Episode 28 - Dr. Aldridge Answers Eating Disorder Questions
This episode features the trailblazing expert on difficult to treat cases of eating and mood disorders, Dr. Delia Aldridge.
We’ll discuss your questions for her about why diets don’t work, how self-harm and eating disorders are connected, what treatment looks like, and the long term complications of restrictive eating - so please pass this along to anyone you know who will benefit from her knowledge!
Ellie Pike: Dr. Delia Aldridge is a leading expert on how complicated patients can find newfound levels of stability and momentum. She specializes in the refeeding process for people with eating disorders who also struggle with self-injury, PTSD, mood disorders, and substance use disorders. After recently joining the team at Eating Recovery Center in Chicago, [00:00:30] I thought it would be the perfect opportunity to dive into some common listener questions we get at Mental Note podcast.
Today's episode will be a fantastic resource for friends and family members of people seeking recovery from eating disorders. We'll talk about why diets don't work, how self-harm and eating disorders are connected, what treatment looks like, and the long term complications of restrictive eating. Please, pass this along to anyone you know who will benefit from Dr. Aldridge's knowledge. [00:01:00]
Above all, I think it's most important to see how hopeful a trailblazer like Dr. Aldridge really is. Eating disorders are one of the most fatal mental illnesses, yet there are proven methods to find recovery and she's here to help us understand them. You're listening to Mental Note podcast. I'm Ellie Pike.
Dr. Delia Aldridge: My name is Delia Aldridge. I am a board-certified psychiatrist and a certified eating disorder specialist, as well as an iaedp-approved supervisor with 17 years of experience in the inpatient partial hospitalization and outpatient level of care, treating adolescents and adults with eating disorder, mood disorder, anxiety, PTSD, self-injury, personality disorder, as well as substance abuse. [00:02:00]
Ellie: We are so honored to have your expertise on this show for a special Q&A. We have a lot of questions that our listeners have sent in. One of them pertains to diets. As you know, diets are very pervasive in our culture. There's always a new diet that promotes that it works. "This is the new diet. This is what will work for you." I'm wondering if you could please share with our listeners a little bit about why diets don't work.
Dr. Aldridge: Yes, most people will lose weight while on a diet, [00:02:30] but the research has shown that one- to two-thirds of people that are on diet regain more weight after they lost within four or five years. That happens because our body is experiencing dieting as a stressor. When we're stressed, we produce high levels of stress hormones such as cortisol and adrenaline. These hormones cause our body to slow down the rate at which we burn calories, and eat more to survive. Our body's intentionally slowing down [00:03:00] our weight loss efforts because it perceives our reduced calorie intake as a threat to survival.
Think like hibernation and the need to save energy. In these cases, body reacts by slowing down our heart rate, lowering our blood pressure, slowing down digestion, reducing blood flow to our hands and feet, and to some extent, our reaction to outside world.
Ellie: For someone who chronically [00:03:30] diets or even someone who has developed an eating disorder, how does that lack of adequate nutrition affect the brain and how someone feels, their mood per se?
Dr. Aldridge: Well, I want to bring up the first study that was done in history, in 1940s by Dr. Ancel Keys, which is called Minnesota Starvation Experiment, in which 36 volunteers that were fed 1,500 calories a day with foods reflecting what was commonly available in the wartime [00:04:00] in Europe, and they looked to document the physiological and psychological effects of severe and prolonged dietary restriction.
Ellie: This famous study sought to answer the basic questions of how human bodies respond to a drop in calories.
Jim Graham: In making plans for relief activities after the war, there were a lot of questions that needed answers. What do you feed a starving person to bring him or her back to health? What's the most economical use of food materials when supplies [00:04:30] are severely limited? We knew fairly well what a starved person looked like, and what starvation did to the human body, but until this time, there had never been an opportunity to measure exactly what changes take place in the body under starvation conditions.
Ellie: What you're listening to is archival audio from Jim Graham, a participant in the Minnesota Starvation Experiment. While experiments like this are no longer viable under ethics standards, [00:05:00] it did help to lay a strong foundation for our understanding of how human bodies respond to the stress of dieting, and why it's doomed to fail.
Dr. Aldridge: The study, participants lost about 24% to 25% of their body weight in six month. They report high levels of depression, emotional distress, so many of them became self-harming.
Jim: We became very irritable and intolerant, little things seemed to annoy us. [00:05:30] We were no longer polite with each other or with visitors. It seemed as if the veneer of civilization had been removed, leaving bare the animal underneath.
Dr. Aldridge: It's similar to what we see actually in our patients that come in with significant weight loss. They also notice reduced ability to laugh, to blush, or they completely have no facial expression sometimes.
Jim: If I tried to smile, it was just a grimace,[00:06:00] and I never laughed.
Ellie: We know that there's a crossover between eating disorders and self-injury. Could you please explain a little bit about self-injury and what that is and how it differs from suicidality?
Dr. Aldridge: Yes. First of all, self-injury is separate from suicidal thoughts or behaviors in which individuals want to end their lives. People usually report that they have no expectation or no intention [00:06:30] to cause death when they engage in self-injury. In fact, in some cases, self-injury may be used to manage intense distress that may associate with suicidal thinking. Non-suicidal self-injury is a term oftenly used interchangeably with self-injury, though it is important to bear in mind that self-injury may carry lethal and non-lethal intent.
People engage in self-injury for many different reasons. One of the most common reported reason [00:07:00] is to cope with negative emotions, such as sadness, or anger, or negative thoughts such as self-criticism. Some people also use self-injury to punish themselves, to gain a sense of control, to communicate their pain, to reconnect with themselves or others, or to alleviate numbness. Some people say to me, "Just to feel something."
Although suicide is not typically the objective of self-harm, [00:07:30] there is increased risk of suicide in individuals engaging in these behaviors. I had situations in which patients were reporting that they were injuring them self to survive, because the physical pain that comes with self-injury gives them a temporary relief from emotional pain that is unbearable.
Ellie: You used some great examples there to explain that self-injury is not necessarily being suicidal, [00:08:00] but it could actually be a way of surviving through expressing emotions that can't be expressed through words, to feel that physical pain that they're feeling emotionally. Can you explain a little bit about how eating disorders and self-injury are related?
Dr. Aldridge: Both self-harm and eating disorder behaviors can be used as ways to escape, avoid, or otherwise regulate negative emotional states. Patients with self-harm and eating disorder behaviors, they often describe [00:08:30] experiencing strong negative emotions, or emotional ability that is feeling out of control. They also tend to judge themselves harshly for having feelings or are afraid of their emotions, which leads them to feel desperately to find relief.
If you ask a patient why they self-harm, or why they engage in an injurious behavior, they sometimes will tell you that those behaviors numb their emotions or they distract them from their emotions, [00:09:00] or give them a brief sense of calm or relief.
Ellie: The connection between eating disorders and self-harm is backed up by data 25% to 55% of eating disorder patients also self-injure, and 50% to 60% of self-injury patients also qualify as having an eating disorder. Recognizing this common ground has a profound impact on treatment.
Dr. Aldridge: The share function of the [00:09:30] non-suicidal self-injury and the eating disorder may have greater success in treatment if we address both behaviors in the same time.
Ellie: How would you treat someone dealing with both of these issues, the eating disorder, and self-injury?
Dr. Aldridge: Typically, we want to make sure that we stabilize the eating disorder, that they're medically stable, that they keep up with their nutrition while they learn ways to cope with their emotions. [00:10:00] Obviously, sobriety has to happen in the same time. Unless we address all there components, sometimes it's hard for patients to mange their emotions. I've been working in the past in an inpatient unit for 17 years where patients would come in from residential programs for eating disorder only to complain that they started to self-injure because they couldn't cope with their body image. [00:10:30]
Patients come sometimes from substance abuse program with eating disorder or self-injury behaviors because their emotions are so unbearable when they try to be sober that they couldn't maintain. I personally have seen many severe cases achieve recovery when the comorbidities were properly treated.
Ellie: You use the phrase comorbid disorders. I'm wondering if you can explain what comorbid disorders is for our listeners.
Dr. Aldridge: Comorbid disorder means having [00:11:00] more than one psychiatric diagnosis. It could be also a medical diagnosis. When we're talking about comorbidities in treating psychiatric conditions, we talked about, for example, somebody having an eating disorder, in the same time having depression, or anxiety, or post traumatic stress disorder or personality disorder. When we look at treating the person, we don't just treat one disorder, [00:11:30] we have to look at the big picture, how's the person in general? We have to look at the medical components. We have to look at psychological component and address what we call a biopsychosocial aspect of the full treatment, full person, basically.
Ellie: I like how you say that, to treat the full person. That's profound. I really want to capitalize on your expertise with treating medically complicated eating disorders. [00:12:00] I know a lot of our listeners are intrigued by what the complications are, the eating disorders, but they need to know that there's hope, that many of these complications are reversible. Can you tell me a little bit about what eating disorder complications are reversible versus irreversible?
Dr. Aldridge: Well, most complications for eating disorder are reversible and treatable if person returns to a normal weight. Some are actually associate with permanent harm. [00:12:30]
Jim: The human body is a marvelous machine. It adjusts itself automatically to a lower food intake. Body weight reduces, of course, but also heart size, lung capacity, stomach size. Everything slows down.
Dr. Aldridge: Now, consuming fewer calories than your body needs means that the body will break down its own tissue. Muscles are the first organs that are broken down. Most important, the muscle [00:13:00] in the body is the heart. Patients are a risk for heart failure as a result of starvation. Their blood pressure goes down then. Their pulse goes down. Heart damage was ultimately what killed singer Karen Carpenter which is the most common reason for hospitalization in patients with anorexia.
Now sometimes, I want to point this out, because some physicians, without enough education, confuses slow pulse [00:13:30] of an athlete, which is due to a strong, healthy heart with a slow pulse of an eating disorder, which is due to a malnourished heart. Sometimes the low heart rate can be the only symptom that we see before everything falls apart.
Ellie: If I were to put that into layman's terms, if you were to take an athlete who was sitting, and then they stand up and walk down the hall, their heart rate should stay pretty low, right?
Dr. Aldridge: Absolutely. [00:14:00]
Ellie: Then it gets confusing if someone who has an eating disorder, and their heart is starting to suffer from the eating disorder, if they stand up and walk down the hall, what happens to their heart rate?
Dr. Aldridge: Well, their heart rate would actually go up, and they would sometimes say they get dizzy upon sudden position change. That doesn't happen with a healthy athlete.
Ellie: Oftentimes it can get confused when they're just sitting and they have a low heart rate?
Dr. Aldridge: Absolutely. We call it the walk test. [00:14:30]
Jim: I couldn't walk up a flight of stairs without stopping to rest once or twice on the way up. I felt like an old man.
Ellie: Is that permanent?
Dr. Aldridge: Typically, the sooner patient weight is restored, the younger they are, the better. Part of this is also the reason why the family-based treatment is one of the successful individual treatment for young patients with eating disorder, because in these treatments, parents do the heavy lifting for their children who are malnourished. [00:15:00] Research supports that only with full and sustained weight restoration, individuals are able to maintain their own recovery.
Ellie: That makes sense. The primary piece that I'm hearing is that first you have to weight restore and make sure that the body gets all the nutrients it needs, and then other things will face in place. Many of these complications are reversible. Is that correct?
Dr. Aldridge: Yes, absolutely.
Ellie: The primary one that may not be reversible is osteoporosis or osteopenia [00:15:30] depending on how long someone has had anorexia.
Dr. Aldridge: Sometimes the extreme low body weight can also cause the body to produce estrogen resulting in a condition called as amenorrhea or no menstrual periods. Low estrogen levels will contribute to significant bone less known as osteopenia and osteoporosis, and put the body at risk for broken bones and fractures. This is one of the irreversible [00:16:00] conditions that could be related to an eating disorder if the patient goes on too long without weight restoration. Studies suggest that low bone mass is common in people with anorexia, and can occur as early as being one year suffering with anorexia nervosa. You can see patients that are 20-year old and they have the bones of an 80-year old, depending on how long they suffer with their eating disorder. [00:16:30]
Jim: My muscles are almost gone, my bones protruded, and sitting on a hard chair was uncomfortable, even for a few minutes. Most of us carried around pillows to sit on.
Dr. Aldridge: Another complication of eating disorder could be the brain atrophy that happens as a result of malnutrition. Sometimes the neurocognitive functioning of the brain could be permanently impaired even though the brain atrophy improves with weight restoration. Which means both [00:17:00] white matter and grey matter can be affected. They can get back to normal with nutrition. However, the functioning is not always 100% back to normal. Even after weight restoration takes place, a normal brain function may not have returned to normal.
This looks like the menstrual function may be the mediator and the best predictor of cognitive recovery rather than the weight, and that full [00:17:30] cognitive functioning may not return until menstruation has been maintained for at least six month.
Ellie: It can take a while for the full cognitive function, but I'm also wondering if the brain is being restored through weight restoration, what's happening to someone's mood during that time?
Dr. Aldridge: As I mentioned earlier in the starvation studies, patients that lose a lot of weight can also suffer with [00:18:00] depression and anxiety. Typically, when patients come in, we don't usually jump on starting them on medication for depression or anxiety because we've seen, especially in young kids, after about a couple of days of eating regularly, we can see their mood getting a little bit better, and their anxiety actually resolving, as well as their sleep getting better.
Ellie: That makes so much sense to me because I know if I miss one meal, I get really angry or hangry, right? If someone [00:18:30] is listening to this episode and they're hearing about all these complications, I know some of it is hopeful, because a lot of this is reversible if you get treatment. What advice do you have for people, if they're listening to this and they're struggling with an eating disorder?
Dr. Aldridge: My advice is to seek help, and aim for full weight restoration and full recovery, because the longer they suffer with an eating disorder, the worse it is to get back to themselves. [00:19:00]
Ellie: Thank you so much for your expertise. I'm so glad that there's doctors out there like you doing this hard work and helping our friends, and our family members, and our listeners heal. Thank you sharing with us. We will certainly link to your books, and we will provide a bio on our website on mentalnotepodcast.com. Thank you so much, Dr. Aldridge.
Dr. Aldridge: Thank you.
Ellie: [00:19:30] Thank you for listening to Mental Note podcast. Today's special Q&A guest was Dr. Delia Aldridge. She recently joined the team as medical director at Eating Recovery Center in Northbrook, Illinois. This treatment location is close the airport and offers apartments for families from out of town. She and her staff provided all levels of care, and are able to treat adolescents of all genders, ages 10 to 17. Today's conversation was brought to you by Eating Recovery Center and the Insight [00:20:00] Behavioral Health Centers. Places where your journey toward treatment will take into account your whole person and just the symptoms.
If you'd like to talk to a trained therapist to see if treatment can help you, please call 877-411-9578. You can learn more about the people we interview at mentalnotepodcast.com. We'd also love it if you left us a review. It helps others find our podcast. Mental Note is produced by Sam Pike, [00:20:30] edited by Josh Wright and Sam Pike, and I'm Ellie Pike, 'til next time.