The Link Between Emotional Regulation and Eating Disorders with Megan Mikhail

And Meghan is a PhD student in clinical psychology, and Megan is doing amazing work that you're going to be so stoked to learn about. Megan's research broadly includes the interactions between biological and environmental risk for distort eating, particularly kind of translating that now into a little bit more human how our emotions play a role in disordered eating

and eating disorders in disadvantage and marginalized communities. Megan is super passionate about integrating the research and clinical practice to advanced care for people with eating disorders, especially those who have been underserved. So you're doing awesome work because you're helping us understand how eating disorders and disordered eating come to be. Right. Yeah, well, thank you so much. And you know, I just want to say I think you all are doing really awesome work to kind of talking

about eating disorders and getting that information out there. So thank you so much for having me. Thank you. I mean, our podcast is about a year old actually, but the past year it has become increasingly easy to get people to listen because we are talking about diet culture so much in the media and disrupting a lot of media norms even from body size to color to ability. You know, all these things are being disrupted in such a beautiful way that a lot of people understand how toxic the

skinny mindset is, if you will. But what people don't know about eating disorders is that it's not just the drive to be thin. It can be caused by as you know, a multi fectoral you know, situation. And I love what you're focusing on. So let's kind of just start with your story. How did you get into this work? Sure,

so this work is pretty personal for me. So I was diagnosed with anorexia when I was actually about eleven um and I struggled a lot with disordered eating all through my teenage years and into my twenties UM, both anorexia and kind of binge eating, and for a long time, I think it was a source of shame for me. UM. So eating disorders weren't really something that we're talked about

in my family, UM. I think in part because you know, I come from a mixed ethnic background and my dad's a first generation American, my mom is Mexican American, and it just wasn't something that was necessarily talked about in their families either. So for a long time, I didn't really understand, you know, why this was something that I struggled with, UM and why it was so hard for me.

And that made me really interested in kind of getting involved in research and figuring out why this is something people go through and what are all the reasons that can contribute to it. So one of the things that we know is that eating disorders are really closely related to other kinds of disorders moved off in things like anxiety or depression, and that's actually something that kind of runs in my family and that I've dealt with all

my life. And I think that really helped me understand how my eating disorder and disordered eating behaviors were kind of functioning in a way to help me regulate my anxiety and my emotions. So that was really personally helpful to me and also made me want to just learn more about that and kind of get that information out there for other people who might be struggling with it. Well, thank you for sharing a bit of your personal story.

I definitely relate to anxiety and depression being kind of like known in my family, but eating disordered disordered eating being territory that my family didn't know about. But what's interesting is you said you've got diagno knows at age eleven, So we get a lot of moms listening who are concerned about their child's well being. Did a parents step in when you were eleven to, you know, say something's going on? You know, there seems to be some sort

of conversation was happening for you? What was that like? Definitely? So, I think what we often see with adolescence, and we see this with adults too, is that sometimes kiddos might not know that something is wrong, um, and I think that was definitely the case for me. So when I was that young, I didn't really necessarily realize that I had a problem. So it's definitely my parents who noticed that I wasn't kind of eating the way that I should,

or I was exercising too much. So I was doing cross country back then, but I would do kind of even extra exercise beyond that. So I think it was my parents noticing that and kind of getting me into the doctor that was actually really important for me getting

help then and doing a little bit better. So I definitely say if parents are kind of noticing that kids are struggling with that, or not eating like they used to, or seem kind of anxious around food um, or maybe exercising more than kind of makes sense, or for reasons that not just like for fun um, those are definitely reasons to kind of seek help into getting that diagnosis at that age feel validating, shameful. Were you aware of

that diagnosis personally as at age eleven? Yeah, So I got into treatment actually around age twelve, so about a year after I really started developing those serious symptoms, so I was pretty aware of it. I went to like an outpatient treatment program with my parents. Um so they were doing something called FBT. So I don't know if you're familiar with that, but it's a family based treatment.

I was actually really lucky to get that because it's one of the most evidence based treatments for young kiddos, and in that treatment, parents are actually really involved in helping kids eat and kind of feel better in that way. So I was aware of it, and I think, as you kind of mentioned, they think a lot of shame did come along with it, because it wasn't really something that I felt like I could talk about with other

people or in school. It's a very secretive thing and it was kind of like a family secret for a long time that that was something I experienced, and I didn't actually even start sort of talking about it or telling my friends about it until I was in my twenties, um because I was worried about what people would think or if people would judge me or think that I was just obsessed with my appearance, if they kind of

learned that about me. So it's really freeing when I finally did start to talk about it with people and realize that people can be really accepting of it, and also a lot of other people had gone through and experienced similar things, even if they hadn't necessarily gotten a diagnosis at that young age or at any age. Yeah, I think that speaks to so many, whether it's a

mental illness or anything. Really is like we all kind of run around with these deep seated secrets that we think, you know, if people knew we would be we wouldn't belong or we'd be judged, or there'd be shame, And like every single one of us is running around with a different little seed of shame. And then you know, over a decade went by for you before you found

your voice to speak about it. And it sounds like by doing so, you know your friends or your your colleagues, maybe we're like, oh well me too, me too, me too, And suddenly you know you're it's kind of just like a big relief to let that air out of the balloon and deflate and relax and say, Okay, you're not broken, or we're all a little bit broken, and that's that's okay, right, That's like being a human is exactly? Was that huge for your healing to be able to talk about something

like that so young? I yeah, I definitely was. Um. I have a friend who once said to me, like sunlight is the best disinfectant, and I think that's a really nice thing, because, like you're saying, I think we all carry around things that we feel ashamed of or

feel like we're the only person struggling with it. And when it's something that's a deep secret that you're not sharing with anyone else, it's really easy for those feelings of guilt and shame to build up and you just kind of feel worse and worse about it um and I think it even makes it harder to change those behaviors if you're having disordered eating behaviors or other kinds of challenges. But once you start talking about it, you realize that you know it's okay, and other people are

going through similar things. And so as part of my training, I also see therapy clients, and I think what I've realized is everyone has these things that they think they're the only one that they that experienced something like that, But usually I had someone else tell me that exact same thing like a week ago. So I think none

of us are really as alone as we think. And when we kind of discovered that, or personally, when I discovered that, it definitely was very freeing and allowed me to let go of a lot of the guilt and shame I've been carrying around. That's awesome, and it clearly I think by doing so allowed you to do the amazing work that you're doing. So let's kind of dive into that work. When did you realize that anxiety or depression could be related to eating disorders? That's a great question.

So I think I sort of realized it some through my own experience and kind of realizing that there were times when I was engaging in certain behaviors because it helped me feel calmer, help me feel better. But their research literature is actually pretty consistent about it as well.

So the research shows that among people with eating disorders and disordered eating, they're really high levels of anxiety in depression, with a lot of research showing that more than half of people who struggle with eating disorders also struggle with anxiety and depression. Um, so there's a really strong link in their research, and part of the reason seems to

be related to biology. So we know that eating disorders obviously are affected by the socio cultural context that we live in, but they're also affected by your underlying genetic risk for developing an eating disorder. And we see that the genes that contribute to eating disorders also contribute to things like anxiety and depression. So I was trained by as a biologist in my undergrad and that's how I sort of started getting interested in learning about genetic contributions

to things UM, and started learning about the overlap that exists. Well, that must really take away the shame and for anybody who maybe wants to kind of like, let's boil that down. I think what you're saying is we have genes and the environment could turn those genes on or off, possibly the environment being anything around you. And if you have that gene and you're predisposed is to a factor that turns that gene on. I think I'm not getting this

completely scientifically right. You're doing it really right. Yeah, then kind of very so I'm oversimplifying it. But outcomes the eating disorder behavior or the anxiety or the depression, etcetera.

So that's so interesting. Would you say that, UM, And I don't know if you could really boil this down, but would you say that anxiety slash depression leads to a eating disorder or would you say an eating disorder leads to anxiety and depression or back and forth, back and forth, That's a really excellent question, and it's one that I think is still being debated in the research literature.

And I think what you're saying about the back and forth is probably a big part of it, because what we know is that when people aren't getting enough to eat, that actually affects their brain as well in ways that can increase risk for anxiety and depression. So there probably

is kind of a circular nature to it. Where people are engaging and disordered eating, it kind of affects their body and also their self image in a way that can increase anxiety and depression, and then disordered eating behaviors can kind of be used as a way to manage those symptoms as well. But the research does show that often anxiety is what shows up first for people. Um So people might have anxiety when they're younger, like when

they're in childhood, and then later developed disordered eating. So that's the way it often seems to go, but definitely

not for everyone. That makes sense in your research, do you distinguish between disordered eating and eating disorders or I know when I was in undergrad I was interested in learning about eating disorders and disordered eating because I was silently suffering with my own and wanted to learn more, although I couldn't put that into words, and I remember that I couldn't find any research that spoke to kind of what I was dealing with, which was more disordered

eating than eating disorders such as an axia, bolimia, you know, eating disorders not otherwise specified even didn't really speak to what I was going through. Has the research expanded to encompass more broad definition of eating disorders. I think it has.

I think there's still work to be done, but I think increasedly people recognize that most people who struggle with disordered eating are kind of having an experience like you described, so they don't neatly fit into a box of one of those diagnoses, but they may still be struggling with their eating or body image um and still suffering distress from it. And so what we think now is that

disordered eating kind of exists on a spectrum um. So you might have people that have these very severe disorders that manifest in specific ways, but then there are a lot of other people out there who are really struggling with disordered eating symptoms in a way that might not fit that diagnosis. But it's still really important to address and when it comes to research and finding people to conduct research on, are we bringing more people into the

mix who don't neatly fit into anorexia bulimia. Yeah. So, actually, almost all of our research is conducted with people from the community and the general population. So at Michigan State University, we are really lucky to have population based twin registry and um I won't go into all the details of that, but having twins is really helpeful for getting at some of those genetic components to things like disordered eating, and in the general population we see the kind of the

whole spectrum. So there are some people who might say that they never struggle with disordered eating or body image, and then there are some people who have struggled with it really severely, and then kind of everyone in between. Um So, in our research, we think it's really important to capture that whole variability because even people who are not meeting criteria for a diagnosis, you know, might still

be struggling and in need of help. One of the things that you research is specifically is our ability to emotionally regulate and how that plays a role in eating disorders and disordered eating. Can you define emotional regulation or emotional disregulation? Maybe both for us? I think of emotion regulation as being kind of how you manage and respond

to your emotions. So sometimes people might have an emotion, but they might respond to that by criticizing themselves for how they feel or trying to suppress that emotion and not show it to other people. And we generally think of those as not very helpful ways to respond to emotions because they tend to make the emotion more intense

or lead to other kinds of behaviors like disordered eating. Um. But there are other ways that people sometimes manage their emotions, one of them being just accepting how you feel and kind of listening to what that emotion is telling you, which is actually kind of one of the most adaptive ways to respond, as well as just kind of thinking differently about the situation or maybe doing something to distract

yourself or change the situation. And those are ways that often one can listen to on one's emotions and respond to them in a way that's less likely to lead to kind of feeling worse down the line. And our emotional regulation skills learned genetic both. So I think that's a question that the science actually hasn't fully answered, but they are definitely not a hundred percent genetic or even

mostly genetic. I it's say because some of the things that we actually do to treat disordered eating and also things like anxiety and depression actually often involved teaching people how to pay attention to their emotions and regulate them

more effectively. So that kind of starts with mindfulness and being aware of what it is that you're feeling, and also being aware that your emotions are kind of there to help you as opposed to hurt you, and then figuring out different ways to kind of engage in self soothing techniques or problem solving techniques so that you can manage those emotions without trying to turn them off with

things like disordered eating behaviors. Yeah, so what I'm hearing, and I was kind of applying my own personal story here, which is I had no emotional regulation skills growing up, which I think a lot of people don't, and everything that I've learned has been learned. I've you know, mindfulness is a huge part of my journey, and I teach what I call modern mindful eating to my students in

a program called Fork the Noise. And what I find most amazing being about the work that I do is when students apply it, it bleeds into the rest of their life. So we start with the food and then it turns into regular life or sometimes my students have an easier time applying the mindfulness concept to life, and then it comes back to the food because you have this expanded, less reactive, less cyclical reaction to your negative

thoughts or even your thoughts in general. And I kind of picture in a circle like if my my brain was going one way in one direction one day, it stopped and it started going in the other direction, and the first way didn't serve me, in the second way really did. But I don't know always how to put that into words. So do you find that, you know, working with a therapist is the best way to learn emotional regulation and things like that. Yeah, So I'm a

big fan of therapy. I always think that if you think you can benefit from therapy, and often even if you don't think you can, you can. Um. So I think therapy can be a really helpful of resource for using these and learning these kinds of skills, especially therapy that's focused on things like mindfulness or um. Dialectical behavior therapy, which is sometimes called DBT, has been shown to be helpful for people with eating disorders in terms of recognizing

and learning to regulate their emotions. And I think a therapist can also be really helpful in helping you learn to accept your emotions and not judge them as much or judge yourself for having them, because they think it can be really easy to get into the trap of thinking you should feel differently, or you're a bad person if you feel guilty or angry or sad, and really that's not true because we all experience those emotions, and so being able to learn that those emotions are natural

and okay, I think is an important part of the process. And your research keeps showing us that this emotional regulation plays a role in the development of disordered eating and eating disorders. Yeah, so, um, there's been a lot of

research looking at that across time. So what you see is that when people have a hard time regulating their emotions or a kind of prone to anxiety or depression like we were talking about earlier, that kind of sets them up for being at higher risk for disordered eating down the line. And what we see is that when people get treatment and learn kind of how to manage their emotions more effectively than their disordered eating tends to

go down, as well as their symptoms of anxiety and depression. So, like you were talking about, it can kind of generalize to multiple things, and especially a lot of research has been conducted with people who might experience binge eating or

other kinds of disregulated eating. We're often that kind of eating can be triggered by really intense negative emotions, and the thinking is that when you have that behavior, it might help you feel better temporarily, but often people afterwards um will feel sort of guilty or ashamed, and it can lead to sort of a vicious cycle, though definitely plays an important role, and then more anxiety, more shame, more feelings like you need to you know, usually restrict,

which leads to another binge and then before or you know what, you're in that cycle exactly. So it's pretty cool because your research isn't just looking for what causes eating disorders. You're also looking for not just the cause, but how to escape it or break the cycle. Right, Yeah, what would you say most of your research is focused on? That's a good question. So I think that I often kind of think about those things as being a little bit interchangeable in terms of like what causes it and

what maintains it. They can sometimes be different, but often the things that started off can be the things that sort of keep it going. So my research focuses on kind of how emotions can play a role in any part of that. So in getting started with disordered eating, um in terms of anxiety and depression contributing to that, but also why eating disorders or disordered eating might continue.

And you know, I think it's kind of complicated sometimes to disentangle what kind of first and what came second. So we use special research designs to do things like that, like having longitudinal studies where we track people over time. M some of our research looks at that to kind of see like what came first and what came second. But I think when you have people who are struggling with disordered eating, like the most important thing I guess is trying to figure out how to help them feel

better once they're in that situation. So I hope is that by researching kind of how emotions contribute, we can sort of develop better treatments to help people who might be experiencing eating disorders. An alway has quite the range of listeners when it comes to age, probably sixteen year olds, I'm sure we have, but a lot of our listeners who write in are fifty sixty seventy, and they feel like it's too late for them, And they'll ask us, you know, do I have a chance at this? And

I personally think they do. But I'd love to know if your research looks at populations who are perhaps forty six seventy. Even so, my research hasn't looked at that specifically. We have tended to focus on younger populations just because

of some other aspects of our research. But I think, you know, to what your listeners would say, I think, you know, there's no evidence that it's ever too late for someone to be helped with something like, no matter the age of the person coming in, whether they're really young or whether they're kind of more advanced in life, like, people can always kind of benefit from help, and like it's never too late to change or to start to

feel better. So all the research that we have shows that the treatments that work for people who are in their twenties should also work really well for people who are in their fifties and older, although obviously some aspects of a person's life might be different at that time. So I think, you know, no matter what a person's age, there's definitely hope for them to recover. That's awesome. Thank

you for sharing that. And tell us a little bit about eating disorders and the prevalence in disadvantaged or marginalized populations. What are we seeing they're compared to I don't know the right word, their regular populations. Now that doesn't sound right, Yeah,

I think more advantaged populations. Yeah, yeah, So that's kind of the other arm of my research, and I think of them as being related because people who are disadvantaged or marginalized, who are experiencing discrimination or poverty, there under

a lot of stress. Right, So if we think that being under a lot of stress and experiencing a lot of negative emotions can be a risk factor for eating disorders, then it makes sense that people who are experiencing that kind of stress um or those kinds of negative emotions might also be at higher risk um And for a long time, I think there have been stereotypes out there about who eating disorders effects. So usually it's a thin,

young white female individual. And what we know now and also you know, I think this resonates with what you said about your listeners, is that that just is not true that eating disorders occur in all kinds of people of all racial and ethnic backgrounds and ages and socioeconomic status is and what their research increasingly shows is actually that belonging to a disadvantaged or marginalized group can really

increase your risk. So one of the places that that shows up is food insecurity, and this probably makes sense, like if you can't get enough food to eat and you're also experiencing other stressors that go along with poverty, your chances of experiencing and eating disorder are actually a lot higher on both at that time and then if you experience that as a child later on in life. So those that's kind of what their research is showing.

And for people who experience things like discrimination because of their race or their sexual orientation, the risk is actually higher for those people as well. And there's some research showing that it may be actually that discrimination per se, that it is increasing their stress and increasing their risk. So the risk factor is the discrimination. Exactly, how can

we help those communities who are most in need. What can we in the advantage communities due to help those struggling with disordered eating and eating disorders in disadvantaged populations. So I think one thing that's really important is awareness because going back to those stereotypes, um, and it's really unfortunate, but the research shows that even clinicians or people who work with people with eating disorders might hold some of

those stereotypes, even potentially without being aware of them. So just being aware that someone who might not look like the eating disorder stereotype might be suffering from an eating disorder, I think is really important. And kind of related to that, I think making sure that services are available and accessible to people is really important. So often, for example, a person might have Medicaid insurance and there are not a

lot of therapists who take that kind of insurance. So I think increasing availability and making sure that people who may not have the financial resources to pay out of pocket, for example, can still access services and access care is really important. A lot of public health initiatives need to be changed so that these people in these communities have

access to mental health care exactly. Yeah, I think that there can be a lot of barriers for accessing treatment even for people who are advantaged in many ways, especially when it comes to eating disorders. So you can imagine that if someone doesn't have very many resources or connections to mental health services, it might be even harder. I think increasing awareness and also increasing access is kind of what's most important to help people get the assistance that

they might need. And when it comes to kind of going back out to your work relating to anxiety and depression, do you study how the variables change when a person is put on medication like an anti anxiety medication or an antidepressant. Yeah, so we don't study that directly, but there is some research on it. So the research suggests that medication can actually really help some people with disordered

eating with some caveats. So sometimes when people are really underweight or engaging in a lot of disordered eating behaviors, it actually changes their biochemistry so that the medications don't work quite as well in their brain as they otherwise would.

So sometimes the first step is really helping the person's body kind of get back to a more stabilized place where their brain and their biochemistry is functioning maybe more typically, and then the medications can be helpful for things like depression and anxiety that might be fueling eating disorders, so

it's kind of a dual barrel approach there. That's probably why it's so important to be working with a team that includes a therapist, oftentimes a dietitian to make sure that you are eating enough that your brain is getting all the nutrients that it needs so that the medications can be dosed properly and changed accordingly, but knowing that they are kind of working as they should be exactly exactly.

I think eating disorders are really complicated, and they involve our minds but also our bodies, and so making sure that we're sort of taking care of all those aspects of it is really critical just kind of give people the best opportunity to achieve recovery and just feel better in life. And I think you hit the nail on the head, which is eating disorders are complicated, and most people don't understand that. Even people with eating disorders don't

understand that. They feel frustrated that they can't just recover, that they can't just eat the food or not binge on the food, or not compensate for the food. But what you're doing is so important because it's really assessing all the variables and kind of showing, you know, us public, that there's so many more pieces to the public that doesn't meet the eye. So your work is so important and Amy and I want to thank you for doing it and for sharing it with us, and for also

sharing your personal story today. We really appreciate it. Yeah, thank you so much, um, and thank you again for having me and for doing this and sharing this information with people out there. It's really great. Do you have social media or anything where anybody can go find you or you stay under the radar and we can just maybe read your research? Can we link anything in the

show notes to show off the amazing work you're doing. Yes, So I'm a nerd and I have no social media, we like, uh, I do have um like a research page. I can definitely send you the link to that so you can take a look at some of the research articles that I've worked on. That'll be awesome. We have tons of like nutrition students and social work students who I'm sure would also just be interested to just read the amazing papers that I got to take a look

at before this episode. And you're really doing amazing work. So thank you so much for your time, Megan, thank you. I really appreciate it.