How We Cope: Food and Eating Disorders at Work

MORRA AARONS-MELE: I’m Morra Aarons-Mele, and this is The Anxious Achiever. Each episode, we look at stories from business leaders who have dealt with anxiety, depression, or other mental health challenges, how they fell down, how they pick themselves up, and how they hope workplaces can change in the future. When my producer, Mary, and I were discussing ideas for an episode that brought to life how people cope with uncomfortable feelings and anxiety. We asked ourselves the question, “What story would we want to hear?” We were sitting in a Starbucks on a Tuesday morning, and we both just said at the same time we want to hear about someone’s struggle with an eating disorder, we want to know about eating disorders.

Why? Well, that might take hours to unpack, but let me just say this. I defy anyone, women and men, living in a society with plenty of food to tell me they eat only when they’re hungry, that they always listen to their body, stop when they’re full, never think about how they look or dieting, et cetera. I’m an American cisgender, white woman in her 40s. I have been on a diet quite literally since I was 12. When I was younger, my eating was more about the desire to fit in because I was 6’1 in seventh grade. And I was large and felt very unfeminine, and I felt, for many years, unworthy of love. I’m still working on that one. When I got older though, eating became about control, soothing, all the feelings. “Eat less, you’re in control, you’re fierce, you got this.” Binge or reward yourself with food? Oh, that means you’re letting go, either to smother bad feelings or feel a release of sorts.

Of course, then you wake up with guilt, and you have to regain the control, fast that day, and exercise a lot. Now, I do that a little bit with alcohol, which I’ll talk about in a bit. I don’t think I have a full-blown eating disorder anymore, but I have disordered eating. I probably think about my weight, my food intake, and my time spent working out for cumulative hours each day. If I have a scary work event coming up, I will diet so I feel more in charge of the situation. I’m a little obsessed with my food intake and my exercise and my clothes and how they fit, and it’s all about control, and it gives me something to focus on that maybe isn’t how I feel. And even saying this really ashamed me, and I can’t believe I’m saying it.

It wasn’t until I talked to Melissa Gerson that I realized maybe all the desire to control life through food and exercise was a way to channel my bad feelings and my anxiety. Think about calories, don’t think about the fear that you’re a failure or you’re worth nothing or everything that we’ve talked about on the show. Gerson says eating disorders serve a function. They’re functional, and they’re very intertwined with anxiety and depression. Not to mention, food is a loaded subject in the workplace, whether you’re surrounded by snacks, birthday cakes, anxious about eating with your colleagues, or feeling self-conscious about your body. It can feel like a real minefield for many of us.

So, to talk about all of this, our guest, Melissa Gerson. She is a licensed clinical social worker and therapist who has dedicated her career to treating eating disorders. As the Founder and Director of the Columbus Park Center for eating disorders in New York City, she’s out there working with patients who suffer from eating disorders, and she has her own story of eating and control, which we will hear. Melissa, you have said that eating disorders serve a function to the person who has one, even if it’s an unhealthy one. What is that function?

MELISSA GERSON: There can be multiple functions of disordered eating behavior. Often, people describe feeling that the behavior gives them a sense of order organization, especially when we’re talking about restricted eating. That experience of controlling the food that you consume for some people can just feel like the ultimate in organization, control, and grounding. We also hear people talk about the opposite behavior, which might be overeating. I think most of us have experienced ourselves using food as a way of self-soothing, that classic, “I’m going to sit down with a bunch of [inaudible] and watch some television and zone out.”

For many of us, that can be healthy and fine on occasion. But for many people who struggle with disordered eating, using food as a self-soothing measure or coping mechanism can be really destructive because it’s often, in a way, so effective at helping the individual numb out or disconnect or self-soothe that it serves as the primary coping mechanism at the expense of all others, which would more likely support a healthy and engaged lifestyle.

MORRA AARONS-MELE: So you’re saying that the eating [inaudible] or really controlling your eating gives you a sense of mastery and control, whereas maybe the letting yourself go, whether it’s with a binge or a giant … for me it’s a bowl of Pirate’s Booty or something … it’s that release, that you can feel. It can be both, but both are equally rewarding.

MELISSA GERSON: Absolutely, and I think one of the central appealing factors of the eating behavior for someone who’s stuck in a disordered eating cycle is the familiarity of it because the behavior can almost become a trusted friend and a closest relationship. So, for example, after a really, really stressful day, there’s almost a looking forward to that comfort and some familiarity of the behavior because everything associated with the behavior is well known and predictable. So, you just know that when you get home at night, and you’re alone, and you have the food there, you know exactly what’s going to happen from there, that there’s going to be this experience of immediately letting go, getting into a comfort zone, having no one to disturb you or upset you. In the moment, you’re free of judgment. The problem is that when that generally pleasurable experience ends, there are repercussions.

MORRA AARONS-MELE: You also say that anxiety and eating disorders can be cyclical, that people might control their food to deal with their anxiety, but that a lack of food can also fuel anxiety, make it worse and even change your brain chemistry. Can you talk about that and a little bit about the relationship between anxiety and eating disorders?

MELISSA GERSON: I think that the most interesting piece of this for listeners might be to hear a little bit about the effects of starvation on the brain. There was a study back in the 1940s, where they had these young army men that were screened really thoroughly for any kind of psychiatric condition. All of the men were really young, robust, healthy guys, and they wanted to see what happened to these men under the effects of starvation. So essentially, they observed the men in a control period for about three months and then thereafter began to cut their calories pretty dramatically and watched what happened to the men under the effects of starvation and weight loss. They observed that these men who had previously been friendly, outgoing, gregarious young guys, many of them, all of them actually, became very withdrawn, introverted. They were isolating. They became totally focused on their food.

When was the food going to arrive? What was the food going to be? If the meal was served just a little bit late, they’d get very agitated. They wanted to talk about recipes and agriculture. Some of them developed rituals around the eating, where they would move the food around on the plate, cut it into small pieces, and savor every mouthful. Essentially, the men developed features of anorexia under the influence of starvation. So, it really tells us so much about the eating disorders that we treat because the brain essentially is under the influence of starvation and changes functionally and structurally, so that it leads to a whole host of symptoms that are what we really consider the core symptoms of anorexia.

Now, that’s a pretty extreme example and that for many people, you’re not starved in a starvation experiment. But for those of us in the treatment field, first off, we really understand anorexia very differently because of a study like that, and we really know that refeeding is essential because so many of the problem behaviors and problem, feelings, experiences, and cognitions really are going to be corrected through feeding. Feeding alone, restoring weight and feeding.

MORRA AARONS-MELE: Wow. Wow.

MELISSA GERSON: Then on a broader level for the general public, what it also tells us is that if we’re going to fiddle with our bodies in a way that many of us do through dieting or different kind of fat experiments with food, we really run the risk of causing more problems than we really would anticipate, in particular, when we begin to push our bodies toward the very bottom of our healthy weight range. If you think about the body as this really well-run machine, it’s really got a happy place. Within that happy place, the body has a sense of equilibrium. It knows it’s getting the food that it needs. But if you begin to trend toward the bottom of that range, well, that’s where the brain can kick in and say, “Hey, something’s not right here.”

MORRA AARONS-MELE: One thing though that it seems to me is that I’ve known a lot of people just anecdotally, and even myself, who in a time of anxiety may start rigidly controlling food intake.

MELISSA GERSON: Absolutely.

MORRA AARONS-MELE: Why do we do that as humans? What does that give us?

MELISSA GERSON: Of course, in our lives, there’s so little that we can control, and food is such an easy target, in the sense that it’s around us all the time. It’s something that we as a society are very focused on. So, there’s endless information and access to information about food, and it’s so quantifiable. You can measure in calories, fat grams, and carbohydrates. There’s this way that you can just completely pick apart food in such a way that you can create any kind of manipulation you’d like to satisfy your interest. For example, if you’re someone who really wants to be healthy and maybe even have some anxiety about your own health, you can begin a mission to improve your nutrition, and you can read endless articles online and really bathe in the excitement of all of the different healthy food options that are out there.

MORRA AARONS-MELE: And not get judged for it either, frankly, right? People aren’t going to negatively judge you.

MELISSA GERSON: Exactly.

MORRA AARONS-MELE: … if you say, “I’m going paleo,” or whatever.

MELISSA GERSON: Exactly. In fact, in our society, oftentimes we admire people who show that commitment or that ability to restrain themselves in that way to resist pleasure. In some ways, we elevate people in our society who are able to follow these kinds of more extreme approaches to eating.

MORRA AARONS-MELE: I want to ask you a question actually about food at work and how it fits into that sort of display. I remember when I was first working in media in New York City, and I was very young, and I just observed people naturally, that a lot of the really senior women would barely eat at events, and I would of course be digging into my dessert.

It wasn’t done. I want to talk about food at work and maybe how you might counsel a patient who’s dealing with some anorexia control issues. I mean, we spend so much of our waking moments and mealtimes at work, and we share meals with colleagues and clients. There are tables of free food, as you said. But also, we want to be controlled. We don’t want to show weakness. Women, especially I think, don’t want to eat too much, or enjoy food too much, or seem out of control in front of other people. How does someone who’s dealing with this in their head get a handle on food at work in a healthy way?

MELISSA GERSON: It’s so challenging, and it starts young. I’m working right now with a girls’ school in Manhattan, and the teachers are reporting that the girls aren’t eating at lunch, and there’s this social contagion experience going on where because certain girls aren’t eating or are eating very little, others feel like they need to follow, and so you feel really embarrassed and ashamed to admit or to give in to your own hungers in front of … in an environment that’s so meager. I think that comes up for adults as well. Males, females, all of us. There are so many … I think that people are so quick to make judgments about others based on their observations of how others eat. So, “Oh, you look so healthy. Oh, you’re such a healthy eater. Oh, you’re slender. You look so healthy.” There’s this association between what we observe on the surface and broader judgments about who the person is and how healthy their lifestyle is.

MORRA AARONS-MELE: And how much in control they are, frankly.

MELISSA GERSON: And how much control they have and how disciplined they might be, right? These are all qualities that are admirable, disciplined, focused, the ability to put off pleasure in order to accomplish something. I think in terms of being in an environment where you’re aware of judgment and you’re self-conscious about your eating based on what others are eating, I think what we always go back to is that we all have to really be tuned into our own personal needs and, as much as possible, try to be true to ourselves and our own needs. I know that that’s much easier said than done, but that’s, of course, I guess, the goal.

MORRA AARONS-MELE: I will share an anecdote, which is that I’ve been going through just a horrible anxiety time, and I’ve lost probably about 10 pounds. I get so much positive feedback. What I have been saying literally is, “Oh, it’s the anxiety diet. I’ve been having panic attacks. Would you like them?”

MELISSA GERSON: Right. Yeah, and people probably respond with, “Yes, I’ll do anything.”

MORRA AARONS-MELE: I had a dear family friend who was a lifelong dieter, and she got cancer. When she had chemo, she said, “I’m finally skinny.”

MELISSA GERSON: Oh my goodness. Yeah, that’s horrendous, right?

MORRA AARONS-MELE: Yes.

MELISSA GERSON: It just says so much about our culture and this thin ideal that has been drilled into our heads since we were itty bitty.

MORRA AARONS-MELE: Why did you get into this work, Melissa? Do you have a personal history? Is this personal for you?

MELISSA GERSON: Sort of. I actually came from a totally different career. I was a ballet dancer for many years. I trained in middle school and high school, and then I joined a ballet company after I graduated high school, and I danced professionally for seven years. During those years in the company, obviously in a pursuit like ballet, there’s so much pressure on appearance and line and body shape and weight, and there’s absolutely, without question, promotion for those dancers who are more on the slender side. Damned is a world where you are going to get more opportunity if you fit the part. So, I really worked very hard throughout those years as a professional dancer, working to fit the part and really struggled because keeping your weight down to that level really requires constant focus and attention on what you’re eating and what you’re not eating. Ultimately, for that reason and a few other reasons, I left ballet but left with a real interest in eating struggles, eating difficulty, maybe also working with artists, dancers, and other artists as well from the psychological perspective. That’s when I really began my journey into psychology.

MORRA AARONS-MELE: It almost seems like a stereotype to ask you this, but is a certain quest for perfection a common thread also among your population?

MELISSA GERSON: I would say so. There’s a typical temperament that we see particularly with anorexia. Most of our clients with anorexia tend to be, as you mentioned, highly perfectionistic, very driven, very comfortable with things that are more familiar, more introverted, very thoughtful as opposed to impulsive, deriving a lot of pleasure and calm from a sense of order. Those are the features that make an individual more likely to latch onto food and control of food and body weight as a way of coping.

MORRA AARONS-MELE: How might someone who’s equally Type A and driven, but overeats, manifest? What’s a storyline that you see there a lot?

MELISSA GERSON: I think oftentimes that drive, focus, and perfectionism unfortunately have some consequences which can be in general just more tension buildup and a higher stress level, and it calls on the individual to need just a lot of skills to be able to cope and manage with the feelings that come up when you have that kind of very perfectionistic-driven success-oriented mindset. At times, all of us struggle to find healthy ways of coping and food can become … is the most immediately available tool, and it can be very quickly learned that it is effective in self-soothing. When we eat, there are neuro-biological changes that occur that, for many of us, lead to a feeling of wellbeing, right? When you’re hungry and you eat, you feel a sense of reward. So, it’s not so hard to see how that loop can be really appealing.

MORRA AARONS-MELE: At HBR, we have a truly global audience. So, listeners who live in different cultures might be listening to this conversation and saying, “These people are crazy. Why do they want to be so thin?”

This is probably a pretty Western-centric, certainly American, phenomenon. I did want to say that. Someone’s listening out there, and they are functioning, they are going to work, they may or may not, if it’s a woman, be getting their period, they haven’t been hospitalized, right? They’re still functioning, but they’re listening to the show, and they’re thinking, “Wow, this sounds like me.” I guess my question is what are the signs that people need to pay attention to if they’re concerned about their disordered eating or about how their anxiety might be feeding into eating, and vice versa?

MELISSA GERSON: I think the first thing is that it’s so important not to expect an eating problem to look like anything in particular. So, you don’t have to have a skeletal frame to have an eating disorder or to deserve and need help. The most important thing to remember is that eating disorders absolutely come in all shapes and sizes. If food and weight is taking up headspace and getting in the way of other pursuits that are important to you, then it means you need help. These are conditions that are actually quite treatable, and it’s just devastating to think that so many people suffer alone without getting adequate support so that they can address the problem and move on. I truly do believe that it’s possible to fully recover, that a life free of the burden of food and body obsession is absolutely possible, and there are treatments that are time-limited, very focused, and concrete that are really structured to create sustained behavior change.

I would say the other really important thing to think about is that you really want to make sure that if you have a problem that is grounded in behaviors, eating behaviors, that the treatment that you seek is designed to address behaviors. So, while talk therapy is great, where you’re able to gain insight and understand more the foundation of your struggles, if you want behavior change, you really need to engage in a treatment that is absolutely concrete, practical, and behaviorally-oriented.

MORRA AARONS-MELE: What’s that called?

MELISSA GERSON: Well, outpatient treatment for eating disorders is a form of cognitive behavioral therapy called enhanced CBT, enhanced cognitive behavioral therapy, and it’s a treatment that was initially designed for bulimia nervosa but has been expanded to treat across all diagnoses. So, it’s considered the leading treatment for anorexia bulimia and binge eating disorder on an outpatient basis.

MORRA AARONS-MELE: I have another question that is about sort of … it’s a “chicken or an egg” question because every single person I see, whether it’s a doctor or a friend, when you’re feeling depressed or anxious, we’ll say, “Exercise,” right? Raise those endorphins, get rid of that stress, it’s natural Prozac. Yeah, yeah, yeah. But I think that also, and certainly myself as a very controlled anxious person, I feel that for me, exercising is almost like controlled eating. It takes up that headspace, and it becomes a little obsessive. Can you talk about that and how someone who might have these issues should think about exercise as part of their stress management plan?

MELISSA GERSON: Yeah. I think it’s good to take your temperature on exercise and really ask yourself, “Do I exercise when I’m sick? Do I exercise when I’m injured? Do I exercise when I’m really exhausted? Do I exercise instead of doing other things that are important to me?” Those are some really important questions, if you even think for a second you might be someone who uses exercise in a way that might not be health promoting. For many people, exercise can feel like a chore, and it’s almost this experience of forcing yourself through something unpleasant in a way that’s not really supportive of overall health and wellness. So, I think it’s helpful to reflect on your use of exercise and your relationship with exercise and think about the experience, how you feel when you’re doing it, and how you feel afterwards.

I think for people who have a tendency to use exercise in a way that might not be health promoting, it’s sometimes helpful to … you don’t want to throw the baby out with the bath water because exercise can be helpful for your stress level, and it is good for you physically in terms of maintaining strength and cardiovascular health. For people who are on the line between having a really healthy exercise relationship and one that’s not healthy, it can be helpful to think about ways to integrate exercise that might be more community-oriented. So, taking a class, being with other people, focusing a little bit more on some of the other benefits that you can achieve from exercise. There may be skill development that you can achieve through a kickboxing class. So, the focus is not just on burning calories but expanding a skill set and achieving mastery in something.

MORRA AARONS-MELE: If you’re a manager or a colleague who suspects something is going on with someone at work, when it comes to having an eating disorder, maybe they’re very, very skinny all of a sudden, or you hear them throwing up in the bathroom. I don’t know. How do you handle that? I mean, think about it. Even just being in a meeting and someone might joke about someone never eating the brownie or eating too many brownies can have a really triggering impact on someone in a way that they will never see. Food is something in our lives every day as is work together. How do we create a food-healthy, mentally healthy workplace?

MELISSA GERSON: It’s a really great question. In terms of approaching someone with concerns, that’s so tricky, and I think there’s certainly legalities depending on the work environment. In a larger environment, my guess is that concern should filter through HR, and that may be handled in an inappropriate way through HR. In a much smaller work setting, it’s always tricky when a manager approaches an employee about a sensitive subject like this. So, I think as much as people within the workplace can be pulled upon who are close friends of someone who might be displaying behaviors that are concerning, I think my experience with people who have been approached by friends is that generally they really appreciate it. What’s been communicated to me is that so often you can be struggling and that nobody seems to notice or care.

So, having somebody approach you and say, “Listen, I just wanted to make sure you’re okay, because I’ve noticed X, Y, and Z, and I want to let you know that I’m here, and I care about you, and I’m available to talk about it,” that can be really helpful. In terms of creating an environment that’s sensitive to food and body health, I’d say being careful about what you say is never a bad thing when it comes to commenting on someone’s appearance-

MORRA AARONS-MELE: Or eating.

MELISSA GERSON: … and weight and commenting on someone’s eating because you just never know where they’re coming from with it. So, even comments that might seem complimentary like, “Oh, I’ve never seen you put junk food in your mouth, how amazing,” you just don’t know what that means to the person that you’re talking to. So, just always assume that it’s a sensitive topic for somebody else and be sensitive about potentially just backing away from comments on somebody else’s eating behavior.

MORRA AARONS-MELE: Every day at about 3:00 p.m., I begin to crave a drink, a drink of alcohol, not at 3:00 p.m., but I think ahead to around 6:00 when my workday ends, and my mom’s shift begins. I think, “What will it be today? Will it be vodka? Will it be wine, beer, Manhattan, which is my favorite? The truth is, most days it’s nothing because I can’t physically seem to tolerate alcohol anymore, or I will have maybe one gluten-reduced beer. But that fantasy and that anticipation are with me I would say every day. I think that over many years, I have come to look at alcohol as the most effective stress and anxiety relief there is for me. I don’t know if that resonates with any of you. I’ve taken lots of anti-anxiety meds. Everything from SSRI to Klonopin to Xanax, Valium, the lot. But I will admit for me, there’s nothing like that sip of a cocktail. It’s like my shoulders just drop.

While I’m not an alcoholic, I over the years realized that I have built a dependency on alcohol, and it scares the hell out of me. I’ve tried to quit drinking cold turkey so many times and have found that I just can’t stop, and then the more I think about stopping, the more obsessed I am about drinking, and I get really, really, really angry at myself. Much is said if you’re a fan of Winston Churchill. Much has been said and written about his struggle with his depression, his black dog, which it turned out was a nursery phrase that his nanny adopted, I think, for his foul moods. Some people say Churchill wasn’t depressed. How could he have been depressed and done all he did? What is known is that he consumed about six glasses of wine and then six glasses of whiskey or spirits every day. Yet some scholars will say, “There’s no way Churchill was majorly depressed or that he was an alcoholic or had an alcohol dependency. Look at all he achieved.”

Look, I am definitely … I can’t even put myself in the same sentence as Winston Churchill, that great man. But I’ve interviewed enough leaders to know that you never know what’s keeping them going, or what’s keeping them up at night, or what’s keeping their demons at bay. You don’t really know about people’s demons who look very successful from the outside. So for me, one of the things that I am really struggling with and really trying to think about is my dependency on alcohol as an anxiety reducer and stress release. It is really, really triggered by hard days when one of my kids might come home from school with a bad day, especially my special needs kid. Travel. Oh my gosh, travel triggers it and of course anxiety. I’m working through it. I’m trying to have compassion for myself, and my therapist recently said, “So you have a glass of whiskey at the end of the day. Is that really so bad?”

I don’t know. As an overachiever, I struggle with the idea of being dependent on something that is not good for me. Although, I suppose psychopharmacology is not good for you either. I’d love to hear your thoughts on using drinking, or even over exercise, or any other sort of substance or behavior pattern as a self-medication for your anxiety, and maybe we can work on this together.

That’s it for this week’s show. If you like what you’ve heard, be sure to subscribe and submit a review in Apple Podcasts or wherever you get your shows. If you have an idea for the show or want to tell us your story, drop me a note at anxiousachiever@gmail.com, or you can tweet me @morraam, that’s M-O-R-R-A-A-M. Special thanks to the team at Harvard Business Review, my producer Mary Dooe, the team at Podcast Garage and all of our guests who are telling us their stories from the heart. From the HBR Presents network, I’m Morra Aarons-Mele, and this is The Anxious Achiever.