Latest / All Bodies. All Foods. / 42. Coping on Campus: College Students & Eating Disorders with Dr. Tristan Barsky, PsyD (he/him/his)

Transcript

42. Coping on Campus: College Students & Eating Disorders with Dr. Tristan Barsky, PsyD (he/him/his) · All Bodies. All Foods.

0:00
Hey,
0:01
I'm Sam.
0:02
Hi,
0:02
I'm Ashley.
0:03
And you're listening to All Bodies All Foods presented by the Renfrew Center for Eating Disorders.
0:09
We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.
0:19
We believe that all bodies and all foods are welcome.
0:23
We would love for you to join us on this journey.
0:26
Let's learn together.
0:29
Going off to college can be stressful.
0:31
It's a new environment with new people.
0:34
There's pressure to pick a major and get good grades.
0:37
Your eating,
0:38
schedule,
0:38
your sleep,
0:39
schedule,
0:39
your class schedule,
0:40
everything suddenly changes and the support system you had back home might be many miles away.
0:47
These are really big adjustments and it's a big transition at such a vulnerable age,
0:52
an age when we frequently see the onset of a clinical eating disorder.
0:57
Big life transitions like this can sometimes be the stressor that triggers on the start of an eating disorder and its co occurring diagnoses.
1:06
So,
1:06
what is it exactly about a college campus that creates the perfect storm for an eating disorder to develop and thrive.
1:14
And how do colleges and universities help students who are struggling with food or with their body image,
1:20
what's happening on college campuses that might be making things worse and what kind of support can students receive at their college counseling center?
1:29
Well,
1:30
we wanted to find out more about eating disorders on college campuses,
1:33
which is why we invited Doctor Tristan Barsky to the show Tristan Barsky.
1:38
He him,
1:39
his is a clinical psychologist who holds a doctor of psychology degree with a specialty concentration in severe and persistent mental illness,
1:47
also known as S PM I from Long Island University.
1:51
He completed a postdoctoral fellowship in residential treatment of eating disorders from the Renfrew Center.
1:57
Doctor Barsky has a background in providing supervising and directing the clinical care of adolescents and young adults diagnosed with eating disorders and or S PM I in university and psychiatric settings.
2:09
His areas of expertise and interest include clinical leadership and training,
2:14
interdisciplinary treatment of eating disorders and S PM I crisis intervention,
2:18
clinical supervision,
2:20
C BT and psychodynamic therapies.
2:23
Doctor Barsky has been on staff at Johns Hopkins Homewood Counseling Center since March 2020 he currently holds the position of associate director of Clinical Services and coordinator of eating disorder services at that location.
2:38
Welcome to the show,
2:39
Doctor Barsky.
2:41
Thank you so much.
2:42
It's such a pleasure to be here.
2:43
We're so happy to have you because you've been working with college students for quite some time now.
2:49
You've been working with eating disorders for quite some time.
2:52
Um,
2:53
just curious what got you interested in the mental health field and what do you enjoy about working with eating disorders?
3:01
Absolutely.
3:02
Um,
3:03
I think as,
3:03
as long as I have been aware of my own interests,
3:09
I've been interested in people's attitudes and behaviors and motivations.
3:14
I've always loved to get into other folks' minds and,
3:18
and get to know them and get to understand them.
3:20
Um So psychology felt like a very natural route for me to take um academically and then professionally,
3:27
I was also very interested in literature and almost took that direction.
3:31
Actually,
3:31
you know,
3:32
a analyzing characters and books,
3:35
you know,
3:35
analyzing fiction as it relates to psychology and,
3:39
you know,
3:39
human motivation.
3:40
But there's something about being of service to others that felt really compelling to me as well.
3:46
And it,
3:46
it seemed to me that clinical psychology was a great way to tap both of those interests in terms of eating disorder.
3:52
Specifically,
3:53
I did a placement during my doctoral degree on an inpatient unit in New York City,
4:00
um a small unit um focusing on severe eating disorders.
4:05
And I became really quickly,
4:07
very,
4:07
very compelled by that,
4:09
that population and began to really enjoy um providing care.
4:15
Um I think it's a combination of knowing that this is such an underserved community and,
4:19
and knowing that there is really an opportunity to provide service there.
4:23
Um But also this connection between internal states,
4:28
emotions,
4:28
thoughts,
4:29
and then folks,
4:29
behaviors and ways of coping with those things is something that I,
4:33
I just find consistently compelling and,
4:34
and fascinating.
4:36
Um something I would add is that th this feels like such a um it's such a powerful moment for me professionally in the sense that I did my postdoc as,
4:47
as you mentioned at the Renfrew Center of Philadelphia where um Sam was my supervisor,
4:53
uh an incredible supervisor,
4:54
someone who provided me with so much important guidance and insight and it feels like kind of a a full circle moment for me.
5:00
So it's,
5:00
it's really so wonderful being here today.
5:02
Thank you for having me.
5:03
Oh,
5:03
of course.
5:04
I know Tristan.
5:05
It was so wonderful working with you.
5:08
You really had a gift and you were able to help so many residents where they're,
5:12
you know,
5:12
they're the highest level of care and it can be so scary and stressful and you just sort of had a way of really helping folks sort of navigate their way through.
5:22
So it was easy to supervise you.
5:25
Thank you so much and it was so easy and so enlightening to be supervised by you.
5:30
I I really appreciate it.
5:31
Well,
5:31
thank you so much.
5:33
I'm loving this right here.
5:35
It's so fun to hear from both of you.
5:38
Um So Tristan,
5:39
I have a question um according to a recent healthy mind study which included a very large sample of college students over the course of eight years.
5:48
Um researchers found that the prevalence of eating disorder risk for college students increased from 14.9% in 2013 to 28% in 2020 2021.
6:03
And we know that the change in transitions can be common stressors that trigger an eating disorder.
6:08
Um And going to college is such a big change.
6:11
It's such a vulnerable age.
6:13
Their students are.
6:14
Um And I'm just curious why are college students at elevated risk?
6:19
And why do you think the risk of eating disorders is on the rise?
6:24
And if you could speak to that,
6:26
it's a great question.
6:28
And I think I'm going to,
6:29
to divide my answer between why college students in general and why do things feel like they're kind of on the rise at the moment?
6:39
Um So to start,
6:41
you know,
6:41
we,
6:42
I think we know from a lot of research and a lot of experience that college students are very vulnerable to developing eating disorders,
6:49
to maintaining eating disorders,
6:50
to relapsing into eating disorders uh because of a combination of a number of different factors.
6:56
Um some of them that come to mind that we are often exploring with folks who receive care with us have to do with adapting to a new environment.
7:04
Um especially because this is a very much a residential uh college campus um as well as you know,
7:12
significant academic pressures which a lot of students are experiencing nationwide,
7:17
a lot of social changes as well.
7:19
Um Many folks have had to,
7:21
you know,
7:21
move away from the,
7:23
the friends,
7:24
the loved ones who had been potentially providing them with emotional support.
7:28
Um And having to develop a new social circle and a new group of support folks um can be really challenging for folks as well.
7:35
Um Another piece that we would often explore and discuss at the residential treatment level of care.
7:42
Um With adolescence is this um increased independence that folks start to take on around that age,
7:50
um including making food choices autonomously,
7:53
um including not having as much structure in general throughout the day and having to sort of self um impose some of that structure that can be really,
8:02
really challenging,
8:03
stressful for,
8:04
for uh for folks and for those vulnerable to behaviors can also be a,
8:09
a really easy slippery slope for them.
8:12
Um And then we've got the,
8:15
you know,
8:15
a really pervasive culture of body image idealization on campuses,
8:19
a ton of social media use on college campuses,
8:22
of course,
8:23
um which could lead to a lot of body dissatisfaction.
8:27
Um So,
8:28
yeah,
8:28
a lot of different things um I might just mention as well that there are,
8:34
there are some different and new opportunities for trauma experiences in,
8:38
in college campuses as well as opportunities for unresolved traumas to be triggered by the experience of moving into a new setting.
8:46
And I think,
8:47
you know,
8:47
knowing as much as we know about the connections between trauma and eating disorders,
8:50
it's,
8:51
this is clearly a really vulnerable space that that many folks are,
8:55
are kind of walking into.
8:57
Yeah,
8:58
that's making me think of like there's,
9:00
you know,
9:01
the sense of safety,
9:02
especially if somebody's experienced a trauma prior to college,
9:05
like the sense of safety that they had created in their space at home and then they move into a completely different environment like that in my,
9:15
like,
9:15
that's gotta feel overwhelming to figure out,
9:17
like,
9:18
how can I create this?
9:20
And then on top of that,
9:21
I typically have a roommate.
9:23
Um,
9:23
and not only do I have a roommate,
9:26
but I live in a dorm with like 100 other people.
9:28
Um,
9:29
and some might be even coed and so that could add another element.
9:33
Like,
9:33
yeah,
9:34
I did,
9:34
I mean,
9:34
that makes so much sense to me what you just said.
9:37
Yeah.
9:39
Yeah.
9:39
And I'm,
9:40
I'm thinking of how,
9:42
you know,
9:42
what,
9:42
what I'm trying to think back when I was in college,
9:44
like,
9:45
decade,
9:45
literally decades ago.
9:47
But,
9:48
you know,
9:49
you know,
9:49
I had gone to visit other colleges too,
9:51
like to visit friends and things like that.
9:53
And it seemed like every college campus had a different culture and I think it largely depends on like,
10:00
what's the culture of your campus and because there's going to be that pressure to fit in and some campuses may feel more inclusive than others or some,
10:10
there might be extreme pressure to perform academically.
10:14
And what do you notice Tristan with,
10:16
um,
10:17
you know,
10:18
you've been working on a college campus for quite some time now.
10:21
And do you feel like the culture plays a role?
10:24
Does it help in some ways or hurt in other ways?
10:29
It's a great question.
10:30
Um I think that again,
10:34
experience and,
10:35
and research shows us that cultures that focus on bodies,
10:40
weight,
10:41
shape foods in judgmental ways will tend to increase the person's chances of developing the kinds of symptoms that we're talking about.
10:50
And so,
10:51
um of course,
10:52
a college campus could have a strong culture around those things or a a microculture within that campus could have a strong a culture around those things.
11:00
Um This may be a good opportunity for us to talk about the pandemic because I think that there are certain things about that experience that many young folks had uh that actually exacerbated that as well.
11:12
I'm very curious how you think the pandemic has impacted college students that are now back on campus today?
11:19
Absolutely.
11:20
And it speaks to some of those statistics that you provided earlier.
11:23
I actually pulled some some statistics as well from our own utilization um here so that you could get some sense of how things are playing out here.
11:31
Um And this will really only focus on students is um self report around the challenges that are bringing them to ask for support.
11:43
So it's not about what providers are diagnosing.
11:45
It's really what folks are coming in saying that they're experiencing a few interesting figures that I think really,
11:51
uh,
11:51
touch on this.
11:52
So in 2018,
11:56
six,
11:57
out of 10 folks reported that eating problems were not a problem or not applicable to them.
12:03
Hm,
12:05
2019,
12:05
1 year later,
12:06
that number dropped to almost 10% and we're much closer to that at this point as well.
12:13
Body image concerns and body dysmorphia.
12:15
Almost half of respondents reported this was not a problem or not applicable.
12:20
That number has been growing each year 2023.
12:24
The number of reports that body image concerns and or body dysmorphia is a severe problem for them,
12:28
almost doubled in 2021 and it has decreased a little bit in 2022 according to,
12:35
to,
12:36
to the statistics that I pulled,
12:37
but it's still significantly higher than it had been prior to 2021.
12:42
And also the number of folks reporting that it's only a slight or moderate problem.
12:46
The the body image concerns has really not changed since 2018.
12:50
So what we're seeing,
12:51
what it looks like is that the the real changes are in this severe and serious problem categories where we're seeing spikes that didn't used to exist.
13:01
Um And I think that has a lot to do with the experience um that many folks have had around the pandemic,
13:07
um particularly I think uh really intense experiences of emotional distress and physical distress in many,
13:14
many people and then a really significant societal turn towards social media in the absence of other kinds of activities.
13:22
Um And for support in some cases,
13:26
yeah,
13:26
that makes,
13:27
that makes a lot of sense.
13:28
Um I mean,
13:29
social media,
13:30
I've,
13:31
I've done presentations on social media and I've read so much research around it and it's sort of like the links are,
13:40
are the consistent and very strong links between social media use.
13:45
And a lot.
13:46
I have a whole slide where it's like a long list of,
13:49
I mean,
13:49
body dissatisfaction,
13:50
eating issues,
13:51
anxiety,
13:52
depression,
13:52
self esteem,
13:53
I mean,
13:53
the list goes on and on and it's really no surprise to me that,
13:57
you know,
13:58
college students are on social media and they're experiencing the same,
14:03
those same things.
14:04
So,
14:05
um yeah,
14:05
that,
14:05
that makes a lot of sense to me.
14:07
You know,
14:07
I'm really curious.
14:09
Um you know,
14:10
you have this college counseling center right on campus.
14:14
Yes,
14:14
we are,
14:15
we are sort of on the edge of,
14:16
of one of the large campuses of OK.
14:19
Yeah.
14:19
So there's a college counseling center right there.
14:22
Do you feel like students feel comfortable going there or,
14:29
or do you feel like is internalized mental health stigma still a thing?
14:34
I know back when I was in college getting help for your mental health was not something that was really openly talked about,
14:44
you know,
14:44
back in the nineties I was,
14:45
when I went,
14:46
I was in college and it,
14:48
and it was like,
14:50
there,
14:51
I,
14:51
there were some people who went to the counseling center.
14:53
I actually worked in the counseling center.
14:56
And so,
14:57
um,
14:57
I know there were some people there but it felt like no one was openly talking about it,
15:04
you know,
15:05
within my friend group or within,
15:07
you know,
15:08
in my classes.
15:09
Do you have,
15:10
do you think things have shifted?
15:14
That's a great question.
15:15
And one of that I think is very,
15:17
very hard to answer in a general way.
15:19
Um I would say that the two ways that I think about this dynamic number one,
15:27
you know,
15:27
while I,
15:27
I certainly think about stigma um as,
15:30
as one of the barriers for folks receiving the support they need.
15:35
I,
15:35
I like to think about it in terms of what familial and or other cultural norms might be defining as preferable forms of support than mental health support,
15:47
you know,
15:47
sort of like privileging certain forms of support over mental health support.
15:52
I think that thinking of it in that way can help us,
15:55
you know,
15:55
deepen our understanding around what cultural impacts might be influencing that,
16:00
that sense of stigma around the,
16:03
that,
16:03
that barrier that exists for the person.
16:06
Um And another piece that I think is not discussed enough and that is very,
16:11
very significant in my experience.
16:12
And also,
16:13
uh according to the research are the vast amounts of historical trauma that certain populations um have endured related to the medical and the mental health industries.
16:26
Um for many,
16:27
many years and how that has placed us as an industry in,
16:32
in a kind of perpetrator role vis a vis them um for completely understandable ways and for completely valid ways.
16:39
Um And so,
16:41
for those two reasons because certain cultures and certain families value other forms of support over mental health.
16:48
And because of these historical,
16:51
you know,
16:52
um injustices and traumas relating to the medical and mental health field,
16:57
it's really our job,
16:58
I think as a mental health field to,
17:00
you know,
17:00
become safer,
17:01
to be safer and also to provide outreach to those communities to speak with them uh in a language that is safe to them and that makes sense to them and really show them what we can do to help,
17:12
support them and hopefully over time,
17:14
we can become more accommodating and more helpful.
17:17
Um And they can receive the support they need.
17:20
Mm That's such a great point and it reminds me so much of,
17:23
of weight stigma um as,
17:25
as a form of trauma that I think,
17:29
I mean,
17:29
as we know in the research will make people less likely to utilize medical services and mental health services because they won't,
17:37
they,
17:37
they don't wanna go somewhere just to be told that if they just lose weight,
17:41
things will get better in some way.
17:44
So I really feel like weight stigma can be a huge barrier.
17:48
I imagine on college campuses,
17:50
whether it's,
17:51
you know,
17:51
the medical care or the mental health care that is provided.
17:56
Absolutely.
17:57
Um You know,
17:58
we,
17:58
we know from research in the medical field and how harmful that can be.
18:02
Um One of the first things that I worked on in terms of outreach in this community was actually outreach to our primary care setting and providing information around how weight normative approaches can be dangerous.
18:14
Um And I,
18:14
I can say with quite a bit of confidence that our primary care arm here in our division is,
18:21
is really quite well informed around that um really operates from a weight neutral approach.
18:26
And I'm,
18:26
I'm really so happy to see that,
18:28
that,
18:28
that I'm not hearing that weight is centered as this like rhyme indicator of health and,
18:33
and that folks are really taking a holistic and,
18:36
and neutral approach to,
18:37
to wait here um which is really so encouraging.
18:41
Oh I love that.
18:42
I,
18:43
I would like to go back to what you were just talking about about the mental health stigma with the um both like the historical trauma.
18:51
Um And then also the um component where some cultures may value other forms of support over mental health.
18:59
What does that mean for college campuses moving forward?
19:04
Like how do they create um in the counseling office?
19:09
How do they create a more welcoming,
19:11
a more safe experience for their students?
19:15
That might be experiencing one of one of these that you just mentioned.
19:20
That's a great question.
19:22
There,
19:22
there are many answers to that.
19:24
I think it's a,
19:25
it's a huge question.
19:26
I,
19:26
the,
19:26
the two things that come to mind are number one in developing and maintaining our clinical systems,
19:32
really holding the I um and creating a culturally sensitive environment of care um and maintaining that and making sure that we're addressing every angle that that means and it's,
19:43
you know,
19:44
it's a multitude,
19:45
really,
19:45
really being super,
19:46
super aware of that is,
19:47
is a big piece of it.
19:49
Um That also means um working to hire and employ folks um who have um the backgrounds and experiences and identities that our students and learners hold as well so that um there can be some affinity and some,
20:03
some shared experiences and some shared identities uh between providers and students and learners.
20:09
Uh Another really,
20:10
really critical piece in my opinion and experience is really centering outreach.
20:17
Um You know,
20:17
it's one thing to create um a good system of support,
20:22
but if folks don't know that it exists,
20:25
if they don't know how to access it,
20:27
um if there are certain barriers relating to their experience with mental health and,
20:33
and with the health industries,
20:35
um that could be addressed,
20:36
all of those things can be um interacted with using outreach and,
20:41
and I think that really centering that is a big,
20:44
big piece of both prevention and also helping folks get the support they need immediately is so,
20:50
so important.
20:51
Mhm.
20:52
Mhm.
20:52
Ok.
20:53
Thank you.
20:54
Um,
20:55
I kind of have another question.
20:57
It's,
20:57
it's completely different really.
20:59
But we sam and I have done some episodes before where we've talked about like lesser known eating disorders and one of the ones that came up,
21:07
um,
21:07
that we discussed and we see kind of highly on college campuses is the term drunk Oria.
21:15
Um,
21:16
I was curious if you've heard that term,
21:18
if you know much about it,
21:20
if you could speak to it and maybe,
21:22
um,
21:23
what you're seeing as far as,
21:26
as that exists on the campus,
21:30
it,
21:31
it's a great question.
21:32
Unfortunately,
21:33
as,
21:33
as I'm sure,
21:34
you know,
21:35
the,
21:36
the assessment tools that we use that we can pull data and pull reports from typically are not as specific as we would like in terms of specific symptom use or specific symptom experiences that folks are having.
21:49
Uh,
21:49
but certainly this is something that I've heard of that I have heard from students and learners specifically.
21:55
Um,
21:56
my understanding is that we're talking about a kind of,
21:59
um,
22:00
internet slang,
22:02
non medical term for restricting food is to compensate for calories taken in,
22:08
um,
22:08
from,
22:09
from taking alcohol from drinking alcohol.
22:11
This is clearly something that is emerging in the research right now.
22:15
Um,
22:16
most likely a larger,
22:18
you know,
22:18
just,
22:19
just 11 symptom of the larger challenge,
22:22
um,
22:22
that,
22:24
uh,
22:24
students and learners experience,
22:25
uh,
22:25
on college campuses that we've already described.
22:28
I,
22:28
yeah,
22:29
that,
22:29
that term has popped up in the news quite a bit.
22:32
Um,
22:33
and,
22:34
you know,
22:34
the other term that,
22:35
that I've heard before,
22:37
um,
22:37
and I,
22:38
I even heard this back when I was in college is the fear of the freshman 15.
22:43
You know,
22:44
that,
22:44
that's certainly rooted in fat phobia.
22:47
Um,
22:47
but ultimately is a fear that starts to drive disordered eating and,
22:51
and can trigger on an eating disorder.
22:53
Is this term still around or is this still,
22:56
um you know,
22:57
do you,
22:58
do you feel like this,
22:59
that,
22:59
that fear is still there?
23:01
Um or are things are things changing?
23:07
So it seems to me that the focus on the freshman 15 is sort of naming this time of,
23:12
of real vulnerability that folks have to begin focusing on their weight on the food that they consume in these kinds of judgmental ways and really is a time um in which it's,
23:24
it's really helpful to outreach to,
23:27
to these populations,
23:28
to provide them with support in case they're experiencing some of that,
23:31
that internalized or even externalized judgments.
23:34
Um I,
23:35
I think in terms of an approach to help support a a student experiencing these things,
23:42
two main pieces to the approach,
23:44
in my opinion,
23:45
and my experience,
23:47
the first is to really help increase insight around the connection between this focus and their emotional life.
23:52
Um As I'm I'm,
23:53
I know you you've discussed and I,
23:55
I know that this is one of your focuses.
23:58
What is making me focus on this specifically?
24:00
What might I be coping with utilizing this focus?
24:04
If I wasn't so focused on this piece,
24:06
what might I be feeling?
24:07
What might I be thinking,
24:08
that kind of thing can be really helpful?
24:10
Um The other thing is that the more we can be aware and experience our internal experience,
24:16
hopefully,
24:16
the more we can also develop some tolerance for some of those emotions and some of those thoughts.
24:20
So that's one piece and then another huge,
24:23
huge piece.
24:24
And this speaks to psycho education and outreach as well,
24:27
informing folks around the negative impacts of dieting,
24:31
the negative impacts of a weight normative approach and how unfortunately attempts to control our weight and our food intake in restrictive ways will tend to actually lead to some of the repercussions that the person fears the most.
24:45
Because as we know,
24:46
when,
24:46
when we put our body through the wringer with extreme uh food related behaviors,
24:51
restricting um eating uh in uncontrollable ways as a result of significant emotional distress,
24:58
these things puts our body through a lot and can actually um put us in,
25:02
in,
25:02
in a place uh physically that,
25:04
that we were attempting to avoid in the first place,
25:07
I think.
25:08
Sure.
25:09
Yeah,
25:09
I mean,
25:09
the research,
25:10
I mean,
25:10
there's so much research on the harm of weight cycling.
25:14
Um just sort of the you know,
25:17
I mean,
25:17
what we know with dieting is that it usually turns into weight cycling,
25:22
you know,
25:22
the,
25:23
the gaining and losing and gaining and losing over and over,
25:27
which is extremely stressful on the body.
25:29
Um,
25:30
and I don't think many people realize that weight cycling is a huge factor in our health and well being,
25:40
you know,
25:40
I think unfortunately this culture just focuses so much on weight and it's like,
25:45
you know,
25:46
the belief that weight gain is always a bad thing,
25:48
but no one's talking about how harmful weight cycling is.
25:52
You know,
25:52
we're not talking about that enough in sort of like the mainstream culture.
25:56
But yeah,
25:57
absolutely.
25:58
And we can even leverage the person's desire to meet their,
26:02
their set weight by informing them that the more extreme measures are used to try to control their weight,
26:09
the more they may actually move away from their set weight in ways that they,
26:12
they don't want themselves.
26:14
So you can kind of use the value system to actually promote health and well being in the way that you sort of described just now.
26:20
I mean,
26:21
not to mention that dieting and the intentional pursuit of weight loss just damages your relationship with food and with your body,
26:29
even for years to come.
26:30
You know,
26:30
even when you stop dieting,
26:32
it takes sometimes years to get yourself back to a place where you can trust yourself and trust your body and,
26:39
and have a healthy relationship with food so well.
26:42
And how unhelpful is that when you,
26:45
when you start that process of not being able to trust your body.
26:49
Um and then,
26:50
and then that disconnect just starts growing from there and that it is so,
26:55
I mean that when I can't trust my body,
26:57
when I can't allow myself the space to just be who I am and be where I am.
27:04
Um I mean,
27:05
that filters into so many other areas of our life.
27:08
You know,
27:08
we often lack,
27:10
being able to trust other people.
27:12
We start to isolate.
27:13
We,
27:14
we often,
27:16
you know,
27:16
that that low self esteem might creep in too and it's just,
27:20
it's vastly unhelpful.
27:22
Um That's a great point.
27:24
Um I,
27:24
I just want to add a little piece because what you said is so important,
27:27
I think um in American culture,
27:30
you know,
27:30
the move to college is really such an important opportunity for developing the relationships that some of which will we will hold on to for the rest of our lives.
27:40
You know,
27:40
it's not uncommon for folks as main social support to be folks they met in college and for something like uh an over focus on dieting and weight loss to become a barrier to that experience in this culture,
27:54
I think is it would,
27:55
it is so unfortunate and,
27:56
and really quite a tragic experience for folks.
27:58
Yeah,
27:58
I totally agree with you.
28:00
And it takes years to get out of that.
28:03
I mean,
28:03
years,
28:04
like,
28:04
you know,
28:04
we're all therapists on here.
28:06
We,
28:07
we consult,
28:08
we,
28:09
you know,
28:09
do therapy with adults that are still kind of stuck in where that started for them and stuck on the college campus.
28:16
And um,
28:17
yeah,
28:18
kind of stuck in that mindset.
28:19
But I actually had a question about that too.
28:22
So,
28:22
you're talking about Tristan,
28:23
like,
28:23
the outreach is part of what our responsibility is.
28:26
So,
28:27
a lot of schools have started like a um sort of a freshman orientation class.
28:34
Um Is that something at Johns Hopkins that you all bring in like counselors or,
28:39
or can you like,
28:41
you know,
28:41
are there opportunities to kind of partner with them and like share some of this information if you will more education,
28:50
more psycho ed on um tolerating our emotions on how to um wh what does a relationship with food look like when I move on to a college campus?
29:01
And how can that be a helpful relationship for me and for my body and for emotions,
29:07
all of that?
29:09
I completely agree with you.
29:10
I think that that is an excellent opportunity to do that in addition to providing all of the different forms of support that exist for folks who may be struggling or who may anticipate that they may struggle um to,
29:21
to really be as clear as possible about the pathways to care and support and not only from a mental health standpoint because not everyone is,
29:28
is wanting or looking for that specific form of support but being as multifaceted as possible as um culturally sensitive as possible and as diverse as possible in the forms of support that we can provide.
29:40
But yeah,
29:40
I totally agree with you.
29:41
Mhm.
29:43
Um Tristan are,
29:45
are there students who in on college campuses who are at elevated risk for developing an eating disorder?
29:55
Because I think it's important for um college students to be aware of this.
30:00
But also family friends,
30:04
coaches,
30:05
professors to all have their eye on this,
30:07
you know,
30:08
who are the people on campus who are most likely to develop an eating disorder?
30:15
We've already discussed the impact of culture um that promotes negative judgments or judgment in general around bodies,
30:25
food,
30:25
eating,
30:26
weight,
30:27
et cetera as placing folks at risk.
30:30
And so any discipline within an academic setting that centers,
30:36
that kind of judgment um would likely also include a population that's more at risk.
30:41
So you,
30:42
you named athletics um athletics unfortunately has a long history of that kind of judgment.
30:49
Um Given that the person's performance is,
30:52
is linked so much in,
30:54
in um in the training and in other settings uh to the to the body and it's functioning and it is often um approached in a kind of weight,
31:01
normative way.
31:02
Um folks engaging in um certain forms of art,
31:07
including um musical performance and dance performance.
31:12
Um There,
31:12
there's often that that kind of culture built into those environments.
31:17
Um So that,
31:19
that's one major thing,
31:20
although I,
31:20
I would center again that anyone coming from a family in which those judgments exist and that's many of us are coming with that,
31:28
that kind of vulnerability as well.
31:30
And,
31:30
and for many folks due to beliefs around things like the freshman 15 that you named are also getting hammered with judgment and are getting hammered with um that kind of messaging that can be internalized and create these,
31:41
these kinds of thought patterns.
31:43
Um I wanna also name something that I don't think is,
31:47
is discussed enough and that is so important to,
31:50
to center if it's true that that eating disorder symptom use is really an attempt to manage to cope with,
31:59
to modulate unwanted internal states.
32:02
And I I really do believe that um considering the impacts of trauma relating to holding marginalized identities.
32:13
So things like systemic racism,
32:15
for example,
32:16
this is a major source of um emotion,
32:21
um emotional distress and uh uh and can cause a lot of barriers to emotion regulation.
32:27
We know that trauma is a source of challenge with,
32:29
with regulating our emotions.
32:31
So folks holding identities that are marginalized in this culture that are marginalized in other cultures where they,
32:38
they may have lived,
32:39
I think are also very much at risk in the sense that they are,
32:42
you know,
32:42
attempting to cope with intense emotions,
32:46
trauma and and may reach for,
32:48
for eating,
32:49
relating uh behaviors to,
32:51
to make themselves feel better.
32:54
Oh,
32:55
absol,
32:55
I imagine,
32:56
especially if it's on a college campus where there's not sort of a sense of inclusion,
33:03
acceptance,
33:03
belonging,
33:05
um spaces,
33:06
safer spaces where,
33:08
um you know,
33:09
folks who occupy marginalized,
33:11
you know,
33:11
multiple marginalized identities,
33:13
it's sort of like where do they go,
33:14
you know,
33:15
LGBT Q folks.
33:17
Um I think it's so important that college campuses think about,
33:21
you know,
33:21
how can we make spaces that feel safer for our students who,
33:28
you know,
33:29
who are experiencing these very unique stressors?
33:31
Um And it surprises a lot of people to find out that it's,
33:36
it's true that oppression and marginalization are risk factors for eating disorders.
33:42
Mhm.
33:43
Yeah.
33:44
Absolutely.
33:45
And these are forms of trauma that we are now finally as a field really centering but that I don't think we have centered enough.
33:52
So it's really,
33:52
I think on us as an industry to be clear that this is something that we are assessing for something that we are making space for in and that we are providing support for.
34:04
So thinking about that,
34:05
thinking about our students that have elevated risk factors.
34:09
What does that mean for?
34:11
Um maybe like the adults or the support systems in their lives.
34:15
So the professors,
34:16
the coaches,
34:17
the family members,
34:18
what are,
34:19
how can we help them help their students?
34:23
Um What do they need to know about this process?
34:26
Mm.
34:27
Yeah.
34:27
Are there signs and symptoms that are unique to a college student that,
34:32
you know,
34:33
what should people look out for?
34:35
Yeah.
34:35
This partly depends on,
34:37
on one's positionality vis a vis the student and learner.
34:40
You know,
34:40
I think that many staff members,
34:43
um,
34:44
have,
34:44
have opportunity to observe a,
34:47
a student or learner somewhat regularly and might be able to detect things like,
34:53
um,
34:54
a,
34:54
a new preoccupation with weight loss,
34:57
food calories and dieting through how the person is discussing those things.
35:01
Um They might be able to notice a refusal to eat certain foods or,
35:07
or an elimination of,
35:08
of certain food groups.
35:10
Um They might start to hear about a new concern around body image,
35:15
um shape size or a,
35:17
a real leaning into those um perhaps a withdrawal from certain environments as well.
35:22
I think of,
35:23
of dining halls,
35:23
for example.
35:24
Um but then,
35:26
you know,
35:26
a lot of the physical symptoms that we can,
35:28
as we can think of that are associated with eating disorder symptom use,
35:32
you know,
35:33
we're,
35:33
we're thinking of fluctuations in weight um both up and down.
35:37
Um And,
35:38
and,
35:39
and other things that,
35:40
that may relate to a person's caloric and nutritional intake.
35:44
Um I always um sort of caution folks to in the over focus on the physical piece,
35:51
uh especially when working with folks who are younger.
35:55
Um It's possible that some of that symptom use will not land on the body as quickly um and might not show up vis visibly.
36:04
Um as quickly as it might for others.
36:07
Uh,
36:07
but they may very well be experiencing severe,
36:10
uh,
36:10
ramifications of symptom use nonetheless.
36:13
Um,
36:13
but,
36:14
you know,
36:14
things as well like dizziness,
36:16
fainting behaviors,
36:17
of course,
36:18
um,
36:18
can be other things to,
36:19
to watch out for and that we hear about a lot.
36:22
Um,
36:23
what I always try to help staff and,
36:26
and loved ones think about when they are wanting to coach or they're in the process of coaching someone towards um receiving treatment or engaging in recovery is to really check their own biases around,
36:39
you know,
36:39
weight,
36:40
shape food,
36:41
et cetera and try to approach things as neutrally as possible when it comes to those things.
36:46
Um as well as really check ourselves in terms of our own expectations of a person's willingness or readiness to get treatment or to get recovery.
36:53
Like if we are approaching them in a pressured way or in an impatient way,
36:57
because we are ourselves feeling anxious about how they're doing that can unintentionally push the person away and,
37:04
and not be all that helpful.
37:06
So I'd say approaching them from a space of true concern of genuine concern being as nonjudgmental as possible when we're labeling some of the challenges that we're hearing about,
37:16
uh keeping in mind that these uh symptom,
37:18
the symptom use,
37:19
these behaviors are almost always attempts to cope with pain,
37:22
um and being patient with the person,
37:24
you know,
37:25
just being available to them,
37:26
centering concern and and knowing that it may take them some time to get there,
37:30
you know,
37:30
that maybe they're just planting a seed in that moment.
37:33
Yeah.
37:35
So I know we're almost out of time.
37:37
But I have one last question for you about how students can actually go and get support on college campuses.
37:45
So,
37:45
if a student is struggle,
37:47
struggling with food or struggling with their body image,
37:50
how do they go about getting services at the counseling center?
37:56
And once they start services there,
37:58
what can they expect in terms of,
38:01
you know,
38:01
what kind of therapy do they get if they have an eating disorder?
38:07
Hm,
38:09
unfortunately,
38:10
I really can't speak to every university or,
38:14
or college setting because there is a pretty wide variability in a lot of the things that you just named.
38:20
I think it may be most helpful for me to provide some sense of how things work here at the moment and to say that many college campuses and universities have similar systems,
38:32
although they will not be exactly the same.
38:34
Yeah.
38:34
So once a student or learner becomes aware that we exist,
38:39
often the first uh interaction they have with a provider would be during an initial consultation meeting,
38:45
which is basically a drop in appointment that's available.
38:48
Hopefully on the day of um we try to make ourselves as available as possible to do those with folks.
38:54
And basically the idea is for the student or learner to tell us about what they are experiencing and how they believe we can help them.
39:02
We present them with a menu of different options,
39:04
including individual therapy,
39:05
group treatment.
39:07
Uh potential referral to primary care,
39:09
potential referral to student affairs or other academically related resources.
39:15
Um Basically trying to be as diverse in the menu of options that we provide.
39:21
Um another entry point that I um that I currently practice as the coordinator of eating disorder services is a service called chat with a counselor,
39:29
which is a nontreatment intervention.
39:31
I do it on a weekly basis and basically any student or learner across the university can register for that.
39:38
Um I meet with them,
39:39
it's fully confidential.
39:40
Um And we can discuss what challenges they're experiencing and I can help them also navigate some of those supports that may exist.
39:47
Um some of the different treatment approaches or recovery approaches that may be helpful to them.
39:51
Um So that's a little bit.
39:53
Um One thing that I would add is that we do have an eating disorder collaborative,
39:57
which is an interdisciplinary team of various folks uh from the student health and Well being division which I sit on.
40:04
We have a member representing each of the different major um disciplines that we represent um in the student health and well being division including a psychiatric provider,
40:14
a medical um team member,
40:17
um a member of our case uh case management team um and others.
40:21
And we also provide consultation to providers who are supporting a person uh in experiencing some of these symptoms and we also provide other types of support as need be.
40:31
Mm.
40:32
That's,
40:33
I love that.
40:34
Yeah,
40:34
we,
40:35
we work a lot with schools as,
40:37
you know,
40:38
you know,
40:38
in,
40:38
in doing outreach and trying to train college campuses and support them as they're working with students and to have that um collaborative team on campus.
40:49
It's,
40:49
it's something that I have stressed um and encouraged school counseling um um programs to develop and to get the interdisciplinary um you know,
41:02
people from across campus to come on and even sometimes um to have,
41:08
you know,
41:08
student led support come up to you and kind of discuss things.
41:12
So I just think that that's incredible.
41:14
I'm glad that you all are doing that as well.
41:17
I heard you mention peer support.
41:19
That is something that we are looking pretty concretely at developing.
41:24
Um you know,
41:25
we have many initiatives and unfortunately,
41:27
that's not one we have focused on enough at this point,
41:29
but it's something we really have intention to,
41:32
to start to develop and hopefully to roll out soon.
41:34
Absolutely.
41:35
It's awesome.
41:36
Yeah,
41:37
before we end Tristan,
41:38
if you could give any guidance to any college student who's listening,
41:43
who might be struggling and they're not sure what to do.
41:47
What do you hope they take away from this episode?
41:51
I think that it's so important for me to communicate to folks that I understand that pain is underneath so much of what we're discussing that this isn't something that someone decides to do out of nowhere,
42:07
out of some intent to do,
42:10
do something involving food,
42:12
their bodies wage shape,
42:13
et cetera that this is often an attempt to cope with something challenging.
42:17
And,
42:17
you know,
42:18
I've,
42:18
I've worked with many,
42:19
many folks and that,
42:20
that's really the con common denominator.
42:22
Um,
42:23
and that there,
42:23
there's nothing inherently wrong about trying to cope with our pain.
42:28
Um That often we just reach for what we know,
42:31
but that there may be another way,
42:33
you know,
42:33
there may be a way that's less destructive,
42:36
less harmful,
42:37
that may match better with your values than,
42:40
than what you're you're experiencing at the moment.
42:43
Um And maybe not,
42:45
but if there is,
42:46
I,
42:46
I hope that there is someone you can turn to that can help explore that with you and help you practice some,
42:53
some other way to manage that pain.
42:56
Um That doesn't um involve as much risk.
42:59
Hm Tristan.
43:01
Thank you so much for being on the show.
43:03
It was wonderful to connect with you again and wonderful to learn more about what's happening on campuses today.
43:09
So,
43:09
thank you for your time and your expertise.
43:13
Thank you so much.
43:14
It was a wonderful conversation.
43:16
Um And yeah,
43:17
I'm honored to be here.
43:18
Thank you.
43:23
Thank you for listening with us today on All Bodies All Foods presented by the Renfrew Center for Eating Disorders.
43:30
We're looking forward to you joining us next time as we continue these conversations.