Called to Flourish Podcast: Eating Disorders

0:09Welcome to the Call to Flourish podcast sponsored by Divine Mercy University. My name is Thomas Cronquist. I'm the cohost with father Charles Sikorsky, the president of Divine Mercy University. Father Charles, how are you today? Tom, I'm doing great. How about you? Very good. Very good, father. We have a very interesting podcast scheduled for this afternoon. We'll be speaking with doctor Frederica Vyblechka, the director of our counseling program here at the university, on a very important topic, eating disorders. Doctor Vyblechka, welcome to the Call to Flourish podcast. Thank you. I'm happy to be here. Well, can you tell us about your background and how you became involved with this, important issue, eating disorders?

0:59Sure. It sorta happened by accident. When I graduated with my master's degree in counseling, I went and worked in treatment centers for substance abuse. And what I found was I was working with, clients who they would get sober, they would detox, and all of a sudden, they'd come into my office and say, by the way, I have an eating disorder. And what I noticed was that the clients in which no care was given for those men and women who had eating disorders, they had a higher relapse rate from the regarding their substance use. And so I started in treatment centers providing group therapy for, men and women with substance use disorders. And then beyond that, in a private practice, started working somewhat with women with eating disorders, and that's where it started.

1:56So what and you've been doing that for how long? I got my license in 2006. So 2006, and currently, I supervise counselors and, I'm starting up a practice again in a couple months to see clients. So I had a brief hiatus and was just doing supervision and teaching and then back to clinical work, more hands on clinical work in a couple months. Yeah. So you've been doing this for a while. And, could you tell us what what we mean when we say the word eating disorder? You know, someone who, occasionally overeats, I'm wondering what what makes something what what what are we how will we define that? What what exactly are we talking about when we say eating disorder? Sure. So, really, it's any eating behavior or pattern that disrupts normal life.

2:50And so that's sort of the very easy way to look at it, but there's different ways in which that demonstrates itself in in the client. So you have anorexia, bulimia, binge eating disorder, kind of the main three. And then from there, there's kind of other specified eating disorders. But for some, people tend to restrict to the point where restrict food intake to the point where the they're not getting enough, and there's other criterion that support that diagnosis. And then for some, there's and I there's a desire to binge and then have compensatory behaviors, and then for some, there's a desire to simply binge. And I think the the main issue is there's a continued, engagement in the behavior despite negative consequences.

3:40It's impacting many areas of the person's life. Is there a common cause for eating disorders, or are the causes very different between these different diagnoses, if you will? It's hard to say there's a common cause. There's common vulnerabilities associated with them. For example, there's a high correlation between substance use and eating disorders. There's a high correlation between trauma and eating disorders, and there's a high correlation between mood disorders and eating disorders. And so we could go down the chicken or the egg road, but at the end of the day, when I see a client that has one of those substance use, mood disorders, etcetera, I always wonder and I always keep in the back of my mind, well, here are some things that could be related, and then vice versa.

4:29If someone presents with an eating disorder, I wonder about the others that there's a high correlation with. How big of an issue are we dealing with? Like, what, like, how many what percentage of the population might have an eating disorder? And, that you mentioned, bulimia, anorexia, and binge eating. Is there one that's more prevalent than the other? I don't know percentages. I could say from an anecdotal standpoint, it's quite high. Maybe that's just because it's what I I see. And I I can I can see it in the population? I can see it not even in you know, when I'm in supervision and my supervisee is telling me about a client, I can sense symptoms that they're discussing and say, is that what the do you think there's an eating disorder here?

5:15But I think it's much more common than people think it is, and, especially, there's sort of this new wave of of what eating, you know, what eating disorders look like now. It's much different than it was, you know, in 2006 when I started. And it kind of follows this environmental trend of what's, for lack of a better word, what's in right now. And so, I would say just it's it's it's more common than people think. The National, Association of Eating Disorders has great stats on there. But, again, I look at the stats and I think, wow. I think it's it's it's probably much more prominent than that. And then at the same time, there's the diagnostic statistical manual of mental disorders that tells you this is exactly what an eating disorder is.

6:02And when I work with a client, if they don't fit that criterion, but they're telling me they're having difficulty, it's okay to to address it as such. This is this looks like an eating disorder. You might not have every single criterion. You might not fit the criterion perfectly. But if you're having a problem and you identify it as an eating disorder, let's work with it as such so that it doesn't get worse and miss full blown. What are the characteristic differences between, for example, anorexia and bulimia? You hear these these these, these words a lot. What are the differences between these two diagnoses? Sure. So so with anorexia, it is more of a restrictive type of eating disorder. There's a significant focus and fear of weight gain.

6:50There's a restriction of caloric intake to the point where there's significant weight loss. And so to meet that criterion to meet the diagnosis, you have to fulfill those criterion. That doesn't mean that you won't see those behaviors in people that haven't met full criterion. It just it just in a clinical perspective, it would mean, okay. This this person's at risk for anorexia. For bulimia, there is a period of time where the person binges on food, and a binge is essentially you eat more than you're supposed to in a short amount of time. And that has to happen at least once a week for three months or so. And then on top of that, there's a compensatory behavior, which could be fasting, laxative use, use of medication to kind of get rid of that binging episode, and sometimes it's exercise as well.

7:48So with anorexia, you're not trying to, there there's no binging and therefore no compensatory behaviors. It's a full blown avoiding food and not getting the calories you need, essentially. Whereas, bulimia, it's a back and forth. With anorexia, a lot of times, you know, you you typically you see the person who who feels like they're overweight or fat and yet tend to be really skinny. What kind of dynamic or what are some examples, I guess, of of, like, if you if you're concerned someone might be heading in that direction, like, what what might you watch out for? I think it's the uncharacteristic fear of gaining weight. It's it's this they don't have a the person does not have a rational perspective of what they look like.

8:38It's and, in turn, the response to that is the restrictive behavior. And so you would notice restrictive behavior in in the person regarding food, and there it would kinda sometimes it starts with picky eating or overly healthy eating to the point where, as I mentioned, it starts to be a restriction significant restriction of calories. Not a not a diet, but a very a very significant restriction of calories. Okay. So some kind of, they don't fully under they, you know, there's misunderstanding what they really look like, and then they can be picky, or you or just sort of fasting or something. You see those kinds of things, that that's an issue. And I would say that kind of the big thing what you'll notice first is probably a significant weight loss, which, you know, from an outsider's perspective who doesn't understand, they might compliment the person.

9:37Oh, I've I've noticed you've lost weight, and that sort of fuels it even more. The then there's more restricting to the point where, you know, they're barely eating anything all day, a piece of lettuce, an apple, that sort of thing. And and there is a fear of of of eating. There's a fear of eating. When the eating happens, a lot of anxiety occurs as the eating is happening. And so it's just a it's just an avoidance after at that point. When I hear the word anorexia, I think of Karen Carpenter. And maybe I'm dating myself here, but, if you if you see, videos of the Carpenters, performing, you can see in the the latter part of her life, she was getting very, very thin. It was very noticeable.

10:24And I'm just wondering, it's always been kind of a mystery to me. Did she not realize where this was going? Or do do people with anorexia just not not realize what what effect they're having on their body, the negative effect effect they're having on their body, or is it is it how does that work? There isn't a realization that there is a negative impact on their body, and part of it is there's sort of I'm not a biologist, but there's there's a or a doc well, I am a doctor, but not a medical doctor. There's there's a brain chemistry change that happens. And as a result, there there is no kind of volition goes away, and there they cannot see the negative impact they're having on themselves. They do not see what everybody else is seeing.

11:10And so it's sort of this, this dynamic where the the anorexia started somewhat from a decision, albeit part of that is a might might be a a genetic predisposition, maybe some environmental predisposition. So it starts. The person engages in the behavior, and then they get so far down the line that it changes their brain chemistry. And in a sense that, for example, they truly aren't hungry. They're just not hungry anymore. They've learned their brain has learned to shut that off. And so part of undoing that is is very difficult trying to get the brain chemistry kind of back from being essentially out of whack because they've lacked nutrients. And then I would argue there's such a strong dynamic of denial involved that and then the brain chemistry changes.

12:05It's hard to undo that. It's not hopeless, but it is difficult. So not hopeless, but difficult. Yeah. That sounds quite quite, quite a challenge there. What what so what what kind of techniques or therapy have you seen that help people, overcome that or or, you know, the reason for that hope? When you have someone that's very severe, you have to hospitalize them. Many times, I I would have this because a lot of my work with the with more severe, clients with eating disorders was in substance use treatment. And they would come in, and they could not address the substance use because the the eating disorder had to be addressed first. They were so either malnourished that they needed to be hospitalized or go to treatment for an eating disorder.

12:53And it's it's it takes, you know, all day, everyday sort of treatment. Family needs to be involved. However, when you have a client that comes in that is not at the level of hospitalization yet, You can still work with them in private practice or just on an individual basis, but the but a really good approach with working with someone with anorexia is group therapy and family therapy. It's it's found to just be very, it allows for accountability and support. Now that being said, I I don't usually recommend family therapy when there is a history of, eating disorders in the family that haven't really been addressed, so it doesn't that doesn't help. But if you have a supportive family, you need to bring them in.

13:40And I would, you know, I would say that goes with any disorder you're working with, but it definitely helps with eating disorders and anorexia. How often do you find an underlying trauma in in your counseling with these people with eating disorders? Is there often an underlying trauma that that began this process? They're they're reacting to that trauma in some type of, some type of way maybe beyond their control? I would say eighty percent of the time, the client had sexual trauma. Eighty percent of the time, sexual trauma. Wow. Now this is my number. This isn't you know? I I don't know if you could Google that, but my experience was eight out of ten times the client had sexual trauma. Okay.

14:26And that's from abuse or Mhmm. So, usually, it was some sort of trauma that happened in childhood, but at the same time, it not all the time, I should say. I I would say that the sexual trauma could have happened at any time, and then it sort of triggered this identity around one's body and sense of self. And it was a way to cope with the pain, cope with how to handle what happened, and almost in many times, a way to attack the body. It was sort of, I'm gonna blame the body on what happened, my body. And so if I can control that, I can undo what happened. So it really just recapitulates what happened until it gets addressed. Wow. Is there a particular demographic or characteristics of age groups, or so forth that that struggle with this more than others?

15:23I mean, women definitely struggle with, I would say, but it looks different in men and women. So there's that piece. I mostly worked with women. And, you know, I've I never worked with children with eating disorders, young young girls. I worked mostly 18 and older, but it was, you know, with the women that came in, like I said, well, I said eighty percent of the time sexual trauma. Ninety percent of the time, the women that came in had an eating disorder. And and it was interesting how it was correlated with their drug of choice. And so many times, women who struggled with cocaine dependency were anorexic and, alcohol abuse or alcohol dependence, bulimia. And so but it was shocking to me how how correlated the two were, that it was once there was once the drug and alcohol was taken away, the eating disorder would come up within three or four days after, you know, kind of this sense of, oh, I'm sober, and I'm working on being sober, but now I'm binging and purging three times a day.

16:35It was like, oh, okay. This is interesting. This is this there's there's no way we can say these aren't correlated. And a lot of times, it was in an effort to avoid pain. So That can happen with all addictions. Right? You you you get over one and you fall into something else. Is that Mhmm. Yeah. Yes. It's, they call it process addictions and and or at the same time, you have clients who have a history of just both since the beginning. But there there's many times, you know, we are we have a tendency in in human nature to be selfish and to avoid suffering. And so in a sense, it's this normal response that's gone haywire. So that's kind of how I I viewed it. It was a way for me to put it into perspective.

17:27We all have this tendency to be selfish, and we all don't really enjoy suffering. And you've got these people who have significant trauma and pain in their life and were not, for whatever reason, given appropriate coping skills, learned appropriate coping skills, didn't have enough resiliency factors to get them through it, and this was sort of a default. With anorexia, I've heard that there one of the factors contributing to it is, the perception of beauty for especially for young women looking at, maybe models or actresses, who tend to be thin and, you know, whatever. And they and they compare themselves to those those people, and they try to be like those people. And, how much of a factor is that?

18:19I think it's a it's a significant factor, and especially in the world we live in today, where you can you can see it within seconds. You immediately compare yourself, especially in the world of social media. I really encourage people not to do social media for that reason. It's sort of this unrealistic expectation. And but, truly, when when you work with this population, there there usually is some sort of comparison, and there's no sense of truth as it relates to who they are and what they look like. It's just completely skewed, which is sad because as the clinician, you see who the person is, and they cannot see it themselves. And that's a that's kind of a significant focus of therapy is getting the client to kind of see themselves as who they truly are and not this idea of what they should be and be and kind of accept them as is because the standards are unrealistic.

19:21We all know this from a cognitive level, but it's in our face constantly, so it's hard to address that cognitive dissonance. Yeah. And then you mentioned to this natural tendency to selfishness and, you know, to seek pleasure, so to speak, which kinda reminds me, you know, we have our here at DMU, our our Catholic Christian model of the person. And that's one of the points is that we're we're subject to what Christians call original sin. What kind of insights from from that model of the person can be held for for FELPA for someone who's struggling, with a knee disorder? I think the most important piece is that, you know, we we do want good. We all want good. But at the same time, like like I said earlier, we're all prone to selfishness.

20:17And a lot of times, there would I would have clients who would get very down on themselves for relapses. And it part of it was saying, you know, this is just I I don't wanna say it's part of the process because the goal isn't to relapse, but the goal but you do have to recognize you're human and you're gonna make a mistake, and your mistake is to fall back in something that you've done before. And so kind of putting that into perspective and helping them understand, okay. Now you know. And if if the client was Christian or Catholic, I would say, now you know your cross. This, unfortunately, is your cross. Everybody has one. This is what yours looks like. So now you know you're gonna fall sometimes, and you just gotta pick up.

20:59And rather than be mad at yourself, that's that's not helpful. That's not what you're called to do. You just acknowledge you made a mistake and move forward. And know that those those tendencies to be selfish, which usually end up hurting yourself, will get fewer and small and they will have less of an impact. And soon, when you get into recovery, it won't be the eating disorder you're falling into as your kind of MO. It it'll be something less hurtful to yourself. I mean, we do it every day. Everybody does it. Everybody is selfish and makes a mistake based on selfishness. So It seems like part of this, is, involves self esteem. The the people who are suffering from these eating disorders have a have a low self esteem.

21:47And I think from our perspective, DMU's perspective, you know, we we, we base our our our dignity, our worth upon our our relationship with God being created in the image and likeness of God. Is does it help in counseling and therapy to, focus on the the self esteem aspect? Is that helpful? Yes. But I understand. I I speak of self esteem in the sense of in order to gain self esteem, you have to be other oriented, which means you have to not be selfish. The more selfish you are, the lower your self esteem is gonna be. And the more other oriented you are, selfless, the higher your self esteem will be because you find there's value in being of service to others and not focusing on self. And when clients do that, anybody does that, their self esteem is rate goes up, essentially, when they are you know, part of the reason why we're called to work is to be of service to others.

22:49And so, especially, with this population, you have to approach that subject delicately because you don't want to say you're just selfish. That's not that's not my point here. But when there is a treatment approach that focuses on undoing this lie they have about themselves and who they are and and kind of addressing that with another piece of being other oriented, being of service to others, there tends to be, in my experience, a lot more success because the shift leaves themselves, which is a big piece of what anorexia and bulimia is, a focus on self and goes outward away from self and towards others. You know, I I think a lot of people have experienced either through families or or friends, people they know who have an eating disorder.

23:42Maybe you touched on this before, but we could touch on again. What are some of the the the signs that that somebody you know, a loved one, has more than has has an eating disorder that needs, you know, intervention, professional help? You you mentioned loss of weight, but are there behavioral other behavioral changes that, you can pick up on and and and, be a signal that, someone needs help? Sure. So, for example, someone who, after they eat, disappears is always a red flag. That usually means some form of purging behavior is happening. Someone who eats in secret, so you're you're never able to have a meal with someone. That would be in because, typically, people who binge wanna do that alone and by themselves.

24:33So that would be a red flag. Obviously, weight loss. Sometimes, just kind of a presentation of kinda dull skin, very just brittle looking is a good example. And I think the key is you never tell someone who might possibly have an eating disorder you don't look like you have an eating disorder, because women with, and men with bulimia, they are average weight. You wouldn't they're average weight, so that's not gonna be the the the factor in knowing whether or not they have bulimia. With anorexia, you can spot the symptoms of the avoidance of spit of food, excuse me, the restriction, and then the weight loss comes later. What so bulimia and binge eating, like, what what would be the difference?

25:26And what what's like could you give an example? Like, what's a binge? A binge is eating a very large amount of food in a very short period of time. I believe the DSM says two hours. So within two hours, you consume three or four meals. Three or four meals in two hours. Okay. So that's different from bulimia in some way. What how would you distinguish? So with bulimia, you would have to have binging and purging. Once a week, I believe within a three month period. Okay. So the cause for binge eating, is it often trauma also, or is it something else? It seems like a very different manifestation, different symptom. What what what what's the primary or primary causes of binge eating? I would say a lot of it is trauma, and then also there's a high correlation between, say, mood disorders, personality disorders as well.

26:27If someone has a family member or maybe, you know, I know I think this can be an issue on college campuses and different schools or something. What would you recommend? How would someone what would they do to turn for help if they they suspect someone has a an eating disorder? Sure. So I would recommend going to either having maybe an evaluation done or just calling a therapist that specialize in it. The other option is, National Association of Eating Disorders has a page of signs and symptoms. But, usually, you'll have someone call a therapist and say this is what I'm seeing. And then going from there, they might give an approach for how to work with the person until they're more willing to come into therapy or not.

27:16But first, to start off with what are the signs and symptoms. Okay. What could the non therapist do, to help and not hurt someone in the situation? Like, without because I sometimes I I yeah. I get all these ideas. Oh, I could really help this person, but I'm afraid I don't want I'm not a professional in in mental health or counseling. But are there things I could do? Let's say, you're in the case that you just mentioned where person doesn't wanna go and get any help or they're just not ready for that. I think the key is relationship. I mean, that is the predictive factor in counseling anyways of the curative factor essentially is the ability to form the relationship. So if your relationship is with good is good with the person and your goal is for them is for their well-being, if you can approach them from that from that perspective.

28:11And then just saying, I'm worried about you, and I'm here, rather than harping on what you're seeing. So I see you've lost weight. I see this. I see that. Starting there. Now the severity also, if you have a child who's, you know, 19 years old and they've lost 20 pounds, you you kinda have to bypass that and worry about their health. So I think you have to take that into consideration too. Mhmm. Severity. Yeah. If it's really severe, you need it, yeah, quicker immediate help. In some cases, do you need, like, a family intervention? The family gets together around somebody. If if they're not, as you say, connected with reality in a certain way, would a family intervention help, or would that that exacerbate the problem?

29:04I don't believe it exacerbates the problem. The problem has been exacerbated. If if you're at the point where you have to if you're considering an intervention, it typically means the client's health is in danger, and you're worried they're gonna die. And so at that point, you you need to do whatever it takes. Mhmm. All the while knowing the person, if they're over the age of 18, gets to decide. Does Divine Mercy University have, particular classes or, focuses in the counseling program that, you know, on this on this problem, on this issue, help prepare therapists, counselors to to deal with it? We don't have classes specifically for eating disorders to treat them. That being said, what we encourage our students to do is to if they're interested in the population, we encourage them to seek out a practicum or internship site and start there.

30:05Most students, when they go through the program, they're gonna learn the foundations for how to work with clients no matter the issue. And then when they graduate, if there's a specialty, then they go towards the specialty after that point. And sometimes they start that in practicum and internships. So sometimes you can have a student who wants to specifically work with people with trauma. They'll go to a place that focuses on trauma. So they can do that, and then they get supervision through practicum and internship from, our instructors to work with that population as well as supervision at the site. Doctor Vyvilechka, we're we're coming, we're running out of time here. This is a very, very important issue and a very interesting topic for the podcast.

30:51If somebody has, more questions or would like more information, can they contact you, or is there a, are there resources? Maybe you can give an email address or a website that people can go to if they want more information. Sure. If they can email me, they can go go to the website, National Eating Disorder Association. If their goal is to have a Catholic therapist, they can go to Catholic Psychotherapy Association and find therapists and email addresses there as well. Your email address is there, you said? Sorry. My email is f v u y v l e c k a. And fvuyvlecka@divinemercy.edu. Very good. Thank you. That I'm sure people, will have some, interesting questions for you, but wanted to thank you very much for this very, very interesting podcast and look forward to having you on again, in the future.

31:54Father, is there anything else you would like to say as we finish here? Well, no. I I would just reiterate what you just said, Thomas. It's been very informative and, learned quite a bit. And thank you, thank you, doctor Veflechka, for this, for your time. Have a wonderful day, doctor Veflechka. Thank you.