Heather Gallivan / Photo provided by Gallivan
This issue, we talk with Melrose Center‘s Heather Gallivan about her work helping those with eating disorders (EDs).
Can you tell us a little about how you got involved in this kind of work?
I had an interest in eating disorders since I was an undergrad when I did a shadowing experience at an eating disorder (ED) program up in Duluth. In college, one of my roommates also had an eating disorder and I felt helpless not knowing what to do. After graduate school, I was an active-duty psychologist in the United States Navy and often times ended up being the provider treating any service members at my duty station with EDs. When my husband and I pondered the idea of moving “home” to Minnesota after my service commitment was up, I saw a job advertised at what is now Melrose Center and decided to apply. And here I am 21 years later!
What inspired you to focus on helping people with eating disorders (EDs)?
One of the things I love about helping people with EDs is that it is incredible to watch individuals reach their full potential. I always say that EDs tend to impact people who are really smart, capable, passionate, driven and the ED tamps down their ability to live up to their full potential. So, helping them get to recovery and live a life bigger than the box the ED keeps them in is very rewarding. I also enjoy that in our field there are still a lot of unknowns. In my career I have seen so many changes and advancements. So, I also love always trying to learn and better what we do here at Melrose Center and how we can help patients and families afflicted with EDs.
What are some signs that someone might be struggling with an eating disorder (ED), even if everything looks fine on the outside?
It can be tricky as you definitely cannot “tell” that someone has an eating disorder just by “looking at them.” Some common signs and symptoms of a possible eating disorder include noticeable weight loss or weight gain (including significant weight loss in an individual who may be in a larger body), severe, rigid, restrictive eating or dramatic changes to how someone is eating; for example, suddenly not eating foods they once enjoyed, prolonged periods of fasting or skipping meals to lose weight, struggling to eat with others, moving food around their plate, trying to avoid going out to eat or eating in more social type settings or places where they don’t know what may be served, going to the bathroom after meals, exercising excessively such as spending a lot of time working out or working out when they may have already had a sports practice or despite weather conditions. Personality changes such as increased depression, anxiety, irritability, isolating more and not doing things they used to enjoy doing can be another red flag. Someone making themselves throw up after eating or using excessive diet pills or laxatives is concerning, along with increased focus and preoccupation with their body weight and shape. Physical symptoms related to possible EDs can include feeling cold even on a nice day, wearing lots of clothes even when it is warm out, dizziness or light headedness, brittle hair and nails, dry skin.
We often hear that eating disorders only affect certain people. Is that true? Who can be impacted, and what are some common myths?
Yes, I think unfortunately there is still a misconception that EDs impact young, thin, white girls from middle to upper class backgrounds and that is just simply not the case! EDs do not discriminate! They impact individuals of all ages, genders, sexual orientations, which is a wide range of ethnic and socioeconomic diversity. At Melrose Center, about 15-20% of the individuals we treat are male. We see patients between the ages of 8-80, approximately 30% of the patients we see are 35 and older. EDs impact ALL types of bodies and in fact only about 6% of people with EDs are medically considered to be underweight. Although the prevalence of EDs is consistent across ethnic backgrounds, people of color with eating and weight concerns are significantly LESS likely to receive help for their eating issues and are less likely to be asked by healthcare providers about possible eating issues. Gay males and transgender individuals are at higher risk for developing EDs and we know that females diagnosed with anorexia are more likely than females in the general population to be diagnosed with autism spectrum disorder. So, the reality is that EDs can affect anyone and everyone and unfortunately, due to ongoing misconceptions, people struggling often don’t get the help they need.
How are eating disorders and addiction connected? Can someone be dealing with both at the same time?
Absolutely! In fact, there is about 25-35% rate of co-occurring ED and substance use disorders (SUDs). In many ways, EDs and SUDs operate in similar ways. Both ED behaviors as well as using substances can serve a “purpose” for that individual to help them manage uncomfortable emotions, stress and distress about things in their life, relationship challenges, loneliness, depression, anxiety, etc. When these disorders co-occur often times, they require co-occurring treatment in order to avoid a “whack-a-mole effect” where in someone may make changes to ED behaviors, for example, but then the substance use gets worse or vice versa.
How is working with a dietitian during recovery different from following a diet or eating plan?
There are a number of ways that working with a dietitian in treatment and on a journey towards recovery are different than just following a diet or a meal plan. One of those is that the focus of working with a dietitian during treatment is to help you focus on healing and not with appearance. Our goal is to restore a healthy relationship with food and body and not to change weight or shape. Dietitians, like other treatment team members, take an individualized, therapeutic approach. They will tailor nutrition recommendations based on medical, psychological and emotional needs and help you work towards social “wins” like eating in front of others or at a grad party or going out with your friends. Typically, a “diet plan” is a one size fits all approach and doesn’t address the psychological roots of disordered eating. It tells you only what and when to eat. Dietitians also focus on overall nutrition rehabilitation including helping to stabilize blood sugars, correct nutrient deficiencies and support brain and body recovery from starvation or erratic eating patterns whereas “diet plans” rarely address nutrient repletion. Dietitians also provide behavioral and emotional support with treatment and recovery. They collaborate with the multi-disciplinary team. They can help you to challenge food rules and provide support through fear, guilt, and anxiety around eating. In recovery from an eating disorder, a dietitian is going to take an approach to food and eating that emphasizes food neutrality and not on “good” or “bad” foods. All foods can fit in moderation. Diet or eating plans often label foods as “good,” “bad,” “clean,” “cheat” etc. reinforcing harmful beliefs about food and eating. Finally, dietitians help people work on making long-term changes. Their focus is on sustainable long-term recovery and reconnection with intuitive hunger and fullness cues compared to “diet plans” which are usually short term and not sustainable over time. In fact, they can lead to high relapses of disordered behaviors. Working with a dietitian is an important part of recovery from an eating disorder.
What makes the approach at the Melrose Center different when it comes to treating eating disorders?
We have a full continuum of care here at the Melrose Center: Residential, Partial Hospitalization, Intensive Outpatient, and Outpatient programming. So, if a patient needs more support or starts needing higher levels of support they can transition through different levels of our program. We also have a multidisciplinary team that treats the patient and family which may include a psychologist or therapist, registered dietitian, primary care medical provider specializing in EDs, or a psychiatrist. Some of our patients may also meet with an occupational or physical therapist as a part of their treatment. This approach helps to ensure that all aspects of the ED are evaluated and treated. We also have psychologists and therapists who come from a substance use background or have additional training in diabetes to help individualize care for people who may have co-occurring disorders.
What does recovery really look like? And how can loved ones offer support without pushing too hard?
Recovery looks different for everyone, and it is important to keep that in mind – everyone’s path is different and that is OK! Recovery looks like taking small steps over time to make changes to thoughts, emotions, and behaviors with the support of your treatment team and supportive people in your life. There will be steps back and detours, but they are all a part of the process and valuable learning opportunities. I have described recovery as a puzzle where there are a lot of pieces that don’t look like anything individually but over time, they come together to create the picture. Eating disorders tend to be very life-limiting and people can feel like they are living in a box. Recovery is living a life full of what you want and dream about without the limitations the ED puts on people. Supportive people are crucial members of an individual’s “treatment team.”
Recovery is living a life full of what you want and dream about without the limitations the ED puts on people.Research shows that people who have supportive people in their lives tend to have a better prognosis and respond to treatment more fully than those who don’t or who won’t allow support to be a part of their care and journey (regardless of age). One way support people can help is to learn about EDs, how they impact people, the treatment process and ways to help. Support people can attend appointments with a loved one with their permission to learn more not only about EDs but ways they can be supportive. Another way support people can help is to speak up. EDs are disorders of minimization and rationalization. This means that often times the person with the ED is telling themselves that their behaviors are “no big deal” or that “no one is noticing” so when support people don’t speak up or are afraid to have a conversation with their loved ones about the concerns they may be seeing, it reinforces that it isn’t a “big deal” and that “no one is noticing.” Don’t be afraid to ask your loved one how you can help and let them know it’s Ok to tell you when it’s too much or that there may be a better time to talk about things. Sometimes family therapy can be helpful to sort through and address any communication challenges or relationship dynamics that may be at play impacting the ED.
Food and body image come up a lot during holidays and social events. What are some tips for getting through those tough moments in recovery?
They certainly do and we can all change that by NOT engaging in those conversations at events or helping to steer the conversation towards something more meaningful. I always say when people start talking about food, diets, bodies, it tends to make everyone feel worse about themselves so why do we do this? For people with EDs these conversations are even more impactful. I recommend that people have a plan going into holidays or social events that includes how they may approach eating at the event and generally having an eating plan or schedule for the entire day. Although holidays and social events can involve unknowns and challenging foods, think about it as an opportunity to practice and remind yourself that holidays and social events don’t happen every day. I also recommend, if possible, having a support person identified who will also be at the event who knows this may be hard and can help if needed. Even a reassuring look from a support person can make all the difference! I also recommend people have an escape plan so if it gets to be too much there is a place to go take a timeout and regroup or make a graceful exit. It is important though to not avoid these types of activities all together because they are a part of living a recovered life.
Is full recovery possible? What gives you hope in the work you do?
I believe wholeheartedly that full recovery is possible. Although there can be fear about the unknown and what recovery may “look like or feel like.” I’ve never had a person in recovery who I’ve worked with come back and say they regret taking a chance and throwing themselves into making changes to get to recovery. I think also remembering that recovery looks different for everyone and it is not typically a linear path. There will be stops and starts and some detours along the way. It also doesn’t happen overnight and a lot of times you may not feel it really happening until you are there. Watching people get to recovery, living a fuller life and realizing goals and dreams has always given me hope in this work. There are also so many exciting things going on in our field to better understand EDs so that we can develop more effective treatments, and movement in our society, around body image and body acceptance and have more conversation around eating disorder awareness, prevention, and ways to challenge stereotypes about “beauty”, appearance, and bodies.
Are there any additional resources you can provide for our readers?
- National Eating Disorder Association
- FEAST
- Melrose Heals podcast
- ANAD (National Association of Anorexia Nervosa and Associated Disorders)
- The Joy Project
Heather Gallivan, PsyD, LP. Heather is the Clinical Director at Melrose Center. She joined Melrose in 2004 and has worked with eating disorder patients in all levels of care from outpatient to residential treatment settings. She obtained her doctoral degree in Clinical Psychology from the Minnesota School of Professional Psychology. Prior to joining Melrose Center, Dr. Gallivan served 5 years in the United States Navy as an active-duty psychologist. She is a passionate leader and teacher concerning the prevention and treatment of eating disorders, and how societal messages impact our beliefs and attitudes about food, weight, and body image.
