Healing Binge Eating Disorder and its Connection with Trauma, Diet Culture, and Weight Stigma
Welcome to the Satiated Podcast where we explore physical and emotional hunger, satiation and healing your relationship with your food and body. I'm your host Stephanie Mara Fox, your Somatic Nutritional Counselor. You're about to hear from a woman who has been in the field of binge eating disorder recovery for 35 years. Amy Pershing is the Founder of Bodywise and President of the Board of the Center for Eating Disorders in Ann Arbor, Michigan. She is the co- founder of Pershing Consulting, LLC, which offers training to clinicians treating binge eating disorder, or BED for short, and trauma worldwide. Amy is also the creator of Hungerwise, a 9-week online program for ending chronic dieting and weight cycling. Amy is an internationally known leader in the development of treatment paradigms for BED, and one of the first clinicians to specialize in BED treatment. Amy has pioneered an approach to BED recovery that is strengths-based and trauma informed, incorporating Internal Family Systems (IFS) and body-based techniques to heal the deeper issues that drive binge behaviors. Her approach integrates a non-diet body empowerment philosophy, helping clients create lasting change with food and body image. Amy lectures and teaches internationally on the treatment of BED for professional and lay communities; she has been featured on radio, podcast, and television programs around the world, speaking about BED treatment and recovery, relapse prevention, weight stigma, and a non-diet approach for eating and movement. Amy is the Past Chair of the Binge Eating Disorder Association (BEDA), and the winner of BEDA’s Pioneer in Clinical Advocacy award. She is the author of the book Binge Eating Disorder: The Journey to Recovery and Beyond and Emotional Eating, Chronic Dieting, Bingeing And Body Image: A Trauma-Informed Workbook. Amy was part of getting binge eating disorder recognized as a clinical diagnosis and has seen how the treatment for binge eating disorder has evolved over the years to now include a focus on the root cause being trauma. We explore what this binge eating disorder healing journey looks like, what a person healing from these behaviors with food needs to learn, approaching the journey in a body image neutral way, and be sure to listen to the end for questions you can ask yourself when feeling the urge to binge. With Thanksgiving coming up this next week, you may notice your binge urges increase. This is why I've put my Somatic Eating® Intensive on sale for 40% off until Tuesday November 28th. You'll receive a 2.5 hour class along with a week of 1:1 Voxer support where you will be able to send me a message every day and receive individualized guidance back personally from me. I'll leave the link in the show notes to check that out. Now, welcome Amy! Well, I am really honored to be here with you today with just how long you have been in this field of supporting others in their relationship with their food in their body and I'm so curious to learn more about your history and how you got into this work and where you're at today with how you support individuals with binge eating.
Amy Pershing 03:26
Thanks. I'm delighted to be here and to talk with you. And I'm so glad that this I feel like when I really started working with BED one thing when I started working with binge eating disorder, it wasn't an eating disorder. It was over eating or compulsive overeating or whatever. But it really was best case subclinical and worst case, really the the recommended treatment was a diet. And so it really wasn't recognized as a full blown eating disorder. My own recovery journey is how I got into this. I had binge eating disorder, but I didn't have a name for it. And so I went to therapy, and I learned a lot of things. I mean, it was good treatment, but it never focused really on my relationship with food and certainly didn't focus on it as an eating disorder. And so I kind of came to realize actually starting with Geneen Roth's work way back in the day and her kind of talking about wait a minute, there's food is doing something for you and so for that A, and I would say B the other piece of that is that dieting is making it worse. And that was really very much a key idea to me, I had either been binging or dieting for most of my life, actually, I started my first diet I was eight years old. So you know, so I really had a long history of that kind of relationship with food, and nobody was talking about it or treating it so that it really was kind of from the ground up. And then from there it was, as I realized in my own work and my own recovery. This really is an eating disorder and needs to be treated accordingly. And we shouldn't be suggesting interventions like dieting that we wouldn't suggest for any other eating disorder. So this isn't we got to figure something else out here. So that was, that was a big part of it for me to start with. And then I really as time went on, and we finally got that in the DSM, I was delighted to be part of that work. And so we really got some recognition for research dollars. And you know, for treatment, not enough treatment, still, but we're getting there. And so that was really exciting. Most recently, I think what's been really powerful is understanding the links between binge eating disorder and early trauma. So that I think has really been kind of the most important direction that I've been going in the last 10 years or so in my own work is seeing that relationship with binging from a strength space. And what I mean by that is that fundamentally, that relationship with food is protective. And so people don't give it up easily, nor should they. So really, we have to, in some ways, I think, almost celebrate that relationship as a way we survived and help people figure out what are better ways to recognize and meet those needs.
Stephanie Mara 05:56
Yeah, I'm completely on the same page. It's exactly how I practice as well. And I find a lot of individuals come to me very confused about seeing their binge eating as a gift. That was actually their best strategy to get through something in their past, where previously it was seen as something that was bad, wrong, needs to be fixed, gotten rid of. And I really appreciate you bringing in this aspect of it's only been recognized as a like, disorder fairly recently.
Amy Pershing 06:31
Right. Yeah. And again, because I think we've got that narrative that if you eat more than you're supposed to eat, then that is a willpower issue. And so there's so much self blame, there's so much that sort of story that, you know, if you just want it badly enough, it being usually being thinner, if you just want that badly enough, then that relationship with food will somehow magically shift and change. And that will happen. And if you don't do that, it's a willpower issue. And of course, what I know from doing this for 35 years, that the people I see have some of the most incredible willpower of anyone I know in terms of surviving. This is not a willpower issue in any way. And yeah, I agree that that sort of narrative that this is a bad behavior, or that I'm a bad person or a weak person, as opposed to I found a way to survive, I found a way to soothe, to distract, to disconnect, right? To reward, to punish, right, all these different uses, that people can have in that relationship with binging has allowed them to make it. And so I sort of say job well done. And yeah, that is that is, in many ways a very different strategy than than we were taught.
Stephanie Mara 07:39
Yeah, yeah. So what in your 35 years of practice have you felt like is missing in the conversation around binge eating, and its protective nature?
Amy Pershing 07:50
Well, I think maybe even just that recognition is still pretty new. I think, really, I like to help people know, chemically, that going to food actually does help in the short run, it releases cortisol, we have a little dopamine hit, it really does help in the short run. So I think just understanding that is, is really important. So that's one thing that I think is missing from the conversation. Another thing, again, is understanding that link between surviving overwhelm and childhood experiences typically, and how that relates to the person going to food. I think that piece is really important. The clinical community I think is kind of catching on there because there's more focus on trauma. So that's, that's the good news there. Another thing of course that's missing is we can still have clinical community that understands the link with trauma, understands how people might go to food to soothe and then still ultimately makes weight loss or shape change, or dieting, a goal of treatment, I think that's a mistake. So we're still not really understanding the damaging impact of weight stigma, the judgments about weight and health, the connections that we necessarily have been taught are true between weight and health, where the evidence really does not exist. So I find a big part of treatment is really about embodiment, that is living in our body as our home instead of a billboard, getting out of some of those self objectification energy. So we're moving around in the world inhabiting our body. So that's a long way of saying, I think the somatic piece of recovery is missing. For a lot of a lot of clinicians that somatic piece is mission critical. The body is one of the biggest allies in treatment. It's really where a lot of healing takes place. So I work in from a framework called internal family systems and a lot of internal family systems is using the body and the sensations and really understanding and paying attention to how food changes those sensations, and again, how that was adaptive. I think those are all missing pieces.
Stephanie Mara 09:56
I completely agree with all of those. It's interesting I'm so on the same page with you in. So I got my master's degree in somatic psychotherapy, and I came into that degree kind of like raring like, I'm going to, you know, bring somatics into this world, because it's missing from the healing approach, when you see that something is happening in your relationship with food, and you don't quite understand it. And so far, the approaches I've seen are very cognitive, and don't really include what the body is trying to relay and why would you be drawn to doing that kind of behavior to begin with.
Amy Pershing 10:36
Absolutely agree. I think so much of what I noticed with clients that really makes for resilient change is their felt sense in the world changes. They're moving around in the world, inhabiting their bodies more, they know their own power and their own strength. They know they're, they're able to identify emotions and needs much more readily, they're able to notice, how, like you said, would go to food to shut down somatic experiences that felt overwhelming, dangerous. So the body is really an incredible marker of our progress of in healing. The other thing too, I find is if, if we're working on developing an allegiance there, we're all really one thing. It's not the head versus the body, right? But we really are one being moving around in the world. It makes it harder to harm that body, with food, but also with shame messages, right? We tend to get more protective, which is exactly what we want. Right? That is a profound, profoundly important part of healing trauma is becoming able to protect ourselves well, and you need the body to do that.
Stephanie Mara 11:45
Yeah, I know, something that you talk about is supporting someone in becoming an attuned eater. And I'm wondering what that definition and what that process has looked like for those that you've worked with?
Amy Pershing 11:56
Yeah, a lot of it is building that that wisdom, everybody's, you know, what I think about as everybody needs a user's manual kind of to their body, everyone's is unique, right? There isn't a right way to eat, there isn't the right nutrition for any given human being. That we don't even have that recipe for one thing. And I would suggest it doesn't even exist, it's different for different people, it's different for different bodies. So I think fundamentally, what I think of when I think of a team meeting is very much that that our body is in the lead. And it's really our job to hear what it has to say. And so what that looks like is becoming better able to recognize hunger cues, and fullness cues, knowing how different foods feel in the body, taking the judgment out of different foods. So there's room for all foods, let's see how different foods truly affect us. One thing that profoundly contributes to binge eating is having certain foods that are forbidden. You know, people don't binge on broccoli, they binge on things, right, that they won't otherwise allow themselves to have. And the narrative is, well, look what happens when I allow that I just eat tons and tons of it. Well, that's not what's really happening. What's really happening is the restriction is driving a binge. So what I find is when there's more permission when it's safe to listen, and that's, of course, a lot of the work of therapy, but when it's safe to begin to really listen to your body, people want broccoli and ice cream, and pizza and stir fry and donuts and whatever. They want a whole variety of foods and they want to delight in a whole variety of foods. I talk about satiety, it's really important that we're eating food that satisfies us. In diets, our own satisfaction around food is irrelevant, right? Have to have particular amounts, or recipes or combinations or omissions or whatever. Let's listen to what really your needs are. And that's also corresponds to doing trauma healing work, what are your needs, really. And then perhaps another really big piece of attuned eating, I think is really challenging weight stigma and diet culture, you know, really being able to protect yourself from those messages coming in. It's not easy to leave a cult. And that's essentially what's happening. And so how do you do that? You have to really protect yourself from the messaging that comes from that space. So I think that's another really big piece of it, too, is being a very conscious consumer.
Stephanie Mara 14:20
Yeah, I'm so glad you brought in that last piece, I find a lot of the conversations that I'm having in sessions are around that of let's pick out where they're receiving diet culture messages, and how rampant and sneaky and subtle they are so that they can start to make decisions for themselves around what feels best to them. And you made such an important point that a lot of also changing our relationship with food is coming back into relationship with the body and that the body might shift and change and what fears come up there.
Amy Pershing 14:54
Absolutely. Absolutely. We have, you know, there's so many narratives around acceptability, lovability and body size and for so many clients who are trauma survivors, the idea that love, that connection is conditional is fertile ground for diet culture to thrive, right, we've got already those stories that if I'm not a certain thing, I am unacceptable. And we see that around us. So you know, part of what we have to help our clients to do is to build resiliency, because they're going to get that message as soon as they walk out the front door, it's going to be reinforced. So I think we really have to, as you're saying, really work on how do we detect messages that are selling us shame. And it's, it's getting, I think you're absolutely right, I totally agree that it's getting sneakier, I think what's happening is our movement has made enough of an impact that the powers that be are getting sharper, about what words to avoid, and what words to accept. And so Noom and Weight Watchers, in lots of different groups are, this is a non diet approach or you know, free eating whatever. But, but, but when you start digging in there, and really sort of look at it, it's the same thing. With just a different wrapping. What I always think about is if there is an expectation or an outcome, right, if there's an outcome that a program is offering you, it's a diet, if you can fail, it is a diet, right? If they're taking your voice away, it's a diet. So it's getting sneakier, people have to get get more and more critical of what their being sold.
Stephanie Mara 16:27
Yeah, and I really love that you just kind of started to bring forth of how we can identify when it is diet culture, because you're so right that now that take the head of probably marketing of diets, of all the many different diets, know the words that are getting more popular that individuals are talking more about, maybe even fighting against. And so they know they can't use the word diet, it will probably even I imagine get sneakier of even talking about weight, and its loss less. And so to really be aware of some of the things that you just pointed out of kind of an expectation or do this and you'll get that. And it's not inviting you into relationship with yourself or giving you back your sense of autonomy.
Amy Pershing 17:17
And they're always predicated on weight loss as a good goal, right? Being smaller is always a good idea. Right? Whether the body would guide you there or not. Right. So I think, again, a big piece of this, ultimately, this work is going to be about every body is welcomed in the room as is, that we're not approaching our health and well being as as though we're broken and we somehow need to fix it. We're going to be approaching it from a place of compassion, right? From a place of curiosity, what does the body I am in right now need? Not how do I need to fix it. Right? There's a lot of money to be made from shame. There's very little money to be made from acceptance, right. So I always suggest to clients, follow the money. Just pay attention that will always tell you the truth. You know, where is that going? Will this program celebrate weight loss? Whether it calls it that or not. Right? But will it celebrate that outcome? As opposed to another outcome. Is it neutral toward weight change? If it's not, get cautious.
Stephanie Mara 18:20
Yeah, and just coming back to the trauma piece, because I find individuals are confused about what trauma is. And also that living in a weight stigmatized society is traumatic, like, even if it wasn't something that necessarily happened to you, if you live in a body, that isn't the societally accepted body shape, that can feel like too much to just even show up as yourself that binge eating can occur simply because of that.
Amy Pershing 18:53
Absolutely. When we think about trauma, there's lots of different kinds of trauma, but mostly associated with folks who are dealing with eating disorders or dealing with weight stigma is what we call complex trauma. And essentially, that's trauma of relationship. And basically what it what it means is that there is some expectation about how you look or who you are or what you believe or what you feel, in order to be accepted in that relationship. So we have to diminish ourselves in some way in order to be in that relationship. Well, that describes weight stigma for sure, right? That we have to be in a certain body in order to be accepted. And that is intrinsically traumatizing. It means I have to be in some way something other than I am, right. It drives those shame narratives forward in some sense, kind of what if we can think about does what I'm seeing, does what I'm being told, make me feel good about my body, or at least neutral? Or does it make me feel ashamed, does it limit where I go and what I do and how I move around in the world? If it does, that's the trauma of weight stigma. There's a term called self objectification. And the idea around that is simply that we're more aware of how we appear, than we are aware of the experience of being in our body. So you think about all the times you adjust the way you're sitting, the way you're walking, or the particular clothes that you wear, are worried about the angle you're being seen from or who's looking at my body in the grocery store, versus just moving around in the world, in your body and taking in the information that your body is discovering. My clients, when I used to ask them, you know, what percentage of the time that you're out in the world do you feel like you're aware of how you appear? And you know, they'll say 70%, 80%, some will say what, there's another option? Right? They're always in that space. Because that's what we're taught, we're taught to present ourselves, not be yourself.
Stephanie Mara 20:52
That is so powerful. Yes. And I'm wondering if we like zoomed out around what you've seen someone who's navigating patterns of binge eating, needs to learn, relearn, discover about themselves, what have you found, or maybe some similarities? And, you know, like, a lot of the time I'm noticing talking a lot about setting boundaries, because maybe their boundaries were broken, or never set to begin with at a young age and relearning what boundaries feel like and look like to that individual. And I'm curious if you've seen any similarities with like, ooh, these are things I'm often noticing that someone navigating these behaviors maybe needs to learn.
Amy Pershing 21:33
Absolutely, yeah, there are a number of things. One is, yeah, that is a big one. Boundaries is a big one. I think another one is even just awareness of needs, you know, for so many of my clients, needs, desires, you know, just in simple needs, needs just for comfort or needs for attention or space, right? Were unacceptable, right? Or the need to not always perform at A level. And I think it's so interesting to think about for so many, and I had this too, so I absolutely understand this. Right? That you know, you're 110% is baseline. Well, that's crazy. If you think about it, right? We should be, we should be kind of aiming for C plus maybe, and hit the A game when it's worth it. Not as a way of living, but that is very much what we're taught. So I think just getting to know where does my life feel like it's in integrity? And where does it feel performative? Where does it feel like I'm doing what is expected, but my heart or my soul or my head, isn't in it? Where do I say yes, when I mean, no, right? I think those are the biggest ones. And then I guess I would say one other one, too, that I feel is really important is because of all that performing, not many of my clients really come in knowing who they are truly, and there's a lot of fear about what they might discover, right? That it's going to be bad, because those have been the narratives, right? That just who I am is not good enough. I have to perform, I have to be thinner, I have to do this, I have to do that, et cetera, et cetera. So I think that's a big piece, too, is we're asking people in the recovery process to be really brave, to have a tremendous amount of courage to really peek behind the various curtains and discover that what's there. It's truly beautiful, actually, but it's very frightening.
Stephanie Mara 23:18
I completely agree with all these pieces. And I find that this healing journey is one of re self discovery that there was maybe something that stopped or halted your self discovery or individuation of yourself. And some of that's a little painful. And there's a grief process. And it's also exciting, and exhilarating of all the things that you may discover about yourself that you didn't know before. Like it comes, just as we started this, it comes all back to coming back to the body. Because to know your needs, and to know how you feel about things is to also listen to your body and its feedback.
Amy Pershing 23:55
Yes, I agree,. Asolutely. I think that's a great way to say that is like there's this limiting of self for so many folks very young, right. And we have to learn how to exist in a culture and you know, be good to each other. And, you know, there's, you know, roles that we have to have in order to live in community. But that's very different than the deselfing that is often expected. So yes, I find that's exactly right, that there's a process of delight, and there is a process of grieving. I see a lot of clients later in their lives and, you know, they're maybe just doing this work just now really, maybe they've even been in therapy for a long time, but they've just never really connected that relationship to food with the work that they're doing. And so it's kind of a keystone in the arch for them. And so there's there's often grieving at time that has been wasted in trying to fit in some way as opposed to be.
Stephanie Mara 24:48
I've seen that a lot as well, that individuals have maybe done a ton of healing work, and then realize, oh, wait a second, this maybe also has to do with what's happening with me with food as well.
Amy Pershing 25:01
Yes. Well, it's interesting. I find often if a client is coming to see, you know, and they're not thinking about it that way, right? If they have this binge relationship, and I think was just a willpower thing, I just need to stick to my diet, why would I bring that up in therapy? Right? So we really have to actively ask those questions, right? And really check in, how's your relationship with food? I think we always should ask that regardless. Because a lot of times people still aren't thinking about this really, as fundamentally a part of healing. And it needs to be, and a good source of information for that healing journey, too. If you've got a part that's, you know, using food, let's get really curious, that part's speaking the only language that knows, we need to listen.
Stephanie Mara 25:45
I completely agree. I like to always wrap up with like a baby step. So you know, when individuals regardless of where they're at on this journey, sometimes it can feel really overwhelming of where do I go next? Or how do I get started? And so what's kind of a baby step you would maybe offer with someone who's, you know, realizing, oh, wow, I think this piece around my binge eating actually has to do with what's I've been exploring, and where do they go with all this? What have you found be the most supportive?
Amy Pershing 26:15
This will sound really self serving, which I do not mean. But I think it is true, I think therapy is almost always really important. Because we have so many different aspects that are trying to keep us away from those realizations, because that's how we've kept food around to stay safe. So there's a lot in our systems, usually, that doesn't want us looking at that relationship. So I think we have a lot of work usually to do, just to feel strong enough to do that. But supposing someone does feel like they're in a good space to do that, what I would say is, yeah, when you notice that drive to go to food, see if you can just buy yourself a little time, don't take food out of the toolbox, if you decide you want to go to food, that's okay. But just see if you can buy yourself a couple of minutes to be curious and compassionate. Just check in and see what triggered this. What am I hoping to go to the food to do? What do I want the food to do? How do I want the food to change my experience of this moment? And see, is there anything else I could do some of that lifting? Is there anything else that could help that other than food? Because food does, there's nothing morally wrong with binging. You're not a bad person if you binge, right, but it does have implications that can be problematic, it can have health implications, it can just feel like we're harming our body. So it has a cost. So are there ways to meet that need that are a little less costly. So it's a few steps in there. But that's, that's what I would say.
Stephanie Mara 27:54
I love all of those. And I actually really appreciate that you named you know, find someone because so often I find on this journey, individuals are trying to navigate it all on their own. And sometimes we need support, we need that coregulation of another practitioner that specializes in what you're navigating in your relationship with food. And that's really important to name that too that it's not just all about doing this all on your own.
Amy Pershing 28:19
And I think for so many folks too, if you think about for them to have to develop that relationship with food, they probably had to be on their own with things that were going on in their lives. Often part of the trauma that my clients experience was being alone with their inner world, there really wasn't any one to support them, or listen or mirror it back or at least not adequately. So they had to come up with strategies to be able to be safe on their own, which they did and bravo. But often that became necessary because there wasn't enough connection.
Stephanie Mara 28:51
I so appreciate all your wisdom today. And I'm wondering how can individuals keep in touch with you and all the amazing work that you're doing?
Amy Pershing 28:59
Thank you, Stephanie, thank you for the opportunity to talk with you. It's been delightful. My website is the bodywiseprogram.com. So you can go there and that has podcast, other podcasts and, and just information about the program and my book and, and different things. So and it also has if you send an email through that link, and it's you can direct it to me and then it will make its way to me, so I'm happy to answer them.
Stephanie Mara 29:22
Well, I will make sure to put all of those links in the notes, the show notes. And thank you so much again for just being here and sharing your, you know, years of experience in this field. I really resonate with everything that you said today.
Amy Pershing 29:37
Thank you so much.
Stephanie Mara 29:38
Yeah, and to those that are listening as always, if you have any questions, reach out anytime, and I look forward to connecting with you all next week. Bye!
Keep in touch with Amy here:
Website: https://www.thebodywiseprogram.com/
Book: Binge Eating Disorder