Binge Eating and the Body as a Site of Survival
In this conversation, I speak with Carla Bredin, psychotherapist and Registered Nutritionist, about ‘Binge Eating Disorder: The Journey to Recovery and Beyond’ by Amy Pershing and Chevese Turner. The book offers a compassionate, holistic lens on binge eating – challenging the traditional focus on weight loss and encouraging a deeper understanding of how cultural messages about bodies, dieting, and worth can distort our relationship with food and self.
Carla and I discuss eating disorders as coping mechanisms, food as a source of safety and rebellion and the impact of being told that the home that we have in our bodies is “wrong”. We also speak about the importance of working with the person and not just the diagnosis.
Jen: Okay, Carla, I’m excited! Let's start with setting the scene. Can you tell me about the book that you want to speak about today? How did it come to you? What drew you to it?
Carla: So, I am a Registered Nutritionist originally and I bought this book as part of my own interest in upskilling and training in eating disorders. My own specialism in nutrition was quite different from eating disorders, so I had done a few trainings in that area. This author, Amy Pershing, had come up a couple of times. So, I bought the book and actually, it is one of the reasons I decided to become a psychotherapist. This book was really transformative for my practice for a number of different reasons, positive and negative.
Jen: Okay, tell me more?
Carla: Well, I think a positive reason was the level of information in the book about working with clients with eating disorders and binge eating specifically - how comprehensive it is for clinicians. It has loads of personal stories in it as well, so I think for people who experience binge eating and want to understand it better, it's really informative for that. That was one of the big positive impacts that the book had on me.
One of the big negative impacts was how ill-prepared I felt as a nutrition professional, when the bulk of the work is more as a mental health professional. That was the big turning point for me in deciding to go back and retrain as a psychotherapist. One of the big messages in the book is about people who come seeking behaviour change, when what they actually need for recovery is deep, complex therapeutic work. It’s about understanding the “why”, accepting the “how” and then kind of figuring out the “what” of coming through it. I got the book when it was released in 2019, or maybe early 2020. Eight months later I enrolled in my course to become a psychotherapist.
Jen: Wow, that's a really significant impact – this book directly led you to the decision to go back to college and retrain?
Carla: Yeah, I think because when you work in this field your whole purpose for doing the work is to be of service to people who need support. You think you're trained in the right modality, but sometimes it turns out you're actually not. That's a really eye-opening experience. I qualified as a nutritionist in the early to mid 2010s – and I did think my job was to support people with behaviour change – just to be like, “oh, you're doing this, would you think about doing that?” Then I’d constantly have people come back saying “I couldn't do it, I'm sorry”, with a lot of very emotionally charged reasons why. I didn't have the capacity to sit with that.
Jen: So, people come in, understandably, thinking this is about food and behaviour change, but actually there's more complexity to that. Of course, in some ways it is about food, but in other ways it's not about food at all.
Carla: Right. Food is the vehicle for something that's much deeper, but a lot of people don't want to think about the deeper stuff. They're just like, “I'm doing this, can you help me fix it?” It sucks so bad when you can't do that.
Jen: It sounds incredibly frustrating – for you and for the clients. Could you say a bit more about how this book changed your perspective or supported you to sit with that more emotional work?
Carla: So, I trained as a nutritionist for metabolic disorders. I was focusing on fatty liver disease, diabetes, high cholesterol, high blood pressure, that kind of thing. But often that came along with some form of disordered eating. Once I got into working or looking at disordered eating from a professional point of view, it really does open up a can of worms if you're not ready or looking for it. A big personal impact that this book had on me was noticing that in both fields, nutrition and dietetics as well as counselling and psychotherapy, eating disorders and disordered eating are spoken about in very delicate terms. They're specialist areas. We’re told: ‘don't mess around with them. Ensure that you are as knowledgeable and as skilled as you can be if you're going take on clients with disordered eating’. What I find professionally, time and time again, is that in the nutrition and dietetics field, many practitioners are saying you need mental health support. In counselling and psychotherapy, many practitioners are saying you need nutrition and dietetic support. So most people are falling between two stools and they never get the help that they need.
Jen: I'm struck by how compounding that might be in reinforcing people’s sense that there's something terribly wrong with them. If you're seeking help, whether that's from a nutritionist or a psychotherapist, and you're being told that this is so complex, so complicated, that I can't really help you – you need to go to this other field for support – what must that dynamic between the professions be like for clients coming into it? It sounds like a mutual handing off of responsibility or care. That messaging must impact the beliefs that clients are already carrying about themselves.
Carla: Right - and at the same I think the reason it exists is because there is a truth to that. It's not incorrect to say that this work is hugely complex. In Ireland, eating disorders fall under the terrain of higher level of care, so usually hospital-based care, specialist dietetic support and then psychiatric support. So, it's like there is this tier of professionals that are ‘allowed’ to work with this and everybody else is scared about it. There is a reason for that. But the biggest downside is that I'm constantly coming across clients that feel like a hot potato. They just get kicked back and forth. Nobody feels confident to work with the person with that diagnosis. I think that's the biggest impact this book had on me. It normalises and destigmatizes the purpose of eating disorders as coping mechanisms and puts a lot of power back in the hands of people who have eating disorders. I think since reading this book, I absolutely respect the limitations of my expertise, but I'm no longer like, oh, my God, I’m not the specialist! Instead, I'm like: this is a person. The thing that they're struggling with happens to be this. If their GP wants to refer them, I'll talk about that pathway to a higher level of care. In the meantime, yes, I'll work with the person.
Jen: Absolutely. We have to work with the person in front of us. I'm wondering whether we could say a little more about this concept of eating disorders as coping mechanisms? Although we're specifically talking here about Binge Eating Disorder, a lot of these concepts apply to eating disorders more generally and beyond, to human behaviours in general. I'm thinking about the sense in which all behaviours, even ones we might describe as maladaptive or unhelpful, can be adaptive or serve some function for a person. Otherwise, we wouldn't do it. There's something there that's working for us, some role that this is playing in our lives. I'm wondering if you could maybe say a little bit more about that?
Carla: Yes, so, something as serious and complex as an eating disorder being described as a positive tool for a person can be quite jarring to hear, but there is truth to it, especially when it comes to food. Food is often the most readily available support that we have. Food comes with a long history within families for soothing, for community, for celebration. So, people can take this readily available resource and use it in a way that can be helpful for dissociation, for a feeling of control or a feeling of rebellion. Those are all pretty good coping mechanisms for dealing with pain and fear and guilt and shame and trauma. The concepts in this book really do apply to so many more things - like how can you take something that's available to you and use it to the extreme to protect yourself from very big feelings or very challenging experiences?
Jen: This reminds me of a quote from the beginning of the book, which says that “recovery is the work of moving from safety based on conforming and disconnection to safety based on turning towards ourselves”. What we’re speaking to here are the various ways that people meet their needs. We’re very good at finding all kinds of creative, unconscious ways to get our needs met. The challenge is, when we’re not aware that that’s what we’re doing, we have less opportunity for conscious choice and sometimes end up relying on automatic behaviours which might be disconnecting us from ourselves. If we can bring that awareness and identify our needs, it puts us in a better position to turn towards our experiences with care and make intentional choices about how to respond. It’s a very complex thing to do but also very helpful.
Carla: Right, which is not to say that turning to food is a bad thing, that you shouldn't be doing it, or there's better ways to deal than this – which would reinforce the idea that you’re not good enough, or feeling like you need to rebel. We’re talking about it in terms of how is it serving you? How can we look at your needs in a much more varied way so it doesn't have to just be related to food, it can be a bunch of other things as well.
Jen: Right, there's such a difference in the mentality of approach in that. It's not about demonising food as a way to meet our needs, it's about recognising what the underlying needs actually are so that you open up a wider range of options for responding – and choose what feels most helpful at a given time.
Carla: Exactly. Is it ok if I ask what reading this book was like for you? I’m curious to know if it was kind of cold jump into this territory as a therapist, not coming from a nutrition background, to consider these things?
Jen: Sure! I mean, in a lot of ways it didn't feel like a cold jump at all. I learned a lot - and at the same time, it all comes back to that shared human experience of trying to find ways to cope with our emotions. As you’ve said, there is a real complexity with eating disorders. It’s important to acknowledge that and engage the appropriate supports. At the same time, we don’t want the reputation that comes with certain diagnoses to end up being othering.
What really struck me about this book is how much eating disorders in general, and binge eating in particular, stem from that shared human experience of finding safety and coping with our feelings through whatever means are available. I suppose the question that comes with that is whether our way of finding emotional safety comes with a cost. Are we seeking safety through restriction, through conformity with social norms? Are we disconnecting from emotion, from ourselves? If that’s the case - how might we go about finding that safety through turning towards ourselves instead?
Carla: I think that sums up the whole process of healing and therapeutic support in this terrain really beautifully. The cost of conforming can be so great and yet the cost of rebellion and rejecting diet culture and beauty culture and all of that, it can be so destabilising in the early days. If you don't seek safety in conforming with the old ways, what do you replace it with? Sure, you turn towards self - but how? I think that is often where additional support can be so impactful. Most people have gone through the coping solo, they don't also have to go through the healing solo. Which is why reaching out to a therapist can be so powerful.
Jen: Absolutely. The work is deeply human, but it's also deeply human to need support - to not want to do that alone. That's why we do what we do.
Carla: And why the diagnosis in some ways doesn't matter. Ultimately what you're doing is working with the human experience in front of you.
Jen: On the topic of human experience, I'd like to go back to the idea of rebellion which you mentioned earlier. This was something that struck me about this book: the socio-political context of food. I'm wondering if you might say more about food as rebellion in our current context?
Carla: Absolutely. This is a lot of the work that I do as a nutritionist. I bring the socio-political lens into the clinic room because one of the risk factors for binge eating, and eating disorders in general is chronic dieting, body hatred, feelings of lack or behaviours like perfectionism. All of those things are normative for the female experience and incredibly prevalent in the LGBTQ+ experience. The same thing applies when we talk about race. When we live in a world where we're taught that the home that we have, our body, is in some way wrong, or in need of discipline, or silencing, or fixing, then the most common thing that we turn to is our control of food.
In the research from the States, binge eating disorder is really high in African American women and in LGBTQ + communities. If you were taught that your home is actually not safe, not acceptable, then you will do whatever it takes to control or change that. When we think about thinness as pursuit of control, binge eating can be a really effective rebellion tool against that. You spend all day restricting, making yourself small, making yourself quiet - and then in the privacy and silence of your own space, you rebel. That rebellion is not super conscious - in fact it is quite compulsive. The way it shows up is often because of a physiological response to restriction, but psychologically there is this huge kind of 180 swing of: You know what? Fuck. This.
Jen: One hundred percent. That context is so important for our understanding of what’s going on around food. I’m reminded of that Naomi Wolf quote: “A culture fixated on thinness is not an obsession about female beauty, but an obsession about female obedience. Dieting is the most potent political sedative in women’s history. A quietly mad population is a tractable one”.
Carla: Yep! I think that’s why I love this book. A lot of other nutrition or dietetic books just talk about making sure you eat a certain number of meals and snacks. All of that is vital information in dealing with eating disorders, but we need to also be looking at feminist ideology, black voices, queer voices - looking at the experience of something bigger than just the behaviour.
Jen: Right, it's looking at all these factors in our lived experience that are being activated or played out through food. When we look at binge-eating through that lens, there's actually so much that makes sense. Being able to tap into those socio-political aspects that play a part in someone's story can really facilitate self-compassion. If we're just looking at this as straightforwardly about food, it's easy to frame these things in terms of a lack of control, weight, willpower, or other judgmental ideas that come out of diet culture. But if we can actually look at the lived experience that this person is responding to and understand the behaviour within the context of that experience, it adds so much richness to the story – as well as a platform for self-compassion, because of course, when we look at it that way, it's all really very reasonable.
Carla: Yeah, Jen, I couldn't put it better myself.
Jen: So, tell me a bit more about how this resource has shaped your work with clients. Are there ways it has influenced how you show up as a therapist?
Carla: Being a pluralistic counsellor or an integrative counsellor, like yourself, we as professionals are building our toolbox on behalf of our clients and then we use what is most effective and appropriate, depending on the person that we see. In this book there are principles of what to work through with eating disorders. The one that I use most consistently is the present moment work, the awareness and acceptance piece. This ties in with my training in Acceptance and Commitment Therapy. You’re taking something that feels huge, and rightly so, and defusing it through present moment work, checking in with how am I feeling in this moment? How is my body reacting to this emotion? Can I sit with this emotion instead of trying to dissociate from it? That takes time. It takes building a relationship between a client and therapist to even go there. It is much longer-term work.
Jen: Right, which is quite different to the work you had been doing before.
Carla: Totally. Before it might have been like, oh yeah, I'll work out a nutrition plan for you, you try and stick to that and you should be grand. You might just have two sessions with someone. This is much deeper work. In supporting that, another principle I use is honouring your history: honouring the ways in which you survived as a child, as a teenager, as a young adult, all those points throughout your life. Looking at how you survived and, particularly with eating disorders, using one's own body as the site of survival has to be honoured, respected and celebrated. Even though it's really challenging, in some terms you could describe it as destructive, yet it is a survival mechanism that means that you still are here.
Jen: That’s such a striking phrase – the body as the site of survival.
Carla: Yeah. So those are the two big pieces that I would use consistently with clients. Honouring the history, all the difficult, challenging, big emotion pieces and taking time to bring them up into the present moment. There’s the present moment work of sitting with big emotions, accepting fear and discomfort and need to dissociate, but working against that impulse a little while longer, to sit a little bit longer in the emotion.
Jen: That connects me to what we said earlier about the plurality of ways that we can meet our needs. Because again, this doesn't mean that in order to heal, or be well, you can never use food to disassociate again. It's just increasing your range of options, being able to consider and respond to your needs with care. We’re asking ourselves, is this what I need in this moment?Sometimes, maybe it is. It is one of the range of options available to you. Which is so different, so far removed from the kind of criticism that we usually see with diet culture.
Carla: Right, what you’re saying speaks to the lack of linear journey through this process. Dissociation and binge eating are available to you. Just because you go back to them doesn't mean that you've taken a step back in your recovery. Maybe those are the best options available to you in the moment. It’s about trying to kind of look at that as non-judgmentally as possible.
Jen: Absolutely. So, obviously, this resource has been incredibly valuable. Without tearing it down, I am curious whether there's anything in these concepts that you feel ambivalent towards, something you've questioned or that you'd like to add a little bit of nuance to?
Carla: I think so. The main author of this book is a therapist and I think that maybe something a little bit more to do with nutrition could work well in there. I understand what the author's doing, because it's the first time that this subject has been taken out of the field of nutrition and talked about fully in mental health terms. I think that now that that has been done and the book is maybe six years old, my feeling would be the next step is to combine those territories. Actually, I believe the author does have a new book out with a Registered Nutritionist looking at binge eating, chronic dieting and body image - so I think that it has now been paired.
Jen: That's great. This makes me think again about the idea of rebellion, which we spoke about earlier. This book was kind of an act of rebellion itself, against dominant narratives around binge eating and weight bias, as well as the diet industry and culture at large. There's huge power in rebellion and it absolutely serves a purpose. At the same time, rebellion is reactive. While we might absolutely support that reaction to this particular context, I can also see what you're saying. As necessary as rebellion might be, now that we’ve made this radical departure from the status quo around food and nutrition, there's a question of reintegration. Can we actually go back and find some value in what we departed from, as well as where we want to go, and find a nuanced way to reintegrate those pieces?
Carla: Yeah, that’s right.
Jen: Before we close out this conversation, is there a particular insight from this book that you'd like to offer to the wider community?
Carla: Well, from a general population point of view, I think the main power in this book is the de-stigmatization of eating disorders, honouring the fact that you have chosen, whether it's conscious or subconscious, a way of coping with your big emotional landscape that is one of the safer coping mechanisms available. Binge Eating Disorder in particular is a hugely underdiagnosed eating disorder. This is still fairly new. If you're looking for validation of what you're experiencing, I think this book really goes a long way to offering that. For clinicians, therapists, nutritionists, or dietitians - I think the idea of not being scared to just meet the person. The diagnosis is not the thing to be scared of. You have all the training you need to meet a person that's in need of support. Just find a way to support them.
Carla Bredin is a Registered Nutritionist and Counsellor Psychotherapist. Her clinic is based in Dublin 2 and online. www.carlabredin.ie
Quoted:
Pershing, A., & Turner, C. (2018). Binge eating disorder: The journey to recovery and beyond. Routledge.
Wolf, N. (2013). The beauty myth: How images of beauty are used against women. Random House.
