is a licensed clinical psychologist practicing in the Atlanta area both in private practice as well as the Eating Disorder Clinical Lead for a multi-disciplinary team at a medical establishment. Dr. Riss has developed specializations in the areas of eating disorders and survivors of abuse and trauma specifically adult survivors of childhood abuse as part of her lifelong dedication to treating women’s issues. In addition, she works with individuals presenting with mood and anxiety disorders, relationship difficulties, chronic illness, as well as developmental concerns related to the college student population. As part of a multi-disciplinary approach in treating individuals presenting with eating disorders, Dr. Riss has developed and run an art therapy-based group for the past 15 years. Specifically, she has supported group members in finding their voices through creative outlets and won several awards for group submissions in the “Imagine Me Beyond What You See” mannequin art contest sponsored by the International Association of Eating Disorders Professionals. The mannequin art reflects the women’s experiences of eating disorder recovery, their perception of beauty, identity, and body image. Dr. Riss has worked in a range of treatment settings from inpatient to partial hospitalization, intensive outpatient, college counseling centers, and private practice. She graduated from Nova Southeastern University where she received her Doctor of Psychology and earned her Master’s in psychology from NYU. Prior to that, she attended Purdue University, graduating Magna Cum Laude, with a Bachelor of Arts degree in psychology. Dr. Riss completed her internship at Indiana University Counseling and Psychological Services and then went on to complete her post-doctoral fellowship at the University of Georgia Counseling and Psychological Services with areas of concentration in eating disorders and trauma.

Episode Transcript:

Sam Zimmer: Welcome to A Wise Mind podcast presented by Sabino recovery. You guys know me at this point, my name’s Sam. And today we have the pleasure of being joined by Dr. Laura Riss. She’s a clinical psychologist who practices in Atlanta, Georgia, and we are really excited to have her on today because Dr. Riss has really dedicated her work to exploring women’s issues as a whole, but more specifically abuse and trauma. And you know, more specifically than that,  adult survivors of childhood trauma, but what to today, what we’re gonna be talking about is eating disorders. Cause she does have a wealth of knowledge in that area as well. And a lot of times, um, Dr. Riss, those two things can kind of play off of each other, can’t they?

Dr. Laura Riss: Absolutely. Yes. And. Is it my turn to talk now?

Sam Zimmer: Yeah. You have the floor

Dr. Laura Riss: Yeah, no, I think this is a really great topic. And, what I’ve noticed when people come into the office, looking for help with eating disorders is that oftentimes there’s a misconception that the eating disorders have to be treated separately from what people will call mental health conditions.

So I spend a little bit of time explaining that eating disorders are interwoven. You can’t really separate out treating anxiety or trauma from the eating disorder because the eating disorder is not about the food. The food is involved, the way the body image is involved, but they’re usually symptomatic of deeper, underlying triggering and maintaining variables.

And so from my point of view, perspective, and training, where the therapy takes place is that we’re looking at what the function of the eating disorder symptoms are. Particularly as a coping mechanism. Not great coping mechanisms, however ones that have been effective and destructive.

Sam Zimmer: Right? Yeah. And, and for me, I’ve learned a little bit about eating disorders during my time with Sabino Recovery. I’m in recovery myself, but it’s from substances. So, I’ve learned that there are some similarities between behaviors, but obviously it’s a whole different ballgame. Because you know, you can find drugs on somebody, right. But with eating disorder, it’s what are those behaviors? What are they hiding that, you know, there’s not gonna be like physical proof about, does that make sense?

Dr. Laura Riss: Yeah, right. And I think sometimes there is a physical proof if one’s in tune to the level of emaciation or obesity, but those are often masked by society’s approval for the thin body ideal and society’s prejudice against people in larger bodies. So as a society we aren’t very in tune with what is going on with eating disorders. 

Sam Zimmer: Yeah. And that’s why we have you here on the podcast so that you can start to educate some people. I’m really excited to learn more about this. So what are some ways that, you know, when somebody does go through childhood trauma or maybe something that happened later on in their life, how can some of those things affect eating and trigger an eating disorder?

Dr. Laura Riss: So I, I was like, what is trauma? Cause I’m like, let me look this up. if you look at certain definitions of trauma, if you look at it, according to the DSM, it talks about either witnessing or direct threat to life or integrity of sense of self or a threat to the life of somebody else. Uh, I think trauma though can be other, other experiences that are a threat to sense of integrity, such as sexual harassment, bullying, things that often get minimized. And I think we minimize them to ourselves and don’t understand the impact and the gravity. So traumas are often experiences, whether they’re extremely intense and we don’t have enough resources to adapt to them or cope with them. Um, or simply just so intense. They’re beyond that, of the extra extraordinary experience. Um, and then trauma can be things that seem a little bit more subtle or low grade, if you will, for prolonged periods of time, like bullying, coercive situations, um, sexual harassment in which the system eventually collapses out and causes a lot of dysregulation.

But in my mind, a traumatic experience is something that leads to a lot of dysregulation with emotions, dysregulation with embodied experience, and dysregulation with cognition. Particularly like childhood trauma, prolonged childhood trauma, sexual abuse, and physical abuse. The earlier trauma starts, the more likely there’s gonna be dysregulation and then the occurrence of PTSD, other traumatic trauma-based disorders, and then eating disorders as a way, and a coping mechanism. whether it’s eating disorders or other addictive processes,

Sam Zimmer: Yeah. I’m just sitting here wondering, so like, is there anything special about the types of trauma that lead to an eating disorder?

Like for example, right. If I can, it makes sense in my head it’s logical. If somebody was teased for being overweight when they were a child, is that something that leads to an eating disorder, or is it any kind of trauma, like you said, like sexual harassment and stuff like that. I’m just trying to get an understanding of like, is there a certain type of trauma that leads to an eating disorder?

Does that make sense?

Dr. Laura Riss: Yeah, it does. And so it can be any type of trauma. There is literature on sexual abuse. So there have different studies have found about 30% of individuals presenting with eating disorders have a history of sexual abuse.

Sam Zimmer: Okay.

Dr. Laura Riss: Um, and then there can be discrete events like natural disasters witnessing that being car accidents, life-threatening experiences.

They can also lead to eating disorders as a function of perhaps trying to assert control. So eating disorders give a false sense of control. Let me focus on managing my weight, focusing on my body image, and all those thoughts that go along with it almost serve as distractors to the traumatic event.

Sam Zimmer: Got it. So it’s less about like the trauma specifically and the nature of what happened. It’s more about these people just wanting to regain control or some sense of control over their own lives. And this is just the way that they’ve chosen, how to do that.

Dr. Laura Riss: So in certain circumstances, right? Like, um, in other circumstances it can be far more complex, right?

Like when, in situations of sexual abuse, uh, the disorders can serve as a metaphor for both perpetrator and abuse victim in the way that the symptoms play out. And it’s like a recap recapitulation of the trauma itself.

Sam Zimmer: Okay. And in your work, have you found that there is any specific type of treatment modalities that you use to aid somebody who has trauma from an eating disorder or excuse me, an eating disorder resulting from a trauma. Is there anything, anything special that you’ll do with an individual like that, that maybe you wouldn’t for somebody without an eating disorder?

Dr. Laura Riss: Well, always a multidisciplinary team approach, right? Because I’m just the therapist I just know the therapy component. And at that I know only certain treatment modalities, right?

We’re always learning and growing. Um, I love my dieticians. They are incredible. And a dietician who has training in eating disorder treatment is particularly powerful, cuz it’s not about telling someone how to eat. So if you think of like control, that’s not gonna go over well, it’s often meeting the person where they’re at and making tiny, incremental steps.

So we need someone to help address the possible nutritional deficits, help find balanced eating, and there’s a therapeutic component. Sometimes there’s gonna be, uh, interaction with a psychiatrist. Often PCPs I’m concerned about labs, and physical functioning. There is a high correlation of physical illness, autoimmune disorders, digestive problems, and migraines; the whole slew of physical complications that can also occur. So trauma impacts all domains: the mind, the body, the emotions, the spiritual components. All these are really important to be addressed. And so a multidisciplinary team approach in my opinion is the best way to go.

Sam Zimmer: Gotcha. Yeah. I’m just thinking about like, you know, we have a lot of parents who listen to our podcasts, right. And, you know, mm-hmm, a lot of times I’m sure people run across their loved one, their daughter, their son, whatever the case may be. You know, they’ve noticed certain things that this, this person might be struggling with eating. They might be restricting, they might be binging, purging, all kinds of things. And those people really are holding onto that control, but like you said, small incremental changes. So what can somebody who maybe isn’t, you know, a licensed clinical psychologist like yourself, maybe like a mother or a spouse of one of these people, what are some ways that they can try to start that process of getting that loved one some help?

Dr. Laura Riss: That’s a good question. It’s not always fun to confront your child, especially a teen. Right? Right. A lot of times people that are experiencing disorders become very defensive and reactive cuz they’re being called out on something. That’s often very shame-based, particularly if there’s a trauma component, shame is integral; shame and disgust.

So I think, but I think also just an honest expression of concern. This is what I see. They’re not gonna like it. Reaching out. So I’ve had a mother recently reach out to me and she is trying to, you know, find the balance of expressing concern, but also giving her daughter some space. Like she knows that hovering isn’t gonna help out much, trying to tell her what to eat and how to eat isn’t gonna help much. On the other hand, ignoring it definitely doesn’t help.

So I think one of the best things is just trying to meet it with compassion. And ask questions, try to understand. The person, the teen, and the child may not understand fully what’s going on. Cause remember, their prefrontal cortex is not fully formed. Um, it also may be just simply hard to articulate. Um, I think having that, the ability to have an open dialog.

And then seeking, seeking treatment for their child and then, and also being open to feedback, family therapy. I think that’s also very difficult. I’ve had parents feel distressed when talking about some behaviors that may be triggering for their children. Uh, and I can understand that they’re doing the best they can with what they know and the resources they have and just understanding that it’s not about, I think a lot of times people, parents blame themselves, right? Like I did something wrong. It’s more a function of, um, the child’s resilience, um, genetic predispositions, temperament stressors, and again, stressors could be tests at school could be peer stressors could be a, could be a traumatic or traumatic events. So it’s more about the interpersonal dynamics than it is about like pointing fingers. Certainly from my perspective.

Sam Zimmer: Okay. Thank you for that. And you brought up, um, genetics, which was another thing I was wondering, cuz you know, I identify as an addict, you know, substance abuse, recovery. Um, and I know that there’s a genetic component to my level of predisposition for that. And I also know that there are a lot of similarities between, you know, addiction and like eating disorder behavior as far as like impulsive nature of it. So is there a genetic predisposition to having an eating disorder?

Dr. Laura Riss: Absolutely. So I think like most things there is like what’s called the diathesis-stress model where we, we all have these, we have the chromosomes, we have the genes for certain expressions. So we have the genotype. The phenotype is not the expression of. The characteristics does not necessarily manifest unless conditions are right.

Which could be the stressor. And again, stressors can range. They can be just depending on what, how the system is taxed, they can range. I think it’s like maybe what, 30%. It might be more than that. I don’t know the statistics. Um, but there are genetic predispositions, the specific chromosome genes are not yet identified. There’s also that with, um, trauma, right. A genetic disposition.

Sam Zimmer: Yeah. That’s something that, um, is interesting to me cuz I knew obviously with the compulsive nature of, you know, substance use and eating disorder. You know, there’s gonna be some carryover between the two of ’em as far as like similarities with genetic predisposition, but the trauma piece, I always just thought that, you know, that’s something that happened to you, you know, it’s more of a, a learned trait, if you will and not something that you’re born with.

Dr. Laura Riss: Right. I think it comes down to like those, just the predispositions of how we’re gonna handle things. Um, and there there’s a lot, there is research that really shows the profound effect of genetics as far as, uh, intergenerational patterns. So there’s research that has been done on Holocaust survivors and for generations, there are changes down to ATP in the mitochondria of children of survivors, and that’s the energy source to ourselves.

So changes take place on a cellular level, then you are right. We interact with our environment. So because of neuroplasticity, the ability to learn and adapt, we are changing. The environment changes our brain. The good news is we can do things to promote healing in our, in our brain centers.

So there’s a lot of new research that’s coming out all the time that speaks to this very good question.

Sam Zimmer: Yeah, no, and there’s a lot of research, a lot of great treatment, especially for eating disorders. One thing I learned recently is that in a treatment setting, an eating disorder as an issue has the highest mortality rate.

Dr. Laura Riss: Absolutely. That is correct.

Sam Zimmer: And that’s more, I guess, for, you know, individuals who need more stabilization, right. And maybe they’re not diving as much into like the trauma, you know, as we do here at Sabino, but, um, just hearing that was just kind of like a smack to the face. It’s like, this is something that, you know, up until recently, I wasn’t aware it, it was affecting people in our country to the level that it is.

Dr. Laura Riss: It’s serious. I’m sorry. I’m just like, it’s serious. And like recently also I’m talking to other providers, um, mental health provider that, that were surprised, taken aback when I’m like eating disorders, have the highest mortality rate. Yes above that of schizophrenia or other, other diagnoses that we consider on the more severe end of the continuum.

And that’s for many different reasons. I think one is that, uh, whether it’s restriction or the purging, like can really cause a depletion in electrolytes, which can lead to heart failure. Um, and there are many other, I mean, there are many others. I won’t go into the details of the medical complications, but there are many yeah. And very, yeah.

Sam Zimmer: Yeah. And I, you know, I’m asking questions as much for our listeners as I am for, for myself, cuz this is kind of a, a topic that I feel like I, I should know better. You know, maybe it’s not the right way to view it in uh, juxtaposition to like substance abuse issues.

Right. Um, can you speak to that? Like how are those two, um, I guess, areas different and how are they similar? Is that something that you can speak on?

Dr. Laura Riss: I can speak a little to it. So substance abuse is definitely not an area that, that I specialize in and I’ve thought about this and I’ve talked to colleagues. I’m like, something feels very different. I know that a lot of eating disorder behaviors, um, hit the reward center, much like addictive processes.

Um, and yet there’s something that feels different. One of the main components is you have to eat to live. Right. So you can, in theory, abstain from substances, we hope that you can for recovery. Um, and I get everyone’s recovery is different and everyone’s path is different but individuals with eating disorders are faced hopefully multiple times a day with feeding themselves, finding nutrition, and getting it into their bodies, which triggers any number of psychological, emotional, and physical reactions.

Sam Zimmer: Yeah, I guess that’s where I get a little bit confused because, and that’s the probably why it’s not the best things to compare, even though there are some similarities cuz with substance abuse, you know, um, I’m consuming something that is bad for me. And then with folks, with eating disorders, the fact that they aren’t consuming what they need, that’s good for them.

So I always just kind of wondered about that. Cuz when I would use drugs, it was to self soothe and self-medicate and I’ve also heard you know, folks with eating disorders are restricting intake for the same reasons, but I just wondered, well, what could be, what is so soothing about that? I get the control aspect of it, but maybe there’s something I’m missing.

Dr. Laura Riss: Yeah. And so I think since soothing is definitely something in common, right? Whether it’s restricting to, um, restrict emotions away, binging is also self-soothing. You’re shoving emotions down you’re numbing out, uh, binging is, can feel rewarding and pleasurable also starvation can feel pleasurable at certain points, endorphins start hitting the brain and people kind of get high off of this, um, purging isn’t so much that, but there is a release and a relief when, um, the food is, is out of the system, whether it’s for these fear of weight gain or oftentimes it can be a metaphor of releasing the trauma, purging the trauma, purging the shame that disgust that they’re holding in their bodies. So self-soothing is a big component, right?

Sam Zimmer: Yeah, I guess. Yeah, no, that makes a lot more sense. And I know obviously binging is, is under the umbrella of eating disorder too, but I just, I’ve had a hard time understanding. You know, the restriction, the purging aspect. Um, but I think what you just said makes a lot of sense. I had no idea that, you know, there’s, um, a certain feeling, a positive feeling that you get at a certain level once you start to, you know, restrict your intake, um, after a certain point.

So thank you for enlightening us. Um, going back to trauma though a little bit, um, You know, obviously we know that eating disorders oftentimes are a result of trauma. I was just wondering if you could kind of delve into that a little bit more. I know that we talked previously about how, you know, sexual harassment and assault and stuff like that are some of the main traumas that will proceed in an eating disorder.

Um, But I guess there’s a little bit of confusion, at least on my end, as far as like how that process takes place

Dr. Laura Riss: The relationship with trauma. So I’m thinking, I could be off on the statistics, so, but the idea is. Um, as far as trauma, there’s a correlation as for anorexia restricting type of more, um, physical abuse.

And, um, as far as anorexia binging and purging or bulimia, there tends to be a higher percentage of sexual abuse, childhood sexual abuse associated with, along with binge eating disorder. And then the symptoms can be seen as a function of the trauma. As we mentioned, it could be self-soothing.

We could want to. I wanna restrict these emotions away because I am, I am experiencing something that’s threatening. That’s horrible. That’s beyond the capacity that I have to cope. That’s overriding. Right? My autonomic nervous system is our survival system and it goes straight into fight or flight.

And eventually, it collapses into depression and there is hopelessness, helplessness, powerlessness. Voicelessness when these things occur. So eating disorder is a way to find a voice. A lot of times I’ll ask, what are you saying with your eating disorder behaviors? People are communicating their level of distress.

Oftentimes there’s not a great response. If someone is able to speak about, uh, trauma, the traumatic incident. There’s failure in their environment to adequately protect, there’s minimization. And sometimes there’s downright denial. So restriction also can be about wanting to disappear. If I disappear, this isn’t gonna happen.

Um, binging can be about shoving things down. With trauma, there’s often the experience of avoiding a loss of sense of self or not even development or integration of sense of self, depending on where it has happened in the spectrum of the lifespan. Uh, it, it is often used as a way to, I’m gonna put on weight in hopes that you will, I will no longer be attractive to you and you will not perpetrate on me.

So the binging and the weight can be seen as a defense and a survival mechanism. And the purging, as I mentioned earlier, is sometimes that reenactment of trying to get rid of these distressing embodied experiences. Right? So eating disorders are in some ways a disorder of disconnect. I’m trying to just disconnect.

I don’t wanna be in my body. I don’t wanna experience the emotions. I don’t wanna experience these physical sensations. So when I’m engaging in the eating disorder, I am not connected. And there’s a level of dissociation with eating disorders and behaviors. The eating disorder takes you away from these distressing emotions in, in varying ways.

Sam Zimmer: No, I think you were right on point with that, you covered a number of different types of eating disorders and why those certain behaviors, uh, or I guess how those certain behaviors have benefit to those individuals. Um, a lot of those examples you used were things that I never even had thought of.

And it kind of got me wondering a little bit, um, You know, obviously someone with an eating disorder, they might, um, be binging or they might be restricting. Does it have anything to do with appetite? Like, is it like I’m triggered by my trauma and now I’m not, I just don’t want to eat. I’m not hungry physically, or is it more of a conscious decision of like the control aspect that we were talking about before?

Dr. Laura Riss: I think it can be both. Right. Because again, if we think about the way that we’re wired, we are embodied people, right? Like if you, um, think about. A stressful situation. I was thinking about the podcast. I could feel my sympathetic nervous system revving up.

I could feel my heart rate increasing. I could feel a little sweating. My thoughts were kind of going in anticipation. So I dropped into breath work to help down-regulate. But when the sympathetic nervous system is activated, particularly when it’s in fight or flight, Um, digestion is impacted. So, it shuts down because all reserves are going to survival mode.

And then when it gives way to the depressed, the more depressed state, which is the freeze. So fight, flight, and freeze are survival response mechanisms. So it often then gives way to freeze and you’re immobilized. You’re not functioning. So definitely impacts the appetite as do many like depression, and anxiety, all of these are interconnected with our physical symptoms.

Sam Zimmer: I don’t know if I believe that you were that nervous, cuz it certainly seems like you’ve done this many times before but if, if you were in that free state, I just thank you so much for not going to the flight state and not wanting to do the podcast . Thank you so much, Dr. Riss. Um, this has been really helpful to me and hopefully helpful to some of our listeners.

I always say that the things that you talked about, you know, the wise words and the education that you brought even helps a handful of people, you know, that’s really why we do this. So thank you so much for your time. And, um, you know, hopefully, we can have you on again in the future.

Dr. Laura Riss: Absolutely. And just one other thing, as far as like, you know, therapy in an ideal situation, you know, you can do some talk like people can do what’s talk therapy, which is a top-down processing. So you’re, you’re dealing with a lot of the cognitions. I’m also a fan of what’s called bottom-up processing, trying to get in and do the experiential work.

And so using creativity. Like yoga. I know Sabino has a lot of different treatment modalities like art therapy. Creativity is one of my favorites. I am not an artist. I am not an art therapist, but I use a lot of those techniques because it taps into the more visceral, um, component and gets more of a, like, it gets that connection up of the physical and the emotional to the brain, to the thoughts. So we want to try to create and support the integration of all of them in a balanced, paced way for the trauma survivor that has an eating disorder.

Sam Zimmer: Yeah, actually, so our, our art studio is just across the way here and I’m at right now is what we use as our music room. So we have instruments and all kinds of cool things in here, mixing board, uh, we even have a Sabino recovery SoundCloud account, along with guitars keyboards drums. So we definitely agree with what you just said and we try to expose our residents to all types of kind of creative outlets like that too. So I’m glad you said that.

Dr. Laura Riss: That is very cool. I just got goosebumps when you said that, because that is just so important. And often what’s missing in, in private, the private practice. It’s just harder to call all these resources and bring ’em to bear.

Sam Zimmer: Yeah.

Dr. Laura Riss: So thank you

Sam Zimmer: Of course. And thank you again so much for joining us and, um, yeah, until next time, hopefully, like I said, we can have you on here again.

Dr. Laura Riss: That’d be wonderful.

Sam Zimmer: All right.