A conversation with Christie Dondero Bettwy

Executive Director of Rock Recovery talks about disordered eating, dieting, compulsive exercise and how to get help if you need it

These are some excerpts from the Rosslyn BID's interview with Christie Dondero Bettwy, executive director of Rock Recovery, a Rosslyn nonprofit that helps people with disordered eating.

Rosslynva.org: How does someone with disordered eating view food and exercise? What tend to be the sources of these perceptions?

Christie Dondero Bettwy: There are a variety of different ways that people have a disordered relationship with food and many reasons why that develops to begin with. One phrase that we use a lot comes from a researcher named Dr. Cynthia Bulik who's with UNC Chapel Hill. She says, “Genetics loads the gun and environment pulls the trigger.” Eating disorders are bio-psychosocial illnesses where there is a genetic component, so you’re predisposed to it or you’re not. There are environmental factors . . . what kind of families you’re in, what kinds of sports you play, if you’re bullied by your peers, what sort of body shape you have and if that’s good or bad at the time . . . all the standards at the time and, of course, media and pressure play into that as well.

Then there are things like life instances, too. Trauma can be a huge trigger for disordered eating. People turn to food or away from food as a means of coping or control. Very often we call it a maladaptive coping tool where either you can restrict or binge — and depending on how your brain is wired — that restricting or bingeing lights up your reward cycles in your brain so you feel better and it becomes a pattern. Our bodies are smart and want to take care of themselves. Another big thing that can cause eating disorders is dieting. I can’t tell you how many clients we’ve seen and how many stories we’ve heard about someone saying, “I just wanted to go on a diet and lose ten pounds,” and suddenly what you wanted to control is controlling you and you are no longer able to eat the birthday cake or do this thing because you’re suddenly so afraid of the food. You are so rigid in your mentality that you no longer have the ability to enjoy a broad array of foods in moderation. Another problem with dieting is that restriction can cause cycles of bingeing as well. People think it is their fault that they can't "stick to their diets" but really their bodies are working with them and trying to send the cues that they need more food to survive. 

Rosslynva.org: Any diets that are the worst?

CDB: Really, in my opinion, all diets are harmful, unless you have a genuine medical condition or an allergy. One reason restriction can be harmful is that you can get into these cycles of bingeing or restricting or begin to fixate on foods. So, when you can’t have the cookie, you think about the cookie all day long, whereas when you eat the cookie, it’s just a cookie and it loses its power.

Any diet where you’re not listening to your body and instead listen to external rules or cues is problematic. If you’re not able to eat when you’re hungry, or if you have to cut out certain food groups or types of foods, that’s a red flag.There’s often no real science behind the diet fads and influencers. People say they’re experts but usually they're not registered dietitians or truly trained. 

We’re big believers in intuitive eating, which is a term that came about from Evelyn Tribole and Elyse Resch, who are both registered dietitians. Their book covers 10 principles of how people eat who have a healthy relationship with food. Eat in moderation and have variety and balance. No food is off limits unless there’s an allergy or a good reason but because of that you’re able to eat things in moderation. You need variety and balance. When I had my eating disorder I didn’t ever want salads because I thought of them as boring or punishment but now I eat a salad every day because my body wants it and now I have a dessert almost every day because I enjoy it and it’s fine.

We shouldn’t think of food as something to be earned with our exercise or "good" behavior. Why does it have to be compensatory? If you want a scone, eat a scone, because food’s meant to be enjoyed. It’s about community. People go on diets and want to lose a few pounds and suddenly what you went on to get control is controlling you. You get so rigid in your mentality. You have no ability to enjoy foods.

Rosslynva.org: When I think of disordered eating I think of anorexia or bulimia, but your site also mentions emotional eating, compulsive eating and exercise addiction. I am very interested in understanding these. For instance, what’s the difference between emotional and compulsive eating? And, in general, I’ve heard a lot of people say they engage in emotional eating. What’s at the core of emotional eating and how can someone curb that tendency?

CDB: I'll start with exercise addiction. Exercising can be great, the problem is when it becomes compulsive. You’re sick and you can’t skip a day because you feel out of control if you don’t work out or think, “I have to go for a run tomorrow morning because I ate XYZ tonight.” Compensatory behavior and rigidity, and that “have to, have to, have to” mentality. If you aren’t listening to your body . . . if you have a fracture and work out past injury, you’re probably going to do some decent damage. Your body needs rest. Really, it's the compulsivity or compensatory nature of it that’s the biggest red flag there. I often work out five times a week, but some weeks I don't. It can be healthy and good to exercise but the question should be, “What is the motivation behind it?”

When I went through treatment over ten years ago I was SO rigid about my exercise and I said it made me feel better, but really it was about control. Sometimes it was the control that I needed. There are a very few things in this world that we can control. Food and exercise are often two things we can control, especially in our western world here. We have access to food, and of course income can play a role in that, too. Some people have more access to certain types of food than others.

We say our culture is disordered. There’s a big diet culture in our world. What happens when you lose ten pounds? You get complimented. What happens when you put on a few pounds? Either there are crickets or there’s some kind of critique. We have people who say, “I have cancer and I can’t eat and I’m getting compliments for my weight loss.” Our society praises weight loss in an unhealthy and unhelpful way. Oftentimes our bodies don’t need to lose weight but because our culture prizes thinness above health it becomes the thing, it becomes the standard.

There was a study years ago, something like 60 percent of women would rather get hit by a bus than gain ten pounds. It was something dramatic and I was like, really? We really value thinness that much that we’d rather have pain and injury? We’re working against the culture in a lot of different ways.

Compulsive eating is another word for binge eating. Until a couple of years ago, binge eating was not in the DSM but it’s actually the most common among eating disorders, and unfortunately so misunderstood. Binge eating is essentially eating large quantities of food, often in a short period of time, where people feel out of control. In addition to our society idolizing thinness, we also shame people in larger bodies. Rock Recovery comes from a Health at Every Size approach (also called HAES). There isn’t just one ideal size or shape we all need to be. People can be healthy at a variety of weights and sizes. When we work with our clients, we are much more concerned with their behaviors and quality of life than the number on the scale.

Emotional eating is often totally normal. You picture someone in the movies eating out of the carton of ice cream when they go through a break up and some of that is normal and healthy and it’s ok for food to be part of life. But when you don’t have other coping skills or when you feel out of control around food, those can be signs of a problem. If food is your main go-to, when you can’t emotionally regulate, you can’t process, you can’t talk to a friend, write in a journal, or pray. If it’s your primary comfort, that’s when it’s most likely problematic. 

We always say weight loss is never the goal. Some people might lose weight when they get their disordered eating under control, but the problem is that people pursue weight loss as the goal and our goal is to help people’s behaviors and relationship with food heal. If you’re trying to lose weight you can’t do that: Be healthy and balanced. When you’re trying to lose weight it becomes really hard to honor your hunger cues if you’re thinking of this secondary goal. So we say, “You know what? You might lose weight, you might gain weight, you might stay the same.” We don’t know, but we’re not focusing on that. We’re focusing on the behaviors, getting your life back, your relationships, all those things.

Rosslynva.org: How do you know when you’re just trying to lead a healthy lifestyle versus when you’ve taken it too far with dieting and exercise?

CDB: That’s so tough for our clients and our culture. We just want to be healthy and it’s hard to know who to listen to and who’s the expert. What’s the right advice? Some warning signs include: How people eat. Is it hurting their relationships? Does someone not want to meet a friend for dinner because they want to go home and eat their safe foods? Are they eating in secret because they are ashamed? Do they no longer eat the birthday cake because they think it has too much sugar or fat? Are they eating before the Christmas party because they don’t want to eat the food that’s there? There are times and places to have strategies and a plan but if your behaviors are cutting you off from the people you love or the life that you love, that’s a big red flag . . . 

It's when there’s rigidity around food and life and eating. Or when the number on the scale can ruin your day or make your day, that’s a pretty big indicator. It’s a tough one, because a lot of us have grown up like that. We tie a lot of value to that arbitrary number.

Rosslynva.org: How can you recognize disordered eating in a friend? What should you do if you think someone has a problem?

CDB: Signs we say to look for in people: They isolate, they don’t want to eat together, weight changes, mood changes, they're sensitive to cold because people start to get their bodies out of whack when they’re not fueling them properly . . . There are different things that play into it, but these are some signs to look for. One thing that is important to note is that people can struggle with disordered eating at any size or weight. So often we picture an emaciated teenager as the only person with an eating disorder, but that is entirely false. People of all shapes and sizes struggle and deserve proper treatment support. 

It can feel really invasive or vulnerable to talk to people about these things. One of our big tips is to take a person-first approach. When you come to someone and say you are worried, 99 percent of the time they’re going to get defensive. They’ll say, “Well, I just like to run,” or “This is what I like to eat.” They’ll tell you why and shut down the conversation. With a person-first approach, we think you should say, “I love you and I really care about you and I see you coping in some ways that aren’t helpful. Could we think about it? Could we talk about it? Would you consider calling a counselor to see if they might think you need some help?” Then, refer them to an expert. You can say, “I can go with you, I can make the appointment.” Showing them you love them, stating your concern and offering your support in that next step. Those are the pieces we recommend. But be prepared for a lot of pushback and maybe even a hurt relationship for a while. The disordered eating, people keep it like their binky and it’s a thing. So the first time your parents try to take away your binky, there’s a tantrum. Same thing. Disordered eating often helps people feel safe, comforted and in control and it’s hard to just rip it away and it can be really scary. We always try to remind our clients to have some grace for themselves for their pasts once they start taking the steps toward recovery. It can be frustrating to look back and see the time lost, but we remind them that recovery is often just a lot of baby steps strung together. It’s never too late to start taking those steps, whether it’s your first try or 50th.  

Rosslynva.org: What strategies do people who are recovering from disordered eating use to reframe their thinking about food and exercise?

CDB: I'm not a clinician but thankfully with my work I get to hang out with therapists all the time! There are a variety of treatment methods and approaches, and at Rock we really focus on changing thoughts, beliefs and behaviors. Cognitive Behavioral Therapy and Dialectical Behavioral Therapy are two methods that are frequently used for adults with eating disorders. Family Based Treatment is the gold standard for adolescents where the families are really in charge of the feeding process with their kids. 

One thing that is unique about Rock Recovery is that in addition to individual and group therapy, we also offer food exposures and supportive meals. We often say eating disorders are about the food, but not about the food. We come together with our clients for group meals that are often centered around a challenge food — think hamburgers (or veggie burgers!) and fries. It is so helpful for our clients to get support from other people who understand what they are going through while also being challenged to eat foods that they might otherwise binge on or avoid altogether. 

Other skills: There’s this idea called distress tolerance: Something will feel intolerable, and we use breathing exercise and reframe things. We use a few acronyms: HALT. When you’re going to the fridge or going for a run you ask yourself: Am I hungry, angry, lonely or tired? One we use with faith-based clients is STOP: Stop, Think, Observe and Pray to help re-center ourselves in that moment.

Anything that slows you down and stops you from going to that compulsive behavior can be really helpful.

Rosslynva.org: I know that Rock Recovery will take a faith-based approach if it's helpful to a client. Has faith always been a part of your life or is it something you found as part of your recovery? How has it helped you stay healthy?

CDB: We serve all people here. We have clients of all faiths, backgrounds and beliefs. It’s beautiful to have people of diverse backgrounds come together and address their behaviors and beliefs and also to address the spirituality piece.

We believe that spirituality is essential to the recovery process. We need to work through our beliefs and behaviors, but the deeper work of recovery is finding our identity and values. We want to help our clients figure out what spirituality means for them. A lot of our clients have experienced spiritual abuse in their pasts. With mental health being widely misunderstood in society and faith communities, we’ve had some well-intentioned faith leaders say having anorexia is a sin.We just don’t think that’s helpful language. Sure, we need to care for our bodies and fuel them, but it’s not a sin to have a mental health condition just like it isn’t a sin to have cancer. 

For some of our clients faith is really critical and we integrate it into their recovery process. We offer a few offshoot programs that come from a Christian perspective if people are interested in digging deeper into faith. 

I actually came to faith through my own recovery process. When I was recovering from my eating disorder, I realized that faith was critical to me to have a foundation of where my value and worth come from. The idea that there was a God who loved me, created me, and wouldn’t forsake me helped me to get through.We don’t require that anyone subscribe to any certain belief to work with us. We just want to help them heal and find wholeness. 

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