35. Attachment Trauma: Treating Co-Occurring BPD and EDs with Fatema Jivanjee-Shakir

Media often tends to focus on and center emaciated, thin, young white adolescents who are hospitalized due to medical complications of malnourishment when speaking on the topic of eating disorders. We don't often hear stories of Black girls with anorexia, Black men struggling with body image, Black families and the impact of these narrow stereotypes on limiting care and life-saving access to care. Today's episode was recorded almost half a year ago, but it still rings so important. Mimi talks with Dr. Erikka Dzirasa, MD about messages we received around mental health growing up and our work as Black healthcare providers in the eating disorder field. *The title was tricky for me to think about, I wanted to capture how Black children experience eating disorders because the narrative is lacking. I also wanted to capture that little Black girls and Black men and non-binary and trans Black people experience eating disorders. Blackness and eating disorders aren't mutually exclusive. I landed on Black Young Girls because that is the experience I can speak to the most and we need more voices. And also, one podcast episode doesn't capture the whole Black experience of eating disorders, there is so much complexity. So just narrowing in on some aspects here. I've also since read the book, It's Always Been Ours by Jessica Wilson, MS, RD, which has been absolutely incredible, I highly recommend reading! We talk about.. Black families and eating disorder care Messages prominent in many Black families around mental health The need for more representation within the field of eating disorder care How stereotypes lead to lack of early diagnosis and are life-threatening Dr. Dzirasa's leadership positions within Arise and Project HEAL, and the importance of diversity within organizations providing care Erikka Dzirasa, MD, MPH, DFAACAP is a double-board certified Child and Adult Psychiatrist who brings more than 10 years of deep expertise in eating disorders and mental health since first seeking out specialized training while in Duke University's residency and fellowship programs. She previously served as the Medical Director of an Eating Disorders specialty hospital system, leading policy and program development to deliver high-quality, effective care in their intensive outpatient (IOP) and partial hospitalization programs (PHP), residential and inpatient units for people living with eating disorders. Erikka is currently Chair of the Board of Directors of Project HEAL, a leading eating disorder nonprofit breaking down systemic barriers and providing education and supportive resources to people of all identities and background experiencing eating disorders. She is a partner in Catalyst Therapeutic Services, a private practice in Durham, NC and a Consulting Associate at Duke University Medical Center. As a mental health advocate, she also serves on the Race, Ethnicity and Equity committee for the North Carolina Psychiatric Association, and is the immediate Past President of the North Carolina Council of Child & Adolescent Psychiatry. Dr. Dzirasa earned her Bachelor of Science at Spelman College, Master of Public Health in Health Care and Leadership at UNC Chapel Hill, and her Doctor of Medicine at Duke University School of Medicine. She is also a certified yoga instructor.  Find Dr. Dzirasa at: IG: @dr.erikka Arise: www.wearearise.com/about Find Mimi at: Main IG: @the.lovelybecoming Podcast IG: @lovelybecomingpodcast Website: www.mimi-cole.com

In this episode, Mimi talks with CEO of Project HEAL, the largest nonprofit in the U.S. working to address inequities in treatment access to individuals with marginalized identities who struggle with eating disorders. We talk about her work at Project HEAL, grappling with how white and exclusive the field of eating disorders has been and paths forward. Months after our recording, it's here. It's tender; enjoy listening and check out links for more information about Project HEAL below: . https://www.theprojectheal.org/ Treatment Funding Assistance Program @projectheal on Instagram . Rebecca Eyre (she/her) is the CEO of Project HEAL, the leading national nonprofit focused on equitable access to eating disorder support. Project HEAL offers direct services to people who are unable to access treatment, providing free treatment, assessments, cash assistance, insurance navigation support, and community education. Rebecca is a licensed mental health therapist who has been treating individuals with eating disorders for over a decade, and she's a vocal advocate at the intersection of eating disorders and social justice.

In this episode, Mimi speaks with incredible therapist, Thaís Sky. We cover... feeling like too much and not enough, Thaís journey thus far exploring why humans feel unworthy and how that keeps us from connection our qualms with co-dependency and thoughts on relational healing and interdependence talking about therapist boundaries and how our interpretation of them reflects our early relationships and beliefs how social media reflects and fuels our discomfort with uncertainty and the beauty of privacy in the midst of highlighted vulnerability and more!! I may be biased, but this episode is an absolute treasure to me. I've learned a ton from Thaís and her gentle connected presence. She is amazing.  About: Thaís is a psychotherapist and writer on a heart-led mission to support the seekers, the edge-dwellers, and the "why the heck do I feel so broken” of the world reclaim their sense of worth (what she calls the worthiness wound®) by learning how to explore, trust and express themselves. Through her podcast, RECLAIM, and work with individuals and groups, Thaís is guided by the belief that when we know who we are, we become more free. She holds a Master’s in Clinical Psychology and helms a therapy practice in Los Angeles. You can learn more about her at IamThaisSky.com and just about everywhere on social media at @IamThaisSky.

In this episode, Wednesdae and Mimi talk about: • Wednesdae’s very own becoming, sharing the story behind their name change • How Mimi’s almost deleting the one time she shared specifics of her eating disorder story and how that vulnerability led to the creation of something really beautiful • How trauma impacts our childhoods and how we heal • Pronouns, gender identity, embodiment, and authenticity • Founding of Rainbow Road, the first LGBTQIA+ Eating Disorder IOP in the country • Healing through art and sharing of our stories Book Referenced: Your Wound, My Garden by Alok: https://alokvmenon.myshopify.com/products/your-wound-my-garden-pdf . You can find Wednesdae on Instagram at: @queer.art_therapist or their website: https://rainbow-recovery.org/

In this episode, realtor Madison White and Mimi talk about... • How chickens might change your mental health (how caring for others helps us care for ourselves) • Life outside of eating disorders --> eating disorder professions; life “beyond ED”, if you will • How a Tennessee law and backyard chickens changed everything for Madison’s mental health • Authenticity, honesty, and how these disarm others and invite us all to show up • Dating when your body changes after an eating disorder … plus a lot of laughs and more ♥️ . Madison White, 31, has been living in Nashville all of her adult life. As a woman with ADHD, anxiety/depression, PMDD, and a history of disordered eating, she has become a mental health advocate.  She has be an licensed REALTOR for 8 years and is consistently ranked in the top 10% of agents at her company.  She works to create a safe environment for her clients as they navigate market challenges.  Madison is obsessed with the fact that she gets to help others find the places they will call home and where all of the biggest little moments of their lives will happen. She truly believes her life’s purpose is to bring joy to those around her. Homeownership gave her the opportunity to become a certified chicken tender to a backyard flock of 7 and dog mom to her English Bulldog rescue, Larry.

In this episode, Gloria and Mimi talk about… ‣ the origins of harm reduction and how this framework translates to eating disorder care ‣ Address common pushback to harm reduction such as the idea that it is enabling the eating disorder or giving up on recovery ‣ Discuss how purity culture, white saviorism, and colonialism play a role in resistance to harm reduction and current treatment approaches . . We will also cover… ‣ Why Gloria’s new motto is “i don’t care” ‣ Caring for yourself while doing work that serves others ‣ Eating disorder treatment in the BIPOC community  . Notes: ‣ 13:31: For me, the narrative of “recovered” largely exists around individuals who recover into thin bodies and hold privileges of access to high quality treatment, believability surrounding diagnosis and family validation, etc. I also believe the term 'recovered' doesn’t create space for how eating disorders can help people cope with marginalized identities and access care due to proximity of body size to privilege. . . . You can find Gloria at: IG: @nalgonapositivitypride Website: nalgonapositivitypride.com And Mimi at: IG: @the.lovelybecoming Website: www.mimi-cole.com

In this episode, you will learn about: • Co-occurring presentation of Borderline Personality Disorder and Eating Disorders • Attachment trauma and the role of a secure base in treatment • How individualistic values impact treatment approaches We also cover… • common ruptures and concerns clients with both disorders bring up • navigating boundaries as providers working with attachment trauma with the knowledge that relationships heal • perspectives on DBT and it’s placement within a western, individualistic society • tips for clinicians who struggle with the co-occurring presentation of BPD and EDs You can find Fatema at: IG: @YourSouthAsianTherapist TikTok: @YourSouthAsianTherapist Website: www.fjshakir.com And Mimi at: IG: @the.lovelybecoming Website: www.mimi-cole.com About: Fatema Jivanjee-Shakir, LMSW is an eating disorder therapist, writer, and speaker. She has extensive experience working with adults and adolescents in individual, group, and family therapy at the residential, partial hospitalization (PHP), intensive outpatient (IOP), and outpatient levels of care. Her work is strongly informed by the Health at Every Size perspective and intersectional approaches to healing. Fatema has a special interest in working with BIPOC clients, especially those of South Asian and Muslim backgrounds. Fatema is a therapist at Conason Psychological Services and a Board Member of the International Association of Eating Disorder Professionals New York chapter.

In this episode, you will learn about: CPTSD The differences between CPTSD and BPD How a trauma-informed approach changes everything from diagnosis to how we treat people with similar symptoms and traumatic experiences based on a label. We also cover.. the realities of stigma and labels, pathologization of trauma Aspects of NARM (the NeuroAffective Relational ModelTM) How to reframe pathologizing diagnosis of BPD from stigma to trauma and understanding Why self-compassion might feel really hard for trauma survivors How to set boundaries around your own lived experience on Instagram Expertise in the field vs openness to always learning and curiosity About Iris McAlpin: Iris McAlpin is a certified trauma coach and NARM® Practitioner specializing in self-sabotage, eating disorder recovery and complex trauma. After struggling with bulimia, C-PTSD and depression for over a decade, Iris became determined to understand what was fueling her self-destructive behaviors and troubling symptoms. This eventually led her to an in-depth study of trauma, which resulted in a radical personal transformation. She now helps people all over the world overcome similar struggles through trauma-informed education, group programs and individual coaching. Find Iris at: IG: @irismcalpin Website: www.irismcalpin.com References: Quiet BPD, Very Well Mind article Find Mimi at: Main IG: @the.lovelybecoming Podcast IG: @lovelybecomingpodcast Disclaimer: Mimi and Iris do not have specific training in or claim to be experts in treating BPD. All thoughts expressed should not be considered a substitute for advice or an individual therapeutic relationship. The hope is to open up conversations for providers and individuals alike to consider how trauma may play a role in stigmatizing diagnoses and care, and to encourage you to keep thinking compassionately and curiously.

In this episode, you can learn about.. • Managed Care • Carceral and Anti-Carceral Care • How care is failing us and perpetuating blame We also cover.. • Trauma and Informed Consent in higher levels of care (HLOC) • Eating disorder treatment contracts • Provider fears of liability in ED treatment • Mimi practices discomfort and communicating through it • Community care alternative to traditional treatment • Jennie answers the time-old question: is full recovery possible for everyone? . Find Jennie at: IG: @dr.jenniewh Website: https://jwhrevolution.com/ Referenced in Podcast: https://fedupcollective.org/ Related Reading: The Language of Recovery: https://wellseek.co/2021/01/05/healing-or-recovery-why-language-matters-in-mental-health-2/ Find Mimi at: Main IG: @the.lovelybecoming Podcast IG: @lovelybecomingpodcast Website: www.mimi-cole.com

In this episode, Dr. Laura Thomas and Mimi talk about some of the biggest intuitive eating questions! Laura established the London Centre for Intuitive Eating (LCIE) in 2017 to help support clients who have a difficult relationship with food and their body. She has a passion for delivering inclusive, trauma informed, and person-centred care for all bodies. She draws upon different therapeutic and counseling skills to support her clients in their recovery from disordered eating, chronic dieting, and body dissatisfaction. She also incorporates different health care frameworks into her work, such as Health and Every Size Ⓡ, Intuitive Eating, and Body Image Healing. Much of her work focusses on advocacy and reducing weight-based discrimination within the nutrition profession. Laura takes a collaborative approach to working with clients, recognising that they are the experts of their own bodies and experiences. Her advice and recommendations are not didactic, rather she helps guide and support clients to reconnect with their bodies. In January 2019, Laura published her first book with Bluebird Books: Just Eat It: How Intuitive Eating Can Help You Get Your Shit Together Around Food.