Eating Disorders In the LGBTQ Community

Eating disorders occur at dramatically higher rates within the LGBTQ community than heterosexual/cisgender populations.  In this week’s episode of In the Den, Jen talks with Caden Jones about different eating disorders and the intersection of those disorders with queer identities. They discuss the challenges of recognizing an eating disorder and ways to find the best treatment for our LGBTQ child’s disordered eating once we become aware of the problem. 

Special Guest: Caden Jones

Caden has a Masters in Counseling Psychology, and is a fourth year PsyD student pursuing a doctorate in counseling psychology at Northwest University. Currently, Caden is a pre-intern for Dr. Monique Lowe, PhD, engaging in neuropsychological evaluation for ADHD, ASD, TBI's and learning disorders. Caden Jones is also an associate mental health counselor at Center for Discovery, offering therapeutic services at Residential, Intensive Outpatient, and Partial Hospitalization levels of care for adults and children of all genders who are pursuing eating disorder recovery. He also runs a private practice in Bellevue offering trauma informed care for individuals and couples. Caden has been in recovery from an eating disorder for over ten years, and seeks to aid others in their healing journey from eating disorders. He is especially passionate about the intricate experience of transness and eating disorders, as the two are often comorbid and compounding. 

Links from the Show: 

Center for Discovery: https://centerfordiscovery.com/

LGBTQ Eating Disorders: https://centerfordiscovery.com/blog/eating-disorder-discrimination-lgbt-community/

Join Mama Dragons today at www.mamadragons.org 

In the Den is made possible by generous donors like you.

Help us continue to deliver quality content by becoming a donor today at mamadragons.org. 

Transcript

JEN:   Hello and welcome. You are listening to In the Den with Mama Dragons. I’m your host, Jen. This podcast was created out of our desire to walk and talk with you through this journey of raising happy, healthy, and productive LGBTQ humans. We are so happy that you’re here with us.

Life has challenges for everyone.  And as parents, we are given the opportunity to help our children face the challenges that arise for them throughout life.  Thankfully, we have professionals that dive into the different issue that might arise.  When we have an LGBTQ child, they might have similar challenges to their cisgender heterosexual peers.  But there are some things that occur at a higher rate among different aspects of the LGBTQ spectrum.  Today,

we are going to get a little more information about one of those common

intersections.  And we brought Caden to help us. 

 Caden Jones is an associate mental health counselor at Center for Discovery, offering various therapeutic services  for adults and children of all genders who are pursuing eating disorder recovery. He also runs a private practice in Bellevue offering trauma informed care for individuals and couples. Caden has been in recovery from an eating disorder for over ten years, and seeks to aid others in their healing journey from eating disorders. He is especially passionate about the intricate experience of transness and eating disorders, as the two are often comorbid and compounding. 

Welcome Caden!

CADEN: Thank you. I’m happy to be here.

JEN:   Before I start pounding you with all the intense questions I have lined up here, I’m hoping you’ll share with us a bit of your personal story. I think it’ll be helpful for our listeners to understand how you came to the place you are now, especially as we’re considering your career path.

CADEN:    Yeah. Definitely. I’ve come from a background where I came to my transition in early adulthood. So I didn’t recognize that I was trans until I was around the age 21. And at the time I was dating someone who was trans. And in my attempt to be a kind and affirming and understanding partner, I started doing a lot of research into trans topics. So, in that journey, I find myself leaning more and more into content that related to trans men then to trans women. And I was like, ‘That’s kind of interesting.” Like, hmm, what’s that all about? And the more that I engaged with that content the more that I felt myself pulled toward this idea of transness and it felt like it really rang true with my own experience. And, long story short, I found this was congruent for myself and I was able to come out and start engaging in my queerness in that capacity. And it’s felt congruent ever since. So here we are.

But one of the important pieces on how this relates to my eating disorder journey as well, is that I’ve been in recover from an eating disorder for over ten years now. And part of my eating disorder experience really was intricately tied to my trans experience. Although I didn’t have the capacity to understand, conceptually, that those two were linked that the time. And I think that’s what is so interesting and makes the two so intricate when you examine them, not just side-by-side, but together. Because, when you have both experiences but you don’t have the understanding of the concepts of both within yourself, it becomes difficult to identify one against the other.

JEN:          We’re going to talk about a bunch of that.

CADEN:    Wonderful.

JEN:          So, as a trans person who’s experienced an eating disorder and now you’re professionally treating patients similar to yourself, I’m hoping to kind of dive into those topics and spend most of our time there. I’m going to launch us into some basic definitions at the start to give us some common language and footing so that we’re all talking about the same thing. So, if you’re comfortable, can we start with eating disorders themselves? I think most of us are familiar with anorexia and bulimia. After that. I’m not sure many of us can identify eating disorders beyond that. So can you kind of explain some of the main eating disorders that have been defined?

CADEN:    Definitely. So you’re right, anorexia and bulimia are kind of those big shiny ones that people tend to know about. Anorexia was put in the very first DSM. DSM-1 And when you look at the rest of the eating disorders that are recognized as diagnosable disorders, you don’t see bulimia show up until the third DSM, which is pretty interesting. That’s in 1980, I believe.

JEN:          Yeah. I didn’t know that.

CADEN:    Yes. And at the time, bulimia actually didn’t necessitate any compensatory behaviors, which are behaviors like purging, laxative abusive, over exercise, things like that. That was just one of five different symptoms that one could experience with bulimia and you only needed three to qualify as having bulimia. So it wasn’t until DSM-3 revision that they actually added compensatory behaviors, which is an interesting little tidbit there.

So we’ve got anorexia which is a restrictive type of eating disorder. Often it looks like having an extreme fear of weight gain. Sometimes diagnostically followed by a low body weight that is maintained. There is a lot of body image concerns that often are found for those who have anorexia nervosa and those same fears are found for those with bulimia as well. So the biggest differences between anorexia and bulimia are that there’s those compensatory behaviors that I mentioned earlier when you diagnose someone with bulimia.

Initially, folks with bulimia, when they were noodling about the idea of adding bulimia into the DSM, they saw it just as a more severe or chronic phase of anorexia. So, it’s definition and separation from anorexia was actually a pretty big deal in the world of psychology. And that leads us to the third kind of biggest recognized eating disorder, which is binge eating disorder, which initially actually was called bulimia, right, because it didn’t have to include the compensatory behaviors of purging. So, that was binge eating disorder in and of itself, follows the same qualities as binging that’s seen in bulimia. Whoever, there are no compensatory behaviors. So there isn’t purging. There isn’t over-exercise. There isn’t laxative abusive in order to kind of combat the effects of the binge for that person. So those are those three.

And then we also have ARFID, which is Avoidant Restrictive Food Intake Disorder. And it was added to this last edition of the DSM. So it’s somewhat similar to anorexia except there’s an absence of concern with body image and fear of a weight gain related to the body image itself. So it’s much more about having aversion toward food, a desire to control food. You also might see a lot of sensory components to ARFID, where certain textures are very off-putting and someone will not engage with foods a certain texture or certain food types.

You also might see someone with ARFID be fearful of choking or fearful of throwing up their food. And so there’s resistance with engaging with food for that reason because there’s a fear of choking or a fear of throwing up. So ARFID is more emerging as an eating disorder in the treatment field in that there aren’t centers that have many treatment that are formulated to actually formulated to treat ARFID uniquely when compared to other eating disorders that focus a lot on body image and weight specifically.

JEN:          Okay. So let me ask a couple questions before you move on to the other ones. With the binge eating, if they’re not purging or other restrictive behaviors, does that mean they’re not as concerned as body image, that it’s motivated by something else like ARFID seems to be motivated by something else? Or is it still related to body issues, they just don’t do those things?

CADEN:    People with binge eating disorder can certainly have body image difficulties. It’s just not necessarily a hallmark of the disorder itself.

JEN:          Okay. What else?

CADEN:                And the last eating disorders that are well recognized outside of Pica, and Rumination disorder, both of which – pica is eating objects that one might not generally eat. Like things like lead or paint or erasers or whatever. It could be anything. So that’s a little bit more like what Pica looks like which is rare and not commonly seen in treatment centers. And ruminative disorder would be regurgitating your food and chewing it. And so that’s also not as commonly seen in treatment centers. But the last two disorders are very commonly seen are other  specified eating disorders OSFED or feeding or eating disorders and that generally says that eating disorder is not directly congruent with only being anorexia or only being bulimia or only being binge eating disorder. It’s a little bit of maybe a mix of different presentations of eating disorders at different times throughout this person’s current presentation or life. So they don’t directly fit into one diagnostic category. And that would look a bit more like other specified eating disorder.

JEN:          Okay. So we know, I’m just going to skip to this part because we already know that statistically there’s a higher rate of trans people with eating disorders as compared to cis people with eating disorders. And I want to talk about that a little bit before we move to other definitions. Is this like a little difference? Like you’re a little more likely if you’re trans? Is this like a pretty significant correlation and is it true with all queer populations or is it just trans people?

CADEN:    That’s a really great questions. When you look statistically at studies that look at the LGBTQ population and eating disorders, there is a higher rate of just overall the LGBTQ population. And the same can be said for the trans folks as well, but even more so than just the LGBTQ folks overall. So, trans folks in particular, have an even higher rate than folks who might have a sexuality that’s outside of the heterosexual.

JEN:          And is that true for trans women, and trans men, and nonbinary or agender folks? Like across the board, it’s everybody?

CADEN:    Yes. So, when you compare across genders, there is a differentiation between one’s gender whether or not you’re cis and whether or not you’re trans. There’s a study by the Trevor Project that was done in 2022 that broke down the percentage of LGBTQ youth, so overall the umbrella again right, who reported an eating disorder by gender identity. So looking at LGBTQ youth and breaking it down by gender identity. So everyone’s LGBTQ in this sample. And of the folks in that sample, it was broken down by cisgender boys or men, cisgender girls or women, transgender girls or women, transgender boys and men, nonbinary AMAB and nonbinary AFAB.

So each gender was broken down by percentage of how much of that sample had, or reported having, an eating disorder. So out of this sample, which I don’t have the number on me specifically of how large the sample was, but it was relatively large. 20% of cisgender boys or men reported having an eating disorder. 26% of cisgender girls or women reported having an eating disorder. 29% of transgender girls or women reported having an eating disorder. 33% of transgender boys or men reported having an eating disorder. 29% of nonbinary AMAB folks identified having an eating disorder. And 35%, which is the highest precent out of all of these, were nonbinary AFAB folks reported having an eating disorder.

JEN:          And just for the sake of comparison, do you have any idea what the numbers would be for cisgender heterosexual people?

CADEN:    So, in a national sample for college students specifically, rates for cisgender heterosexual populations tended to be between .55% for men and 1.85% for women.

JEN:          So that’s a significant difference. So as parents and friends and family of queer folks, this is something we need to know about and super pay attention. So I got one more question in this realm of statistics. I think you mentioned six, I didn’t count, six different eating disorders? Are all of them found at a higher rate in the queer community?

CADEN:    Yes.

JEN:          All of them are higher. We’ve got to help out our people. In the realm of this conversation topic also, I think three things are going to overlap a little bit. So I’m hoping you’ll define those also. And the first would be body dysmorphia. That’s the term I see most often misused in conversations about trans people online. So body dysmorphia, eating disorders, and gender dysphoria. Can you talk about those three things and kind of compare and contrast what those are?

CADEN:    Yes. So, body dysmorphia specifically relates to the discomfort that one has within their body regardless of gender. So the experience of body dysmorphia that is experienced by a cisgender person and a transgender person would be similar for someone with, let’s say, anorexia. So, overall, I have a discomfort with the amount of fat on my body, right? Maybe we think about my stomach and feel like it’s bulging right out of my clothing. And that is something that is not necessarily gendered per se, right? So if I have an extreme discomfort with my body, just overall, then I might have body dysmorphia. However, if we’re looking at . . .

JEN:          I was going to jump in and ask a question about what you were saying. Does body dysmorphia have to be your whole body? Like, does it count as body dysmorphia if I’m like, “You know what, overall I’m doing okay, but my pinkies are repulsive.” And then I show them to people and they’re like, “Your pinkies are pretty normal.” And I’m like, “Nope.” Does that count as body dysmorphia? Can it be little things?

CADEN :    Yeah. That’s actually a wonderful question. There is a different diagnosis that you can have that’s called body dysmorphic disorder. And lot so of people correlate that with eating disorders, like “Oh, I have body dysmorphic disorder if I have extreme body dysmorphia with an eating disorder.” However, that’s not necessarily the case. You can, in body dysmorphic disorder specifically, when we’ll highlight one thing, maybe a couple things, but can be something by your pinky and just be repulsed or really disturbed by the look of their pinky. And they can be completely overwhelmed by that discomfort, so much so that it actually impacts them on a daily basis. And one would say it has clinical implications on that person’s wellbeing because there’s so much distress that comes along with how much dysmorphia I have around my pinkies. So that could be something as simple as having extreme discomfort with your pinkies. Or it can be your appearance overall, so it really varies person to person.

JEN:          And then how about an eating disorder in general? Like, does everyone, well you just talked about this, right? They don’t always have to go together.

CADEN :              Mm-hmm. They don’t always have to go together. So body dysmorphia for someone tends to show up for those with anorexia and with bulimia. And the reason why that gets confusing for our trans folks is because, when we’re looking at gender dysphoria, gender dysphoria can look a lot like and get tangled up with body dysmorphia.

For example, in my own story that’s were things got confusing, right? Because I had a really intense hatred of my body and the fat that was on it, it was difficult to identify that that discomfort was coming from a genders place rather than just an eating disordered place. But I remember very specifically when I was a teenager, looking in the mirror and doing all those body checking things that someone with a eating disorder might do, right, like pinching fat on your stomach and things like that. But I also would do that with my chest. And I would hide my chest with my arms and look at my body in the mirror.

And that behavior isn’t quite as common with someone who is cisgender and has an eating disorder. That behavior is a bit more congruent with gender dysphoria in that I was imagining myself without breasts. So, in that experience, I didn’t have the concept that I could be trans. That wasn’t something that I knew. I’d never met a trans person before. I’d never heard of trans men before. I didn’t know that that was something that could exist within myself. And so here I am, being completely uncomfortable and distressed in my body, very disordered as well, and all along there was this compounding factor of gender dysphoria really exacerbating that.

JEN:          So is that common when people are trying to sort themselves out and their trying to figure out, like, is this dysmorphia? Do I just hate my body and it’s irrational? Is this an eating disorder? Is this dysphoria? Is it pretty common  for people to be stuck in that place where they can’t tell the difference?

CADEN:                Yes. And that’s what makes it, I think, scary for parents. Is that, like, they want to be able to support their child, especially parents who have a little bit more knowledge about queerness, maybe about trans topics, and are open and willing to have their child engage in gender affirming care. And, yet, there is this understanding that there’s so much distress around my body, how can I tease these things apart? How can I be affirming and be supportive and understand that these two things are very nuanced ways different than one another. So that can become a challenge.

JEN:   Yeah. So, before I move on, I want to talk about treatment. But, before I go that direction, does anybody know why these eating disorders are so much more prevalent among the queer community?

CADEN:    I think, no one actually knows why, why. There’s lots of theories why. It would be really nice if there was just one reason.

JEN:   I’m a big fan of theories.

CADEN:    There’s probably lots and lots of different reasons why. Many of them connected to overall gender dysphoria and not having early access or knowledge that gender affirming care can alleviate body distress. So, instead, the body becomes the enemy and  the body is targeted as the reason for distress, which then is connected to my overall appearance and the easiest and quickest way to change that is by doing our best to change our bodies with our intake.

Especially when we think about the way that our bodies are gendered, often it is connected to where fat lies on our body, you know? When you look at secondary sex characteristics for “female” humans, you’ve got breasts and a butt. That’s what makes you female. It’s like, okay, really. So connecting breasts and butts to gender, eating disorders are just going to be a hot bed. Like, okay, I feel more comfortable when I have less fat on my body because then my chest isn’t as prominent and maybe my buttocks also is not as prominent. And it’s like, “Huh. I don’t know why I feel so much more comfortable right now.”

JEN:          That makes so much more sense when we think for trans masculine people how they start to feel better – not everybody – but start to feel better if they’re lifting weights and kind of building up some muscle and stuff because it does lead toward that slightly more socially masculine appearance.

CADEN:    Right. Yes.

JEN:          Kind of gets rid of some of that extra shape that people experiencing estrogen kind of go through in puberty. So, I want to talk about the treatment between and the different things. I’d like to start with dysmorphia just to like skim across the top, because that’s not really our target, like body dysmorphia disorder. Start with that one, how do you treat dysmorphia? If I hate my pinky and it’s awful and only to me, everyone else thinks it’s normal, as a professional, what do you do to treat that?

CADEN:    Well, there’s lots of different treatments that can be used for things such as that. We’re generally going to be looking at our cognitive and behavioral therapies. So we’ve got CBT, we’ve got DBT, and we’ve got ACT.

JEN:          No one’s going to suggest that I cut it off?

CADEN:    No. No. Yes. Yes. Yeah, you’re right. Not generally our go to.

JEN:          But, statistically, in a treatment plan, is there any evidence that that would help, that I would start to feel better if we cut off my pinky.

CADEN:                I haven’t seen any case studies that have said that, per se. Um, so it would be a little hard to suggest that doing so would ease someone’s distress. But I can say there’s a lot of evidence for CBT and DBT and ACT in being able to alleviate body dysmorphia. In particular with those types of treatments, you’ll see a lot of cognitive-based work where we look at recognizing what thoughts you are feeding into that relate to the distress you’re having around that body part. And a therapist might ask you to, not only recognize what thoughts you have around that body part, but also intentionally shift and change what thoughts you are having about it.

So, if I’m saying whenever I look at my pinkies and the thought that comes up for me is, “Oh, my gosh. I’m so disgusting. I can’t believe I went outside today. Everyone’s seeing me like this. I need to spend the rest of my day at home because I’m such an embarrassment.” Then we’ll be like, “Hang on. What’s a different thought that we might be able to support in those moments where I start feeding myself these thoughts,  that then impact my feelings, right? When I have a thought like that, I begin to feel very shameful and I want to isolate myself. So what thoughts can we do that would change the trajectory for that. Maybe not even like a body positive way, but a body neutral way. And I think that can be very important when you’re thinking about treatment. The other components of ACT that really stand out are acceptance, right? Just allowing for and accepting the feeling that’s coming up and arising and allowing yourself to just sit with it, to recognize that this feeling exists and that’s OK. But I don’t have ot have it control me.

JEN:          It sounds like anxiety work, almost.

CADEN:    Yes.

JEN:          So compare that to, actually, let’s start with gender dysphoria. We have guidelines. We know how to treat gender dysphoria which is not the same as body dysmorphia. So talk about the treatments for gender dysphoria.

CADEN:    Yes. This, you said it earlier, when you chop off your pinky, right, the answers no. But with gender dysphoria, doing gender affirming care such as a surgery would actually be recommended. It kind of seems like kind of spooky when you think about, “Oh, I’m making this big change on my body in order to help with gender dysphoria.” But it is clinically proven time and time again to increase mental health and well being for folks who are experiencing gender dysphoria which I will add is not all trans people, right? So just for folks who are experiencing gender dysphoria overall, gender affirming care such as hormones, HRT, or gender affirming care with surgeries can be and have been, very helpful in alleviating that distress.

JEN:          And, now, eating disorders is going to be a lot harder to talk about treatment because, like we just mentioned, there’s this pile of eating disorders. So, if you need to kind of break it down differently, kind of dive into this because we do have listeners, for sure, who’s kids are in the throws of eating disorder, one type or another. What kind of treatment, start with ARFID, like, how do you treat that?

CADEN:                So, for ARFID specifically, there is a CBT that is designed specifically for ARFID that one might follow. It’s not as well known for clinicians as-of-yet because it just recently was created. So, again, this is a disorder that is gaining in treatment efficacy as we speak. There are more and more research created around how to appropriately treat ARFID. But CBT for ARFID is definitely one that is highlighted, as well as those three, therapeutic modalities I mentioned earlier such as CBT or act or DBT. Behavioral components are very important her as well. We don’t want to ignore the importance of having a dietician on hand. And as a core part of treatment for all eating disorders. But with ARFID in mind as well, being able to do ERP work, Exposure Response Prevention work with someone who has an eating disorder is very important, especially for someone with ARFID who has maybe these sensory sensitivities towards certain foods. You want to be able to engage in those foods so that the distress that’s correlated with those textures is reduced over time with each time that I come in contact with that food or texture. So that’s a big, big piece for those with ARFID.

JEN:          What about some of the other issues? Do they all get lumped together if you go to an eating disorder clinic? Or all six of you hanging out in the same place, kind of getting mostly the same treatment?

CADEN:                Yes. So there aren’t very many treatment centers that actually differentiate between different disorders because, fundamentally, many of them respond in the same way to these different treatment modalities such as CBT, DBT, ACT, ERP. So, in that way, these treatment modalities tend to be a bit trans-diagnostic. They don’t all respond exactly the same, but they all are effective for those populations. But there have been some arguments about the possible benefit of targeting people with anorexia, with ARFID, with binge eating disorder and just focusing on that population because there are difference. There are intricate differences?

JEN:          It feels like that, like if I’m eating cotton balls when people aren’t around watching me and then someone else is eating cupcakes when nobody’s watching them, and when someone else is exer – it seems like really different issues. But maybe they all come down to some of the core principles to start with.

CADEN:                Yes. and that’s in part why working with your individual therapist in a treatment setting is very important because this is where we get more into nuanced differences. So, while, when we’re doing group therapy, we might speak to everyone in the room who maybe has all six of those different disorders, when you come into the therapy space, that really is where that individuation and unique work for your presentation specifically will start to shine through as well as with your dietician who will recognize what you’re bringing to the table and create goals and meal plans specific to what your needs are. So, while you’ll be eating at the table with everyone, each person has a unique plan and treatment template that has been given them by the dietician specifically for what there needs are and for what ED presentation is.

JEN:   OK. So, if a parent has a queer kid and they’re super aware of all these comorbidities and they’re sort of looking at there kid thinking, “I wonder if you have an eating disorder?” What sorts of things can they look for before they start contacting professionals? What sort of signs are the tell-tale signs?

CADEN:                Yeah. That’s a really great question. Eating disorders are so sneaky. So by the time that you are thinking your kid might have one, the likelihood that they have one is much higher than one might anticipate because they are so often engaged in isolation. Often, by the time that folks come into treatment, they have been engaging with there eating disorder for at least a year, pretty significantly. So it takes a while to lose weight. It takes a while to gain weight. It takes a while to create a mental intimacy with my eating disorder, right? Eating disorders don’t have an on/off switch. They develop over time. And, even though one might have a moment where an eating disorder really clicks and one might become very overwhelmed by the eating disorder, I’ve heard some patients say before, “I become possessed. There might be a moment where I feel like I lose control and my eating disorder is really controlling me.” However, before that moment, there was a buildup. And that buildup lasted for quite a while.

So if, as a parent, you’re seeing your child restrict at dinnertime and they’re not engaging – number one, I always recommend have family dinner. Don’t have your child eat alone in their room. Don’t eat at different times for dinner time. Sit down and have a meal together where you can connect, where you can engage in social safety which is a huge part of our overall wellness is this idea I can connect, I can be intimate and safe with those that I love.

So, when we allow ourselves to engage in something like family dinner, not only do we reinforce our ability to engage in these social safety signals with our family, but we also are making sure as a parent that my child is engaging with food. And you’re not together most of the day. You don’t get to be together, maybe for breakfast. Some parents don’t eat breakfast with their kids before they go off to school. You’re not together for lunch, right, they’re at school and you’re at work. So, if your child is restricting dinner, the likelihood that they’ve been restricting lunch and breakfast as well is, probably, pretty high. So having that dinner time as kind of a pulse and seeing how your child is engaging in food at that time, can be a good indicator of what’s going on. So, as far as restrictive behaviors, you might see that.

You also might see, for someone with bulimia, the use of the bathroom immediately after meals. So if, after dinner time, your child immediately takes a shower every single night, that might be a little bit of like a “Hmm, what’s happening in the bathroom every night after dinner time?” I might have some curiosity about that. It might be a good time to just check in, right? If someone with binging disorder is there a large quantity of food that goes missing suddenly, maybe at night time? I wake up the next morning and where are all the chips or the ice cream or what-have-you? And that’s kind of a consistent thing that you see on a weekly basis, there might be binge behaviors that are occurring. So those are some possible signs you might see, just behaviourly, based on how someone is engaging with food. Not to mention, obviously, the indicators that we see with one’s weight that might fluctuate.

JEN:   I’m just going to jump in here and say parenting is too hard. They didn’t, they did’t tell us, you’re trying to get your kids to eat, and everybody back in the car, and everybody back to the practices. When I had four teenagers, the food was always missing, when I came back from Costco.

CADEN:                Right. That makes sense.

JEN:          Monitoring these things just seems hard. But it is smart to know what to be aware. So, this one’s probably going to be difficult. But what if you have a friend or loved one or your own kid, you’re like 1,000 percent sure they have an eating disorder, maybe hasn’t been diagnosed officially yet, but you know that they do. And they just don’t see a problem, like, “I’m fine. I’m fine. It’s not a big deal.” Is there a way that you can help them see the reality because eating disorders are very dangerous.

CADEN:    Certainly.

JEN:          Is there a way, like if I have body dysmorphia and I’m restricting my eating and I drop down to a 102 pounds, probably, the world is going to reward me.

CADEN:    Yes.

JEN:          You look so great. Look at that size 2. You’re so healthy. I’m getting all this positive feedback and then my mom’s saying, “This is a problem. You need to see a doctor.” I’m probably not going to believe her. So how do we move past that?

CADEN:            Yes. So that’s a really great question. That’s something that is very difficult and challenging for adolescence that we see. Often, adolescence aren’t there because they want to be. They are there because they have to be because their parents told them they have to, Right? When you’re working with an adolescent who’s in that situation, the most success happens when that kiddo has internal motivation, their own reasons for wanting recovery. Sometimes those reasons can look as simplistic as, “Well, my doctor told me that my vitals are unstable and that I cannot participate on my volleyball team until I’m medically stable again. And the only way to do that is to engage in recovery.” So there’s a pretty natural consequence, right? “Here I am. I’m engaging in my eating disorder. However, there are actual natural consequences that happen here. I am not physically well.

And so I might not be able to, based on doctor recommendation, engage in this hobby I love so much which is this sport. So I might engage in recovery in order to be able to gain that ability back to be back on that sports team I love.” So it can be something like that. And the reason why I bring that up, that’s a little bit more of an easier example because a doctor steps in and says, “Hey, you actually can’t engage in sports anymore. Something needs to change for you to engage on your volleyball team.” But, sometimes, when it hasn’t reached that point right, where someone is actually being told by a medical provider that there needs to be a change, the motivation to engage in recovery is always going to be most effective when there’s natural consequences.

I’ll share a personal story for me. I went to treatment when I was 18 years old. And at that point, I was really heavy in my eating disorder for a couple of years. It was probably two intense years. But like I said before, there’s a build-up. There’s a build-up. There’s a build-up. You’re dabbling and doing whatever. But there was about a two-year period where it was pretty intense. And, at that point, my metabolism had completely crashed. I wasn’t losing weight anymore regardless of my intake, regardless of how active I was. From all intensive purposes, when I actually went to treatment, my body weight was very average. No one would’ve known from looking at me that I had an eating disorder.

So it certainly had gotten to that point, right, where my body was not reacting in the way that my eating disorder wanted it to. What shifted for me was I had a moment where I was in my bedroom, just relaxing I guess, maybe, for the evening. I don’t remember what my food engagement had been at dinnertime. Perhaps my dad noticed I’d been restricting or something of that nature and came upstairs to talk to me like a dad does. And we started having this back-and-forth conversation. Him saying, “You know, you really need to get help. Something needs to change here.” And of course, I blew him off, “And I’m fine.”  and all those things that you mentioned, Jen. And there was a moment where he was kneeling beside my bed, and I was sitting on my bed. He was kneeling beside my bed and he started to cry. And I looked at him and I was like, “What is it?” And he said to me, “Where’s your heart? Can’t you see how much your hurting me?”

And that was a big moment for me because I recognized that my eating disorder was more important than my family, that I’d really truly did not care that he was scared for me, that he was hurting for me, that it hurt him that I was engaging in this eating disorder. And so when he said, “Where’s your heart?” I felt nothing. I felt numb. I felt empty. I don’t remember how I responded. I think I just kind of stared at him. But that moment stuck with me and that’s really what carried me through my recovery, was, “I don’t want to be a person who loves their eating disorder more than they love their family.” And that was, obviously, my own experience in that moment of how I portrayed and engaged with that experience. But, ultimately, having that internal motivation of, “This isn’t who I want to be. These natural consequences of this eating disorder are not worth it to me” is what made the difference in my recovery.

JEN:          Is there a correlation between eating disorders and suicide ideation. Like, the idea that, “I know this isn’t healthy. I know it’s not good for me. But I’m going to die anyway” Or kind of like a slow, self-harming element?

CADEN:    Yes. 100%. Again, on a personal note. I was planning on starving myself to death my first year of college. So the year I went to treatment, that following year was college. So eating disorders as like a slow form of suicide is definitely something one might see. The rates of suicide for people with eating disorders is higher. I don’t have the exact percentages. But, I think, particularly for those with anorexia, it definitely is higher. And higher rates of depression as well. So, you can see that correlation, definitely.

JEN:          It kind of reminded me of the ideas of denial and shame and secrecy, almost addictive type nature with also have high suicide correlations also. So, many years ago, when our youngest was experiences some signs of an eating disorder, we found a specialist and we were on a waiting list for over a year to get in to see that specialist. And I understand this is quite common. So do you have tips for parents to find, first of all, to find appropriate care? It’s not easy to access in the first place. But tips for how to navigate that time until you can get the care. And some kids, right, we keep parenting you’ll when you’re in your 30’s. And we’re trying to fill that gap. Do you have suggestions for those people?

CADEN:    Definitely. So, the first things that jumps out to me is, I actually had the privilege of doing my practicum year at Swedish as a behavioral health provider. And, as a behavioral health provider, I was able to see clients generally like once a month-ish. Once every two weeks if I had the capacity and I felt there was a more acute need. However, once a month was generally the amount I was able to see. And it was a couple of sessions, right. We’re not supposed to see people long term in that capacity, in that environment. As a behavioral health provider, I was able to assess where someone’s at. Give them tools and support while helping them engage in reaching out to other providers who will be there for them long term, reaching out to treatment centers if that is a need that they have right?

Let’s say this person has an eating disorder, right. And I did do this for a few patients of mine at Swedish. I was able to say, “You know, your need is very high. And I enjoy working with you. This is a privilege for me. And we need to connect you with higher levels of care and here’s why.” And if I have the by-in from that person, like maybe these kiddos you’re referring to who are going to be connected to higher levels of care, but don’t have it at the time, seeing if you can have access to behavior health support through a behavior health provider at your primary care provider’s office can be a very helpful tool. It’s free, generally free of charge. It goes through your insurance, so it’s not something that is paying out-of-pocket like you would with a therapist. And it can be something that can tide you over until you can get to those long term, or higher levels of care.

JEN:          Before I let you go, do you have any overarching wisdom or some question that you wish I had asked and I didn’t that you would like to pass along and make sure our listeners understand about these topics?

CADEN:    I think something that’s come up a few times when I’ve been talking with parents lately, especially with parents who have a kiddo with an eating disorder and has gender dysphoria. Is gender affirming care while a person is in recovery from their eating disorder is very important. And it may not “Cure” your child of their eating disorder. That’s very important too. You need to focus on care for both. Gender affirming care is not going to make it so that your child wakes up tomorrow and they’re eating disorder is gone.

I think I felt, when I went through my transition, I felt the intensity of my eating disorder subside. But it didn’t make it go away. I still had to do my work. I still had to engage in treatment. I still had to engage in therapy. I still had to engage with meals three times a day and snacks. I had to do all that work still. So I think what’s important to me is making sure that we’re not banking on one solving the other but that we prioritize care for both as both require different types of treatment. And both treatments together, have the highest likelihood of overall recovery and wellness for that person.

JEN:          I actually appreciate that. I’ve heard that from multiple people. Like, “He says he’s trans, but right now, we can’t worry about that. We need to focus on.” I think sometime we underestimate the importance of gender-affirming care. Where most of us are going to understand the importance of treating an eating disorder. But both are life threatening in different ways or can be. So I appreciate you highlighting that.

I want to thank you so much, Kayden, for coming. I know how busy you are working on your Psych Degree and working in a practice. I appreciate you donating an evening of that busy schedule to help us understand another topic that us parents might need to make sense of while we’re interacting with our fellow humans. So you’re awesome. Thanks so much for coming.

CADEN:    Thank you so much. It’s been an honor.

JEN:          Thanks so much for joining us here in the den. If you enjoyed this episode, please share it with your friends. We’d also love it if you could take a minute to leave us a positive rating and review on whatever platform you’re listening to us on. Good reviews make us more visible and help us reach more folks who could benefit from listening. But, review or not, we’re glad you’re here. For more information on Mama Dragons and the podcast, you can visit our website at mamdragons.org or follow us on Instagram or Facebook. And if you’d like to help Mama Dragons in our mission to support, educate, and empower the parents of LGBTQ children, donate at mamadragons.org or click the donate link in the show notes.