Nina Savelle-Rocklin, Psy.D. is a Los Angeles-based psychoanalyst who specializes in weight, food and body image issues. She is a recognized expert in eating disorders, interviewed and quoted by the Los Angeles Times, Prevention, Real Simple, Huffington Post and many other publications. She is considered a thought leader in eating psychology, and contributes regularly to the Eating Disorder Hope website and the National Eating Disorders Association blog.
Dr. Nina brings a fresh perspective to the treatment of disordered eating, helping people understand "why" they turn to food instead of focusing on the behavior itself. She writes an award-winning blog, Make Peace With Food, hosts a popular podcast, Win The Diet War with Dr. Nina, (voted “New & Noteworthy” by iTunes the first week of release) and offers "food for thought" on her video series, The Dr. Nina Show. She is currently writing a book for Rowman & Littlefield on the psychoanalytic treatment of eating disorders. For more information, please visit www.winthedietwar.com.
Our culture is obsessed with dieting. What is your opinion about diets and healthy ways of losing weight?
I often say there’s a reason the word “die” is in diet. Diets work, until you go off them, and they ultimately kill your mood, spirit, sense of enjoyment and self-image.
Diets fail for both physiological and psychological reasons. Physiologically, diets are often restrictive, which leads to hunger and also a slower metabolism. When you don’t get enough calories, your body goes into starvation mode. Fewer calories come in, so your metabolism becomes more efficient, requiring fewer calories to keep your blood flowing, your heart beating, your organs working.
When you go off the diet, you gain weight because your body needs fewer calories just for maintenance. It’s a vicious cycle.
Also, if you’re not taking in enough calories, or enough of the right kind of calories, you lose muscle – which also lowers your metabolism (muscle requires more calories to maintain that fat). With less muscle, you don’t burn as many calories and you don’t need as many calories. Again, that leads to gaining weight more easily once you’re off the diet.
Essentially, dieting often makes people gain weight more easily.
In terms of the psychology of eating, which is my area of expertise, ultimately, diets fail because diets only deal with food. They focus on what you’re eating, not why.
The cycle of losing weight by dieting, then regaining the weight, causes frustration, anxiety, a sense of powerless over their own bodies, and often a feeling of failure. When people use food to cope with painful feelings, the painful and upsetting experience of dieting can actually lead to overeating.
Most importantly, diets do not address the underlying conflicts that make you turn to food in the first place. There are many reasons for eating issues, ranging from using food for comfort, for distraction, to go numb, to be symbolically fulfilled or to express pain (for example, people who eat until they are in pain may be unconsciously converting physical pain to emotional pain).
Dieting keeps you in a perpetual battle with yourself. In my experience, when people stop dieting and start tuning into their thoughts, emotions, needs, wants, and attend to other areas of their lives, they lose weight naturally. By making peace with yourself, you make peace with food.
How would you say body image contributes to eating disorders?
I once posted a graphic on my Facebook page that read, “If he’s only interested in your legs, breasts or thighs, send him to KFC.” And although that quote was specific to women, the idea that we are more than our bodies is one that we must challenge as individuals and within our culture.
Body image can definitely be a contributing factor in the development of eating disorders, because it pertains to a person’s sense of self. When people don’t feel good about themselves, they may try to change their bodies as a way of feeling better about themselves.
Eating disorder behaviour is a way of trying to resolve a psychological conflict through a physical action.
People often think that when they lose weight, their lives will improve, and they will be more confident, outgoing, and relaxed. They believe that by controlling the number on the scale, they can manage many aspects of their lives, including their likability.
Weight can symbolically represent the qualities you want to get rid of – such as shyness, insecurity, anxiety, and so forth. Viewed in this way, losing weight becomes equivalent to losing those unacceptable “parts” of yourself.
It may be less painful to focus on losing weight than think about shedding disappointments, fears, concerns, worries, and anxieties. Staying focused on body image therefore distracts from difficult thoughts and “weighty” emotions that need your attention.
In your experience, what else causes eating disorders? Do people look to food as a substitute for relationships with others?
People often ask me, “Why food? Why is food my thing?”.
My answer is that as human beings, our first experience of love, bonding and relationship is the experience of being fed. On a primal level, turning to food is an unconscious way of recapturing the blissful state of union that we experienced as babies, while being nursed or fed. By “unconscious” I refer to the aspects of our minds that are out of awareness but not out of operation.
Sometimes eating is a way of avoiding emotions. Sometimes it’s a way of expressing emotions. And sometimes it has to do with not fully trusting relationships.
Maybe it’s hard to trust that the person you love or care about will be consistently available. Maybe you don’t like separation, and you’re worried that “out of sight” leads to “out of mind.”
Maybe you binge because you’re “hungry” for love but you don’t trust love. You may fear on some level that you’ll never get enough or be satisfied in a relationship. People can be unpredictable and unreliable. They can lie to you, cheat on you, disappoint you, annoy you, and they can change. Unlike people, food is always the same, and always available.
If you feel safer with food than with people, it’s important to explore your anxieties or expectations about relationships. When you trust the bond of a relationship, you are less likely to use food as a substitute for people.
Maybe you’re powerless in other areas of your life. It’s easier to focus on your intake of food or your weight than to deal with an unpredictable boss, teacher, significant other or friend. You can’t control a person but you can try to control yourself, turning a relational issue between you and someone else into an internal conflict between you and food.
Control is also a way of protecting yourself from feelings of vulnerability. That’s a difficult feeling for everyone, but especially for guys, who are taught to be tough. Man up, and all that. Trying to control food feels active and is a solution to the passivity of vulnerability.
When you deal directly with the conflicts in your life, whether it’s a conflict with another person, or with an emotion, then you’re less likely to cope with it indirectly – with food.
You also have had your own personal experience with eating disorders. What was that like for you and what helped you to realize you needed help?
One of my earliest childhood memories is looking at my thighs and thinking that they should be smaller. I was a perfectly normal weight child. I was also five years old.
I grew more obsessed as I got older. My teenage diaries list all the food I’d eaten, and calories burned, with vows to get smaller. I fell asleep counting calories and fat grams. I woke up thinking about what I was going to eat, and not eat.
I alternated severe restriction and deprivation with bingeing and later, with purging. I later went to therapy, discussing my relationship issues, talking about my parents, my friends, my dreams and my fears. I was open with my therapist about every aspect of my life - except one.
I never told her about my eating disorder behavior.
At the time, I did not want to change. My ability to restrict made me feel superior to other people, and special, and I did not want to give that up, even though the inevitable bingeing made me feel worthless. My struggle was too shameful to admit to anyone, including my therapist, so I waged my war with food in private.
Several months into therapy I began to notice that things were changing. Restricting food no longer made me feel superior. Instead, I felt deprived. I started to feel hungry - for food, for life.
I became aware of feelings that I had denied. In therapy, I learned to process those emotions, rather than deny them. I began using words to comfort myself, and talking to myself in a supportive way, instead of criticizing myself.
Not once did I reveal to my therapist what was going on with food. Not once. And, by the time I left therapy, my eating disorder behavior had vanished.
How was this possible?
My eating disorder was an outcome of my harsh relationship with myself. In therapy, I learned to cope with difficult situations, instead of using food to distract from them. I learned to soothe myself with words instead of using ice cream or cookies.
What are the warning signs and what can a young person do if they notice themselves developing disordered eating behaviour?
Your question brings up an important point, which is that young people are not the only population who struggle with disordered eating. In my private practice I treat several men and women in their 40s – 70s who struggle with these issues, and have done so for decades. So, whatever a person’s age, if he or she recognizes that they have an unhappy, unhealthy relationship to food, the best thing to do is realize that whatever is going on with eating, it is a “symptom” of an underlying problem or conflict (although it definitely feels like “the” problem).
It’s important to attend to one’s emotional and physical health, and to see a psychotherapist who specializes in eating disorders to address the underlying reasons why you are turning to (or from) food. Therapy helps people understand and recover from eating disorders. The process helps people develop new ways of coping with stressful situations by learning to identify emotions and conflicts and learning to respond in different, healthier ways.
Warning signs include:
- Food disappears from the house at a faster-than-normal rate (people struggling with binge eating or bulimia often create elaborate excuses to explain the disappearance of food, explaining that the food went bad or fell on the floor and had to be thrown away).
- Frequent statements such as "I'm not hungry" or "I just ate".
- Going to the bathroom after every meal.
- Frequent complaints of stomach problems (laxative abuse is a common method of purging).
- Rapid weight loss or weight gain.
- Focus or fixation on body image, clothing size, comparisons to others.
- Sudden interest in becoming vegan or vegetarian, with extremely strict rules about diet.
- Excessive exercise.
- Withdrawal from friends and family, increasing isolation.
- Moodiness and an insistence that nothing is wrong.
What can our culture and society do to address our relationships with food?
I recently read a fascinating book called The Body Project, by Joan Jacobs Brumberg, in which the author looked at the diaries of girls over the last hundred years or so, and noted the shift in what the girls were talking about in their diaries. In the past, girls were concerned with being good, moral, decent people. Over the last few decades, girls write primarily about their bodies, their size, and their appearance.
This is a significant problem in our culture, which privileges the body as the primary self. We have to remember that “our bodies” are part of our overall sense of “ourselves” and do not define us. We must attend to those aspects of us that are more than physical, those qualities that are intellectual, emotional, relational, spiritual (which can mean different things to different people), creative, and more.
We are more than our bodies.
From your research, what treatments have you found to be successful at treating eating disorders?
This is purely anecdotal, and drawn solely from my personal and professional experience: I think that for most people, psychodynamic or psychoanalytic therapy is the treatment of choice. I have seen many people who benefited from CBT or DBT for a period of time, but their symptoms had returned.
As a clinician, I find that when people recognize what is going on in their heads and hearts, when they learn to relate to themselves in a new way, and have a new experience of relatedness in therapy (Freud once said that psychoanalysis is a cure through love), real and lasting transformation takes place.
Psychoanalytic treatment is not about symptom reduction; it changes the basic structure of a person’s relationship to self and others.
That said, there is a saying that there are many ways to reach a mountaintop, and it really is a matter of what works for what individual.
What can someone do to help a friend or family member that is struggling with eating disorders?
It’s important to know what not to say. Many friends and family members have good intentions but they may actually make things worse.
I recommend that people never, ever be the food police. Comments such as, “Do you think you should eat that?” or, “Maybe you should make a healthier choice” or, “Do you really need a second portion?” are more hurtful than helpful. Those types of observations create embarrassment, shame, guilt and anger. Since people often turn to food for comfort, as eating soothes, numbs or distracts from uncomfortable feelings, food policing actually causes more harm than good.
Logic also backfires. Don’t say, “If you want to lose weight, just eat a little less.” The reason is that what seems like a weight problem or a food problem is usually not about food at all.
Again, whatever is going on with food is a “symptom” of the problem. To stop overeating, people have to identify and work through the conflicts and emotions that lead to overeating. Talking about food or being logical isn’t going to help, because the focus is on the wrong thing.
I recommend saying something along the lines of: “I’m worried about your health. What can I do to help?”
Be supportive, letting your friend or loved one know that you are there for him or her. When you speak in a concerned, in a caring, gentle and non-judgmental manner, it allows others to feel safer to open up.
By communicating effectively, you can better understand the person you care about, and develop more trust and a deeper connection. And that may help your loved one turn to you for comfort and connection instead of to food.
What does healthy eating look like to you?
As my focus and concern lies in the area of psychological health, I would say that healthy eating means a relaxed, attuned relationship to one’s body. To me, healthy eating is honoring one’s hunger and eating until satiated without guilt, fear, anxiety or distress. Healthy eating is being able to enjoy food without feeling “good” or “bad” about yourself based on what you have eaten.
Ultimately it’s about being able to take in the food of love, as well as actual food. When you stop battling your needs, wants, emotions, and thoughts, your healthy relationship with yourself will be reflected in your relationship to food. And that, as I like to say, is how you win the diet war.