Eating Disorders Awareness week is from February 26th to March 3rd. Something you may not know, is that eating disorders affect people of every age, race, size, gender identity, sexual orientation and background and about 28.8 million Americans will experience an eating disorder in their lifetime. Eating Disorders have the highest mortality rate of any other psychiatric illness (aside from the recent increase of opioid related deaths).
Lending her expertise in this field is Rebekah Bardwell Doweyko, who has over 20 years of clinical experience with eating disorders. Rebekah is the Assistant Vice President of Clinical Operations, Ambulatory Services, at Walden Behavioral Care in Middletown CT. She earned her Master's degree in mental health counseling and is a licensed professional counselor in CT and other states, and she is a certified eating disorder specialist. Rebekah says that eating disorders are complex, and for some people social media can be difficult to manage in treatment. "Social media is an avid partner in contributing to the power of diet culture and weight stigma. We encourage our clients to discontinue, pause, or edit whom they follow on social media in order to limit the images, stories and/or reels that can be activating for their eating disorder. We have a group called "Eating Disorders in the Media", that focuses on teaching our folks how to develop a "fact checking" lens for social media use." Rebekah also says that CT Paid Leave a lifesaver, because it is instrumental in getting people into lifesaving treatment. Rebekah has worked with several patients and caregivers who have used the CT Paid Leave program. She feels it is a lifesaver as it gives patients and their families the time to engage in proper treatment, without worrying about lost income.
Eating Disorders Awareness week is from February 26th to March 3rd. Something you may not know, is that eating disorders affect people of every age, race, size, gender identity, sexual orientation and background and about 28.8 million Americans will experience an eating disorder in their lifetime. Eating Disorders have the highest mortality rate of any other psychiatric illness (aside from the recent increase of opioid related deaths).
Lending her expertise in this field is Rebekah Bardwell Doweyko, who has over 20 years of clinical experience with eating disorders. Rebekah is the Assistant Vice President of Clinical Operations, Ambulatory Services, at Walden Behavioral Care in Middletown CT. She earned her Master's degree in mental health counseling and is a licensed professional counselor in CT and other states, and she is a certified eating disorder specialist. Rebekah says that eating disorders are complex, and for some people social media can be difficult to manage in treatment. "Social media is an avid partner in contributing to the power of diet culture and weight stigma. We encourage our clients to discontinue, pause, or edit whom they follow on social media in order to limit the images, stories and/or reels that can be activating for their eating disorder. We have a group called "Eating Disorders in the Media", that focuses on teaching our folks how to develop a "fact checking" lens for social media use." Rebekah also says that CT Paid Leave a lifesaver, because it is instrumental in getting people into lifesaving treatment. Rebekah has worked with several patients and caregivers who have used the CT Paid Leave program. She feels it is a lifesaver as it gives patients and their families the time to engage in proper treatment, without worrying about lost income.
Hello, Connecticut and welcome to the paid leave podcast. The title basically says it all. I'm Nancy Barrow and I will be delving into this new state program and how it can help you and your family. This podcast will give you information you should know about Connecticut paid leave, and maybe just a little bit more. Connecticut paid leave brings peace of mind to your home, family and workplace. Welcome to the paid leave podcast. Eating disorders affect about 20 million women and 10 million men and it's way more complicated than just wanting to get skinny 50% of girls aged six to 12 are worried about getting fat. Just think about that. And every 52 seconds someone dies from an eating disorder. Connecticut paid leave gives 12 weeks of income replacement when you need to take leave from your job to take care of your own serious health condition or that of a loved one as a caregiver. We also cover mental health treatments and addiction treatments if you are incapacitated and get continued treatment from a health care provider. We have three types of leave there's the block leave where you take all 12 weeks at once if you need it or intermittent leave so you can continue to work and maybe take time off for doctor's appointments or therapy. And there's reduced schedule leave where you can work maybe a half day and do half a day of treatment. Some people get confused with FMLA and Connecticut pay leave FMLA will give you job protection when you're on leave. And Connecticut paid leave gives you the income replacement. While out on leave. They are two separate programs. Here to talk about eating disorders is Rebecca Bardwell Doweyko, and she is the Assistant Vice President of Clinical Operations and ambulatory services at Walden behavioral care. She earned a master's degree in mental health counseling, and is a certified eating disorder specialist who has worked with some state agencies like DHMAS and DOC. Rebecca, welcome to the podcast.
Rebekah Doweyko:
Thank you so much for having me.
Nancy Barrow:
Can you give a little background before we get started, because you've been in the treatment portion of eating disorders, pretty much your whole adult life,
Rebekah Doweyko:
My senior year of college, I all my life, I always wanted to train marine animals, I might have a slight obsession with manatees. And so I did an internship my senior year like any responsible senior college your student would do. And I quickly discovered that it was not what I had thought I was signing up for. So I had to break the news to my mother. And that semester, my senior year in college, I had taken an abnormal psych class and found that I actually wanted to go to class. Even though it was one of those larger lecture size classrooms, I was pretty excited. I don't think I missed one. I read the whole textbook before we were even halfway through the semester. And it was just something that really felt important to me, and that I felt really passionate about. And so I quickly learned in order to do anything with the field, you needed at least a master's degree. So I went right into grad school. And I do think it was fate or shared or whatever word you want to use for it. And the woman that I was sitting next to, in my first day of grad school, I said to her, you know, I should probably get a job in the field, I learned my lesson. I said, I should probably get a job in the field before I go through all this graduate school to make sure this is something that I really, you know, I'm sure that I that I couldn't see myself doing. And she was like, Oh, I work at the Renfrew center. And we're always needing Psychiatric Technicians and things like that. And I was in grad school and South Florida and the Renfrew center of Coconut Creek is right down the road there. And I was immediately immediately struck by how debilitating this illness was. I think that eating disorders get a lot of are often glamorized, and often seen, you know, I think when people ask me what I do, and I say work of people eating disorders, I often hear things like, Oh, I wish I had an eating disorder, or, you know, can and make comments like that. And it's hard to hear things like that. Or when people say like, oh, no, I'm I definitely have this type of eating disorder because eating disorders are not glamorous. They are not fun. Nobody wakes up in the morning and says, I think I'll have an eating disorder today. They are debilitating, deadly illnesses. And as evidenced by my first day at the Renfrew center, I was sitting there at the table eating and a girl, a teenager had a seizure at the table. Wow. And I was shocked because me like most people at the time without a lot of education about eating disorders, only thought about anorexia, right. When people think about eating disorders, they usually think about anorexia, when in reality, anorexia is actually the rarest occurring eating disorder and people also think anorexia has the most medical complications and the other eating disorders aren't dangerous. This young woman happened to have bulimia nervosa. And there she was at the table in her teens having a seizure because of the medical complications. And so, and I also realized at Renfrew, just how little treatment there was available, oftentimes after residential, these people had to just discharge back to their outpatient provider home that had no idea how to treat eating disorders, that there weren't any specialists available. And so I was like, This is what I'm going to do for the rest of my life, I'm going to be a part of making treatment more available, having more treatment options, educating people on eating disorders, helping to break the myth that they are just a phase or that they're an illness of choice or vanity, because they could be they couldn't be farther from the truth. I've always felt passionate about female empowerment and women's empowerment. And so I think that was also something that spoke to me, the Renfrew center of Florida is a female only or assigned female at birth now only treatment center. However, I want to be clear that eating disorder has happened to all genders, all races, all ethnicities, it's just that again, as I was speaking to before, there is a privilege and accessing care. And the research that was done a lot of the times is done in treatment centers. So you're only speaking to and learning from the people that are in treatment centers. But if the only people that have access to treatment centers are affluent, Caucasian females, then that's how the illness gets. That's how that story gets told. But it's just because we're not talking to the right people. We're not doing a good enough job assessing for it. And we're not doing a good enough job making treatment accessible and affordable for everyone.
Nancy Barrow:
well Let's start at the beginning. So how do you explain an eating disorder? Because there's more than what I always knew, I always knew there was anorexia nervosa and bulimia like, those are the two that I knew. But what is an eating disorder?
Rebekah Doweyko:
That's such an important question. When people think of eating disorders, usually anorexia jumps right into mind. And I think because it's been the most visible, and it is something that people think they can see and notice and other people and it's often glamorized. And then you're right, second place usually goes to bulimia nervosa, but again, because of the stigma of binging and purging via self induced vomiting or laxatives, there's more shame that comes with that illness, whereas there seems to be an there is shame for the person who has anorexia nervosa, but there is less shame publicly for people that have anorexia if there's almost a fascination with it versus you know, something that's more ego dystonic or goes against your, your own values, right?
Nancy Barrow:
Because I think with bulimia, you're still eating, you're just throwing it up. Right, like so, with with anorexia, you're not you're restrictive with what you eat.
Rebekah Doweyko:
That's another thing that people don't realize is that there's actually two types of anorexia nervosa. So there is the anorexia nervosa, the restricting type, which you like many, many, many others think that that's as far as it goes. But there's actually also anorexia nervosa, binge purge type people with anorexia nervosa also, excuse me also binge and purge.
Nancy Barrow:
That was my freshman college roommate. She was anorexic. And she had bulimia. And I was like, this is just awful. And she left after the first semester like she left school.
Rebekah Doweyko:
I hope she left to get some treatment and some help.
Nancy Barrow:
I hope so too.
Rebekah Doweyko:
Yeah. So it's it's extremely dangerous, because, you know, restricting food obviously disrupts not only our psychological systems, but our medical reproductive, endocrine systems, and then when you add in binging and purging that disrupts your electrolytes as well. So bulimia nervosa is an extremely dangerous eating disorder as is anorexia as is binging disorder, as is a typical anorexia as is arfid. And I think the theme here is that all eating disorders are dangerous, not just anorexia. And, and again, yeah, anorexia nervosa has also a binge, purge component to it. So people with anorexia nervosa do also binge purge. The only difference the difference is that somebody with anorexia nervosa binge purge type is it a significantly low weight, where somebody with bulimia nervosa that binges and purchase isn't necessarily at a low weight?
Nancy Barrow:
It's fascinating do most eating disorders involve coexisting conditions like anxiety, depression, obsessive compulsive disorder, or bipolar disease? Are there intersecting conditions?
Unknown:
100 percent ! I would say it's rare to see somebody without an intersecting condition. So without a co occurring disorder, when you think about eating disorders are set Similar to substance use disorders in that way that they're maladaptive coping skills, they aren't coping skills, they're just maladaptive. So oftentimes, the depression comes first anxiety comes first, a trauma comes first. And the eating disorder is used to cope with symptoms of PTSD, depression, anxiety. Eating disorders can also lead to depression and anxiety because of malnutrition, when we aren't eating enough, and when we aren't, or we are eating, or we're not eating in a balanced way. It's just it's not just about eating enough, but eating enough of everything that our body needs, then it affects our cognitions it affects the way our neurotransmitters fire, it affects the, you know, levels of brain chemistry that we need to think clearly and properly experience a full range of emotions, and eating disorders interfere with that.
Nancy Barrow:
At Walden how do you categorize when someone comes in and what they need? Like with other diseases? There's stage 123, and four like cancer?
Rebekah Doweyko:
Yeah, that's a really great question. And so important. So at Walden, we have our admissions team. So somebody is worried that they might have an eating disorder or their spouse gives them an ultimatum or a friend expresses concern, or they just are like, I can't live this way anymore. And they start doing a Google search, right, and they find Weldon's number and other treatment centers number at Walden, you call our phone number, and our admissions team answers, and they set you up with an evaluation. And you meet with a clinician that does a very thorough yet not hours long evaluation. And from that evaluation, basically, we look to assess the frequency of your eating disorder behaviors, the severity of your eating disorder behaviors, any current medical complications, that you're experiencing a history of medical complications that you may have experienced, we might ask you to send us some lab work. For adolescents, we often look at growth charts, and we so that we can make a complete assessment of your psychosocial and medical functioning. And from there, we determine whether or not we feel you would need intensive outpatient, partial hospitalization, residential or inpatient treatment.
Nancy Barrow:
Like I said, half of all girls between six and 12 worry about getting fat. How young Do you treat people like what's the youngest that you've treated in the oldest that you've treated?
Rebekah Doweyko:
So we have a separate IOP program for, for our food for avoidant restrictive food intake disorder, and we take kids as young as 10. In that program, we also have taken kids as young as 10 in our residential and inpatient units as well. And we go up to any age, we've had clients in their 70s and 80s, that we work at all levels of care that we work to help treat their eating disorder.
Nancy Barrow:
It seems like eating disorders are really secretive, like they like to hide what they aren't or are eating. Why is it? Is it a shame issue? Or is is this part of what the eating disorder does to people?
Rebekah Doweyko:
Yeah, I would say both. I think that, that both are true that I think there is shame and stigma. And there is very much a part of the eating disorder that folks feel. How would I live without this illness, that it becomes very much a part of their identity, and giving it up? Feels so scary and so vulnerable? That they are you know that they fear letting people in and letting them know what they're doing? Because then they'll have to do something about it.
Nancy Barrow:
When you get people in sometimes do you just say they need to be hospitalized?
Rebekah Doweyko:
So if somebody came in and their electrolytes are imbalanced, or their heart rate is low, or they have severe ortho stasis, or suicidal ideation, there are high rates of suicide with people in eating disorders. About 26% of people with eating disorders die from suicide.
Nancy Barrow:
Yeah, cuz I mean, if you're losing someone, every 52 seconds, that's really daunting. Yes. Yeah. How do you help that?
Rebekah Doweyko:
So again thats part of it is we have to the person has to re-nourish themselves. So that's always the first step because it it's nearly impossible to tease out if this person's depression is organic, or their anxiety is organic, without refeeding them because when you are malnourished, and that doesn't, again, that doesn't mean that you're not eating enough. malnourished can mean lots of diff One things, that means you're not eating a balanced amount of all the things. So first we have to work on re nourishing people and refeeding people. And even that can be dangerous because your body, our bodies are these amazing machines that are programmed to keep us alive no matter what. So the body will just work to find, you know, a new homeostasis. So we have to monitor people often daily when they are nourishing them, nourishing themselves in a better way to make sure that the body is slowly readjusting to that. And then we have to see, you know, okay, and do an assessment of what medications might be helpful for this person's depression or anxiety. We also do treat PTSD co occurring with the eating disorder. So at Walden, we use CBT, which is cognitive processing therapy to treat PTSD symptoms while people are having are in the process of being treated for their eating disorder. Because it makes sense, why would I feel safe enough to give up my eating disorder? If I don't feel safe enough in this world? And why would I just give that up and be left with nothing? But feeling unsafe?
Nancy Barrow:
I know everything is individualized, because no two people are the same. But what is the average stay to treat an eating disorder at Walden? And do they gradually go back into less therapy, less time and therapy,
Rebekah Doweyko:
the average length of stay at eating disorder treatment centers is a very different conversation than what would be the ideal length? Yeah, right. Right. Right. So because you remember, we oftentimes want to keep people longer and feel they need more time yet their insurance company is saying, it's time to go. And insurance companies often make that decision based on weight alone. And disregard the other context of things that are that are happening, and disregard the risk of relapse. And so then you see people stepping down too soon to the next level of care, then they have to just come right back, which actually probably cost more money in the long run. But for whatever reason, that's still it's hard to, to help. Insurers come around to that. And I imagine that part of the reason for that, is that because treatment is expensive. But you know, I think it all depends on the severity of somebody's illness, how long they've had it, right. So if I've, and the severity, right, so even if I've only had my quote, unquote, only had my eating disorder for a year, if the severity is high, and I've been using my behaviors multiple times a day, it's going to take me longer to break that cycle than somebody who has who has been relying on their eating disorders in a in a less severe way. Right. So ideally, people would spend three to six months in treatment, ideally, Does insurance always pay for that? No, I think at Walden, you know, we see our length of stay, and from anywhere from 30 to 40 days in the higher levels of care. And that's often the most we can get out of insurance companies,
Nancy Barrow:
do some people have a lifelong treatment for their eating disorder? Or is that a misnomer?
Rebekah Doweyko:
So I do think that eating disorders get a bad rap, too, in terms of being like this terminal illness that once you have an eating disorder, you always have an eating disorder, and you're never going to get well. People make a full and lasting recovery. I see people get well and all the way well and stay all the way well, all the time. The difference for those people and the people that do struggle, and certainly you can struggle lifelong, is that the right help isn't available. Or they don't follow treatment recommendations, or they don't have access to all the levels of care, right? I mean, you heard me just say that ideally, people would stay for three to six months. But how many people can afford that? How many people can afford to take time off from work or to take time away from a family to to get the help that they that they need, which is why there are other levels of care available that have less restraints, but still it does any treatment requires you taking the time to invest in that.
Nancy Barrow:
How important do you think programs like Connecticut Paid Leave are in in the help of treatment and giving people time away from work to focus on their health or their child's health?
Rebekah Doweyko:
The Connecticut paid leave program is literally life saving, we have people that would not be able to get treatment without it. They wouldn't be able to support themselves without it. They wouldn't be able to keep their insurance without it. They wouldn't be able to support their families or their children without it. We have lots of parents that use it in the way that you were describing that maybe they just take a half a day, right they have to go into work late because they need to be home to have breakfast with their child to make sure that their child is following you know what their what their read nourishment record wires. Children and Adolescents require supervision in order to ensure that they are meeting their their needs. And that requires families eating with them and supervising and often attending treatment with their child, as well. There are family meals, family therapy that has to happen. I think that, you know, an antiquated way to treat children is to send them off to a residential treatment center. And Hatton, the family has the expectation that all they need is to go to residential for 30 days, and this treatment centers going to fix them and send them home and they're going to all live happily ever after. And it just doesn't work that way. residential facilities are an important part of the treatment process to break the cycle. And yes, it may require going to another state, but it doesn't end there by any means. That is that is the first stage in in a multi staged treatment process that takes education of the parents to how does the parent know how to guide the child how to support the child. Parents need their own education, understanding themselves the severity of the illness, they need to know the DBT skills or the CBT skills that their child is learning so that they can suggest them to them in the moment when they see them struggling. They need to understand the illness so that they don't inadvertently make comments that are invalidating and that could potentially make the illness rear its ugly head.
Nancy Barrow:
Yeah, the trigger points, right. How long do you follow people when they leave your treatment and our home? Do you check in occasionally? Or what's the policy?
Rebekah Doweyko:
Yeah, so we typically like to do a seven day discharge follow up just to make sure that they met the the expectations on their aftercare plan. So every client leaves with an aftercare plan and outpatient appointments set up, or reengagement appointments set up with their outpatient therapist, we work really hard to have people start their outpatient therapy, or resume their outpatient therapy, while they're still in IOP and intensive outpatient treatment with us so that that transition is much more solid and smooth. And we want to increase the probability as much as we can that they will be successful in continuing therapy.
Nancy Barrow:
You've mentioned this before, but I saw on your website that you say you welcome all genders and diagnoses. And what about the LGBTQ plus community and other marginalized communities? Is there something specific for them?
Rebekah Doweyko:
Yeah, so it's, it's definitely not all the same, especially for folks in the LGBTQ plus community, I think it's really important to remember that especially people that don't identify with the with what the gender they were assigned at birth, their body, quote, unquote, dysmorphia is very different. They are not necessarily manipulating their food to change their body shape or size, they are working hard to feel like they are their gender reflects their gender identity, that their body reflects their gender identity. And so that is a much different experience than somebody who is having gender dysphoria related to their I'm sorry, body dysmorphia, related to their shape and size. And for that reason, we do have Rainbow Road, which is a virtual program, that is PHP and IOP. And that is a program that is run by staff that also identifies LGBTQ plus for clients in the LGBTQ plus population. And again, it is super important that folks feel safe in an environment in order to heal, and, and have groups and topics and feel safe to talk about things within a group where it feels safe to do so especially because marginalized folks not just LGBTQ plus but but and LGBTQ plus have been traumatized have been othered experience microaggressions regularly. And it's important that we provide a safe space for them to share those things with a group that feels safe to do so.
Nancy Barrow:
So you're kind of famous, I just want to let you know that I watched the HBO documentary "Thin" , and you were in that tell me about that experience, because that was a powerful, powerful documentary.
Rebekah Doweyko:
Yeah. It was. It was a really, you know, I do feel so fortunate that I was able to have an experience like that in my career. Not it's a once in a lifetime, really. And my takeaway from that is, you know, certainly whenever you watch a documentary on an eating disorder or substance use disorders, there's always a little bit of that of I was portrayed and a little bit of mixed feelings at the time. And still today, what I appreciate is that it helped take some of the glamour out of these illnesses in that really showed the pain that is associated with eating disorders. It showed that people die from these eating disorders, it portrayed family dynamics. It portrayed some treatment center dynamics, it portrayed weight stigma, and so many important topics.
Nancy Barrow:
A lot of people say dieting is just a normal part of life, but it's not because it can get deadly like it did in "Thin".
Rebekah Doweyko:
Yeah, it's not really, you know, I think it's one of those myths that, you know, similar to every college student binge drinks, that like every everyone diets, you know, and I think that diet culture is very powerful. And, and it seeps into all of our brains through social media and through commercials and, you know, depicts people being happier because they're on a diet. And I think that it's so important to I do want to also delineate that not everybody who goes on a diet is going to develop an eating disorder. But most people with eating disorders, a diet was the quote unquote, gateway drug, so to speak. Yeah. To their eating disorder.
Nancy Barrow:
What is your hope for this new year of 2024? When we're talking about eating disorders?
Rebekah Doweyko:
Oh, I love that question. My hope is that at the lowest levels, pediatricians, primary care physicians, parents, spouses, loved ones, we have to do a better job assessing for these illnesses. When you walk into your primary care physician's office, you fill out a survey about substance use, you fill out a survey about depression. Nobody is asking about eating disorders. Nobody is asking. I shouldn't say nobody. Rarely are you given a survey that asks about your relationship with food. And if any eating disorder is being assessed for it's usually anorexia, and it's usually just being asked questions or just being asked and females that are exhibiting signs of anorexia, and we have to do a better job assessing for these illnesses, again, because of the shame and stigma involved, people aren't going to just come out to their doctor and say, I think I have an eating disorder, especially because most of the time again, anorexia nervosa is the rarest occurring. So most of the people when they do express a concern about their relationship with food, if they aren't underweight and significantly underweight, the doctor will say, but you don't look like you have an eating disorder.
Nancy Barrow:
So what should people look for, as a parent or a friend, maybe telltale signs that someone has an eating disorder?
Rebekah Doweyko:
Yeah. So you know, I think I don't want to just talk about dieting, because I think that that's obvious. And that's talked about enough. But I think you can tell when somebody's relationship with food is changing, if you're looking for it, and and I think that we have to be aware of it too, and to not ignore things that we see, it might. It might be wrappers in somebody's room, it might be food disappearing, it might be noticing that this person seems to be avoiding having meals with you or their friends, or all of a sudden when it's meal time, they're nowhere to be found. Somebody that used to really enjoy celebrating with food no longer wants to do that. It might be a market change in their mood, right? irritability, avoidance isolation. I think a change in the type of clothes they wear. So you might see rituals around food or mealtime behaviors, comments about their own body comments about other people's bodies.
Nancy Barrow:
Interesting stuff. And I just want to thank you and everybody Walden for utilizing Connecticut Paid Leave and letting caregivers and patients know about it. I really think that's wonderful that you're doing that.
Rebekah Doweyko:
Definately We are so grateful for it. It's saved countless families and they're and you're right, though there are some people that it doesn't occur to them. And we have to be like, hey, we'll write you a letter you can take leave, like that's what it's for. And people are like, oh, yeah,
Nancy Barrow:
Rebecca Bardwell Doweyko, Assistant Vice President of Clinical Operations and ambulatory services for Walden Behavioral Care. Thank you so much for being on this podcast. It was really, really important for us to talk about this.
Rebekah Doweyko:
Thank you so much for having me and thank you so much for being willing to talk about this topic
Nancy Barrow:
And for more information or to apply for benefits you can go to CT paid leave.org. This has been another edition of the paid leave podcast. Please like and subscribe so you'll be notified about new podcasts that become available. Connecticut paid leave is a public act with a personal purpose. I'm Nancy Barrow and thanks for listening.
