SLIP: LINK

TRANSCRIPT:

Colleen: Welcome back to Hot Flashes and Cool Topics Podcast. We are going to be speaking

with Mallary Tenore Tarpley on the show about her new book called Slip.

Welcome to the show.

Mallary: Thanks so much for having me. I found this book really

interesting, and Bridgett did as well. Obviously, our demographic is midlife and

beyond. But from the research that we’ve done, a lot of eating disorders are kind

of relapsing in that time of life where you’re losing control and life is changing

and things are happening either to you or with you or about you. And you’re feeling

kind of out of control. So your new book, Slip Life in the Middle of Eating

Disorder Recovery was very impactful. I have a daughter who went through a struggle

with an eating disorder, ended up in treatment at Renfrew and back and forth.

So I know from a mother’s perspective what the eating disorder does to a family and

to a girl. But your perspective is very personal, mixed with a lot of interviews.

Why did you structure this book that way.

Mallary:  So thank you for that. It was really

important to me to be able to expand the narrative beyond my own story. So I have

lived experience with anorexia and I’m in ongoing recovery from the disorder. But in

many ways, my sort of story fits the stereotypical mold of someone with an eating

disorder. I’m white. I identify as female. I live in a smaller body, I’m middle to

upper class. And that’s often what we think of when we think about who struggles

with an eating disorder. Often we think about young people too. But for me, it was

really important to say, what else can I do to really broaden people’s scope of

understanding and my own about eating disorders and who they affect? So I ended up

surveying over 700 people with lived experience from 44 different states and 37

countries and interviewed about 175 of these survey respondents plus clinicians and

researchers and was able to weave all of that together so that the book

sort of brings together the intimacy of my own personal narrative but then expands

that lens to look at the latest research and to see how eating disorders affect

people of all different ages and genders and races and ethnicities and body types.

Bridgett: Right. You know, and Colleen’s talking about her daughter, and I was on

the bulimic end when I was younger. And I did not fit the stereotype.

I was never in a smaller body. I was never in a really large body either, but a medium body. And you talk a lot about the BMI scale and how that has

to meet certain criteria for insurance coverage. Can you talk about what that’s like

and the problems that that creates for people who are trying to go into recovery?

Mallary: Yes, it is really challenging. We know that we can’t simply say that someone is

recovered just because they have reached a healthy, quote unquote “BMI.” And we also

know that there are some individuals who are denied treatment because they do not

have a low BMI. We know that there is something called atypical anorexia,

which it’s actually more typical than atypical, but it’s when individuals meet all of

the diagnostic criteria of someone with anorexia and nervosa, but they’re not

clinically underweight. And many people who struggle with all different types of

eating disorders are not clinically underweight. And we really need to pay attention

to that. There is a study that I cited in the book that looked at hundreds of

adolescents with all different types of eating disorders and found that only 6 % of

them were actually underweight. And yet many of them were still suffering extreme

physical symptoms and were in dire need of care. So there’s a lot of systemic

issues, partly that stem from the lack of medical training around eating disorders,

but also around just insurance companies’ confusion about what these disorders look

like. Insurance companies like disorders that have a very clear recovery path and

trajectory with reproducible results, but that is just not the case with eating

disorders. We know sometimes these can be chronic, oftentimes recovery is ongoing. And

so there are some people who just can’t get the level of care that they need

because of these different BMI parameters that really are limiting their access to

care. There have been some improvements in certain states, like Colorado,

for instance, is one of them that is trying not to just look at BMI as a

parameter for whether or not someone needs care. And we’ve made improvements over the

years, but there’s still a long way to go.

Colleen: Another thing I respected in the book is that you are very honest about recovery

and that really the term full recovery is a misnomer because you liken it more to

a long -distance relationship where it’s far enough away. You’re not seeing it every

day, but certain triggers can affect that and that’s a very different perspective.

Why was it so important for you to be honest in this book that there really isn’t

a full recovery term that’s accurate?

Mallary: So I always wanted to write a book ever since

I was a little girl and I thought that I had to wait until I was fully recovered

to write the book because all of the books that I’d read on eating disorders were

either clinical and or written from the perspective of people who are fully

recovered. And I always felt like there was this lack of a mirrored image there

because I didn’t see my own story reflected there as someone who was better but not

all better and as someone who still lives with the imprints of my disorder. And so

I really wanted to write about what I call the middle place, which is this gray

space between acute sickness and full recovery. Because for so long, I told people

that I was fully recovered. And for some time, I was in a good place in my

recovery after I left treatment, but I relapsed in college and for a decade was

stuck in a cycle of binge eating and restricting, but kept telling people I was

fully recovered because I was ashamed to admit that I wasn’t. And so for me,

that narrative felt really inauthentic because there was this misalignment between the

sort of identity that I shared outwardly and the one that I was experiencing

inwardly behind closed doors. And I thought for a long time that I was the only

one in this middle place. And then once I began doing research for the book, I

realized that so many people are in this space. 85 % of those 700 plus people I

surveyed said they could identify with the middle place. And yet we’re not talking

about it. It very often gets stigmatized, particularly in the eating disorder field.

And so for me, it was important to really expand our thinking around what does it

mean to recover and what does it mean to be better, but still know that your

disorder remains a vulnerability. So my hope is that I can really give voice to

people who are in this space.

Bridgett: Well, it certainly did. I felt like I had a voice when

I read your book. I was just talking to Colleen before

we started the interview. I’m 57 now. I think this started (binge eating and vomiting) when I

was 15. I think I was about 19 is when I quit throwing up,

but still, it is always there in the back of your head.  I’ve

been through dieting cycles, gaining weight, losing weight, things like that constantly

my whole life. And this was the first time I’ve seen somebody write it down that

it’s always there. You’re in recovery. You always are, even if I haven’t done the

act since I was 19 years old. So I really do appreciate that you’ve included that

in your book. And you also talk about triggers. Different people started from

different triggers. And you have your book divided into 12 different chapters about

the different phases. But everybody has a different trigger, it seems like. Do you

mind sharing just a little bit about what your trigger was?

Mallary: Sure. So my trigger was

the death of my mother. So she passed away from metastatic breast cancer when I was

11. And I did what I knew how to do best, which was to put on a happy face and

pretend that I was okay. So I went to school the day after she died. I read her

eulogy without crying. And people praised me for being strong and resilient. But

behind that happy facade, I felt like I was falling apart and didn’t know how to

grapple with that. And the more that time passed, the farther away I felt from my

mother. And at the same time, I was taking a seventh grade health class where we

were learning about quote unquote, “good foods and bad foods.” And I was learning that

I could change the way my body looked and the size of my body based on what I

was eating. And so as a 12 -year -old, I conjured this idea that maybe if I stayed

the same size I was when my mom was alive, I could somehow be closer to her. So

food restriction was never about being skinny, right? It was really about trying to

stay small and be safe. And so I fell into this food restriction and it very

quickly descended into an eating disorder within a matter of about six months. But

it took a while for us to actually find a doctor who recognized that I actually

did have an eating disorder because in those months when I was really struggling, my

father and I really didn’t have the words to describe what it was. I thought people

with anorexia didn’t eat anything at all. And I was still eating enough, not nearly

enough, but I was still eating something. So even I had so many misconceptions about

what an eating disorder actually looked like.

Colleen: Along the lines of the misconception,

I know in my personal experience with my daughter, when she was in Renfrew, we would

go to family meetings where we all sat. And one of the eye -opening things that I

learned that I wasn’t aware of is that it’s not just restriction, that it’s on a

spectrum. When I first attended, I walked in and there was a woman in her

30s who was overweight. And she was struggling with binge eating.

And it’s so, it’s so sad that people look, hear the word anorexia and think thin

Teenager, but they don’t realize that eating disorders run the gamut from being very

thin to eating too much. You mentioned that in the book. You talk about that in

the book. Is the narrative changing or still, are we still stuck in that, like you

said, white, middle class, thin girl?

Mallary: I would say that the narrative is changing

within the eating disorder fields. Lots of treatment centers are really

trying to show that they are inclusive of all different types of eating disorders

and that they specialize in a wide range of these disorders. And slowly we’re

starting to even see more media coverage of different eating disorders. So the

narrative is changing slightly, but just in conversations with people, I can tell

that this idea that eating disorders only affect young teenage white girls is still

very much at play. And there’s something really unfortunate about that. I was quoted

in a New York Times story about anorexia in middle age. And I heard from so many

people who said, I didn’t even know that this happened in middle age or that people

could still struggle when they’re older, when they’re in their 40s or 50s or 60s

and beyond. And a lot of times I’ve talked with people who don’t realize that there

are all these other eating disorders besides anorexia. I think that that can be

really harmful when that disorder alone is glorified or when that’s the only one we

really hear about because it silences so many of the other people who are struggling

with bulimia, with binge eating disorder, with orthorexia, all these other disorders.

We also know that many people who struggle with one eating disorder will often

develop symptoms of another eating disorder. So, for instance, I had anorexia nervosa,

but later on developed binge eating behaviors. And the field refers to this as

diagnostic crossover. But these sort of different diagnoses from these different eating

disorders can come together for one individual to the point where you’re struggling

with lots of different disordered behaviors.

Bridgett: I was reading how you said that so many physicians are not aware of what

it’s going on with anorexia or with eating disorders. And it just reminded me,

Colleen, of how in the menopause world, so many physicians don’t realize what’s going

on in menopause either. Do you see that changing? Do you see doctors becoming more

aware? Is it just another thing that, you know, your primary care physicians maybe

just don’t know enough about it?

Mallary: We still have a really long way to go when it

comes to just educating medical professionals on eating disorders.

Research shows that doctors get between zero and two hours of training on eating

disorders in med school and in residency, which is just mind -boggling when you

consider the fact that 30 million Americans will struggle with an eating disorder at

some point in their lifetime. Oftentimes, eating disorders are considered niche

disorders or they’re considered sort of just a realm of mental health, but we know

that they have very serious repercussions on the body and can be fatal and life

-threatening. So it’s really the case where there’s so many doctors who still are not

getting training around these disorders, and much more of the emphasis is on treating

obesity. We know certainly that people with eating disorders can live in larger

bodies and can be obese, so there can be crossover there. But the sort of study of

obesity should not preclude the study of eating disorders, because if we continue

down this path of the lack of medical training, then we’re going to continue to see

these misconceptions around eating disorders and these stereotypes are going to just

continue to persist if we don’t have more education and awareness around who eating

disorders affect and how they take shape.

Colleen: And as we mentioned in the beginning, the

women that we speak to are primarily over the age of 40 or 50. And in doing my

research, I saw that 13 % of women over 50 experience symptoms of an eating

disorder. And in your book, you mentioned that there’s treat to the trait.

And there are certain traits that such as perfectionism, rigidity, persistence,

preference for routines, attention to detail. And when I was reading through those, I

went, of course it’s going to affect women over 40 and 50 who have children leaving

for college, who may not even recognize their partner anymore, whose parents are

getting older, their career may be changing. Just like a young teenager who’s going

through all of these emotional changes while estrogen is running rampant, we’re going

through all these changes and the estrogen’s leaving. When you were interviewing

people that were in the midlife world, like I think Henry was one of them and some

really great examples. What resonated with you? What seemed to be the common

denominators for midlife people?

Mallary: So many of the people I talked to were not

anticipating how different life transitions would basically spur relapse or spur these

disordered behaviors and thoughts because there were some individuals I spoke to who

felt like they were in a relatively solid place in their recovery, but then they

went through menopause or their child’s left home to go to college. And suddenly

their sense of purpose as a mother just felt totally out of whack. And so there

was one woman, for instance, who I interviewed. And I didn’t end up including her

in the book because I interviewed so many more people that I could include in the

book. But I have other narratives like this in the book. But she basically said

that she had struggled with anorexia and bulimia in her teenage years and in her

early 20s. But then once she became a mother, her priority shifted. And that was

really a strong point in her recovery. And she wasn’t engaging in disordered

behaviors. But then her son went off to college. She was having some struggles with

relationships at home and ended up falling back into the eating disorder to the

point where she needed to go and get care. She went to a treatment center, but she

was by far the oldest woman there. And she felt like she had to play this maternal

role where she was really trying to take care of the younger patients, most of whom

were teenagers. And so she didn’t feel like she had a real safe place to go and

concluded after that experience that she did not want to go back to a treatment

center because it didn’t feel as inclusive of people her age. And there are lots of

narratives like that from people who feel like they’re too old, so to speak, to get

care or that they should be beyond the eating disorder at this point in life or

that it’s somehow selfish for them to be struggling when they have children to take

care of or other priorities. So time and time again, I would talk with individuals

who experience that. And found that to be true, too, with transitions like pregnancy,

menopause, many people weren’t anticipating how those transitions would affect the way

that they perceived their body, nor were they anticipating the ways in which medical

doctors would describe weight loss, right? Or say, well, you know, you should just

consider weight loss. Your body’s changing during menopause. If you want to get rid

of that belly fat, here’s what to do, right? So those messages can be pernicious

for anyone, but particularly if you have lived experience with an eating disorder,

those can be incredibly triggering.

Bridgett: Right. You also talk about the psychological help

that is needed, not just for the patient, but also for the family or the people

around. Can you talk a little bit about the importance of that?

Mallary: That is so

important because eating disorders are really enigmatic. They are difficult to

understand. I remember my father loved me dearly and tried to take care of me as

best he could, but there were so many occasions when he would say, why can’t you

just eat Mallory or you’re so smart, why can’t you figure this out. And we now

know that there are so many neurobiological changes that are happening and there’s so

much sort of working against us as we kind of get deeper into the disorder. And

it’s so hard to recover. Part of what we need to do is really empower families and

caretakers to understand more about these disorders. Because years ago when I was in

treatment, the mentality was that the child or the patient should really be sort of

taken away from the home. And part of that had to do with mother blaming. The

thought was that mothers were to blame for eating disorders. So if we sent the

child away, then he or she could get better. Now there’s much more of an emphasis

on family -based treatment, which really empowers families to both learn and understand

more about the eating disorder, but also equips them with the tools to really help

their loved one get through these difficult points in the disorder so that ideally

the person can recover at home without needing higher levels of care. Now,

certainly some individuals do require hospitalization or inpatient treatment, but if we

only think that that’s the sole option, then it can lead people to get stuck in

the cycle of being hospitalized to the point where that almost becomes part of their

identity. So the more we can help caretakers understand these disorders, the more we

can really help and then thereby help patients.

Colleen: It was invaluable when my daughter was going through it. And I think when I think

she was around 12 or 13 when it started. And then she graduated high school in

2014, so it was probably around 2008 or 2009 there was nothing. Trying

to find a therapist was hard enough but then if the therapist said she needed

nutritionist she had to go and research for that and then if you needed a family

therapist and it. Now a lot of them are offering it one -stop shop like. You

can go in and they have all these resources but the inpatient facilities,

like for my daughter, insurance is so finicky. Our insurance coverage would have 100

% covered her inpatient, but not outpatient. And we really wanted at the time for her to

be an outpatient. And so we had to take it out of our own pocket. And a lot of

people cannot do that. What do you suggest for people who are, even in midlife,

who simply don’t have the means or their insurance coverage to get treatment.

Mallary: Yeah, that is such a huge barrier to care. We know that there are a lot of

providers who just unfortunately can’t take insurance, right, And so many of these

eating disorder specialists don’t take insurance. Many of the treatment centers don’t

take public insurance. So there’s all these different hurdles. So there are some

providers, though, who do specialize in eating disorders, and they do take insurance.

I would always try to look and see if there are local providers who can offer

those services at a rate that would hopefully be somewhat affordable and to find

ones who can take both private and public insurance. But if that seems insurmountable

or if that barriers too high to get over, being able to talk with someone who you

trust is so important because eating disorders really thrive in secrecy. And there’s

so much shame around them, particularly for people struggling in midlife and beyond.

And so I know for me, I do still see a dietitian and a therapist who specialize

in eating disorders. It took me a very long time to find individuals who took

insurance. So I’m able to sort of see them and it’s not cost prohibitive. But I

also talk with my husband quite often. In these times when I might slip or I’m

having a difficult stretch, I make sure to talk with him about those slips and to

be really open about it. And I’ve had to learn to do that over time. But that has

been important to just set up support structures at home as well. And so if we’re

lucky enough to have someone who we can trust, whether it be a family member,

friend, spouse, the extent to which we can open up to them will really be helpful

in the recovery process.

Bridgett: You mentioned the word slip and that’s the title of your

book. Can you talk about what a slip is when you have an eating disorder?

Mallary: Yes. So Slips are really important to talk about. And I remember when I was writing

this book, there was a clinician who I interviewed who said, well, I wouldn’t title

the book Slip because that word has a really negative connotation in our field. And

I thought, well, that’s precisely the point. That’s why I want to title it Slip

because all too often we’re not taught that slips happen, right? I think that

treatment centers have done a much better job over the years since I was in

treatment in terms of having relapse prevention programs and talking about the

possibility that slips can happen. We talk less so, though, about the fact that

slips can happen in an ongoing capacity. Very often we think, well, slips are just

something that happen over a couple of months period after we leave treatment. But

for many of us, myself included, these slips keep happening. And so slips are

typically kind of a blip as we think about the road to recovery. So they’re common,

they’re inevitable, and yet they’re often stigmatized. But a slip can often occur

when people are trying to make progress, because when we’re doing really hard things

in our recovery, inevitably, we may slip here or there. And the tendency is to want

to stigmatize those slips. But if we can look at those slips and normalize them and

say, we how to slip, why is that? Who can I talk to about it? And how can I get

back up now, right? Not next week, once I’m past my deadlines, not next month,

once the kids go back to school, right? But how do I do that now? That’s really

important so that we can make sure that those slips don’t turn into slides. Because

when we’re in this pattern of every slip leading to a slide, it can really lead to

a relapse, which is more so a repetitive pattern of eating disorder of thoughts and

behaviors with an inability to get back on track.

Colleen:  With the slip becoming a slide,

for midlife women, a lot of times, isolation is a real big problem for our health,

for our aging.

Colleen: Do you suggest for women when they maybe have a slip and they’re home alone and

the kids are in college, the husband’s working or he’s out got whatever he’s doing

reaching out to a friend reaching out to a community of like -minded women what can

they do?

Mallary: Yes, So I would say try to reach out to someone who you really trust and

or look and see if there are some support groups that you could be part of the

National Alliance for Eating Disorders for instance has a recovery support group for

people and midlife. And so there are some organizations that are trying to be more

deliberate about offering services for individuals in midlife. And that is incredibly

important because that isolation is just a huge part of all of this. And if we can

talk with someone about the slip, it’s so important. Part of that too, especially if

we’re talking to, say, a spouse or a friend, is to really be clear about what kind

of support we need because sometimes it can feel just kind of intimidating if we go

to someone and we’re afraid that when we tell them about our slip, they are going

to point fingers at us or they’re going to be accusatory. And so I always will

say, I want to be able to talk with you about this slip. And I’m just looking for

you to listen and for you to offer support from a place curiosity and compassion,

right? I don’t want to feel like I’ve just done something really wrong. I don’t

want to be made to feel like I’m bad for having slipped. I just want your help

getting back up. So the more you can communicate the type of support you need, the

better in those situations.

Bridgett: you know,

when Colleen and I were younger, so we’re a little older than you. But when we

were younger, and probably for you as well, thinness and being super skinny was so

glamorized. And you mentioned in the book that there were still groups that

glamorize it, like on YouTube and social media. I do see some progress in body acceptance.

I really, I do. I know that when I go to the beach now, I see people of all

sizes in bikinis and bathing suits and having a wonderful time. And I am so happy

to see that. Are there any suggestions you give for people that have been taught that you have to look this way, or

 you could just hear the critical ears of the people who would

judge you. Any suggestions for that?

Mallary: Yeah. So that sort of noise can be incredibly

loud when we’re just hearing all this messaging from diet culture because they do

live in a society that’s steeped in fat phobia and diet culture. And there’s really no

getting around that. There’s interesting research around what’s called normative

discontent, which is essentially a fancy term to just describe the fact that the

vast majority of people in our society have some level of discontent with their

bodies. And so to think we’re never going to have a bad body image day and our

society is almost unrealistic. I also don’t think that we need to feel as though we

always need to love our bodies. Often we think in terms of extremes where it’s body

loathing or body love, but there can be more body neutrality where maybe some days

you do feel better about your body, but other days you don’t feel so great about

1. If we can think about arriving at a place in the middle where we have more

acceptance of our body and can think more about who we are as opposed to what we

look like. That can be really hard, but that can be a helpful framework for

thinking about how do we live in a body in the society? How do we feel more

comfortable taking up space? How do we recognize the ways in which our body helps

us to move and to play and to kind of just move through our day.

And one line that I often keep in mind is this idea that the body is an

instrument and not an ornament. So it’s not something that we always have to think

about displaying. It’s something that is really helping us to hopefully thrive and to

get through the day to day. So that’s an important framework that I’ve thought a

lot about as a woman in recovery, knowing that I am probably never going to

unconditionally love my body, but I’ve gotten to a place where I can accept it and

appreciate it, even if I have some days where I’m just really hard of myself.

Colleen: I think that’s such an important way to end the interview because women really,

we hear a lot about body acceptance, but that term acceptance, maybe neutrality is

easier, less restrictive term, like you may not accept it,

but you’re neutral about it right now. And that’s okay. One day, it might be good.

One day it might be bad. So I think that’s a really good way to kind of put this

all in perspective. But thank you so much, Mallary, for joining us. Slip, Life in

the Middle of Eating Disorder Recovery is out now. Make sure you check it out.

We’ll have the links in our show notes. Thank you so much for joining us.

Mallary:  Thanks

so much for having me.