In this podcast, which comes on the heels of reports linking social media use to reduced self-esteem in teen girls, eating-disorders therapist Shira Collings discusses person-centered, socio-culturally aware approaches to dealing with disordered eating and other food-related challenges in youth (and adults).
Shira Collings, M.S., N.C.C., is Mad in America’s Assistant Editor for MIA Continuing Education and the Youth Coordinator for the National Empowerment Center. She received her B.A. in Communication from the University of Pennsylvania and an M.S. in Counseling and Psychology from Troy University.
As a person with lived experience of recovery from diet culture, disordered eating, and trauma, Shira is passionate about supporting others in finding freedom with food, body acceptance, and the ability to be their full, authentic selves and live according to their values. She is an advocate for trauma-informed, person-centered approaches to mental health care.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Miranda Spencer: Eating problems are said to be one of the deadliest mental health issues, and there are many different types listed in psychiatry’s diagnostic manual. Why are there so many different emotional/behavioral issues associated with nutrition and eating?
Shira Collings: One commonality and underlying thread that’s present in every eating disorder and every diagnosis is restriction. Most, if not all, eating disorders begin with a period of caloric restriction, of weight suppression. Sometimes people respond with more restriction, and sometimes the restriction leads people’s bodies to feel very deprived, and they may respond through bingeing or through bingeing and purging.
There’s a lot of different factors that play a role in restriction, but a very common factor is body dissatisfaction and the social idealization of thinness and devaluation of fatness. Other times, people may lose weight unintentionally. For example, that might be through a physical illness or other factors, and they may get praised for that or reinforced for that [weight loss] in some way, and that prompts more restriction or some sort of disordered eating cycle.
I would also add that restriction leads to a host of emotional and behavioral issues that can impact someone’s relationship with food and their body and other aspects of their life.
Spencer: Eating disorders are typically associated in a lot of people’s minds with teenagers. Is that an accurate representation of the population that most struggles with this type of issue?
Collings: Eating disorders affect people of all ages. It is most commonly recognized in adolescents and teens for a variety of reasons. One of those reasons is that stereotype, and because of that stereotype, medical providers may screen for it in adolescents and teens and stop screening for it in adulthood. Eating disorders often develop in adolescence, so recognizing and treating them at that point is really important. If we can recognize them in youth and start the treatment there, that can prevent it from becoming a life-long issue.
Spencer: What is it about adolescence that makes one self-conscious about one’s body?
Collings: That’s when people are dealing with figuring out their identity or navigating who they are or what groups they belong to; dealing with different dynamics with their peers. So, for sure, that can influence people and result in restriction or body dissatisfaction.
I think if people are involved in activities that place a high emphasis on appearance and on body weight, such as sports or dance, that can definitely lead to restriction or disordered eating. Then sometimes it has to do with family messaging or family attitudes, but that’s not unique to eating disorders.
Spencer: If there’s going to be some issue displayed in adolescence, why does it end up being an eating issue rather than something else? What do we know about the origins of disordered eating in terms of family eating behavior or attitudes, versus social pressures like bullying or Instagram?
Collings: I think all of that certainly can play a role: negative messaging from family, schools, peers, and the media. Those certainly can have a big impact, but I think it’s just different for everyone in terms of what has the most impact.
Spencer: I suppose that makes it more challenging in terms of helping someone, because it’s not as if you can go to a script: It’s caused by this, and so the solution is that.
Collings: I think that’s true. At the same time, there are things that we know do play a role and are major contributors, such as restriction or weight suppression. So, that’s definitely something that we can keep coming back to, the effects of that.
And we don’t always have to know the specific setting that the negative messaging is taking place to address the fact that negative messaging about bodies and about eating and about weight do play a role and can lead to that restriction.
Spencer: Are there are other stereotypes or beliefs about eating struggles?
Collings: I think a very common stereotype is that eating disorders only affect white, thin, teen-aged or adolescent girls. But the reality is that eating disorders affect people of all sizes, backgrounds, ages, ethnicities, sexual orientations, and genders.
I think one of the most harmful stereotypes is that people in larger bodies don’t have eating disorders, or restrictive eating disorders. Or that you can tell by looking at someone whether or not they have an eating disorder, or maybe the severity or the type. I think it’s really important to acknowledge that weight suppression and restriction in any size body can be very harmful. And we do have research showing, for example, that someone in a larger body who has lost a significant amount of weight rapidly may be suffering from more medical consequences than someone who is categorized as underweight according to the [body mass index], but who is in a smaller body to start with.
And I would also add that binge eating disorder, or disorders that we commonly associate with eating, “excessively,” often if not always result from restriction. That’s usually one way that the body is making sure to get enough food or to compensate for the deprivation that it’s facing. So, the approach to treating binge eating disorder is through addressing the restriction. Not through addressing the bingeing behaviors.
Spencer: That’s really interesting, because I think about popular diets like Keto, which is mostly protein and very focused on making sure that you only eat certain things. Where do we draw the line on what is a choice and what gets into the territory of emotional distress?
Collings: I personally don’t really draw that line. We have plenty of evidence showing that any form of restriction, including a diet that’s normalized or popularized in our culture, can be harmful and can create real mental and physical health consequences. [For example], keto has resulted in many, many different types of physical health issues, mental health issues, [even] death in some cases, which is really tragic.
Spencer: Struggles around food and eating are considered a mental health problem, but you’ve also told me that disordered eating can actually cause or exacerbate mental health problems. Can you talk about that?
Collings: The idea that an eating disorder or disordered eating results from an underlying issue or means that someone has something wrong with their brain in the first place, [is] kind of a misconception; it’s a lot more complex and nuanced. The idea that it’s a mental health issue that causes starvation versus starvation that causes a mental health issue is a bit over-simplified.
I want to talk about a study called The Minnesota Starvation Experiment that was a study done in the aftermath of World War II to study how to re-feed victims of…