Episode 167: In this interview, I chat with therapist and eating disorder specialist Jennifer Rollin. We chat about Jennifer's history with an eating disorder as well as navigating personal relationships and intimacy in recovery, getting stuck in partial recovery, and exercises to help with body image.
Jennifer Rollin is a therapist and founder of The Eating Disorder Center in Rockville, Maryland, who specializes in working with adolescents and adults with eating disorders including, anorexia, bulimia, and binge eating disorder, body image issues, anxiety, and depression.
Jennifer has experience working in a variety of settings including, an outpatient mental health clinic, residential programs for adolescents, and a sexual assault crisis hotline. She serves as the chairwoman of Project Heal’s national network of eating disorder treatment providers. Jennifer has been named as one of the top eating disorder experts in the world by Balance Eating Disorder Treatment Center.
Jennifer has a certificate in Enhanced Cognitive Behavioral Therapy for Eating Disorders. She also has a certificate in Dialectical Behavior Therapy. She is a Certified Intuitive Eating Counselor. She is on the Junior Board of Directors for The National Eating Disorders Association. She was invited to serve on the conference committee for The National Eating Disorders Association’s 2018 Conference.
Jennifer has been interviewed speaking about eating disorders on television including on Fox, ABC, PBS, and NBC. She gives talks about eating disorders at national eating disorder conferences, therapy centers, and colleges.
She is an expert writer for The Huffington Post and Psychology Today. Her professional blog was named one of the top eating disorder blogs in the world.
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Chris Sandel: Welcome to Episode 167 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is www.seven-health.com/167.
Welcome to Real Health Radio: Health advice that’s more than just about how you look. Here’s your host, Chris Sandel.
Hey, everybody, and welcome back to another installment of Real Health Radio. This week I’m back with another new episode, and it’s a guest interview. This week on the show is a returning guest in Jennifer Rollin. Jennifer is a therapist and founder of the Eating Disorder Center in Rockville, Maryland who specializes in working with adolescents and adults with eating disorders, including anorexia, bulimia, binge eating disorder, body image issues, and anxiety and depression.
Jennifer has experience working in a variety of settings, including an outpatient mental health clinic, residential programs for adolescents, and a sexual assault crisis hotline. She serves as the chairwoman of Project HEAL’s National Network of eating disorder treatment providers. Jennifer has been named as one of the top eating disorder experts in the world by BALANCE Eating Disorder Treatment Center. She has a certificate in enhanced cognitive behavioral therapy for eating disorders; she also has a certificate in dialectical behavior therapy. She is a certified intuitive eating counselor.
She is on the Junior Board of Directors for the National Eating Disorder Association, she was invited to serve on the conference committee for the National Eating Disorder Association’s 2018 conference, and she has been interviewed speaking about eating disorders on televisions, including FOX, ABC, PBS, and NBC. She gives talks about eating disorders at national eating disorder conferences, therapy centers, and colleges. She is an expert writer for the Huffington Post and Psychology Today, and her professional blog was named one of the top eating disorder blogs in the world.
So, a lot of stuff that Jennifer does around eating disorders. As I said, this is the second time she has appeared on the podcast. Her first appearance was back in Episode 108, so roughly two years ago, and I’ll link to that episode in the show notes. If you haven’t listened to it before the first time round, then I highly suggest checking it out. There may be some ideas that we touch on in both of these episodes, but mostly I believe this is a new conversation.
Jennifer is incredibly easy to chat with, and there was lots of practical ideas and resources that get covered as part of this episode. I start out the call with Jennifer outlining what we’re going to cover, and we stuck to that fairly well, going into each of the topics in a decent amount of detail. So rather than me repeating myself here, let me just get on with the recording. So here is my conversation with Jennifer Rollin.
Hey, Jennifer. Thanks for joining me on the show again. It’s a pleasure to have you back on.
Jennifer Rollin: Thanks for having me. I’m excited to be here.
Chris Sandel: Last time you were on the show was December 2017, so I think it was recorded a bit before that, nearly two years ago. Do you want to just give a bit of an update? What have you been up to since then?
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Jennifer Rollin: Oh wow, yeah, I can’t believe it’s been two years. Since then I’ve started the Eating Disorder Center, which is a group practice of eating disorder therapists based out of Rockville, Maryland, and we work with people worldwide. I’ve done more speaking engagements, done some fun things in my personal life. Yeah, a lot has happened over the past couple years.
Chris Sandel: Nice. Maybe we’ll get into some of that a bit more as we go through this. There are a handful of areas that I want to go through as part of this episode. One is about relationships and intimacy in recovery, another is people feeling stuck in partial recovery, and then the final one is interventions around body image. We’ll probably get sidetracked and go in other directions, but that’s a lot of what I want to cover today.
For anyone who hasn’t listened to the first episode that we did, are you able to give a bit of background on yourself – like who you are, what you do, what your training is, that sort of thing?
Jennifer Rollin: Sure. I’m an eating disorder therapist and, again, the founder of the Eating Disorder Center. I personally struggled and recovered from my own eating disorder, which has really inspired my passion for the work. Then in terms of training, I’m a certified intuitive eating counselor, I’ve gotten training in CBT for eating disorders as well as dialectical behavioral therapy and trained in body image. Did my own self-teaching in that area, to be honest. I now actually do my own eating disorder trainings that I have for professionals and people in recovery.
I started as a therapist working in a few different clinical practicums, and then I worked in a residential program for teen girls with eating disorders, mood disorders, and trauma for over 3 years. Then I started my own individual practice only working with people with eating disorders, and now I have the group practice. So it’s really come full circle for me.
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Chris Sandel: You mentioned something there in terms of your own eating disorder. This wasn’t something we really covered in detail last time, but I know this is something you’ve subsequently started talking more about. It would be good to hear about your story around that. What were your childhood and your adolescence like in respect to food and dieting and body image?
Jennifer Rollin: Growing up, I think I always had some body image issues, which really tied into anxiety and some self-worth issues. I didn’t feel great about my body, but it wasn’t a focus for me, if that makes sense. It wasn’t something I fixated on. It was just kind of there in the back of my head, not feeling attractive in general.
I grew up with a mom who is a registered dietitian, who has been incredibly supportive and truly meant well, but I think growing up, I internalized some of the messages around good or bad foods. There was one holiday where she made tofu pumpkin pie – which was disgusting, by the way. [laughs] About as gross as it sounds.
Again, she’s evolved in the same way that I’ve evolved, so she wouldn’t do that now. But I think when I was younger, she was very much on the traditional dietitian bandwagon, making some diety foods at home and sometimes making comments about food.
So I responded to that by rebelling and saying basically, “screw you, I’m going to eat whatever I want and I’m going to eat it in front of you.” I would eat chips and cookies, and I think I had some rebellious eating, and definitely at times used food – which everyone does – as a form of comfort. But for me, I think it was a little more than the average person when I was growing up. But again, definitely not a clinical eating disorder in any way. I think some of this is normative in our society, but bringing really large containers of nuts or whatever it was into my room and just sitting there and eating them for the comfort feeling. But again, it wasn’t particularly disordered.
Then as a teenager, my relationship to food and body was relatively okay. Again, I still struggled with feeling like I didn’t fit in and not feeling good about myself, but it wasn’t a focus for me. It wasn’t until my senior year of high school – mine actually started a little later than a lot of other people’s, but it really varies person to person. Some people don’t get an eating disorder till far later in life.
But my senior year of high school, I was very anxious about the transition from high school to college. Transition times are hard for me. I was comparing myself to my friends, and I felt like I was larger than my friends. So I told myself I was going to go on a diet, which really ended in me abusing prescription medication – it was Adderall – and taking that to not eat for about a month.
I lost a significant amount of weight. Eventually, the school counselor confronted me, my parents confronted me – about the pills, not about the weight. Everyone just said I looked great and no one was particularly concerned about the weight element. I started weighing myself obsessively at that time, too.
After the month when I was found out by my parents and by the school, I stopped doing the pills cold turkey and resumed back to normal eating somehow. But it was kind of a foreshadowing of what was to come. It became a nonissue again. I thought it was a nonissue.
Then in college, I was drinking a lot, and I became really uncomfortable with my body, and I told myself that I was going to lose weight in a “healthy” way, which didn’t go well, obviously. I said “I’m not going to do what I did in high school. I starved myself. I’m not going to do that. I’m just going to be healthy.”
It started out as eating all the stupid diety foods, and then it transitioned into orthorexia, more of this obsession with “healthy eating,” “clean eating,” exercise compulsion. Then from there, it spiraled into anorexia and completely consumed my life – which was honestly very surprising to me at the time, given my history of having one month in college where it was a struggle, but the rest of my history not really having any issues around food per se, significant issues.
Then I would later learn that I had a close family member who’d had an eating disorder as well.
Chris Sandel: Were you away from home at college or university when this all went down?
Jennifer Rollin: Yeah, I was away from home, but my college was maybe 30-40 minutes away from my house, so I still went home a lot. But I wasn’t living at home.
Chris Sandel: How long before people started getting alarmed?
Jennifer Rollin: I think what’s interesting is that people really didn’t get very alarmed, I don’t think, until things were pretty bad – and even then, I remember when I was really mentally struggling and I had lost weight, but I didn’t appear emaciated, and friends said to me, “What are you concerned about? I think you look great.”
So I didn’t visibly appear incredibly unwell, but it hit the point where at least my family became really concerned, and I think I ended up telling them what was going on because I wanted to seek treatment. At that point, my parents were really concerned, but to be honest, I hid a lot from my friends, and my friends just didn’t have a very good understanding of eating disorders. Initially, they thought I was just being overly anxious about it and that I was fine.
Chris Sandel: Given your mom’s profession, had she worked in this area at all? Did she potentially pick up on things earlier because of that, or did she have skills in terms of “hey, you should definitely check out this person” or “we can get you into this clinic because I know this from my own work”?
Jennifer Rollin: She didn’t really work with eating disorders at the time. She had a familiarity with what they were, but she definitely didn’t know the local resources or catch the early signs. Again, I think I was pretty secretive about it for a little while. But yeah, she definitely didn’t pick up on the early signs, I would say. I don’t necessarily think that that played in, but I think she was very, very concerned, like incredibly anxious when I was first diagnosed. I remember that just being a really hard time. And understandably. To watch your kid resisting food is a really hard situation to be in for any parent.
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Chris Sandel: Yeah. What did your recovery journey look like? You said before about you realized that you needed to get help, so how long did it take for you to get to that place?
Jennifer Rollin: I think it was relatively quick for me in the grand scheme of things. I might’ve been struggling for maybe, I don’t know, 3 to 5 months before I sought help. I initially reached out to somebody at my school who had been pretty vocal about having struggled with an eating disorder, just to talk to her. I think after I got the confirmation from her that, yes, this was a problem, I sought out initially a dietitian, and then an eating disorder therapist.
So I was really fortunate in that I think it scared me because it was so different from how I’d been before, where I didn’t care at all about what I was eating. It was just such a 180, and I started to feel so trapped and so miserable and exhausted. I felt suicidal, I felt really depressed at the height of my eating disorder. While I was terrified, obviously, of doing the things I had to do for recovery, there was a big part of me that was like, “I need help. I’m scared. I need someone to help me.” So I was pretty good about getting help.
From there, it’s a winding journey. It definitely was not easy and I had periods where I slipped back into behaviors or just wanted to give up. But there was this part of me that had seen what my life was like at the height of an eating disorder, and it was awful. It was compulsively exercising all the time, feeling like I constantly had to be moving.
Without giving away too much further triggering detail, it was being very isolated from people. I was in a relationship at the time, but I was hardly present in that relationship. I was constantly ruminating about food, about my weight and my body.
So it just became the thing I thought about 90% of the time, and everything else faded into the background and didn’t matter anymore. I became – again, in part due to isolation, in part due to the malnutrition – incredibly depressed. I remember my mom and I had gone on a trip to New York for the weekend, and I spent the whole 6-hour car ride back crying.
I’d always dealt with some anxiety, but I’d never dealt with depression before. For me, getting help was not an option at that time. I just kept reminding myself I knew where that path would lead, so I did the really hard and scary things, and I asked my dietitian to eat desserts with me every week because I was so scared of them. But again, I don’t want to paint that it was easy. It definitely was an up and down journey, and I definitely needed a lot of support as I was going through the process.
Chris Sandel: I think it’s wonderful – and I don’t know why this occurred for you, but for you to reach that point of “I need help” within 3-5 months, however long you said it was, is really quick in the whole scheme of things. For a lot of people I work with, it goes on for a really long time before they hit that point of “okay, this is enough, I need to sort this out.”
Jennifer Rollin: Yeah, and I feel really fortunate in that way. Again, it was just such a shift from where I’d been before and so miserable and exhausting, I was just like, this is not sustainable to be sitting at home crying on the couch, wishing that I was not alive. There has to be another way that’s better than this.
Chris Sandel: With the dietitian, was that outpatient? Have you ever had time inpatient?
Jennifer Rollin: I’ve not ever been inpatient for my eating disorder. Yeah, it was outpatient treatment. I had a dietitian. I saw a few different dietitians, actually, over the course of my recovery. I had an eating disorder therapist, and then I had a mentor through Mentor Connect – which is now shut down. So I had that. I felt like I had a decent amount of support at the time.
But I will say that residential was suggested to me when I first sought help. I just was stubborn. I don’t think there’s a right or wrong here. I think some people really do benefit from residential, but that actually motivated me when my dietitian suggested that because I was so scared of that option, I was like, “okay, I’ll do what you need me to do.”
Chris Sandel: Hindsight is a wonderful thing, but if you had your time over, would you say residential would’ve been a better or quicker solution?
Jennifer Rollin: I’ve thought about this, and I’m happy with how everything turned out, obviously, but I do think getting residential treatment early on could’ve been really helpful – depending on where I went. We hear things about different programs, and some, unfortunately, can, I think, be more harmful than beneficial. But I think seeking a higher level of support earlier on probably would’ve made things a little bit quicker and less painful.
Chris Sandel: You said you’ve jumped around or you had a number of different dietitians. Was that because some of them, you were like “I don’t think this is the right approach” or “this isn’t working”? Because I know not everyone is going to be the right person for every person, and you need to get that match right.
Jennifer Rollin: I think it was just trying to find a good fit, somebody that I really trusted and an approach that worked well for me. Obviously dietitians all practice differently and have different philosophies, so it was really just about finding that person who’s the best fit for me and who I felt like I could trust around something that felt incredibly scary.
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Chris Sandel: What about in terms of friends? Obviously, you mentioned about your family knowing about it, but was this something that was hidden and your secret, or it then came up and you were open to talking about it with friends?
Jennifer Rollin: I’m trying to remember back, but I think I was pretty secretive about it. I think felt very ashamed, and I didn’t really know a lot of people who had struggled with an eating disorder. So it was something that I felt like I wanted to keep under wraps at the time. I think my boyfriend knew about it, but I wasn’t very open with him either.
I think it was more something that I felt was a secret at the time. Which, looking back, I wish I could’ve opened up to more people, but I really tried to lean on my mentor and the treatment professionals rather than leaning on friends, because I think I was afraid of judgment and what people would say. I told a few friends, but I didn’t reach out to them or lean on them for support.
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Chris Sandel: Are there other things that now, because of what you do and the experience you have, that you wish were done differently – either that other people did differently, that you did differently – now that you know what you know?
Jennifer Rollin: Absolutely. There were a few things, but one massive one was the therapist that I saw initially for over a year, I really liked her at the time, and I think she was a solid therapist in some ways, because it’s not black or white, but I would later learn when I personally stumbled upon Health at Every Size that she did not – she told me she didn’t believe in Health at Every Size. Like, pretty intensely did not believe in it.
I wish I had seen a Health at Every Size professional. I think that would’ve made a massive difference in my recovery.
Chris Sandel: In terms of because she was then keeping your calorie recommendations lower, or she was like “you don’t want to do too much and end up in binge eating disorder”? That kind of thing?
Jennifer Rollin: She would say things to me when I was having a freak-out, and she would say things like, literally, “Don’t worry, I don’t let my clients get obese.” Things like that. All it did was fuel that anxiety that I had and the feelings of fatphobia that I had.
I’m trying to think about other comments that she made. I know that was a really big one. She also made comments that she could tell – basically she assumed anyone in a larger body had binge eating disorder. There was just a lot of weight stigma and weight bias.
Another thing she said to me was – I’m just remembering this now – when I first came to see her, she told me – I’m not going to say numbers or how much she told me I needed to gain, but it was a very, very small amount of weight that she said I needed to gain, literally just by looking at me. I would go on to gain more weight than the amount of weight that she said. She was like, “You only need to gain X amount of pounds,” just by looking at me. Not being my dietitian. That, again, came from her own weight bias of like “if you gain this many pounds, you’ll look more presentable.”
Thankfully, I didn’t stick with that too much. Somehow I was able to brush that off. But I could see somebody holding on to that comment and being like “I failed because I gained more than X amount of weight.”
I think it would’ve helped me a lot to have somebody who was like, “You know what? It’s okay. However much you need to gain to get to your natural weight is fine, and it’s perfectly okay no matter what size you end up.”
Chris Sandel: Yeah. Again, I think you’re probably more at the anomaly end of things of being able to brush that off and think “I need to find someone else,” or finding someone else and that being more helpful. I’ve seen clients where that’s not the case, and they were told a goal weight when they turned up for treatment. “We’re going to get you there and then we’re going to be able to keep you there.”
My mind is just like – you’re putting someone on a diet. Yes, you’re increasing their weight, but how are you able to guarantee where someone’s going to end up? And what happens when they don’t do that? When they go over, what is the solution? And then how is that not just further fueling an eating disorder?
Jennifer Rollin: Yeah. I think it’s unethical to tell somebody that you can guarantee they’re going to be this weight and then you’re going to keep them there, because like you said, what are you going to do then? Restrict their food at that point?
So yes, I think I was able to brush it off because I had started steeping myself so much in the Health at Every Size literature myself. When I get into things – this is part of what made me sick and part of what I think has helped me, like a strength and weakness – I put my 120% into things.
At one point when I was seeing her, I was really trying to improve my body image because, no shocker there, she didn’t really help me with body image. [laughs] She helped me with other stuff, but not with that. So I was doing my own research and I stumbled upon Health at Every Size, and then I went full force, reading all the studies and all the literature. At that point I was able to see this was wrong, some of this information I was told, and I really believed that. I think that voice became stronger than things she had said to me.
Chris Sandel: Something you just said there that I’m constantly getting clients to recognize is when something apparently looks like a weakness, but is really a strength. There is that ability – and I see this a lot with my clients – to be very dogmatic about things and to really persevere and push through, and it’s just been channeled in the wrong direction. I think that can be put in the right direction to do something that is really constructive and helpful, whether that be for themselves or for wider society. It is an amazing gift. But it just needs to be put in the right place.
Jennifer Rollin: I couldn’t agree with that more. That basically sums up what’s helped me to be so successful – and I don’t say success, just achievements in multiple areas of my life now, and it’s also what got me into trouble in the past.
Chris Sandel: Again, it can then rise up and be a problem because someone overworks or that kind of thing. But when it’s channeled in the right direction with an understanding of self-care and boundaries and all of those other components, then yes, I think it could be a very helpful skill to have.
Jennifer Rollin: Absolutely.
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Chris Sandel: Let’s then focus on the topics that I mentioned at the top of the show. The first one is around the relationships and intimacy part of recovery. There’s obviously lots of different areas around this. Do you want to start by giving your thoughts, and then we can see what direction we want to go with this and I can ask some further questions?
Jennifer Rollin: Sure. I wrote an article recently about this topic, and I wanted to write and speak more about this topic because I think it’s one that’s left out – which is understandable because there’s a lot to focus on when it comes to recovery.
But my experience of being in an eating disorder and the experience I see with clients is that typically the deeper someone is into an eating disorder, the more isolated they become, the more their relationships, if they’re in them, start to suffer. Some people might have relationships, like I talked about actually being in a relationship in my eating disorder, but it wasn’t a fully connected relationship, if that makes sense. Because I had another relationship which was more important to me, which was my eating disorder.
I think first off, a lot of people struggle, depending on their stage of recovery, with just feeling really isolated and lonely and that they’re working through something that other people won’t be able to understand.
I guess what I want to say is relationship issues can manifest in many different ways when someone’s in recovery. It can manifest as pushing everyone away, disconnecting from people, feeling really isolated. It can show up as being in an intimate relationship, but the eating disorder is slowly taking away from that relationship in different areas. It can look like intimacy and body image issues that impact the relationship, which is very common.
I think when we think about specifically relationships and recovery and some of the common struggles, one challenge is, whether you’re dating or currently in a relationship, feeling like a burden. This is something I hear a lot. People are concerned about utilizing their partner for support because they don’t want to burden them with their eating disorder. I’ve also heard people saying “I don’t want to date anyone because I bring too much ‘baggage’ into the relationship.”
So I think first off, it’s important to debunk this idea that – I mean, we all bring baggage into relationships. Finding somebody who does not – and it’s really just looking at, what is that person open to supporting you with? My belief is if somebody says “yeah, you having an eating disorder is too much,” they’re not the right person for you. And that’s okay.
But it doesn’t make someone a burden to need to rely on other people as part of the recovery process.
Chris Sandel: I would agree. Just out of interest, if you’re reflecting on your client population, how many of them are single in recovery versus in a relationship? Just so I can get a bit of a sense of how often this is happening.
Jennifer Rollin: I’m trying to think about it. I think it’s really a mix of both. I definitely have plenty of people who are in relationships, married, engaged, and then I have plenty of people who are single, doing the dating thing or not dating. I would really say in my practice, it’s probably about 50/50.
Chris Sandel: I’m trying to think myself. I would probably say it’s skewing more towards people being in relationships than not.
With your clients – and again, you’re going to be speaking in generalities here – how often does it feel like the client’s partner really gets it and is on board and is supportive versus that is quite a struggle area because they just don’t understand, or maybe the partner is potentially triggering in terms of “maybe you just need to go back on a diet” or that kind of thing?
Jennifer Rollin: I think it’s really a toss-up. Of course, a lot of partners might not feel like they understand or might feel frustrated, and I do a lot of work where I’ll bring the partner in if that’s an issue, and we’ll do some psychoeducation and include them as much or as little as possible.
But I would say when I really reflect on it, the majority of partners of people that I work with have been incredibly supportive even if they don’t fully get it. I think what I tend to see is people who want to help and want to be supportive, even if they don’t fully understand.
Chris Sandel: One of the ones that also comes up when I’m thinking about this is the point at which the person who’s dealing with an eating disorder gets into the relationship with their current partner.
What I mean by this is if they are at a low weight when they’re starting the relationship, there can be more difficulties than if they’re at a higher weight when starting a relationship, just because of where they feel like their change is heading and their status as part of that change. Is that something you have conversations around?
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Jennifer Rollin: Definitely. I think a big area where that impacts things – which, again, we don’t talk about enough – is when it comes to intimacy and sexuality. If somebody is having weight restoration or their weight is changing as part of their recovery, it can be really hard if they’re struggling with just looking at themselves in the mirror to feel okay about getting naked in front of their partner and engaging in sexual activity.
That’s definitely something that I’ve talked about with clients and with their partners, and it’s something that sometimes can bring up a lot of feelings of shame, I think, for the person who’s struggling.
Chris Sandel: What advice are you giving, or what are you covering as part of this kind of conversation? I know, again, it’s going to go in lots of different directions, but anything that comes to mind?
Jennifer Rollin: I think the first step when it comes to anything that involves in shame – which typically this topic tends to bring up for people – is starting with being honest and vulnerable, specifically with their partner.
What I might do is we talk about it in session, and when they feel ready, we bring their partner in and have the person – again, if they feel comfortable – share with their partner how they’re feeling about their body image and how it’s impacting things. I think it can already feel uncomfortable for some people to talk about sex and their needs in that department. Add in the layer of body image and self-hatred, that can make it feel even more uncomfortable.
Often it can be the elephant in the room, where the partner knows about it, but they don’t talk about it. So I think it’s important to really open up that conversation. The first layer of intimacy and being vulnerable is being honest about how you’re feeling and letting the other person support you in that moment.
Chris Sandel: For your clients, bringing the partner in to have the consultation or the session with you, is that often when they’re able to be most open about it? Like having you in the room breaks down something for them that makes it easier for them to open up? I’m not saying easy, but easier?
Jennifer Rollin: Yeah, I think it’s helpful to have someone else in the room and to know that I’m there if they freeze or get stuck or don’t know what to say or need help explaining something.
I think it’s a good space to be able to talk about things and bring this conversation up. Then maybe they talk about it more when they get home, but opening up that window of communication I think is really important, and letting the partner ask questions. Obviously you want to try to frame them in a sensitive way, but it can be really hard to know how to help someone or understand someone struggling with an eating disorder if you haven’t personally struggled, so bringing that up.
Another thing that I’ll do is we’ll talk about, what would feel most helpful in this moment? If you’re feeling really bad in your body, what would be helpful for your partner to do or say, or to not do or say? Really training them on how to be a good support person in those moments and not having to mind-read as to what the person needs.
Then another thing that we might do, if there’s a lot of anxiety or shame around intimacy specifically related to body image, we might do a hierarchy, the same way we do a fear food hierarchy of different situations that invoke a feeling of anxiety or shame. Maybe undressing in front of my partner, having sex with the lights on.
We might start with very gradually challenging them and looking at the thoughts, feelings, and emotions. Maybe starting with I lay in bed with my partner fully clothed, but he’s touching my arm or something. What are the feelings/thoughts that are coming up? Then we can gradually work towards more difficult situations in a way that feels safe and supported.
Chris Sandel: It’s in a sense like exposure therapy by getting someone used to going through those experiences and realizing that the sky doesn’t fall in and they’re able to get through it.
Jennifer Rollin: Exactly. Then at the same time, looking at the thoughts and feelings that are coming up that are making these situations challenging, and really trying to explain to their partner as much as they can what’s going on for them.
Chris Sandel: When you’re thinking about this for your client, are you also trying to figure out how much of this is coming from body image, and then how much of this is coming from a physiological place? Because I also know that when someone has been undereating, over-exercising, has been dealing with an eating disorder, lots of things get shut down, and reproductive hormones are one of those things. Some of it’s then going to be coming from a physiological place, not just how they’re thinking.
Jennifer Rollin: Absolutely. If someone’s malnourished, at that point in their recovery we’re definitely doing some psychoeducation, like you said, around the impact of malnutrition and how that can turn off sex drive, and trying to use that as one motivation to help people eat more – how it can positively impact their relationship. But like you said, there’s definitely different stages of recovery, and I was thinking more about some of the middle to later stages. But if somebody’s in the earlier stage and they’re not getting enough nutrition for their body, I think that’s a whole other set of considerations to look at the physiological responses.
Chris Sandel: Yeah. If you’re not bringing the partner in for the sessions, are there other resources you can use that can maybe bridge that gap so that you’re not there, obviously, but the client isn’t having to explain to them themselves? Are there any books or videos or documentaries or anything that you’re like “they can watch this together” to open up this kind of dialogue?
Jennifer Rollin: There aren’t a ton of resources that I’m aware of related to intimacy in recovery, but if you know of something, I would love to hear about it. But just basic psychoeducation, something like the 8 Keys to Recovery. I also have a video for support people that I’ll sometimes send to them. NEDA has a great toolkit as well for friends and family members, and then often I’ll send them different articles that are relevant to different things.
So yeah, there’s a lot of ways to get creative without having to have the partner in the room, and certainly we can talk about some of these areas individually, without having the partner in the room as well.
Chris Sandel: Perfect. Any of those resources that you have to hand or you use regularly, send them over. I would love to be able to put them in the show notes that people can access.
Jennifer Rollin: Awesome.
Chris Sandel: The one that comes to mind that I’ll often recommend – and not just for this, for lots of reasons – is Emily Nagoski’s Come As You Are. I think it’s a fantastic book that man, woman, anyone should read because of how well it explains so many different facets of sex and what goes into that and why we feel and think the way that we do.
I learnt a ton from that book, and I think it’s then an easier way of being able to say, “cool, let’s both of us read this book and then let’s talk about the things that come up as part of it,” because it gives you language to use that someone may struggle with being able to use. Because of having that language, you’re able to think about things more clearly. So it can take away maybe some of the stigma, some of the difficulty in having that kind of conversation.
Jennifer Rollin: Yeah, I think that’s a great idea.
00:39:45
Chris Sandel: What about trauma? I know that this is something that comes up a lot with eating disorder recovery, so I’m just wondering how that fits into this piece in terms of the intimacy piece.
Jennifer Rollin: Absolutely. There’s a high percentage of people with eating disorders who are also trauma survivors, and I think when we’re talking about trauma, it’s really important to define it more broadly.
Trauma can be what we think of as sexual assault, somebody being in combat, exposure to violent situations, but it can also be really anything that overwhelmed your ability to cope at the time. It could be your parents getting divorced, the death of somebody, loss of a friend. Regardless, for trauma survivors – specifically individuals who have experienced sexual trauma – it can be really difficult for some of them to engage in sexual activity without having that fight or flight response going off, feelings of anxiety, panic, or shame.
I think when it comes to trauma, we’re first doing a lot of work with the individual as it comes to grounding, if there’s dissociation, helping them to learn how to center themselves. So we’re doing a lot of pre-work, ideally, before they’re getting into intimacy with their partner. That way they can better tolerate it and not feel so triggered, if that’s something that’s a struggle for them.
And then I think trauma therapy obviously is crucial, whether that’s EMDR, CPT, prolonged exposure, and really, again, helping them to build those distress tolerance skills.
Depending on the type of therapy, I might do something similar of the hierarchy – again, being very sensitive, making sure the client is even in a place to do that. You have to be really cautious when it comes to trauma, and make sure ideally – again, people have different philosophies, but in an ideal world somebody would be in a more stable place in their recovery in order to do the trauma work, because I think doing trauma work with a malnourished brain while actively using behaviors is not super useful for people.
Chris Sandel: You trained in trauma yourself, so do you do some of those modalities that you talked about there? Or is this an area where you refer out?
Jennifer Rollin: I’m trauma-informed, so I do some trauma work, but I definitely refer out for adjunctive EMDR treatment if that is necessary for the client. I do that all the time.
Chris Sandel: That’s the same with me. I’ll have conversations around this, but I always put my hands up and say I’m not a trauma specialist. I don’t know and have not been trained in how to deal with this.
Typically what I will recommend is Bessel van der Kolk’s book The Body Keeps the Score, which I really like as a book. You can tell me your thoughts and if there’s any disagreements or reasons why that’s not a good recommendation; I’m definitely open to hearing about that. But why I like it is the first half of the book talks about all the physiological side of trauma and how it impacts the body, and then the second half is looking at all the various modalities that there are that have research around them to support recovery from trauma. That means that someone can read through that and think “that one sounds more like me” or “I’d like to try that way of dealing with it,” because there are many different ways of being able to deal with it.
Jennifer Rollin: I really like that book too. I also like Healing the Fragmented Selves of Trauma Survivors. It’s another really good book, and it is super interesting. She is obviously more of a trauma specialist and not an eating disorder specialist, but it does talk a tiny bit about the intersection and how some eating disorder behaviors actually are used – clients unconsciously use them to try to turn down the fight or flight response and deal with hypo- or hyper-arousal that comes up as a trauma symptom. I thought that was super interesting.
Chris Sandel: You said something before about often it’s not worth dealing with in the beginning if someone’s got a malnourished brain, which I definitely agree with you on. It’s no point doing all of those things at once when you don’t necessarily have to and you can get someone into a place of recovery where they have had more food coming in, where they are in a better place, and then deal with it.
But are there situations where it feels like, actually, the trauma is so front-and-center, how are we going to get this person to get over this without dealing with that first up?
Jennifer Rollin: Absolutely. Treatment is obviously going to be individualized to each person. I think if somebody is really destabilized by their trauma, then maybe we’re not having them do full-on EMDR, but I would want them to be doing a lot of the distress tolerance skills for dealing with trauma.
But again, certainly if trauma seems like it’s really impeding their ability to work on recovery, that might be a time where we try to do it at the same time. Again, it’s not a hard and fast rule. I think the biggest thing is making sure there’s enough support, because if we’re going to be bringing up trauma, that’s very destabilizing, and then they’re also working on recovery at the same time. I would just want to make sure they had a lot of support – which is why it’s best done, I think, in a higher level of care where they can have round-the-clock support if we’re working on both at the exact same time and they’re both pretty intense.
But I think what that might look like is having an extra session. Let’s say they see somebody for EMDR and they see me as well. Maybe I meet with them later that day or we do a check-in or something. So just having a lot of wraparound support I think would be important.
Chris Sandel: At the inpatient level, do you know many places that get that right across the board? My thoughts are there might be a place that’s really strong in terms of eating disorder recovery, but then might not be so good in terms of the trauma. Are there places that you know of that are just really good on all fronts?
Jennifer Rollin: I hesitate to recommend specific treatment facilities, but there is one that seems to have a really good handle of both that I hear consistently, which is Alsana. I don’t know if you’re familiar with them. Again, people have different experiences at different places, so I’m not saying I would endorse this place hands down, but they do seem to do a good job of addressing both the trauma and the eating disorder, from what I’ve seen.
Chris Sandel: Cool. The other part of intimacy and relationships is the eating side with the partner. What are you talking about with clients in regards to this?
Jennifer Rollin: That’s a big one. I think really looking at how the eating disorder is impacting the relationship as a way to build motivation – again, not shaming anyone for struggling, but looking at, what would you like to do in your relationship that you’re not doing right now because your eating disorder is getting in the way?
Maybe it’s “my partner makes French toast in the mornings and I don’t eat it with him, and that’s a goal that I have.” I think this is one reason why eating disorders like to isolate people, because relationships typically involve food. So it’s really looking at – again, I try to use it as an asset, like what are the ways that your partner can support you while keeping a healthy boundary? We’re not trying to make your partner your therapist or create co-dependency, but are there ways your partner can support you if you guys are eating out? And if not, at minimum it’s somebody there to be a distraction.
Continuing to help them challenge their food and exercise rules, and again, utilizing the relationship as a source of motivation if possible, and support.
Chris Sandel: I think this is one where new relationships can potentially be helpful, although not always .it can be very difficult. But Christy Harrison from Food Psych has talked about this, and I’ve noticed it with other clients, that sometimes getting into new relationships, because of what happens in a new relationship – you’re eating out more, you’re going out more, you’re being more sociable – can be something that helps this to happen a little more naturally.
It’s not that it’s then easy; it’s still a struggle, but it just creates a dynamic where there is naturally a bit more spontaneity. There is just a bit more eating out than if the person had to make that decision on their own.
Jennifer Rollin: Exactly. I think that can be really scary for the eating disorder, but like you said, that can be such an asset because it feels less needing to – again, setting goals is great and I do that with clients all the time, but like you said, it happens more naturally. That can feel a little bit better for some people.
Chris Sandel: Nice. In terms of what you said before, in terms of goal-setting, I’ll go through, “What are your fear foods or what might be challenging?” and then be like “Cool, where do you want to start with this?” and just begin picking those things off and doing them until they become normalized. I know you mentioned about eating desserts with your dietitian, and you talk about doing this with your clients. Is that a pretty regular thing that happens with your clients, that they’ll come in and eat some food with you?
Jennifer Rollin: Yeah, I do that a lot, and that’s one of my favorite things to do with people because I think it really brings the eating disorder into the room. Yes, I do some meal and snack challenges with people, and I found that to be really helpful for me when I was in recovery.
Chris Sandel: Are you the one that has to go out and buy the stuff? Are you constantly searching for donuts and cookies and that kind of thing?
Jennifer Rollin: Yeah. I do a lot of grocery delivery. I don’t know if you guys have Instacart over there, but it’s a game-changer. But I’m ordering definitely a lot of donuts and cookies, and I do it with some virtual people as well, so then I’m just getting it for myself. But if it’s in-office, I’m bringing it too, usually.
Chris Sandel: Nice. Is there anything else on that area that we haven’t covered, that I haven’t asked you about?
Jennifer Rollin: I think we covered a lot. I think, again, the biggest, most important piece is recognizing that people are not alone. Whether trauma or an eating disorder is impacting your relationship or intimacy, they’re definitely not alone in that. I think it’s awesome that we’re talking about it on here because it helps to lessen some of the shame and stigma for people.
Chris Sandel: The only other thing I would add is it’s messy, and relationships are messy, and partners are going to make mistakes or say the wrong thing, and so are you as the person who’s in recovery.
I think also having a realistic idea of what that’s going to look like – because I know you said earlier that most of the time, the partners are on board and they’re super supportive. I think sometimes with people in recovery, they’ll listen to something like this and then think that that’s how it should be and it’s always that way, and there’s never any difficulty, and create some false narrative about how easy it is for other people, but not for them.
So I just want to make out that even when someone does have a supportive partner, it doesn’t mean that the relationship doesn’t have struggles or there aren’t issues as part of it.
Jennifer Rollin: Oh, totally. I’ve had people with partners who have their own eating disorder. There definitely can be struggles when it comes to bringing the partner in, so I also don’t want to paint that it’s always a rosy picture either.
00:52:10
Chris Sandel: The next area is people stuck in partial recovery, which I think is a huge thing and is a lot of what I deal with. Why don’t, again, you start with this and take it in whatever direction you want, and then I can ask some specific questions?
Jennifer Rollin: Sure. I think this is such a common struggle for people because there’s this false belief that partial recovery – your eating disorder will tell you it’s the best of both worlds. I can hold on to a piece of my eating disorder, I can try to “control” my weight, and I feel like I have more freedom and there are more things that I can do.
So I think a lot of people get really stuck here, and some people get stuck without even realizing it. This is actually something that happened to me. Early on in my recovery, I remember telling myself, “I can gain weight, but I want to gain weight in the form of muscle” – which is such an eating disorder thought. So I transitioned – again, this is very early recovery – into being really fixated on weightlifting and protein bars and stuff like that. I don’t even know what I want to call it. It wasn’t orthorexia, but more this fitspo idea. I didn’t realize until I was into that for a little bit that I had just simply transitioned into a more socially acceptable eating disorder.
Again, some people don’t even recognize it, but this is just such a tough place to be because for some people the motivation can feel less strong because the eating disorder feels less consuming, and then they still have that piece of the eating disorder which feels safe.
But I would argue that partial recovery is actually the worst of both worlds, because you don’t get to be fully free, and you still have that piece of your eating disorder. It’s like no one wins. The eating disorder isn’t fully happy, your wise-minded self who wants to be free from this is not fully happy. So you have one foot in, one foot out, and that, again, can be a really hard stuck place for people.
Chris Sandel: I think what you alluded to in terms of your own experience is because the world that we live in, in terms of disordered eating and thoughts around food and assorted exercise and all of that has become so normalized, so that when someone is visibly unwell, it’s like “okay, we need to get you some help.” Then outside of that, it’s more “cool, you’re doing such great work” and you’re really congratulated because you no longer match up to the stereotype of what an eating disorder is, and you’re matching up to the stereotype of what a healthy eater is or someone who looks after their body or however you want to call it.
It becomes more difficult because actually, you’re now having to go against everything that society is saying. It’s not even just “I’m recovering from an eating disorder and most people in society think I need to be recovering”; it’s “now I’m having to go against everyone.”
Jennifer Rollin: Yeah, and it’s such a common recovery narrative. At that time, I followed a lot of recovery accounts, some of which I think can be truly helpful for people, and some that can be really triggering because it’s people stuck in partial recovery who don’t realize it inspiring other people.
It’s such a common issue. I remember when I was sick, seeing all these narratives of like “person recovers from anorexia and becomes weightlifting pro,” and there’s all these articles that really endorse this fitness, orthorexia lifestyle and see that as recovery. I think for me, full recovery is not trying to control your body, the way it looks. It’s not trying to be super thin, it’s not trying to be super – I wouldn’t even say fit, but super muscular.
I think it negates the purpose of recovery, which is to find self-worth outside of food and body and to let go of this false sense of control.
Chris Sandel: Definitely. I also want to just clarify what I said as well. I was talking very much from someone who fits the normative bill of what an eating disorder looks like, and I’m well aware that there are people struggling with an eating disorder, especially a restrictive eating disorder, where society is telling them “you don’t have a problem with a restrictive eating disorder, you need to be eating less.” So I just want to clarify that I’m aware that not everyone fits up to that stereotype I was talking about.
Jennifer Rollin: Yeah, absolutely. As you and I both know, eating disorders happen to people across the weight spectrum, and people can have a need to restore, to get back to their natural weight, even if they’re not “underweight.” I think that’s important to highlight.
Chris Sandel: Yeah, and I think something you said before of getting stuck in that place – one of the ways that I conceptualize it or think about it is if you’ve been living at a 1 out of 10 for ages, where everything is so painful and life just sucks on pretty much every level, when you’re now at a 3 out of 10, it’s amazing how much different that feels. You’re like, “this is night and day, I feel so much better, I’m no longer having XYZ symptom like I was before.”
It almost feels like “oh cool, I’m there,” and you don’t understand that actually, you’re still at a 3. You haven’t got to all of the other places that could be so much better, but you just don’t realize it because of perspective in comparison to how bad things were.
Jennifer Rollin: Exactly. You can’t know what you don’t know. People might think “this is the best it’s going to get, I feel so much more free,” but it’s like, no, there’s a lot further you can go, and you can feel even more free. But I think having that experience, it can be hard for people to have faith in something they’ve never felt.
Chris Sandel: I also think as well, with that, a lot of the mind stuff and beliefs and that shift can take longer to really shift. Someone’s perspective on weight or someone’s perspective on health can take longer to shift. So if you have some changes in terms of physiology, feeling a little better, but you haven’t had the mind stuff change yet, it can be hard to keep pushing because you’re like “but I don’t want to keep pushing,” because you haven’t really experienced what that benefit is going to be like.
Jennifer Rollin: Yeah. That’s such a tough place to be, as you know, where people get really stuck with they’re feeling a little bit better physically. People think they “look so much better.” Everyone’s like “oh, you’re healthy now” – which is a really unhelpful thing to say to people, even though they mean it well. But inside they’re still really struggling with all these thoughts and feelings.
So that can be another common trap, where I feel like I have to “look sick enough” for people to take me seriously – which for someone in a larger body is even more awful to have to deal with because they’re often never believed and in fact told eating disorder advice.
Chris Sandel: For me as well, it’s not even trying to convince others; it’s trying to convince themselves. The amount of times that I see people when they’re like “I used to have an eating disorder but now I don’t,” and then I go through it and I’m like, are you sure you don’t anymore? Because there’s still a lot going on here. Yes, you’re not in the depths that you were in before, but this does not sound like recovery.
Jennifer Rollin: Exactly.
00:59:55
Chris Sandel: I know we’ve touched on some of these, but why do you think partial recovery is so common? Are there other things you’d want to mention around this?
Jennifer Rollin: I think it’s also really common because of our culture, which we kind of touched on – how praised certain behaviors are and the thin ideal standard. It makes it really hard for people to want to keep pushing when, again, they feel a little bit better and then they’re culturally reinforced like “you look so great now!” Maybe they’re not even fully at their natural body weight, and people are telling them how much better they look, and then their eating disorder is like “oh, don’t gain any more weight.”
So I think the societal messaging – I mean, part of recovery is really going against every societal message that we’re given, and that can be really hard and scary for people.
Chris Sandel: Just so I have a point of reference with you and your clients, how often would a client be coming to you really at the beginning phases of recovery, so you’re pretty much their first port of call, you’re the first person they’re dealing with this thing with, versus someone who has been struggling for years, maybe decades, and you’re now helping them, but they’ve had a lot of other people in the past?
Jennifer Rollin: It’s really I would say a mixed bag for me. Maybe leaning more towards people who’ve had treatment before, I would say is probably a little more common. But I do have people where I’m the first person who’s diagnosed them with an eating disorder.
Chris Sandel: Part of why I think it is so common is in terms of treatment centers and where they fall down. There’s many areas that they fall down in, and nothing’s perfect, but there’s a lot of focus on “weight restoration” where it doesn’t go much further than that. There isn’t all of the other components that go into why something may have occurred, but it’s just purely a numbers game.
The other one is that not a lot of places are informed around the problems with weight stigma and fatphobia and all of those other areas that mean that people just don’t get the recovery guidance that they should. You talked about this earlier on in terms of one of the people you worked with.
But my sense is, from so many of the clients that I work with who have been struggling with this for a long time, it is pretty heartbreaking hearing their stories about other attempts at this and people who should be well-informed doing things that are just so counterproductive to helping someone recover from an eating disorder.
Jennifer Rollin: Absolutely. I think that’s a huge barrier and just such a problem. I’m sure we could have an entire podcast episode talking about some of the issues with eating disorder treatment. And the fact that I don’t know hardly any that are Health at Every Size-informed is also completely insane to me.
So I totally agree. If you’re given the roadmap to recovery being “just get back to this weight and then you’re good,” why would you think you need to go beyond that? And then if your weight stigma and the fatphobic viewpoints that you have are reinforced or endorsed by professionals, it’s easy to buy into those messages, and also, after many treatment attempts, to feel like “Maybe I’m just a chronic case. I can’t get better.”
Chris Sandel: Yeah. In terms of the chronic case or repeated attempts, some of the time I really feel that there’s a problem with the way that eating disorders are talked about in terms of fitting into neat boxes, because especially the longer things go on, the more excuses or reasons why someone feels like they’re not the typical person and why “maybe this isn’t really my issue and maybe it’s something else,” and there’s always the second-guessing.
Then if you have to do something that is incredibly hard, when you start that and there’s symptoms that are getting worse in the beginning before they’re getting better – which is very common – if you don’t believe that this is the right route, then it’s really hard to follow through on that. So I think the fact that eating disorders, at least if someone’s looking in the DSM or looking in terms of the symptoms, are meant to neatly match up, and then their lived experience is that there is no neatly matching up.
Jennifer Rollin: Yeah, I completely agree. As you and I both know, the DSM also, there’s some weight stigma when it comes to their diagnostic criteria, specifically anorexia. I definitely agree; I think diagnosis can be useful at times, but there are certainly areas that are missed out on, which definitely includes not everyone is going to fit into a neat category. That can leave people feeling not sick enough.
01:05:30
Chris Sandel: Definitely. Are there other reasons for you where you think partial recovery is happening, like glaring mistakes or errors that are going on with the recovery treatments or within society?
Jennifer Rollin: I think lack of access to treatment, so people who don’t have access to an eating disorder specialist, people who don’t have the financial resources to go to residential treatment. That can be another common struggle. Depending on the area of the world you live in – I hear there are certain parts of the world where it’s even harder to get treatment and you have to be at a certain BMI in order to even get the help. And same here. Insurance companies can deny and say they’re not going to cover because of your weight. So, unfortunately, the eating disorder is reinforced, I think, through that.
Chris Sandel: If you’re saying that there’s actually not that many centers that do it particularly well, you are really playing a lottery in terms of if you’re at the right weight, if you’re going to get referred to a treatment center because of insurance, and then that you’re going to get referred to the right treatment center that actually gets you to that place – the odds aren’t stacked in anyone’s favor.
Jennifer Rollin: Yeah. And lastly, is insurance going to cover enough time, or are they going to cut after 30 days and say that you’re better now? Even if you get to treatment.
Chris Sandel: With insurance, we have a very different medical system over here than in the States. Is it that it’s normally a length of time, or once you get to a certain weight then it cuts off? How does it often work?
Jennifer Rollin: I honestly don’t have the best understanding of insurance. It seems so random to me at times, but I know depending on the insurance company, there are definitely times where they will cut saying that the person is weight-restored – I’m talking specifically about residential treatment – or saying that the person is better now. Again, it seems very random, but insurance will definitely cut. I think their aim, honestly, is to pay as little as possible, so they’ll use any reason under the sun to try to get people out of treatment earlier than they need to be out.
Chris Sandel: The other one that I think of in terms of why people get stuck – and especially if they’re coming from a restrictive eating disorder – is just the fear when extreme hunger hits, or if extreme hunger hits for them, and just the not knowing how to listen to that or give in, just because it can feel so overwhelming. It’s hard for them to be able to follow through.
Jennifer Rollin: Absolutely. Extreme hunger and a variety of steps that can happen for people in the recovery process can be really scary and difficult to sit through. If people are able to sit through them, they can come out the other side and things are so much better. But it’s that whole idea of getting better feels bad at first. So I think there are so many points – even if someone’s in partial recovery and needs to take more steps to get to fully recovered, it feels safer in a way to say no.
I think a big part of it is people convince themselves they’re fine where they are in partial recovery because doing the other thing feels really scary. If I believe that I’m fine and I can tolerate this, then I don’t have to make the scary changes.
Chris Sandel: I think that connects into something we said earlier on about if you then can convince yourself that what you’re doing is healthy, like stopping exercise, even though it could be very beneficial for someone’s recovery and is really needed.
They’re like, “That feels really uncomfortable when I try and do it. Everyone talks about how healthy exercise is, so maybe I don’t need to do that as part of my recovery.” Or “I can eat some more food, but I’m going to do it with these healthy versions or healthy alternatives of those foods because everyone knows that (fill in the blank food) is unhealthy for you.” So it’s the “this is really difficult to do, and when I try and do it, I can’t, and then I’ve got this other excuse or other way of framing it of why I probably don’t need to do it anyway.”
Jennifer Rollin: Exactly. That’s why I think you need a really skilled team if you have access and the resources to have one, who can recognize the sneaky eating disorder behaviors and really pay attention to those things.
Chris Sandel: Is there anything else you want to mention on this one before we move on to body image and body image interventions?
Jennifer Rollin: I think the only other thing I would say is I know it’s so hard to trust something that you haven’t seen, but just really try to take small steps and remind yourself – something I like to say to clients is, you know how to have an eating disorder, right? If you’re in partial recovery and you take steps towards full recovery and it feels intolerable, you can always go back to your eating disorder. But life can be so much better than where you’re currently at right now. So why not take a leap of faith, take some steps – and again, your eating disorder is always there, but I don’t know anyone who’s recovered who wants to go back to their eating disorder.
Chris Sandel: The other one that I would say in a similar vein – and I’ve done a blog post on this before – is the idea of being sick enough. People are like, “maybe I’m not sick enough to deserve recovery” or “maybe I’m not really sick enough at all.”
My point as part of that article is just reframing it, and not to be looking at if are you sick enough, but if you had a magic wand, would you want things to be better? Would you like your relationship with food to be better? Would you like your experience when eating in public to be better? Would you like to be able to have days off of exercise and to be exercising for fun as opposed to compulsion? All of these different areas, would you like them to be better than where they currently are? If the answer to that is yes, then it doesn’t matter if you’re “sick enough” or not; it just means that you want to change something, and then to be able to embrace that and go through whatever the difficulties are as part of that change.
But I say this just because I think sometimes people stay stuck because they’re looking at it through the wrong lens of “am I really sick enough?”
Jennifer Rollin: Yeah, 100%. I completely agree.
01:12:15
Chris Sandel: The final topic, then, is around body image and body image intervention. Again, you just start and then I’ll ask some questions.
Jennifer Rollin: I think there’s a lot to talk about here. I’ll try to make it succinct. I think when it comes to body image interventions, it’s about the body and it’s not about the body, if that makes sense. We need to be talking about specific interventions and thoughts and feelings that are coming up for the client around their body, but then we also need to be looking at connecting to a life worth living, meaning and purpose, finding value outside of their body.
I think for me, there are a few questions that I like to have people ask themselves when they’re hit with bad body image. One thing I like to highlight for clients is that body image is typically not consistent for people. Often it ebbs and flows. I think we’ve all had the experience where you wake up one day, or in the middle of the day, and you suddenly feel negative or bad in your body. Your body hasn’t objectively changed overnight, but there’s something that’s shifted.
The first question I like to have people ask themselves is, “Is there anything else that’s bothering me or stressing me out, which I might be expressing through the language of negative body image?” I really see negative body image as a language, almost like that pair of comfortable yoga pants that we put on at the end of a long day. It can become very habitual and automatic as an easier way of communicating deeper thoughts and feelings.
I think it’s important to, again, look at, are there other areas of my life that feel out of control right now or feel stressful that I’m projecting onto my body?
Just thinking about it, I had a client. I asked the words that she was using to describe her body, and one of the words – she said, “I feel disgusting and gross.” I’m like, “What are some of the other feelings?” She said, “I feel weighed down and heavy.” So we looked at other areas of her life where she felt weighed down. So we were able to talk about that and get at the real issue, which was not her body.
I think that’s one thing to really look at, because again, often there’s a real correlation between negative body image and other life stressors.
The second question is, “What am I telling myself that having an ‘ideal’ body would bring me?” No one wants to have a body type simply for having it. We want to have it because of the meaning and the stories that we tell ourselves around that body, which are culturally reinforced.
Really looking at, if some of the things I want are healthy goals, how can I achieve those goals without having to try to change my body? If I believe that losing weight will help me to find love, are there people your size and bigger who have found love? I would say yes, there are.
Also, I want to point out while validating that for people in larger bodies, there is real weight stigma in this world. We don’t want to minimize that. We want to validate that yes, that can make things harder, and what is the price that you pay with all this weight cycling? Because your body wants to get back to its natural place.
So really looking at what is underneath that desire to change your body. What are you really looking for? Again, we don’t want the body just to have the body; we want the body because of the meaning and the stories.
And then really thinking about self-compassion and asking yourself, “How can I be kind to myself in this moment?” I think there’s a lot of thoughts that can come up. Let’s say I have a negative thought about my body. I think my body is disgusting, and I’m telling myself I need to lose weight. Then maybe the thought I have is “Oh shit, I shouldn’t be thinking this. My therapist keeps telling me my body’s not important. Why am I so shallow? I hate myself.” It becomes this terrible thought spiral.
Again, really just thinking about how I can be compassionate with myself – many people in this world struggle with body image issues, and I’m in recovery from an eating disorder. These thoughts are going to pop up. But just because I tell myself something, does not mean that I have to act on it, does not mean it has to change my food, and does not mean that it’s a fact.
I think we talked about this last time, but there are other cultures where being large is seen as a sign of beauty. So it’s not your body that’s the problem; it’s the meaning and the stories you attach to it, and then it’s the cultural stigma that we have towards people in larger bodies.
Chris Sandel: Just going back to the first point that you made in terms of other things going on in someone’s life and that getting filtered through to mean “something’s wrong with my body,” or that’s when people feel they’re having worse body image days, that is something I notice all the time with clients.
It’s something I’m always trying to get them to recognize or notice in terms of, what else could’ve happened in your life around this time? Could it have been that you went too long without having a meal? Could it have been that you didn’t get good sleep the night before? Could it have been you had a conversation with someone or you received a certain email or whatever? What I find for clients who’ve had food and eating and body struggles for such a long time, everything just gets funneled through that same place so that any time there is that kind of a feeling, it hits them like that and it means that it has to be about their body.
I did an article – I can’t remember how long ago I wrote the article, but I was out walking my son when he was really young, and it just started absolutely bucketing down. It was freezing. I became very angry during that experience, simply because I was so cold. It was really interesting for me to watch that come over me. I was like “I’m not going to tell myself a story about this, or the story I’m going to tell myself is this wind is freezing and this is why I’m feeling this way” – but it could’ve very easily been a moment where I start telling myself it’s about the relationship I’m in or it’s about this other thing.
The situation I was in had a change on my physiology that created an emotion. So I’m always trying to get clients to look at it from both ways in terms of, are you creating stories that are then leading to certain emotions that are happening? Or are you having certain emotions arise and then you’re creating a story to explain why you have that emotion?
Jennifer Rollin: That’s such a good point. It reminds me – for people who’ve experienced trauma as well, there’s something called an emotional flashback, where they feel an emotion that’s similar to what they felt, or a body sensation, and then someone who struggles with PTSD might feel triggered.
I think what you’re pointing out, obviously, is how much our physiology can impact our mind because our minds are like meaning and story makers. They try to come up with explanations for things. So yeah, it’s really interesting, like you said, how our physiology and changes in the environment can really impact the stories that we tell ourselves.
Chris Sandel: When you’re getting clients to notice this, are you saying write down the stories you’re telling yourself or write down what you’re saying to yourself? How do you do it in practical terms?
Jennifer Rollin: There’s different ways that we can do it. Sometimes I will role-play it in a session, where I’ll have the person be their eating disorder and then I will be their wise mind, and then we’ll switch. I do like to have people write down core beliefs and stories they’re telling themselves.
It’s actually funny that we’re talking about this, because side note, next week I’m going to be in California at Camp HEAL, talking about rewriting your body image story with my colleague, Dr. Colleen Reichmann. So it’s very relevant.
So I’ll have them write them down, and then we’ll start to think about, rather than asking yourself, is that story true or not true – because I think people get very stuck there – it’s like, is that story helpful in terms of getting in the direction of the life that you want and your values? If it’s not, can we come up with something more helpful? It doesn’t have to be cheesy affirmation, just something that feels actually more true and believable.
Chris Sandel: I do the same thing in terms of doing some writing exercises that then we get to see what someone’s beliefs are, and then starting to ask them, do you really believe these things? Where could there be areas where there’s edge cases where you stop believing these things? What happens in this other scenario? What if I change the word “fat” to “black” or “gay” or whatever; would you still be saying the same things that you’re saying here? Just start to challenge those things and get them to think about it.
But also, the other side of that, as you said, even if something might be factually true – and it’s always up for debate around that – it’s like, is this belief really helpful for you? Could we find other beliefs that are actually going to be more supportive to get you to the place that you want to do?
For other people who have that belief, what do you think they do differently? How do you think they approach this?, etc. Trying to get them to put themselves in other people’s shoes or solve someone else’s problems or explain it from someone else’s perspective, just because I think people really struggle with finding a solution for their own issues, but they’re very good at being able to do it for everyone else.
Jennifer Rollin: Yeah, I notice that a lot. I think that’s a common thing. People are much more able to be compassionate with other people, often, than themselves. So I’ll use that too.
But yeah, even just highlighting this idea that thoughts are not facts. I think they say we have something like 70,000 thoughts a day, and many of them are on a loop of similar thoughts we’ve had before. That mindfulness piece of helping people to recognize that I can’t control my first thought, but I can control how I respond to that thought and the behaviors that I do. And over time, if I practice some more helpful self-talk, it can start to become more automatic and feel more natural over time.
Chris Sandel: I think that’s the important part, the “over time.” There is no quick win with this in terms of I point something out to someone and they’re like “oh cool, that’s fixed everything.” This is habitual.
Also, one of the things that I will do with clients is I’ll go through an exercise to really demonstrate how much of this is a learned behavior, and I’m of the belief that you can unlearn this behavior the same way you can then learn a new behavior, and it is simply about repetition and being aware of what you’re saying again and again.
Jennifer Rollin: Yeah. Like you said, it’s not a quick fix. I think the practice is so important because you’ve been unintentionally practicing telling yourself the unhelpful things for a very long time. So we have to practice the more helpful statements pretty regularly in order to get them to start to rewire neural pathways in our brain.
Chris Sandel: Another thing, talking about whether something is correct or not, is often when clients will talk about how much things used to be better before, I’m always like, “Let’s explore this a little bit.” So often, when we do some digging, it’s like, you are looking back on this past event where you were in this different body with very rose-tinted glasses. You’re forgetting a lot of things that were going on around that same time that made this not the enjoyable experience that you’re remembering.
They remember 10% of it and then forget the other 90%, which was the hell. It comes up with this story about why it would be so advantageous to get back there, even though that never matched up to their reality.
Jennifer Rollin: Yeah. It’s funny; I was thinking about the glasses analogy, and then you said it. But I completely agree. I think you have to remember that an eating disorder is going to say whatever it has to say to try to get you to use the behaviors. It’ll even try to change, like you said, the past and have you remembering the 5% that felt good and rewarding, and leaving out the parts that were super painful and negative. I think being able to highlight that for clients is important.
01:25:35
Chris Sandel: What else would you recommend around body image in terms of – are there particular resources you think are helpful? Are there particular books, documentaries, that kind of thing?
Jennifer Rollin: I think the biggest thing is really going in and doing a cleanout, if you’re on social media, of your social media accounts, and then trying to add in images of people in all different shapes and sizes and people in more positive messaging. It’s been shown that seeing images of body diversity is really important when it comes to body image. So that’s something I think would be really helpful.
I think also starting to do exercises like writing down the stories you’re telling yourself and trying to challenge those and look at, “Where did this story come from? Where did I learn it?”
In terms of specific books, I think I liked Embody, that book. There aren’t a ton of body image books, but I love – I know some people really like The Body Image Workbook as another option, by Thomas Cash.
I would say actually a book that I would recommend – which might seem strange because it’s not at all related to body image, but I promise it’s relevant – would be The Happiness Trap. The reason being I think another step when it comes to healing body image is really connecting to a life worth living and your values that have nothing to do with your body, and really trying to fill your life. If you think about the analogy of marble jars and having a set of amount of marbles, when we put most of our marbles into the body image jar, they come out of other areas.
Looking at, again, the values and the kind of person that you want to be, The Happiness Trap talks a lot about that. It’s about acceptance and commitment therapy and values and what we think makes us happy and all of those concepts. I think really starting to recognize that first off, chasing after our appearance and body love is not the goal here. Our bodies are all going to change as we age, so putting our self-worth into them is a recipe for being unhappy.
And thinking about – as long as someone doesn’t have suicidal ideation – what would I want my obituary to say? At my 80th birthday party, what would I want people to be saying about me? I’m pretty sure it’s not “she was so thin and she ate a lot of vegetables.” That’s not what we want to be remembered for on this earth.
Chris Sandel: I’ve seen The Happiness Trap on Amazon. It’s probably one of the books that comes up when I purchase something and says “maybe you should purchase this as well.” I want to check that out, because that sounds really interesting.
I’ve read a lot around positive psychology. I think Authentic Happiness is one that I quite like, just looking at the research around what does actually lead to happiness and how people feel fulfilled happiness. I think Martin Seligman wrote that.
You mentioned about The Body Image Workbook by Cash. I’ve started using that with clients. Do you have any strong feelings around it?
Jennifer Rollin: I don’t. I think it’s probably my own bias, to be honest. When I was in recovery, I tried to get into the workbook thing; I didn’t really love it. But certainly if a client comes in and says they’re really interested in that, I definitely would use that workbook or the 8 Keys to Recovery workbook. I think for clients who need a little bit more structure, those workbooks can be super helpful.
Chris Sandel: I actually find that I use them later on with clients, when we’ve done other exercises I’ll go through. Later on I find it quite good where it’s got this nice systematic process that they can work through. So yeah, I’ll use that. I haven’t used the 8 Keys book with a client yet. Some clients have already read it, but it’s not one that I use at this stage.
Jennifer Rollin: The workbook is pretty good. I like the book overall. It leaves out some stuff about Health at Every Size and weight stigma which I think is really important – but I’ll try not to get on a rant about that. [laughs] So I recommend that book with caution.
Chris Sandel: The other thing that comes to mind with this stuff as well – and this is more at the practitioner end – is being okay to sit with someone when they’re in pain and they’re struggling without the need to try and show them all the silver linings or explain why it’s not as bad as they think or trying to move them out of that place. Being okay with doing some exploration around it without the “I’ve got to fix this” I think is really important. I think for me, as I’ve got better at doing this work, that’s one of the areas where I’ve got better and I know that it helps clients more.
Jennifer Rollin: Absolutely. I think it’s so hard, because we got into this field because we want to help people. It’s hard to see people in pain. But I think sometimes the most powerful thing we can do, like you said, is to sit with someone and have them feel like they’re in a safe space, and to let them cry, and to let them feel their emotions without feeling a need to jump to positive spin on things or silver lining. We don’t want somebody to move in and live there, but we want them to be able to experience an emotion without feeling like we’re trying to quickly divert them into something else.
Chris Sandel: Definitely. I’m reading Range at the moment, a book by David Epstein, which I highly recommend. It’s one of the best books I’ve read in a while. It’s all about why being a generalist is better than being really specialized and looking at the research around this. He talks about learning in general.
They did a study where they looked at different teachers and whether someone did well on a test versus what happened two years later when they had to remember that information. What they found was the people who did really well on the test in the early stages did most poorly on the test in the latter stages and vice versa. But the people who most rated their teacher as being the best and amazing were also the people who later on did worse.
So I think there is something to be said – and you’ve got to get a right balance with this, but not solving everyone’s problems for them and giving them all the right answers, being okay with leaving it ambiguous and having people struggle through things so that they get to that place themselves and they learn how to critically think, they learn how to be able to do these things themselves as opposed to “I’ve just got to ask this person and they’re going to tell me how to do everything.”
Jennifer Rollin: Absolutely right. We want to do psychoeducation and give people tools and strategies, but ultimately we want to bring out their own inner wisdom and intuition, which many of them are not able to access in the beginning. But yeah, like you said, ultimately the goal is for them to connect to their own inner wisdom.
Chris Sandel: Anything else that you want to mention around body image? What’s the talk that you’re doing in this area? Is there anything you’ve got in that talk that you haven’t covered yet?
Jennifer Rollin: I’m trying to think – that talk is really starting to look at, again, the stories that we’re telling ourselves. We have some specific exercises in there. I think we covered the main concept of it, but we just deep dive into some of those things, and then Colleen and I talk about our own body image stories and how our body image has developed and tools that helped us. But I think we got the general vibe of it.
01:33:35
Chris Sandel: How do you feel like your body image has shifted from where you were in terms of your eating disorder to where you are now?
Jennifer Rollin: It used to be an obsession for me, and even if I had momentary highs after losing weight, it was still never, ever good enough. I still found flaws. I think being able to recognize that a lot of that for me personally stemmed from trauma and from low self-esteem and anxiety, now the biggest difference is that I’m not fixated on it.
Before, it took up so much of my time. I was taking pictures of my stomach, doing all these things that made it so much worse, and now I’m able to recognize that my body is a part of who I am and enables me to do all these cool things, but it’s not the be-all, end-all. It’s not something I have to focus on. If I go up a size, it doesn’t matter. I think really detaching my sense of self-worth from the way that my body looks and recognizing that I no longer desire to have a six-pack or these things that I thought in my eating disorder were so important, like a flat stomach.
What I want is a full and meaningful life where I’m impacting real change in the eating disorder community and having the relationships that I want and working on self-care, and focusing on trying to change my body only takes away from all of those things. So I think really I’m at a place of acceptance.
Chris Sandel: How do you think about where certain things fit? The idea with working on body image isn’t to wear a hessian sack for the rest of your life because you have no care whatsoever about appearance or fashion or anything along those lines, but more for that to be in proportion and within context of your life. It’s like, cool, you can still care about what you wear or you can still care about “I like going shopping” or that kind of thing, but where that’s not overruling your life.
Jennifer Rollin: Exactly. It’s not black or white. I think we want to make things very black or white, like “you shouldn’t care at all,” but I certainly like going shopping. Primarily at Target. I don’t know if you guys have that out there. It’s very enjoyable. [laughs]
I like shopping. I like painting my nails or whatever. But I think the distinction, again, is it’s not a part of your self-worth. It’s a form of expression; it’s not scrutinizing “How do I look in this outfit? How does it make my body look? How does it make this specific part of my body look?” It’s more like “I like this color and it makes me happy.”
So yeah, there’s nothing wrong with caring about your appearance, but it becomes in proportion to the rest of your life. Before, my appearance was my whole life.
01:36:40
Chris Sandel: This has been awesome. We’ve covered a ton. Is there anything else that we didn’t go through that you wanted to mention?
Jennifer Rollin: I think we covered so much. The last thing I would say is urging people to really start to look at the values piece of this work – which again, I think The Happiness Trap is a good resource for – and really trying to connect to that deeper meaning and purpose, especially in moments where you feel like you want to give up. Thinking about why you started recovery in the first place and the life that you’re working towards.
And again, just really thinking about “What type of person do I want to be in this world? What’s the impact that I want to have?” Eating disorders get us into this micro-obsession with calories and number of steps taken and all of that, and number on a scale, and you really want to expand and broaden, like, “What do I want my life to look like?”
Chris Sandel: The only caveat I would add to that is don’t have that then become a problem. I think for a lot of people, they’re like, “But I have no idea. I don’t know what my purpose is, I don’t know…” and then that becomes something where they get stuck. So for me, when I’m recommending this kind of stuff, start to be curious around these sort of things. Start to explore different ideas and do different things without the implication that “they have to have this all figured out now, and if they’re not going to figure it out, then what are they even really recovering to”?
Some people have this real clear light guiding them about “this is who I am, this is what I do, and this is the track that I’m on,” and the vast majority of people don’t. They just find the things that they’re enjoying at this moment, and then they do that until the point at which it’s no longer enjoyable, and then they move on to the next thing.
Jennifer Rollin: Yeah, absolutely. One of your values could be “I want to be more present in the moment.” It doesn’t have to be “I’m changing the world.” Or “I want to be nice to other people, go out of my way to say ‘thank you’ for things.” It doesn’t have to be something big and all-encompassing, and it’s okay to not have it all figured out also.
Chris Sandel: Definitely. I think sometimes the word “purpose” carries baggage in terms of like if I’m not saying I’m going to be the next Brené Brown or fill in the blank, then I’m wasting my life. The vast majority of people aren’t going to be that person, and you don’t have to be that person for your life to be purposeful or for you to feel like you’re adding meaning or anything along those lines.
Jennifer Rollin: I would absolutely agree. I think it’s about shifting that goalpost, too. Not, like you said, turning it into another problem where you’re super perfectionist about it. Just thinking about what you said, someone who positively impacts my life every day – and I’m not joking – is one of the baristas, John, at Starbucks. He’s like the nicest human. We have good conversation. He always upgrades my drink for free. He makes a positive impact, I kid you not, on my life every day.
So just recognize that any person can have an impact. You don’t have to be writing a book or speaking to the masses.
Chris Sandel: Definitely. Jennifer, where should people be going if they want to find out more about you? You obviously mentioned a talk that you’ve got coming up. If there’s any others that you want to mention, feel free.
Jennifer Rollin: My website is just www.theeatingdisordercenter.com. They could also find me on Instagram, where I enjoy being and oversharing at times. It’s @jennifer_rollin. Then I have the upcoming talk in California on rewriting your body image story, and I think in October I’m speaking at the National Eating Disorder Association Walk in Baltimore.
Chris Sandel: Perfect. I will put all of those links in the show notes. Thank you so much for coming on the show again. This was awesome.
Jennifer Rollin: Awesome. Thanks so much for having me.
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