133. EATING DISORDERS: Signs, Symptoms, Social Media, & Support Systems feat. Dr. Sam DeCaro

Feb 2

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Today's guest is Dr. Sam DeCaro— a licensed psychologist who provides individual, family, and couples therapy. Dr. DeCaro also served as an Assistant Clinical Director at the Renfrew Center for Eating Disorders and currently shares her eating disorder expertise as a writer and speaker. In this episode, we discuss common risk factors for eating disorders, signs that someone may be developing an eating disorder, ways that parents and loved ones can support someone with an eating disorder, how social media can affect body image and contribute to eating disorders, common eating disorder myths, and eating disorder resources that people can turn to for help.

Mentioned In The Episode…

+ The Renfrew Center

+ 1-800-RENFREW

+ Renfrew Center TikTok

+ National Eating Disorders Association (NEDA)

+ NEDA Parent Toolkit

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About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: [00:00:00] Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

Dr. Decaro: . oftentimes families are really scared that, you know, is my kid gonna get better? How long is it gonna take? And I'm here to say I've seen it with my own eyes. I've been doing this work for over a decade. People do recover. . I've worked with folks who have been in recovery for 10, 20 years, [00:01:00] and some of them say to me, I never even think about my eating disorder anymore. It's just not part of my life. Yeah. Which is amazing, and I think it gives people so much hope because you can get to that place when that eating disorder is so strong, it's hard to envision it being any.

hello. Hello and welcome back to She Persisted. Today's episode has been highly requested. I've gotten so many reviews and messages requesting that I dive into eating disorders and disordered eating on. She persisted, and so today we have an expert to give all for insight and experience on the matter, and I'm very excited.

Dr. Sam Karro is the director of Clinical outreach and education for the Renfru Center, which is an eating disorder treatment center. So she has so much experience working hands-on with patients as well as working within the eating disorder treatment industry. She offers so much insight and information On everything. Eating disorder treatment, struggling with an eating disorder, how parental relationships can impact an eating disorder or disordered eating. We talk about common [00:02:00] myths about treatment and things to know if you are struggling with an eating disorder or if you're a parent of a teen who is struggling.

So, so many amazing pieces of wisdom and insight in this episode. I really wanted to have the best of the best come on and give their perspective rather than speaking without experience on this one. And so I'm super excited to share this episode as a resource and I hope you find it helpful.

As always, I feel like with she persisted, we kind of have an implied trigger warning. The topics are always included in the show notes and in the episode title, but obviously this episode does touch on disordered eating and eating disorder, so if that is triggering for you, skip this episode. Listen next week.

But thank you for tuning into She Persisted. As always, if you enjoy this episode, share with a friend or family member follow on social media at She Persisted podcast and let's dive into it.

Sadie: Thank you so much for joining me today on She Resistive. I'm so excited to have you on the

Dr. Decaro: show. I'm thrilled to be here. Thank you so much for inviting

Sadie: me. Of course. So I'd love to start with your [00:03:00] background. What brought you to working in the mental health field, specializing in eating disorders and,

Dr. Decaro: yeah, sure.

So I. I have always been fascinated with psychology and human behavior ever since I was little. And so it was just a subject that had always interested me. And when I went on to grad school and to get my master's and my doctorate, I ended up doing internships with substance use. I also did internships working with children who had experienced trauma.

And when it came time for me to choose a post-doctoral residency, I found this residency at Renfru and I knew that they worked with eating disorders. And what's interesting is that most grad schools don't teach much about eating disorders. And it's very, it's very rare to even find an internship that has eating disorders.

But what was interesting [00:04:00] was that I knew disorders frequently. Don't travel alone. It's never just an eating disorder. And eating disorders often co-occur with trauma substance use. And so I was coming with this experience of, you know, with that background and I thought I could. Really contribute something to the eating disorder field.

And then when I joined Renfru and I started working with eating disorders, I just realized it was just such a great fit for me. And it incorporated everything that I had been learning about and working on, and I really fell in love with the work because of how transformative it can truly be for someone who's in recovery.

to see, especially at the residential level of care. You know, oftentimes it's maybe 30 days. And just to see the difference emotionally in someone who goes through treatment, it's remarkable. It's like their whole personality comes back and [00:05:00] they have this renewed sense of who they are and, and what they wanna do in life.

And so it's just, it's really a beautiful thing to see. And I've stayed working in eating disorders ever since.

Sadie: I love it. It's, it's so inspiring to hear you talk about that shift and having seen so many people go through that. I'm sure that brings so much hope for both teens that are struggling and parents that also have a team that's struggling and, and are navigating that as we speak.

Dr. Decaro: Right, exactly. I think oftentimes families are really scared that, you know, is my kid gonna get better? How long is it gonna take? And I'm here to say I've seen it with my own eyes. I've been doing this work for over a decade. People do recover. . I've worked with folks who have been in recovery for 10, 20 years, and some of them say to me, you know what?

I never even think about my eating disorder anymore. It's just not part of my life. Yeah. Which is amazing, and I think it gives people so much hope because it's hard to even [00:06:00] imagine that. Mm-hmm. , you can get to that place when that eating disorder is so strong, it's hard to envision it being any.

Sadie: I'd love to hear your thoughts on the causes of eating disorders.

It's obviously something where there can be many contributing factors. But I think one of the hot topics in the mental health field right now is really the impact of social media on body image and the development of eating disorders. And we're seeing so much editing of content, we're seeing unrealistic expectations to live up to.

And you also specialize in parental body image and how that impacts the development of eating disorders in teens. So I'd love to kind of hear your thoughts of what you think. Some risk factors, some causal factors are for eating disorders that listeners can be aware of and keep an eye out for in their own

Dr. Decaro: lives.

Sure. So I get this question a lot. What caused my eating disorder? Everyone wants to get to the root of it.

Sadie: Yeah. Because then they're like, oh, okay, then I can solve that. And it's right. Sometimes it's more [00:07:00] complicated.

Dr. Decaro: Exactly. Exactly. So, There is no one cause, and I educate a lot of families on this and clients that actually eating disorders are very complex psychiatric disorders.

And there are many factors that can come together and sort of create the perfect storm for an eating disorder to develop. And then there's other factors that maintain it. So those factors could be, you know, when we talk about the etiology, the cause of eating disorder, Genetics, biology, psychological factors, culture neurobiology, like, there's so many different factors, and what happens is usually there's something in the environment that triggers it on, and that could be something extreme as a trauma.

Or it can be something as innocuous as a transition going to high school, going to college, just a big [00:08:00] change, A big transition in life sometimes can be enough to trigger it on. For many folks, even the simple act of trying a diet can trigger on an eating disorder. NITA has estimated that 20 to 25% of folks who diet will actually go on to develop a clinical eating disorder.

It's crazy. Yeah, so, and especially because dieting is just so normalized in this culture, but there's so many factors that go into eating disorders and what maintains them. And I think many times parents are very worried that they've done something to cause it. And one of the first things I teach families, parents can't cause an eating disorder.

There are just too many factors at play. However, parents, caregivers partners can be very powerful supports in the recovery process. So I wanna empower support people [00:09:00] to step in and help and maybe do things differently and support their loved one differently because it can be so powerful. In the treatment process, you know, we don't heal in isolation, we heal in connection, and yes, it's the connection with your treatment team.

Yes. It's the connection with the community, but also the connection with your support people. Yeah. And half the work is teaching families. How to support their loved one differently because the families, I think, are doing the best they can. They're just kind of using their instincts around what they think their kid needs, and oftentimes there's major shifts that need to happen in the way that they're approaching this eating disorder.

So that's, that's a lot of the work that we do. What

Sadie: are some of those shifts or, or ways. Families, friends, loved ones, can support a team that is struggling with an eating disorder. Whether it's relationship dynamics or shifts that you can [00:10:00] make in a household ways you could support a friend. Kind of that entire spectrum of how do you support someone, because it can be a really isolating experience to be struggling with an eating disorder, like you mentioned healing.

in the context of a community is so crucial, and yet I feel like there's a real disconnect in the general population between, okay, we wanna support, but how do you support, I'm thinking of all of these quintessential TV shows or movies where they bring them to a restaurant, they eat a normal meal, and then you're like, oh, okay, it's better, it's healed.

We move on with our lives. Right? And it's like, that's not how it works. So what is your advice there for supporting someone struggling? ,

Dr. Decaro: such a great question. I think oftentimes support people are like, just tell me what to do. Yeah, I'll do anything. And, okay, so let me just start by saying one of the most powerful things you can do, especially if you're a parent or a caregiver, and this is easier said than done, is to address your own relationship with food and your own [00:11:00] relationship with your body.

You know, if, if you're not in therapy and you don't have your own support around that, that I often recommend that family members go get their own therapist. That's one of the first things, get your own support. because the reality is if you have a poor relationship with food, a poor relationship with your body, those things are going to surface in your relationship with your.

Or your partner? It could be. It doesn't have to be, you know, this happens in a lot of different relationships. But for example, what are you talking about around your kid? Are you talking negatively about your own body? Are you talking negatively about the bodies of others? You know, what are you eating or not eating in front of your kid?

How are you talking about food? All of these things can potentially be internalized by your. , you're teaching your kid how to treat their own body. You're teaching your kid how to relate to [00:12:00] food and it, in some cases, maybe you're directly doing that, but kids can pick up on non-verbal cues. They can pick up on very subtle ways that you might be reacting to.

Someone on TV or a meal that someone's eating. And kids and teens are very perceptive and we often in, in psychology, we call this internalization, we internalize what our parents are saying and doing and it eventually becomes a voice in our own head that feels like it belongs to us. , it's like an inner critic.

Mm-hmm. . And in therapy, it's interesting because when my clients have a really strong inner critic, sometimes we just have to take a pause and say, who does that sound like? Does that voice remind you of anyone? [00:13:00] Because oftentimes we're actually internalizing the voice of some attachment figure in our.

it feels like it's a thought in our head or a belief system that we have, and therapy is oftentimes unlearning those beliefs and those thoughts. So parents, the first thing that you can do is. , examine your own relationship with your body with food, and strive to have a healthier relationship with it.

So that's one piece of it, but I think another piece. And this is another thing that we, we teach in eating disorder treatment is how to validate emotions because eating disorders are emotional disorders. And one of the big misconceptions about eating disorders is that it's about food and weight, and that's it.

It's like once this person nourishes themselves and learns how to eat again, and the issues are resolved, that somehow they're cured. And I [00:14:00] have to really manage expectations with many families. And I explain that actually. You know, if someone's in residential care, when they discharge from residential care, that's just the start.

And recovery will go on for quite some time. and your loved one will decide when they want to say they're recovered or if they want to continue to say that they're in recovery. But treatment is not a place where someone goes to get fixed because they're not broken. Yeah. And yeah, so I have to teach families that eating disorders are emotional.

Oftentimes the behaviors, whether it's binging, purging, restricting, are attempts to avoid manage dampen emotional experiences. One of the really powerful things families can do is to validate emotions and learn how to do it. It's a skill. Yeah. And so that's a big piece of, [00:15:00] of, of the work is being able for the whole family to tolerate emotions and be able to express them in a healthy way.

Sadie: This is why I love D B T because they make the parents learn the skills also. Yes. And I gave a talk yesterday to a group of parents that are trying to support your teens that are navigating mental health challenges. And when I was doing my slide deck, I asked my parents, I was like, what is your advice?

What did you wish these parents would hear? And they both said, . Just recovery, whether it's from depression or anxiety or an eating disorder or any of these things works so much better when the parents learn the skills alongside the kid. Yes. When you're both being so much more effective at tolerating distress and being interpersonally effective and navigating crisis and regulating your emotions, you have almost.

A double chance of, of success because you have both people being way more effective and not only navigating their own distress, but supporting each other. And it's just an [00:16:00] amazing thing to see how the whole relationship and family dynamics change when both parties are doing

Dr. Decaro: the work. Absolutely.

Absolutely. I, I couldn't agree more. Including family members and supports is crucial in the work that we do with eating disorders at Renfru. You know, I think sometimes teenagers are hesitant to involve their family members and they might say, oh, they're, they're never gonna get it. I don't want them involved.

I can do this on my own. And I really try to take time to. teenagers understand that first of all, I get it that you're kind of losing hope that your parents can. Understand this stuff and actually use

Sadie: it. And especially if there's that blame piece there where we talked about how parents can impact that and that critical voice, if that's added to the picture, like I know when I started treatment I was like, I do not want my parents involved at all.

I you not want them involved in any therapy [00:17:00] session. I had such an aversion to being vulnerable with them at all. Like it's just such a mess. And it feels counterintuitive to involve them in the

Dr. Decaro: process. Right, exactly. And and I, I should say that there are some, where you know, we, we should not actually involve the parents and there are definitely examples of that. However, I have worked with many parents who really do the work and really make the shifts they need to make and they really end up being amazing support. Yeah, so they're kids and, and that's really a beautiful thing to see. I really try not to give up on parents and oftentimes what we see is that the parent is really just playing out maybe what they were taught when they were a teenager, you know, the way maybe their, their family treated them and the relationships their families had with food and their own bodies.

you know, a lot of the work is about breaking [00:18:00] patterns, breaking intergenerational patterns. and being the first in the family to do things differently. Like maybe this is gonna be the first generation that just doesn't diet. Yeah. You know, and, and that can be kind of mind blowing to people. It's like, well, my family always dieted and we've always been chasing a smaller body.

And it's like, yeah, but you don't have to do that anymore. Mm-hmm. , you can break the cycle right here, right now and, and see what life is like when you actually have a healthy relationship with.

Sadie: I've love that. Are there factors? We talked about what can cause eating disorders. We talked about those different roles that relationships and genetics and all of these different things can play.

You mentioned maintenance factors. What are the different things that maintain an eating disorder after you have initially developed this dynamic that makes it so difficult to recover from? I mean, one of the biggest statistics that float around that most people are aware of is that eating disorders are the deadliest mental illness.

Like it's very, very serious. And I [00:19:00] think a huge piece of that is the maintenance. So what are some things that are added to that equation? .

Dr. Decaro: Yeah. So I'm so glad you brought that up, because eating are dangerous. They're very serious. They're, they're the second deadliest in the DSM five second only to opioid use disorder.

Okay. So we do have to take them seriously. Mm-hmm. and we, ideally we wanna treat them quickly and aggressively so that, I mean, that's really the situation. . Accessibility to care is a whole other episode. Oh, . Yeah. Mm-hmm. . But ideally if you do have access to care and you're fortunate enough, we do try to treat it early, but there are a lot of factors that can maintain an eating disorder. I mean, I'm glad you brought up social media before because social media there, you know, the research that I've come across, there are connections between social media use, disordered eating, poor body image anxiety, and it seems [00:20:00] like all the research is pointing to you that the more you use social media, the harder it is to get a handle on all of that stuff.

it's interesting because some research that I found, there's certain behaviors on social media that seem to also impact anxiety and body image and disordered eating, like for instance, editing and posting a photo of yourself. What they found was in certain studies that subject experienced.

increased issues with their body and increased anxiety when they did that. I think also comparing yourself on social media, you know, folks who are already kind of prone to comparing themselves. Social media is a really hard place to be if you're someone who is just sort of wired to compare yourself.

know, One of the things that I talk about in my trainings and in eating disorder treatment is how important social media literacy is and media literacy in general, because we have to be first aware of what we're [00:21:00] doing. We need to take a pause and make more informed choices around who we're following, what we're liking, what we're actually doing on social media, and create boundaries around it if need.

There's a lot of good stuff on social media too, by the way. I mean, I'm not, I'm, I'm on social media. I'm a mental health creator, a mental health content creator on there, so I don't think it's all bad. But I do think that oftentimes boundaries are needed, and what can be really helpful is to be sure that your feed is diverse and actually looks like the rest of the world, and not just looking like images.

Our thin, white you know, just kind of like falling into this rigid ideal of what society tells us. Mm-hmm. , you know, we should look like. So, part of it, I think is making sure that we are, we are [00:22:00] conscious and mindful of the way that we're behaving on social media, but also that purposefully following creators that are diverse, in body size, race, gender.

We wanna be sure that what we're looking at on social media actually reflects the world around us and not just this. You know, very small section of the population.

Sadie: That's huge. And I think it's something very reasonable, a very good shift to make in your feed. And you, you can be a critical consumer.

I feel like With social media, we're like, oh, it happens to us. But the algorithm is really good at picking up on what you don't want to interact with. Right. And it's really good at increasing images or videos or whatever it is. Giving more attention too, especially TikTok. So if you are increasing engagement with content that boosts your mood and makes you feel good, and again, is reflecting those values you just mentioned, that shift can take place really quickly and the algorithm will just [00:23:00] get better and better and better at making social media a quote unquote happier place

Dr. Decaro: to be in.

Right. Exactly. We can teach the algorithm what to show us. Yes. It might take some time. I've heard some people even create a second account. Mm-hmm. with only. Positive mental health, pro recovery type content and they sort of experiment with, how do I feel on this account the other account.

Mm-hmm. . And what they often find is that they just feel so much better on the other account that they end up just switching over Yeah. To, to the new one. Mm-hmm. . Yeah. So that can kind of be a cool experiment if you're not someone who is ready to maybe change

Sadie: your current, we can follow everyone, you know,

Right. Exactly.

Dr. Decaro: But maybe it's a big experiment with like creating. Whole new account just to see, just Yeah. It's an experiment. Just to see what happens and, and what it's like. Yeah. To be on a different side of TikTok. .

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Sadie: So you mentioned a couple of different phrases throughout the episode, whether it was dieting, which can lead to eating disorders.

We talked about disordered eating and then having an eating disorder. I would love to hear your thoughts on that spectrum and when you kind of cross over into these different areas. And so listeners, if they're listening, they're like, I don't feel like I have a great relationship with my body. , I don't really know where I lie on that spectrum, but how can people be aware of when the idea of dieting becomes unhealthy or the disordered eating becomes more serious and when to ask for help, look for support and, and know that something's not normal.

Because like we [00:25:00] just talked about, if your environment, whether it's online or in real life, is. So skewed. It can be really difficult to be in touch with like, is this normal? Is this okay? Or is this something that could be improved or better? Do I not have to live my life this way? And so I think it's helpful to kind of get some clarity there on these different components of of the eating disorder

Dr. Decaro: spectrum.

Yes. Thank you for saying it's a spectrum. I think you're the first person that you know that I've gone on a podcast with that acknowledges that. Yes, it's, it really is on spectrum. Yeah. And I think there are so many people who dabble in disordered eating, and it may or may not be causing them many issues medically, socially, cognitively.

However, you don't have to have a full-blown clinical. eating disorder to have problems with food and with your body. Mm-hmm. . So I just wanna be clear that you don't have to fit neatly in a category in order to get help and get support. You know, there's lots of [00:26:00] therapists and dieticians who are very skilled with, with just working with disordered eating and just helping people have a better relationship with food.

Yeah. In their bodies. So, but I think There definitely are some signs that things are getting more in the, the realm of an eating disorder. So if you are noticing that you're having obsessive thoughts, intrusive thoughts about food, if you notice, it's like all you wanna talk about. Oftentimes with eating disorders, it's like they're so consuming that your world gets so small and your whole world becomes.

what you weigh, what you're going to eat, when you can get to the and everything else just sort of fades away. And I think for some folks that's part of what is maintaining the eating disorder because there's things they just don't wanna think about. Yeah. . And so the eating disorder can be comforting in that way, but what happens is you end up shutting everything [00:27:00] out, not just the things you're trying to avoid.

So if you notice that you're feeling so anxious, so guilty, you're likely depressed because. with eating disorders. Oftentimes malnourishment is part of the territory, and a malnourished brain is often a depressed brain. So if you're experiencing all kinds of mood issues, if you are feeling so anxious, not only during a meal, but before a meal, after a meal, so much so that maybe you're not even going to restaurants anymore with your friends.

Maybe you can't go to an event unless you know exactly what food is gonna be there. , these are all signs that maybe things are spiraling more in the direction of eating, disorder with exercise, for instance, exercise we see across many different eating disorders. But if you're someone who feels so guilty, if you miss a day at [00:28:00] the gym or you're someone who's willing to work out, even if you're injured or sick, because it's just, you feel like you can't handle the anxiety if you miss.

Yeah, that's the red flag. That's a red flag. so. with eating disorders., when we talk about eating disorders, we're talking about certain symptoms. We're talking about restricting, we're talking about binging. We're talking about purging. And purging can take many forms. So I think the public often thinks of self-induced vomiting, right?

Mm-hmm. as purging. But purging can be overexercise. Purging can be laxatives. So if you're finding yourself using these behaviors to cope, and you're feeling like you can't stop. That is probably time to go and reach out and get an assessment and talk to someone because there is hope for this. . Yeah. And sometimes you just need some structure and support to break the cycle.

And treatment programs can offer [00:29:00] that. Sometimes you might just go to a therapist and a dietician and they, they can help you get on track. But it's not uncommon for someone to really need that kind of support structure and supervision to break the cycle because these are really challenging.

Disorders to treat. And so anyone out there who's struggling and you're beating yourself up because you feel like you can't do it by yourself, guess what? Well, first of all, you don't have to do it by yourself. Yeah. But it is extremely difficult to try to break these cycles on your own. We, we really heal together, and I, and I believe with eating disorders, you heal best in a community of other folks who are going through the same thing, whether it's a support group or a treatment program.

you know, it's so therapeutic to talk openly about this stuff and break down the shame and talk to each other and heal. And in a community setting,

Sadie: what are those resources that you recommend people start with? Is it [00:30:00] going to their pediatrician and getting that referral for a therapist and a dietician?

Are there certain books that you recommend treatment programs, et cetera? Where do you direct people to when they're like, I think I want support, I want help, but I don't know where to. .

Dr. Decaro: Sure. So the National Eating Disorders Association has a great website with all kinds of resources. Any parents out there, they have the Nita Parent toolkit, which is this really comprehensive document of all kinds of information about eating disorders and what to do and just to , help parents better understand what they are.

But also our. Redford center.com. We, we provide free blogs for people. We have free webinars, of good info on there and quizzes you can take to figure out. where you stand with your own relationship with food and your body. So those can be a good place to start. Definitely your doctor.

Going to your doctor and being brave [00:31:00] and being honest about what's actually going on. Mm-hmm. And to ask specifically to be screened for an eating disorder and doctors should know how to do that and insist on. You know, and, and that way your doctor can give you a screening and then if the screening comes up that you're at risk, they can hopefully refer you out for.

more specialized services. It's really important for folks who are struggling with an eating disorder to at the very least have an interdisciplinary team. Mm-hmm. and cuz I think the misconception is that, oh, I'll just go to a therapist, but actually eating disorders are treated by not only a therapist, but a doctor.

A dietician and sometimes a psychiatrist, because eating disorders affect the body. Yeah. So it's, it's a brain and body disorder, so we do need a team to treat. And then there's the nutritional piece, which is, you know, figuring out how to eat [00:32:00] differently and almost like relearning how to eat again. Mm-hmm.

Yeah, because. Eating disorders are disorders of disconnection, and folks become very disconnected from food. Mm-hmm. . And so there's a relearning that happens. So a treatment team is really the best approach. And to find a team that specializes in eating disorders, because there are many providers who are trained in this.

Yeah. And can sometimes do more harm than, Especially any providers who are recommending weight loss or recommending dieting, which can actually exacerbate Yeah. Eating disorder symptoms. Mm-hmm. . So to really, if you're fortunate enough to have access to care to look for, for an eating disorder specialist.

The

Sadie: last thing I wanna ask you about is treatment myths and kind of debunking eating disorder treatment because for whatever reason, I feel like there are [00:33:00] so many different, movies and TV shows and stories that very heavily portray eating disorders and glamorize them and it's, it's very inaccurate, especially eating disorder treatment.

So if you could debunk some common myths that you hear. Fears that you hear people coming into treatment with where you're like, that is so not accurate. I don't know where you got that from, but I promise it's not like that. For people that are having that anxiety about getting support from what they've seen on social media and in TV shows and movies and et cetera, what are some of those myths that you could debunk?

Dr. Decaro: Oh, well, I'm wondering, Sadie, what myths come to mind for you? What? What do you hear?

Sadie: Well, I mean, I feel like I have a slightly atypical view, because a lot of the girls that I was in treatment with, either an inpatient or residential, also struggled with eating disorders. So I feel like I had more of an actual view of what it's like.

But I would say, , all you drink is ensure is one thing I would say. , assuming that going into treatment means you would get a feeding tube, which is definitely not always the case. I remember [00:34:00] having at different points when I was exploring in my journey, like, is this something we're gonna focus on?

Having a fear that like, , if I didn't comply with the recommended diet or eating schedule, like, it's like very all or nothing. you either stick to this protocol or there's a loss of privileges and relationships.

It's very all or nothing. Right. . What else? Just so overly emotional and a lack of consent, like I think this is a big thing in, in the teen world is that a lot of the times you're not making the decision to go to treatment because your parents have a lot more of a say over your, your medical treatment, whether it's getting surgery on a broken leg, but also mental health care.

So a lot of teens that aren't ready for treat. . So I think having that piece of going into eating disorder treatment, but at the beginning, not wanting to take that step. And then I think there's just so much glamorization of different eating disorder behaviors, whether it's purging into a box or all of these things that you see in shows where you're like, [00:35:00] What is happening here.

But those are the ones that come to mind.

Dr. Decaro: Yeah. So this is such a great question. So let's start with the ensures. So for folks out there who are listening, ensures are essentially supplements mm-hmm. That come in different flavors that, that folks can have in eating disorder treatment. First. I want anyone out there listening to know that treatment should not be about forcing people to do anything.

when we're coming up with a treatment plan and goals, this really should be a collaborative process. and the goals actually are supposed to be in what we call client language, so mm-hmm. actually the goals are literally quotes that the client says something they want to work on.

Yeah. And so I want everyone to know that , yes, you have a treatment team, but you're part of that team and you're part of creating your treatment plan. So and actually every week or every month, depending on what level of care you're in, you're [00:36:00] actually signing off on that treatment plan and agreeing that these are the goals that you wanna work on.

Mm-hmm. . So a really skilled provider, whether it's a therapist or a dietician, is going to go at a pace that feels doable to you. Creating goals and facing gradually. So now unless you're in imminent danger, and someone has to intervene because your safety is totally on the line at that point, then there might be a conversation about what to do about that.

Mm-hmm. , that's a conversation actually that happens in the very beginning of treatment, and it's part of the consent process. It's like, you know, if you need to go to a hospital, maybe to get, you know IV fluids or something like, Because you are in imminent danger, would, would that be okay with you?

And so there really is a lot [00:37:00] of consent that happens before and during treatment. So no one should be forcing you to do anything because forcing someone to eat is not going to help someone with an eating disorder. Yeah. Supplements are an option for some folks who maybe aren't ready to face some certain fear foods, but they still need nutrition.

Mm-hmm. to heal, that can be an option that they can choose. To try mm-hmm. that they can also decline as well. So I think that's, that's one of the most important things, that it's a collaborative process and consent is a big part of it. You brought up a feeding tube.

So I think, yeah. I have heard parents say, you're not gonna put a feeding tube in, are you again, consent? Yes. And yeah, and, and a feeding tube. You know, sort of a last resort. Mm-hmm. for someone who is really, really struggling with getting the nutrition they need and a feeding tube can sometimes be [00:38:00] a helpful tool to help someone get some nourished.

And maybe even face those fears in a more gradual way. And we will not place a feeding tube, or a provider should not place a feeding tube unless all parties involved are on board with it and fully consent to it. So the folks I've worked with who have needed a feeding tube through the years they did want.

And found it So any intervention in eating disorder treatment, ideally. , we want the client to consent to it and understand why this tool, why this intervention is going to be helpful, and then mm-hmm. , it's something that they're on board with. , so yeah, I, I think that , hopefully when you are in any kind of treatment, whether it's for eating disorders or another mental health issue, that you do feel like your therapist and your treatment team are working with you and working at a pace that feels comfortable [00:39:00] to you, and it's really about gradually building up confidence.

and gradually facing fears so that you're at the point where you're ready for that next challenge.

Sadie: Mm-hmm. , a hundred percent. And I think what you, you brought up with these different interventions being helpful for the client or the client agreeing, because it, it feels easier, the right step to take.

I think that it's very true. And Put it in context, if you chose an intervention of a feeding tube, would be like facing those fear foods or the anxiety that comes with mealtimes, like once a day rather than three times a day. And so, it makes sense why these are different things that are worked into treatment protocols and yeah, I I definitely love what you shared then.

I think, and it's very helpful to keep in mind if you're navigating the treatment world,

Dr. Decaro: right? And I, I often remind clients that if you are not agreeing with the treatment plan, you know it's okay if you decide to go to a [00:40:00] different treatment provider or a different therapist or a different dietician, and I think.

It's important for folks to understand that there's more than one road to recovery. Yeah. And certain treatment models and certain programs just might not be a good fit, and that's okay. And I think what's important is that you find a treatment model and a team that feels like it's a good fit for. and it's aligned with what you wanna accomplish.

So there are many, many roads to recovery. You know, you talked about D V T. There are so many different modalities and I think it is important to learn about a little bit about each one so that you can decide which one you'd like to try and then find a provider that specializes. .

Sadie: I love that. And I think that is very, again, a very reasonable and realistic thing to explore in your journey.

And you mentioned resources to get information on those. [00:41:00] If people wanna continue to consume your content and follow along or work with you, where can they find your information?

Dr. Decaro: Yeah, so renford center.com is a great place to start and a really easy number to remember is one 800 renfru, which.

Take you right to our program Information I'm the director of Clinical outreach and education at renfru, so I put out a lot of free mental health content and I do free support groups. You can find me on TikTok, I run through's, TikTok page, I write blogs, and I also do free webinars. So if anyone's interested, all you have to do is go on the website and.

Sadie: Amazing. Well, all of those will be linked in the show notes and everyone that is doing their new social media account should definitely follow you so they can add that to their feed and create a positive little digital environment. So I love that. That

Dr. Decaro: would be great. I would love to see some new folks on

Sadie: there.

Even if it looks like fake accounts with minimal following no profile picture. [00:42:00] She'll know that we sent you .

Dr. Decaro: All are

Sadie: welcome. Yes. I love it. Well, thank you so much for joining me. I'm so glad we got to do this, and I know this is gonna help so many people. Well, thanks

Dr. Decaro: so much for having me. It was wonderful to talk about this with you.

Sadie: Thank you so much for listening to this week's episode of she persisted. If you enjoyed, make sure to share with a friend or family member, it really helps out the podcast. And if you haven't already leave a review on apple podcasts or Spotify, you can also make sure to follow along at actually persisted podcast on both Instagram and Tik TOK, and check out all the bonus resources, content and information on my website.

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