Eating Disorders & ADHD with Special Guests Dr. Roberto Olivardia and Paige Kinzer
Trigger Warnings: This episode describes the experiences of a minor living with an eating disorder, as well as exploring the details behind eating disorders and its relation to ADHD. Listener discretion is strongly advised. If you or someone you know is struggling with an eating disorder, you don't have to go through it alone. Help is available: National Eating Disorder Association Helpline: (800) 931-2237.
This episode also includes a brief discussion about suicide. Listener discretion is strongly advised. If you or someone you know is engaging in self-harm or contemplating suicide, there are people who want to help. Please reach out: 988 Suicide & Crisis Lifeline (US): Dial 9-8-8 to talk or send a text to 988 If you are outside the US, please click the link to find a helpline for your country.
We've got something of a special show this week, one that is — we hope — as impactful and educational a conversation for you, as it is personal for us.
Nikki's daughter is in recovery from an eating disorder, a condition that impacted her emotionally, physically, and made for some dark times in the family. She also lives with ADHD. It turns out, those two things are frustrating bedfellows.
In fact, research has shown that those with ADHD have a greater risk for developing binge eating disorder or bulimia nervosa than their peers without ADHD and a 2007 Harvard study found that girls with ADHD were almost four times more likely to have an eating disorder than those without ADHD. Why is someone with ADHD more likely to have an eating disorder? That's our work this week.
To help us out, we've invited Dr. Roberto Olivardia to join us. Dr. Olivardia is a Clinical Psychologist and Lecturer in the Department of Psychiatry at Harvard Medical School. In his private psychotherapy practice, he specializes in the treatment of ADHD (particularly with comorbid disorders), Body Dysmorphic Disorder (BDD), Obsessive-Compulsive Disorder (OCD) and in the treatment of eating disorders in boys and men.
He graciously agreed to talk to Nikki, and our very special guest, Nikki's daughter, Paige, who shares her experience in her own voice.
Learn more about Dr. Olivardia and check out his book, The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys.
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Pete Wright:
Hello, everybody and welcome to Taking Control: The ADHD Podcast on TruStory FM. I'm Pete Wright and I'm here with Nikki Kinzer.
Nikki Kinzer:
Hello, everyone. Hello, Pete Wright.
Pete Wright:
This is a special show.
Nikki Kinzer:
It is.
Pete Wright:
It's a unique and special show.
Nikki Kinzer:
It is.
Pete Wright:
You want to set it up?
Nikki Kinzer:
Yes. So today, we are going to be talking with a doctor, a very special doctor, and we're also going to be talking to my daughter who's a very special human being to me. She's going to share her story today.
Pete Wright:
Yeah. She is. We're talking about eating disorders and so, trigger warning, we're talking about a lot of very complicated things that involve a lot of very complicated emotions and experiences for a lot of people and you'll hear a lot of people as we meet our guest.
Our guest is Dr. Roberto Olivardia. He is a clinical psychologist and lecturer in the Department of Psychiatry at Harvard Medical School. He does maintain his own private practice in Lexington, Massachusetts. He specializes in the treatment of ADHD, particularly with comorbid disorders, body dysmorphic disorder, obsessive compulsive disorder, and in the treatment of eating disorders in boys and men. He's a co-author of the Adonis Complex which is a book that details the various manifestations of body image problems in males and he's been all over the place, you guys. This guy, he's in all kinds of publications. He's on the advisory board for CHAD and the Attention Deficit Disorder Association. He sits on the scientific advisory board for attitude and is a featured expert for Understood and an active member in the Decoding Dyslexia Massachusetts group. You actually met him at CHAD ADDA.
Nikki Kinzer:
Mm-hmm. We did.
Pete Wright:
That's how he comes to us today. He is fantastically generous with his time, you'll note. This is a bit of a longer episode. Frankly, we've already had the conversation. Nikki and Paige and Dr. Olivardia already had their conversation. It's a bit on the long side. So I'm telling you, I know it's going to feel like a longer episode. Just pause it and come back if you can't make it. If doesn't fit in the commute, just pause it and come back because there are gems all the way to the very end from Dr. Olivardia.
So we sure appreciate your patience for your understanding in that for members, there was no live stream of this event because Paige was involved. She's a star. She's an incredible speaker and advocate for herself and for people who are living with the specter of the eating disorder and ADHD. So that's it. We're going to table everything else. You know all the drill. Find us at patreon.com/theadhdpodcast. I'm not going to belabor all of that. Thank you members. You're amazing. Now, let's go ahead and get to it and meet Dr. Olivardia.
Nikki Kinzer:
Thank you so much for being here, Roberto. We appreciate it so much. It's a very special episode that we are having today with myself, my daughter Paige, and Dr. Roberto Olivardia is joining us and we're going to talk about a hard topic, one that is not easy to talk about. Our mission today is to shed some awareness around ADHD and eating disorders and we want to talk about our own personal experience that we have had in our own family. My daughter has a story, her story that she wants to share, and we hope that it brings hope to some people that are listening and that we can get you into the right direction if you are looking for help or need more research and understanding around eating disorders and ADHD. Roberto, tell us a little bit about your experience. I know that this is something that you write about, you talk about, you shed a lot of light around it.
Roberto Olivardia:
Sure. So I'm a clinical psychologist. I'm a lecturer in the Department of Psychiatry at Harvard Medical School, and for about 30 years, have been researching and treat people with eating disorders. Particularly, I specialize in working with boys and men with eating disorders which is vastly under-recognized. I co-wrote a book many years ago called The Adonis Complex which talks about all kinds of body image issues from eating disorders to body dysmorphic disorder, anabolic steroid use with boys and men, although I've also treated girls and women. As far as ADHD, I have ADHD. I come from a long lineage of people with ADHD and having this intersection of ADHD which we know rarely travels alone. So I work with lots of patients who have ADHD and a mood disorder, OCD, a substance abuse issue, and see many patients with ADHD and eating disorders.
I feel very passionately particularly about this comorbidity because a lot of times, it's vastly misunderstood. The ADHD is often not even really clinically recognized in individuals who struggle with eating disorders. When I work with patients who have both, when they understand the role that ADHD can play, it can actually be very validating to them to be like, "Oh, okay. Now, if I understand that my brain is wired this way and having a ADHD lends us to run the risk of lots of different kinds of behaviors, some of them are going to be good and healthy and some of them not so much then..." But most importantly, when we understand the role that ADHD plays, the treatment and the intervention can be better targeted and these people can get help and that recovery is possible.
All too often, I've worked with patients or done consultations of people who just are like, "There's nothing that could help me with this eating disorder," and eating disorders are difficult conditions to treat but when ADHD is in the mix and it's not being recognized and it's not being treated, these people feel hopeless, understandably. And then, when they understand the role that ADHD plays, targets the treatment, and people get better. That's the main takeaway we all want to hear, for people to take away from this is recovery is possible and that this is something also that a lot of people unfortunately hold a lot of shame around.
Even aside from eating disorders, people with ADHD are just more highly prone to dysregulated eating, even if it doesn't fit the criteria of an eating disorder, of impulsive eating, of dysregulated eating periods of restriction. These are some experiences that I've talked about in my own life of just my relationship with all of that and how ADHD plays a big role in it.
Nikki Kinzer:
So you bring up a really interesting point because I know that there is a difference between an eating disorder and disordered eating. What is the difference there?
Roberto Olivardia:
So the main difference is with an eating disorder, we're referring to the Diagnostic Statistical Manual of psychiatric disorders, the DSM, will list eating disorders that are these diagnosable conditions. So we have anorexia nervosa which is characterized by severe caloric restriction, often coupled with a lot of negative body image. We have binge eating disorder where people are eating an incredibly large volume of food in a short period of time to the point where they're uncomfortably full, often feel worthless and demoralized afterwards. Bulimia nervosa which are binge eating episodes but then coupled with compensating behaviors, what's known as purging behaviors and that could be self-induced vomiting, laxative use, fasting, overexercise, and then disorders that might not fit all those criteria 100% but are close to it, things called ARFID or Avoidant Restrictive Food Intake Disorder.
With disordered eating, it's maybe eating that's not... It may not necessarily even hit a medical threshold of necessarily being as unhealthy or as life threatening as those other eating disorders are which they are. I mean, eating disorders carry a 10% to 15% mortality rate. That's very, very high. It's also important to note that just as many people lose their lives to the illness but also eating disorders carry a high suicide rate. And so, just as many people die from suicide who struggle with eating disorders die from medical complications of having an eating disorder.
But with disordered eating, it's more these just dysregulated eating. So I might have a patient who might eat 10,000 calories in one sitting and might not even refer to it as a binge. They're just like at a buffet and they just can't stop themselves. It's very dysregulated eating and then not eat for a day or two. And then, when they eat, maybe they are eating only high sugar foods because the ADHD brain responds to sugar in a much more enhanced way. So they can go to the doctor and nothing will stand out in terms of their vitals, perhaps, at least on the short term, their blood pressure but their relationship with food is very erratic and has these complications.
Or cognitively, people could eat, let's say healthily but then they might feel bad about themselves if they have a cookie. So it's not that they're binging on cookies but their view of themselves as, "Oh, I shouldn't have eaten that." And so, their relationship with food now takes on this approach that certainly puts them at risk for an eating disorder. But we know people with ADHD, I often talk about with food, with sleep, that the things that we do every... We have to eat every single day. Those are the things that ADHD can find its way into with more prevalence are those things that we're supposed to do every day.
Nikki Kinzer:
So where does body dysmorphic disorder come in? Is that part of the eating disorder or is that a different thing altogether?
Roberto Olivardia:
So body dysmorphic disorder or BDD is a different disorder and it's classified in the obsessive compulsive spectrum disorders. What that means is the spectrum disorders are all these conditions that share genetic underpinnings are... So if you almost imagine a family of disorders of which OCD, BDD, anorexia nervosa, they're all cousins of each other. With BDD, most people with BDD don't have an eating disorder, and that's characterized by people who have a preoccupation with a part of their body. It could be multiple parts of their body that they think looks ugly or defective or repulsive.
It's more than just having negative body image. It's often characterized by people who have a real distortion of the way that they see themselves and it's coupled with a lot of obsessive thinking about that body part. A lot of compulsive behaviors like mirror checking, excessive grooming, camouflaging behaviors and/or avoidant behaviors, mirror avoidance, not leaving the house, and covering one's face or... Depending on what part. I mean, I've worked with patients with BDD who could obsess about literally every body part. I mean, fingers, muscles, hair, skin, all different body parts.
With eating disorders, many people with eating disorders do have body image issues but not all people with eating disorders have a body image problem. Negative body image is not a criteria for all eating disorders and we can talk more about that but many people with eating disorders do have body image issues and may also have BDD. I've worked with many patients who when they're recovered from their anorexia or bulimia or binge eating disorder, it turns out there's also BDD that's still in the mix. It just might not be connected to their body weight.
Nikki Kinzer:
What is it around ADHD that makes it a higher percentage? So I was reading a magazine that you wrote or an article that you wrote for Attitude Magazine and you had said that you found that girls with ADHD were almost four times more likely to have an eating disorder than those without ADHD. And then, another study found that 11% of women with ADHD compared to 1% of women without. I'm assuming the numbers have to be similar for boys and men too, they're just not being researched maybe or talked about. What is it about ADHD in this component of making it more likely to have an eating disorder?
Roberto Olivardia:
So there are many different factors and it's a great question because what I always am excited in sharing this data is I want people when they hear it to be like, "Oh, of course. That makes total sense when we understand ADHD." So let's first understand the biological components of ADHD. So in a nutshell, we have all these neurochemicals in our brain. One of them is dopamine. Dopamine is implicated in motivation, it's implicated in reward. An ADHD brain has a deficit of dopamine. So as someone with ADHD, I think of ADHD as an orientation to the world as to what is going to stimulate me. And so, everything that's pleasurable is stimulating. There are lots of things that aren't pleasurable that are also stimulating like danger and anxiety and conflict and dramas, very, very stimulating. So when we're talking about with binge eating particularly or bulimia, the kinds of foods that people typically binge on are going to be typically high carb which basically, simple carbs break down like sugar in the body, high sugar kinds of foods. I've never met anyone who binges on Kale or-
Nikki Kinzer:
Yeah.
Roberto Olivardia:
Never happened.
Nikki Kinzer:
If you ever find that person, you need to get them on our show and ask, "Why? How?"
Roberto Olivardia:
I'd be intrigued by that.
Nikki Kinzer:
Yeah, really.
Roberto Olivardia:
Very much intrigued. So it's making sense that it's self-medicating this dopaminergic response. Now, even with anorexia which is less common... I mean, typically, the comorbidity you'll often see more with binge eating and bulimia. However, I've treated many people with ADHD who also have anorexia. Interestingly, in a starvation state, patients will often report this euphoria associated with having that starvation state. So there's some element that says, is the brain almost adapting in some ways and getting some level of reward? Because patients will say they feel a high when they're starved in that sense.
So we know that there's that dopaminergic kind of response. Now, we understand from a cognitive perspective all of the executive functions that are associated with eating. I mean, to eat healthily, you have to plan meals, you have to think about what you're going to eat, not just at the time you want to eat. So if I'm thinking about dinner, I should be thinking about it maybe even the night before. I might have to defrost meat. I might need to do those kinds of things and that's hard for people with ADHD which could then lead them down a path of relying on quick and easy fast food, processed food, things that are more accessible which often aren't always going to be healthy in that way.
Also, I mean, I remember in college, I used to use this term procrastinating. That anytime when I was procrastinating on something, I would eat. I mean, the most glaring example in grad school, I'm supposed to be working on this 40 page paper and I spent three hours analyzing this menu of chicken wings that's placed near my house at the time that makes really good chicken wings. I'm looking through it. I'm like, "Ooh, do I want the garlic parmesan? Do I want..." Even thinking about the food is already elevating that dopamine. I mean, even thinking about it, then I'm ordering it, then I'm anticipating it, and then I'm eating it and I ate I don't even know how many chicken wings, and then I feel like I'm in food coma so I'm like, "Here's this whole block of not getting work done and food-"
Nikki Kinzer:
Not going to work on that paper now. Yeah. No way.
Roberto Olivardia:
Not working on that paper. Absolutely.
Nikki Kinzer:
Yeah.
Roberto Olivardia:
That food was very rewarding and it's this dopaminergic response. Food is accessible. It's very easy in some ways, in the ways that some people might self-medicate with alcohol or drugs. Food is something that's just always there. And then, psychologically, when we understand for a lot of people with ADHD, there's a high degree of anxiety and executive stress that comes along with just getting things done and food is sensory. As ADHD individuals, we're sensory-driven sensory seekers and what is more sensory than food? We smell it, we taste it, we touch it, we bite it. It's engaging all of our senses and that's very grounding for people with ADHD.
Not only the food itself but I want to emphasize the thoughts of food also. Even with, again, patients who are more on the restrictive side, they'll also talk about the fixation on thinking about not eating or thinking about food, it still has this rewarding element because their thoughts are not all over the place. For people with ADHD, to be focused on a singular thing could be very reinforcing when you're used to thinking of 15 different things. So if food is the thing you're thinking about, even if it's thinking about not eating food, that's still satisfying that need for this singularity of thought that-
Nikki Kinzer:
A hyperfocus almost.
Roberto Olivardia:
A hyperfocus. Exactly.
Nikki Kinzer:
Yeah.
Roberto Olivardia:
And then, just some of the self-esteem issues that can come along for people with ADHD and sometimes food eating disorders and negative body image or extensions of overall negative self-esteem, then we know that people with ADHD are more highly prone to those issues.
Nikki Kinzer:
So before I bring my daughter into the conversation, I have a question around being diagnosed. I was trying to remember when we were at that point when she was diagnosed who diagnosed her and it's all a blur between the therapist and the doctor and at some point, we had a nutritionist come in. So how does a person get diagnosed with an eating disorder?
Roberto Olivardia:
So first of all, it's so important to know only 10% of women and even less for boys and men and going to what you said, absolutely, I work with a lot of men and it's just there isn't as much research on boys and men but those prevalence rates would be very similar with men and boys with ADHD. But going to treatment, studies show that only 10% of women who have an eating disorder are treated for an eating disorder.
Nikki Kinzer:
Wow.
Roberto Olivardia:
10%.
Nikki Kinzer:
Wow.
Roberto Olivardia:
That means-
Nikki Kinzer:
That's crazy.
Roberto Olivardia:
90% are not and for boys and men, it's even more-
Nikki Kinzer:
It's even less. Yeah.
Roberto Olivardia:
It's even less. So to even get diagnosed and get treatment, it's like consider yourself fortunate that you're in that category of people that are-
Nikki Kinzer:
Getting that diagnosis-
Roberto Olivardia:
Getting that diagnosis and getting that help. But typically, it could be through a physician. So for some people where their vitals are not where they should be, for girls, if they have already started to menstruate and they're no longer menstruating, although that's not a criteria for anorexia anymore, it used to be a criteria, if... But it could also be just the presence of certain behaviors like binge eating, purging, engaging in very unhealthy behaviors. It could be with the physician, it could be with the psychologist that someone is working with when they present with those symptoms, along with a lot of negative body image issues to get diagnosed with an eating disorder.
Nikki Kinzer:
Mm-hmm. Well, I want to welcome Paige.
Paige Kinzer:
Hi.
Roberto Olivardia:
Hi there.
Nikki Kinzer:
I thought it would be good for Paige to talk a little bit about what her experience was with getting diagnosed with ADHD and shortly after, getting diagnosed with an eating disorder. It all happened around the same time. So why don't you go ahead and share, when did you know that something was different and you came to me and said, "Hey, mom. I think I might have ADHD."
Paige Kinzer:
I was on FaceTime with my friend in... What was it? 8th grade, probably? 8th grade, 7th grade, and we were just studying our 50 states just to know where they are which I had learned in 5th grade so it shouldn't have been that hard. But she had studied all of them and knew where everything was in 30 minutes and I was there three hours later still trying to figure out where Alaska was. And so, I walked downstairs to my mom's sitting there and I was like, "Am I stupid?" I felt really stupid like how is this so hard for me? And so, my mom being an ADHD coach was just instantly like, "Oh, you might have ADHD." And so, we went and got diagnosed or went to the diagnostic testing first or did we get my teachers?
Nikki Kinzer:
We actually did talk about this on the show, her road to getting treated because her primary doctor didn't believe that she had a ADHD because of how her teachers filled out the paperwork. This is where I think having the expertise around ADHD helped because I knew that she was probably inattentive and that's why they didn't see it. She was a good student and they loved her and she was very charismatic. And so, I knew that we needed to get a little bit deeper and that's when we went to the actual psychiatrist that did the actual diagnosis.
Paige Kinzer:
Yeah. Because when I was in class, it was never like I couldn't stop moving or I wasn't focusing. It's like I sat there and I totally looked like I knew what was going on and I would just shake my head but nothing they said would go through. We would read a paragraph in a textbook and I would have to re-read it multiple times just to understand the concept of what we were reading. And so, from just the eyes, it didn't look like there was anything wrong but I never noticed that. I just thought that was everyone until I was with my friend studying and I was just like, "This does not seem normal. This shouldn't take me this long."
Roberto Olivardia:
Well, I think a lot of what you're pointing out too is how important it is to get a real thorough clinical evaluation of ADHD and this is something that leads to... I mean, people often think ADHD is overdiagnosed. I think it's actually vastly underdiagnosed because there's... So I'm 50 years old. So when I was younger, the only kids that were diagnosed with ADHD were kids that were burning the school down. I mean, kids with major conduct disorders and a lot of those kids were my friends. But I did well enough in school, I had good social skills but it's the behind the scenes of understanding what's the process because it's not as observable all the time and especially for girls.
We know that ADHD, you'll still hear that boys outnumber girls. That's not true. Boys outnumber girls in identification maybe but not in actual prevalence. With eating disorders, we know now that boys and men make up 25% of people who have eating disorders are boys and men. When I started doing that research 30 years ago, it was seen as a rarity, that boys and men hardly had these problems. But what you're speaking to is exactly that, that notion of needing to peel back the layers and understand, "Okay. Just because she's not bouncing off the walls, are you taking in the information? What's happening?" Because I know for me, when I was in high school, I was in a world in my head. I have a very vivid inner world, inner imagination because I got bored so quickly and I just knew how to hustle and get through. It was really in college that I feel like I became a student, honestly. Prior to college, it was not fun.
Nikki Kinzer:
Difficult. Yeah. Well, and then around the same time is, and I'll let her talk about this, but 8th grade was a really interesting time for her because she was getting the diagnosis of ADHD, she stopped doing gymnastics, and then also, this is when I think her relationship with food was starting to be disordered. Why don't we talk about that a little bit?
Paige Kinzer:
Yeah. I think that with not... Honestly, the ADHD diagnosis, I didn't know anything about ADHD that much. I didn't know it by myself at all so I never thought about that with my eating. So I now know that I'm a very routine-y person. I like to know what I'm doing from Monday through Friday like I know my schedule. I'm very routine-y. I don't like traveling because I don't like it being different. I didn't know that back then but I think that is one of the biggest things that started my eating disorder was the big change of leaving gymnastics was I was so used to five and a half hour practices after school that now all of a sudden, I would come home and eat a snack and sit on the couch or I wasn't as active as I was.
I don't think I realized how big of a change that is because everything switched and I wasn't as active as I was. And so, my muscle started to go away and I felt very disproportional. I felt very just... It was never bad. I was just a normal looking young girl. I just thought that I was so used to being strong and being what I look like to now, I was just like, "Well, I can either be strong or I can be skinny and I'm not able to get as strong because I was 13, 14, I can't drive and go to a gym." And so, it was so easy for me to just start to not like how I looked because not only was quitting gymnastics was a big change but now I'm eating the same or more with not the same working out and my body changing was just too drastic and I feel like that's what made my mind really spiral and not like my body anymore.
Roberto Olivardia:
Mm-hmm. But you're highlighting some really important things that are important for a lot of people, both with ADHD and what we know about what can be risk factors for eating disorders. So one is change and the transition of change and gymnastics was very... It was structure for you. People with ADHD, sometimes we... I sometimes still cringe with that word structure. I'm like, "Ahh!" like I'm going to be put in a box. But at the same time, I like it.
I'm similar too. I like to know how my week is going to look when it's the beginning of the weekend, what fun things, what's happening. I need to have a sense of shape to time in that kind of way. Otherwise, it can feel very destabilizing. And so, I can understand when you have a chunk of your day just taken away, now it's like, "Okay, what's going to fill this gap?" and that can create a certain level of ungrounding and people with a ADHD are highly prone... We need to feel grounded. Otherwise, we can get into unhealthy places pretty quickly.
But the other thing you're mentioning which can also... People with eating disorders often do have difficulty with change and with transition and things being not in control. One of the theories behind eating disorders is it's a way of having the most ultimate control of your body when everything else around you might feel chaotic and it makes sense.
I mean, this is why I think it's so important to understand it from a functional point of view is that it's human nature to want to feel in control of things. When things feel out of control, it could be our bodies, it can be the most minute trivial thing that we'll attach ourselves to so that makes sense. But the other thing you're mentioning too is as people with ADHD, we're very, again, sensitive, not only emotionally sensitive but just physically in how we feel.
The fact is, if you're doing gymnastics and then suddenly you're not, your body's going to feel differently and you're at an age where... I mean, I certainly wouldn't want to go through puberty again. I mean, that's like you're at an age where your body's developing and changing and that is often, the age of onset for eating disorders is around that time and it's not accidental. It's because the body is changing, you're not in control of those changes, they're just happening, and that could be very overwhelming. And then, you put a ADHD on top of it where there's now all of this executive anxiety of like, "What do I do with this and how do I think about this?" and I can see how all of that is happening at a time. And then, discovering some of these things academically that could set up a recipe, no pun intended, for an eating disorder so that makes a lot of sense.
Nikki Kinzer:
Well, and this was all happening in February of 2020 so guess what happened in March of 2020?
Roberto Olivardia:
Yep.
Nikki Kinzer:
COVID hit and that's where it really took, I think, a turn-
Paige Kinzer:
Yeah. Because-
Nikki Kinzer:
For the worst.
Paige Kinzer:
When I was in school, it wasn't that bad. It was more, I just didn't... It was just like I didn't have to eat. I could wake up late and go to school on time but not have time to eat and then not pack a lunch and come home and maybe eat a snack and dinner and that'd be fine. But then, school shut down for two weeks and also during in person school at that time, I think that's also what started the eating disorder was just like you said with the sense of control was I had one class that was hard, it was the hardest class I'd had for middle school, and I would study every day for three hours for a test on Friday and somehow still get a D.
And so, I just had no idea what was going on. And then, she would... I would retake the test and be fine but just during... I would study so much and not be able to get it. And so, I think being able to control how much I was eating and what I looked like is what calmed me down, is that if I can't control how my mind is thinking and learning and I can't control my grades, that I can control what I look like. I can control what I'm putting in my body and what I'm not putting in there and I think that's what very much spiked it was-
Nikki Kinzer:
Well, and something we were talking about too when we were prepping for the show is it's also an age where you become very aware of other people and what other people are doing. And so, there was a lot of body comparison and I mean, social media was also-
Roberto Olivardia:
Ooh, yeah.
Paige Kinzer:
Yeah.
Nikki Kinzer:
She told me that it glamorizes it.
Paige Kinzer:
Especially TikTok now for... When everything had shut down, I swear everything I saw was romanticizing eating disorders and starving yourself. But everything that was posted was the pretty part of it was they were like, "You're skinny," or, "Oh, I haven't eaten all day," and not the behind the scenes of how an eating disorder actually is. So for me, it was hard to see because I was like, "Well, everyone has an eating disorder. I'm fine. Everyone is like this," but I was confused on how these people seem so happy about having an eating disorder but I was over here suffering in silence and not knowing... I didn't feel good ever. I don't know how people were able to smile online.
Roberto Olivardia:
Right. Yep. No, but all that you're mentioning and it's so important too and I want to underscore your message of the experience with ADHD that often gets missed because ADHD is like, "Oh, I'm so ADHD," and people don't understand the pain that can be behind it is how demoralizing it can feel. I can relate because I remember those times studying, studying, studying, and I'd pull a D in chemistry. My daughter just took a chemistry midterm and she's doing better in chemistry than I did but I remember I failed every midterm and final for lots of classes because the cumulative knowledge was way... I was like, "Oh my gosh. How do I sift through this?" and it just feels defeating.
And so, the hope is that you either find other strategies of getting through that or you have something else to attach to. Music, for me, continues to be and has always been a therapeutic thing. That was my salvation. I can drown myself in that. But that makes a lot of sense and understanding that when we treat the ADHD, it can help prevent some of those other issues from cascading in that way.
But to social media, I have very strong feelings with social media and I have a almost 18 year old son and almost 16 year old daughter and they recently got social media. I feel very, very strongly. Now, part of it, and I told them because we're an ADHD family, they have ADHD and I said, "If I were a teenager now, I would absolutely have a problem with it." I would be the number one consumer of all of this kind of... This is true but it's funny is that even when I was growing up, I wanted MTV so badly and my parents did not get cable until the day I went to college.
Literally. Literally, they couldn't wait 24 hours. I call them, I'm like, "I'm all packed in mom," and I was like, "What's that noise behind you?" She's like, "Your father got ESPN," and I'm like, "What? Wait, you got cable? You couldn't even wait 24 hours until..." She's like, "Yep," but honestly, they knew who their son was because I would've been glued and instead, I was writing songs and I was out with my friends and being very physically active.
But it is really, really hard to expect a young developing impressionable brain to be taking in all of that information and these apps, these social media apps, are designed to keep people on them. They're designed that way and studies show... I have to tell you, in my practice, there is a clear inflection point, having been doing this for as many years as I have before social media and afterwards, I have seen younger kids as young as eight or nine treating for body image issues and eating disorders who now, instead of talking about celebrities which always felt a bit untouchable... Oh, I want to look like that person. They're now looking at your influencers, your social media influencers which don't feel as untouchable which feel relatable enough that it's like, "I should look like that. I should do that. I should eat or not eat that way."
You're absolutely right, Paige, is that it gets put out there in such a glamorizing way that it almost invalidates for patients I work with who are like, "Are these people really happy? Then I'm even failing at having an eating disorder. I'm not even good at this because these people are walking around and they're the bomb and I'm tormented by this. So what is going on?" and it just becomes this spiral.
There are algorithms, obviously, in social media that if you are looking at body image related content, it's going to send more body image related content so it feeds upon itself and it's a pretty dangerous... There are studies that show very significant correlations of Instagram, particularly with Instagram usage, TikTok and negative body image for boys and girls. Even, unfortunately, studies will show even with body positivity which the intention of body positivity is, "Hey, let's show different bodies and let's show you can have pride in whatever body," and I'm all for that. I mean, we should never discriminate or shame people for whatever body. But studies show even those images are still resulting in a lot of negative body image because it's still objectifying the body in some ways.
So when Lizzo posts in Bikini and Lizzo is a fantastic singer and a great artist and I'm all for the message of, "Hey, I have no shame about how I look and I shouldn't be put down," but it's still showing that her body is still something that has to be put out there as opposed to she has this amazing talent of her voice and that's what... Whether she's in a large body or a thin body, a tall body, short body, your value and worth is the same. So even when the intention is meant to be good, it's still sending a message that it's still important to be seen in that kind of way.
Nikki Kinzer:
Something that I just want to share with people that are listening that are parents or partners or anybody that might have someone that they're worried about, that was something that was really... It was really difficult for my husband and I because we noticed that she stopped taking lunch to school. We noticed that she wasn't eating as much. She would wear baggy clothing and so we wouldn't really be able to tell what she really looked like.
Because of COVID, she went into a depression and was definitely isolated anyway. I remember when she was driving, she was 15 and she was learning how to drive, and it was in the summertime so she actually had shorts on and I actually saw how thin her legs were and that was very concerning. And then, there was a few months later where her eyes were really red underneath and I thought it was makeup. I really honestly thought it was makeup and I realized that wasn't makeup and it was really scary. It was really scary. That was the time that we had her talking to a therapist. We had her talking to her doctor. They were like, "Yes, this is happening," and she refused treatment.
Paige Kinzer:
I hid it from you, guys.
Nikki Kinzer:
You hid it. You hid it for a long time.
Paige Kinzer:
Because I didn't actually start talking about it until... Because it all started when I was about 13 and I didn't actually say anything until I was about 15 but I never actually said anything. I would hint at things like how you guys said that I would always post on my Instagram about eating disorder awareness but I would post things about it and awareness about it and I would just tell them about it. I'd be like, "Oh, this is that and this is this," without actually saying it like, "Oh, I'm doing this. This is me. This is my problem." I was just explaining what I learned. And so, that's how... And then, you can-
Nikki Kinzer:
Well, and then even my husband was like, "I think she's reaching out for help. I think she needs help," and I had this hope because we had the therapist, we had the doctor, and we had a nutritionist that we were going to have her talk to. When you do the research, that's your team, right? That's the team that you want to have. I was like, "Oh, good. We have this team." One meeting with the nutritionist and Paige was out.
Paige Kinzer:
Oh yeah. That was not good.
Nikki Kinzer:
And then, she fired her therapist and told her therapist she didn't need therapy.
Paige Kinzer:
I emailed my therapist and told her that as a decision, me and my family decided I'm healed. I don't need therapy.
Nikki Kinzer:
Yeah.
Paige Kinzer:
True.
Nikki Kinzer:
No, and because she's a minor the therapist was like, "Um. I don't know if this was truly a family decision." I'm like, "Yeah. No."
Paige Kinzer:
God, I didn't like the nutritionist because she would ask me... One of her first questions was, "What are your comfort foods?" and I'm like, "What?" I was like, "I don't want to talk about that." I was like, "I don't want to eat food. I don't want to know what my comfort foods are. Why would..." I was very offended just like, "Why would you even ask me that?" and I just got mad and defensive really fast and just didn't even finish the appointment and then was just like, "I'm not doing this. I don't need this."
Nikki Kinzer:
What's interesting is that the therapist, our last call that we had with her was just my husband and I because Paige wouldn't come, and she said, "Just remember, it's the eating disorder. It's not Paige," and there was some comfort in that to see that okay, the resistance isn't... It is this other thing and to try to separate this thing from who she was and it was helpful so it was an interesting journey. Yeah.
Roberto Olivardia:
No, I agree. I think that's an important point because similar to what we would see with addiction, that we... Culturally, we often moralize addiction which we shouldn't. There are people that engage in addictive behaviors and their personalities might be different. They might do things in service of the addiction that they wouldn't do otherwise like steal money to get drugs and whatnot, that doesn't mean that they're bad people. It's that this entity has come over them.
Eating disorders are the same way. Especially if it's involving more anorexic or restrictive eating, your brain is literally not getting... It's not thinking clearly. It's just not getting the nutrients. I mean, when we're malnourished, our brain can get a little wacky. It's like sleep deprivation. If we are sleep deprived, our brain is not thinking clearly. We can't regulate our emotions as well.
This is on top of people with ADHD but we already have a higher than typical degree of emotional dysregulation. But the nature of an eating disorder is... So in psychiatric diagnoses, we refer to symptoms as ego-syntonic or ego-dystonic. So ego-dystonic is when the person is like, "There is nothing in this that I want." When people are depressed, it's very ego-dystonic. I don't want to feel this way. This is not who I am. I want to get out of this. It's only reward and getting better is only reward.
With addiction, with eating disorders, there's an ego-syntonic quality which means the part of the disorder is people resisting treatment. Because the fear is, "If I am not in this, then A, what am I? B is I'm going to lose something with recovery. I'm not gaining. I'm losing something. I'm losing control. I'm losing my bodily autonomy. I'm going to gain weight. I'm going to..." So even when we talk about treatment, their version, your version even with the nutritionist is like, "What is the goal here? Because your goal is different than my goal," and I've heard that from many patients.
I mean, even patients with body dysmorphic disorder first session, part of the nature of BDD is people who don't think they have BDD. They think they're ugly. They just think they're actually inhuman looking. And so, I'll have patients that are like, "I don't have BDD. I'm just really ugly and if you're trying to convince me otherwise, this isn't going to work so I don't know what to tell you. I really should be at a plastic surgeon because to fix... If I was in a car accident and my face was deformed, you would probably have me go to a cosmetic surgeon. Well, that's what I look like."
So the nature of the illness and the diagnosis is that and so it has to be in a very measured approach and approach of compassion and understanding, "Okay, where can we join here? What part of this can you agree is not working for you?" and it might not be the main thing that everyone around her or him thinks is the most important thing but anything that could be.
I remember with one patient, I worked with a young male, he had severe case of anorexia, and the thing that got him in was he... You don't sleep well when you don't eat well, they go hand in hand. He was really bothered that he wasn't able to sleep well and I'm thinking, "Okay. That's not the biggest issue here. I mean, the biggest issue is you're not sleeping well because you're not eating well," but at least that got him through the door and we started working on his sleep.
And then, I was educating him about how sleep works and how it's coupled with metabolism and with eating. But more importantly, it's what is someone hoping to get from the eating disorder? Because eating disorders are not just about food and weight and you spoke to that beautifully, Paige, and what you said is control, it's structure, it's all these things. So then, when you can tell a client, "Oh, I totally understand those things. There's a being in control and having less anxiety and all that, we can get to those places but without damaging your body," and that's the sell that we're trying to help people understand.
Paige Kinzer:
Well, because I think it's interesting too how you said about comparing it to almost like an addiction is I think that's one of the reasons why I was so against treatment because I was treating it as if like, "Well, I could stop if I wanted to." I didn't think I was sick enough. I didn't think I was actually like that. I thought I was going to be a lot worse before somebody was going to say something to me. And so, I just thought, "Well, if I wanted to eat, I could." Like If I wanted to gain weight or if I wanted to stop, it would be so easy for me too. But that was never the case, I just convinced myself that I was fine and that I was able to stop if I really wanted to. But no matter if I had ever tried to stop, it never worked and I could never actually stop but I just continued to refuse treatment because I didn't want help.
I didn't want to stop. I know that like you, my mom would cry to me and people would say they're worried about me but none of that cared to me. I didn't mean for it to come off as rude or that I don't care about your feelings. But truly, I didn't care at all that she was sad that I was skinny. I was happy. I was like, "I'm glad you're noticing. Thanks, dude." I didn't want help because I wasn't done yet. I wanted to keep going. I wanted to be smaller because I didn't know how small I was until now. Looking back at those photos now, I never thought I looked like that once until now.
Roberto Olivardia:
What we find, particularly with anorexia, with restrictive eating disorders, is the more weight someone loses, the more distorted their body image gets so the more farther away they actually feel from their goal. That sometimes is the bottom that people can hit is they're like, "Wait a minute. I thought 20 pounds ago I was going to feel happy and now I've lost even more weight and I'm less happy. This isn't working," and you've reminded me just when you said sick enough, there's a fantastic book I would recommend by a colleague of mine. Do you know that book called Sick Enough?
Nikki Kinzer:
I bought it. Yes.
Roberto Olivardia:
It's a Jennifer Gaudiani.
Nikki Kinzer:
Yes.
Roberto Olivardia:
She's a fantastic clinician in Colorado and she wrote this book called Sick Enough because a lot of people, what prevents people from getting treatment sometimes for eating disorders is fully identifying that they have an eating disorder because they're looking at the TV movies of people who are in the severe like life and death stages of eating disorders that they're like, "Oh, I'm not that. I'm not emaciated where I'm falling down all day," or, "I'm not purging 10 times a day like that character in that movie. I'm only doing it once a day."
In that book, she outlines beautifully all of the systems of the body. She literally goes circulatory system, the cardiac system, and how even behaviors that people might even see as subclinical which is a very misleading term because we think of subclinical as not as serious and that's not true at all. It's just as life-threatening. But let me ask you, Paige, what turned around for you? When did you want help? What changed?
Paige Kinzer:
I think one of the biggest things that I noticed with my eating disorder was how scared I was all the time. My anxiety was always at 100%. I would be home alone and I would so badly want to take my dog for a walk but I couldn't physically get myself to go outside because I was scared of getting kidnapped or to get hurt. I never thought I was skinny. I never thought I was actually small. I knew I was weak. I knew I couldn't get out of bed easily in the morning. I knew how weak I was and my fear that if somebody were to see me and grab me, that like I know. I accepted that was my faith, that I wouldn't be able to fight back. I look weak and I know I am weak because I was used to being strong.
I was once strong. And so, now that I wasn't, I knew that I wasn't strong, I knew I was weak. So I had a few moments where I was in a situation where it's like I couldn't do anything. I was just weak. I think the times that I felt so bad about myself and I felt so scared is what kind of made me like, "I don't know if I can keep doing this," and I had completely changed my life by... I switched to online school but a few months before that, I had started working and I had noticed that my first week of work that I couldn't go five to six hours without food. It was hard for me. I couldn't learn. My manager would be trying to train me and I couldn't really comprehend what was going on because I was just so hungry and fatigued and ADHD.
Nikki Kinzer:
I mean, you're taking all factors, right? Yeah.
Roberto Olivardia:
Absolutely.
Paige Kinzer:
I couldn't get it and I had surrounded myself with different people, especially now that I was at a place in a completely new area of work with people I've never met in my entire life. That was hard because I was just so used to being around the same people that now, there's all these people who are older than me and don't know me. Even one of my coworkers who, I don't work with her anymore, but we became best friends and she said that the first time she saw me, that she thought to herself that she hopes I don't get bullied in school for how skinny I was because she did. She would get bullied in school. When she had told me that, I took that as a compliment, that made me so happy that she thought that I was skinny and was hoping I wasn't getting bullied for it. It's so interesting because me and her talked about that just a few weeks ago how that would be an insult to her but for me, I took that with pleasure. I was like, "Thank you so much."
Roberto Olivardia:
Yeah. But it shows how the thinking can get very distorted and that's a very, very common phenomenon. Even in eating disorder residential and in-patient programs that sometimes... Sometimes people absolutely need that hospitalization and we know it's a very common effect in hospital programs where people start comparing, "Oh, I'm not the sickest one," as if the sickest one is the one that wins the award in a sense.
But what I like about what you said is with the weakness part is it sounds like what you uncovered because what the eating disorder promises, and I'm talking about an eating disorder like it's an entity, it's not you, it's something outside you, that the eating disorder promises, "Here's this thing that will give you a sense of control, that will give you a sense of power, that will give you strength, that will give you all of this," and when you recognize how weak you were, it was like, "Wait a minute. I'm not feeling strong. I'm actually feeling so weak that I feel so vulnerable and almost paranoid to someone kidnapping me like this..."
It sounds like something, it's almost the illusion was like the Wizard of Oz curtain was pulled away and it was like, "Wait a minute. This is not... What is this giving me?" like something clicked and that's often what I always hope that what patients can connect to. It's like, "Wait a minute." I remember this young woman, she had a ADHD and vastly with binging, and it would get restrictive, and she's like, "I started this because I wanted people to like me more. I'm an extrovert." She goes, "I wanted to be more socially acceptable and I figured if I looked perfect then..." And she goes, "And now, I realize I don't leave my house because I feel ugly or fat or this or that. I'm not socializing with anyone."
She goes, "So this eating disorder has literally moved me as far away from the original intent of what I was..." She goes, "It's a lie." She goes, "It's a liar. The eating disorder is a liar," and it was like confetti could have been burst in the room and I was like, "Yes, that's exactly," and that was the beginning of recovery. Those are the moments that I always hope that people can connect to is like, "This isn't giving me what I'm ultimately really looking for."
Paige Kinzer:
Yeah.
Nikki Kinzer:
Well, and something that she told me yesterday when we were talking about this is that it was important, and she can speak more to this, about how important it is that the person has to want it.
Paige Kinzer:
Yeah.
Nikki Kinzer:
Because I could have told her a million times how worried I was, how loved she was, how beautiful she was inside and out, and it wouldn't have mattered, right? But there was something that clicked with her that all of a sudden, and she can talk more about this with her coworkers, she surrounded herself with different people and she was hearing things from a different-
Paige Kinzer:
Point of view-
Nikki Kinzer:
Point of view and-
Paige Kinzer:
From a different person.
Nikki Kinzer:
And from a different person that weren't her parents or a therapist or whatever and the timing was right.
Paige Kinzer:
It felt like it wasn't somebody like a therapist who that is what they're there to help me. It felt like it was from somebody who just genuinely wanted to help me or genuinely wanted to inform me on food and nutrition and how important it was. Just like you said, I think one of the biggest things for people who are struggling with an eating disorder or know someone is that you have to be the one to decide that you want help. People can want that. People can want you to decide that but you have to be the one. That I would've never have healed or started to move on if it wasn't for me being like, "I can't do this. I can't keep doing this to myself. I feel terrible. I'm not happy. No matter how skinny I'm getting, I will never be satisfied."
And so, I feel like what really changed my outlook on it was realizing that I'm not happy and I don't think I ever will be. I thought that I was going to be struggling with this feeling and that depression for my entire life and never thought things were going to get better. I kind of just accepted that, "Well, this is my life. I'm a sad person," but then I was just like, "I don't have to be sad." Because you would have moments when you're depressed that do make you smile and you do have joy and I took each one of those moments and realized that I can have more of these, I'm just not trying. That I can be happy if I tried. I want to be able to go out to dinner with my friends and not have to make it miserable for myself by trying to find the calories on the menu. I want to be able to have fun without obsessing over something.
Roberto Olivardia:
I just commend you, Paige, just for your courage in sharing your story because when people who are struggling hear from people in recovery and hear from people who have known that journey, it has an extremely powerful impact. I mean, I think that visibility is so important and you're describing the experience in such a way too, that will just resonate with so many people.
I think what you said is 100% true that you have to get to a point of wanting the help, feeling you're worth that, and really exposing in a sense, the eating disorders that this isn't actually getting me to where I want to go. Clearly, you got a lot of support from your family and I think and I empathize with you, Nikki, because as a parent it's like, "Oh my god. It is..." With the parents that I work with, it's torture. I mean, you see your child engaged in this and it's not like you can shove food down somebody's throat in that way. It's a lot of patience and love and trust and of course, the right support so I just commend your courage in sharing your story.
Nikki Kinzer:
I do too.
Paige Kinzer:
I think another thing too, that's very important that I would like to say is that I know for my parents that they thought that they didn't do enough and that if it wasn't for me to have gone on with recovery, that I would've just died that way or kept like that. But I think one of the biggest things for people who maybe has a daughter or a son or just anyone they know who's struggling with eating disorder, that is not your fault.
They did everything they could. I didn't let them know enough of what was going on that the stuff that they did know, they did do enough. They just didn't know all the behind the scenes and I was refusing treatment. That it was never your guys' fault and nobody ever made me feel fat. No one ever made me feel bad. It's just that it's a whole mind thing. Eating disorders are... It's not just about your body and it's not just about what you're eating, it takes over you. Your entire mind, there's this voice in the back of your head that just keeps telling you, "Don't eat this. Don't talk to this person," or, "Refuse treatment." It was never anyone's fault.
Nikki Kinzer:
Well, what was interesting as part of the recovery piece and I appreciate you saying that, I really do. Because it is hard not to take blame and it is hard to not feel like, "Was she sick enough and I didn't pay attention?" After reading that book, especially, it was like... Anyway, yeah. It's hard, no doubt about it. But one of the things that I think as we start to wrap it up and we start to talk about recovery and where she's at, she was having some health issues and so she had to get some blood work done and she had some heart issues and there were some things going on. I think with the people that are around you that encourage you to be well, not losing weight, not gaining weight, it was more around health and wellness. And so, she started going back into the gym. She started getting stronger. She started eating more. She was a vegan for a long time.
Paige Kinzer:
I was-
Nikki Kinzer:
Do you want to talk about how that changed?
Paige Kinzer:
Yeah. So I went vegetarian for about three, four years ago while I was in an eating disorder because I thought that was going to help me lose weight. I was like, "Cut meat out and that'll be perfect," but I just stuck with it. Even now, I just got used to it and I didn't mind it. I didn't eat meat that much. But then last year, on December or on January 1st, I went vegan on a bet and it was who could go vegan the longest and I won.
And so, I just kept going because I was like, "I really like this," and I was learning so much about food that being vegan, it taught me how to shop for my own food and it taught me how to eat. It taught me what to eat and I realized that with such a restriction of a dietary need like that, I needed to eat food. I couldn't just eat a piece of meat in the morning and be good for a little bit. I had to make sure I was getting the vitamins and the nutrients.
And then, I was also getting into the gym. I was getting into weightlifting and muscle growth. And so, I was learning about protein so I was trying to get protein in which is hard with vegan food but I was able to do it. But then, I got more blood work done because I wasn't feeling good. I got diagnosed with POTS syndrome. And so, I got my blood work done. We went and talked to my naturopath about that and she was just like, "If you have really good reasons to be vegan, then you can stay," but it is just that it became really unhealthy for me. I was malnourished. I was deficient in vitamins and...
Because I was telling them that I feel worse now. I'm eating the most food I've ever had and I am the heaviest I've ever been and I feel worse now than I did when I didn't eat. I had much more energy then and now, I don't have none. I crash in the middle of the day. We discovered that I was all just from my diet. And so, now I'm no longer vegan and I eat meat and the past two weeks, I feel so much better. I feel great. I'm eating good food that's not processed chemicals made into fake meat.
Roberto Olivardia:
Yep. No, but there's something... Unfortunately, I know we're out of time but a colleague of mine, James Greenblatt who does actually work in ADHD world as well as eating disorder world, he's here in Boston. He did a webinar recently. He strongly feels that any developing individual should not be a vegan because he does a lot of work actually with supplementation and with diet and minerals and things like that and there are a lot of proteins and things like that... I was a vegetarian when I was in high school and it did not work out for me either. I was big into animal rights, that was the main thing that brought me to that and it wasn't good.
I was eating... Now, this was at the time where carbs were like, "Oh, there's no fat in carbs," and I was eating tons of carbs to make up for protein. I wasn't really eating and it wasn't good for my metabolism, for my weight. And so, meat is not a bad thing. It's just everything, regulation, moderation, and it's what you're eating with it. It's maybe the french fries and it's, again, not that we... It's like, "Oh, I should never have french fries," but it's just eating things in moderation so it's really important. I think past development, after 30, if someone wants to be on a plant-based vegan diet, studies show it might not be as negatively impactful but you have to still be really careful and aware of that. So I'm glad to hear that you've incorporated that and you see the difference.
Paige Kinzer:
Yeah. I realized that I would rather be healthy and feel good than just continue being vegan because I've been doing it for so long. So it was a hard change but I did it.
Nikki Kinzer:
Well, I think one note that I want us to leave on is when we talked, I talked to her about what do you think about your recovery? Are you in recovery? How does this feel?
Paige Kinzer:
It's not consistent.
Nikki Kinzer:
Yeah. So why don't you talk a little bit-
Paige Kinzer:
I-
Nikki Kinzer:
That voice.
Paige Kinzer:
Yeah. I think of it as a way of grief that it's not consistent. It's not a five stage process and how I do eat now and I work out and I make sure I'm fueling my body and I take good care of myself but there is always that tiny voice in my head that will never go away. I am carrying the weight of my eating disorder with me probably forever that I don't listen... It will say it at the end of the day and I've eaten a lot of food and I just have to keep reminding myself that this is okay, that I did eat a lot of food today but I also went to the gym and I worked and I did a lot today that I do need this food.
Especially with looking at my photos from when I was deep in an eating disorder, I still will sometimes think, "If I didn't think I was skinny then, is my mind twisted now?" I'll look in the mirror at the gym and I think like, "Is this really what I look like?" I double guess myself. I get confused and I get sad. Sometimes I don't like how my body looks and sometimes I do. Sometimes I think I'm too fat and sometimes I think I'm too skinny, even though I'm not any of those, honestly.
So I think recovery I is, I'm not fully recovered and I don't really know if you ever fully recover. I think that you can but there is always that little piece of you that won't go away because it took my entire life. I didn't know who I was. I let that be my identity was that I was skinny and I don't think that reminder will never go away. I'll be doing something now that I would never have done two years ago and I just think, "Why am I doing this? I was so against this. What am I doing right now?"
Roberto Olivardia:
Mm-hmm. Well, I think that you speak to what the common experience is when we think about what recovery is and I have worked with people where it truly is... They don't have that voice in their head anymore. They did for a long period of time. But again, making that analogy with addiction, it's, I think, very similar. There are some individuals where it's a day by day by day by day process. Even though they're 40 years sober, they feel like it can derail if they don't watch their skills and work on what they need to work on. And then, there are other people I've worked with where it's so detached from their identity and they almost feel like it was a different person.
But I think that's so important to mention, it can be varied and the fact is that having the presence of that voice doesn't mean you're not in recovery. It doesn't mean you're not healthy. Because honestly, for anybody, we can replace whether it's a voice about our bodies or just an ADHD, a voice about ourselves. "You're stupid," or, "You're this or you're that," and we can be like, "Yeah. You are just a negative thought that's not helpful. What I am doing is I'm fueling my body. I'm at the gym, I'm connecting with people," and you look at the data that's in front of you, but that's exactly right. With eating disorders, it gets so intertwined. And also at a developmental period in life where identity is just developing in puberty. So they get so intertwined that it can take a while to really undo that, to be like, oh, wait a minute. Yes, this is the new me, the person that goes to the gym that is eating this food and this is, this is me. Feels a little funny from who I, who the me was, you know, two years ago and maybe like you said, those thoughts will be there and it's just counteracting them. And at the same time, you might be surprised that one day those, that voice gets smaller and smaller and smaller and smaller because your life gets bigger and bigger and bigger and bigger.
Nikki Kinzer
And I know people can't see this, but when you said that Roberto, she was smiling... I could see you looking.
Yeah. Yeah. But I can see that there's that, that smile of, oh, when, you know, I'm, I want that. I'm ready. I'm ready for, I'm ready for that. But you know, something that she said when we were talking about the show is that she said I was ready to fight this. I was ready to fight the voice. And I think that's really, you know, telling that she was ready, it be done. Ready to live a life that I was supposed to, you're. Dad and I and your family love you very, very much and we're very, very proud of you. And, uh, thank you so much for sharing your story, Paige, because I, I think Roberto is right, it's gonna help other people. I hope it does. Shed some light on awareness around ADHD and eating disorders.
And Roberto, oh my gosh, thank you so much. Thank you for being here.
Dr. Roberto Olivardia
Oh, you're welcome.
Nikki Kinzer
Its great to meet and yes, and having this conversation, as I told you at the conference, I didn't want anyone else but you. And I just really appreciate you being here. Thank you. Thank you so, so much.
Dr. Roberto Olivardia
Well, thank you for the opportunity to be here. And it was nice to meet you, Paige, and, and again, I, I'm in awe in of your story and I tell people, anyone who's in recovery, to know the amount of strength that it takes to do that. And I always tell patients that when they encounter other things that might throw people, you're gonna be like, you know what, I got this. I've been through a whole lot worse and have navigated through that. And there's, you know, there's growth that comes from that. And so I, I wish you well in, in your recovery and really happy to be part of this conversation.
Pete Wright
Nikki, I have to tell you, I know Paige is a star. She's amazing. And the way she talks about her story and the vulnerability with which she shares these things is, uh, is extraordinary. I was really moved at just how many of the points were made that line up with my experience with my relationship with food, frankly, like I've complained about my relationship with food for years and had no idea that this was the kind of thing that we were going to be hearing about today, not even a little bit. I don't think I truly understood what an eating disorder was, and what disordered eating was. That was such a great question that you asked and, and explored. So how do you feel now that you've done it?
Nikki Kinzer
I feel great. I feel that it couldn't have gone any better.
We were both really nervous going into it. And as being her mom, I was really nervous because I didn't know how much she wanted to share or what she felt comfortable with and, but I let her lead and and she was a star. And I think that there was more she could have said if we had longer time.
And it and same thing with the doctor. This conversation could have gone for a long time cause there's just for sure so much to it. But no, I feel really good about it. I think that one, one thing that I would want to say that I didn't have a chance to really talk about because we were running out of time, is Paige is in recovery.
She is in therapy now. She is not refusing it. She actually asked to go to a therapist. It's not necessarily around her eating disorder and ADHD, although those things I'm sure come up, but it's just, it's hard being a teenager. And and she is seeing a therapist. She also continues to see a doctor and she's seeing a holistic doctor right now too, because she was having some health problems. She mentioned at the end that she was diagnosed with POTS and that has a lot to do with your heart, right? Everything to do with your heart and and the symptoms. She just wasn't feeling good. And so we're glad that she's changed her diet to put some more protein and iron and things that she was not getting so right.
I would say she's in recovery. I'm so proud of her. It's one of those things that you just wanna hold onto just, I don't wanna go back. Yeah. So I just hope that, she keeps fighting that voice that she hears every day and that she keeps winning. Because right now she's winning and I just want her to keep doing that because it's so important to take care of yourself, your mind, your body, all.
Pete Wright
Such great thanks to Paige and Dr. Oliveria and you, mom, for doing this and for making it happen. Because I think it's a truly valuable conversation.
I know I got a ton out of hearing it and then editing it and it's really great. So thank you. And thank you to everybody for downloading, listening to this show, the whole thing, if you got to the end, you're fantastic. Yes we sure appreciate that. And again if you want to hear any of the goodies join us on Patreon at patreon.com/theadhdpodcast.
Nikki Kinzer
And one more thing, Pete, before you leave, if you want any more information or you need help either yourself or somebody you love or care about, we do have the suicide hotline in our show notes. Yep. And we also have the Eating Disorders hotline on our show notes as well.
Absolutely. Find all those in the show notes. Store on the website door and Patreon. We've got it everywhere or in discord. We'd love to see you over there, so thanks everybody. On behalf of Dr. Roberto Olivardia and Paige Kinzer and Nikki Kinzer. I'm Pete Wright. We'll see you next week right here on Taking Control the ADHD Podcast.
