In this member profile, Amy Woods, a counsellor at Eating Disorders Victoria, talks about why the Covid pandemic may have caused an increase in eating disorders, EDV’s ‘stop gap’ five-session counselling support model, and some of the signs that a client may have an eating disorder.
PACFA: Could you share something of your approach that you've been taking with clients of eating disorders?
Amy Woods: I guess keeping in mind that the pandemic has had a huge impact on people with eating disorders, a lot of the approach is kind of meeting people exactly where they're at, but also acknowledging that there might be quite a bit of wait time for them to be seen in formal services or, you know, get into a program or a hospital admission or things like that. So a lot of it is just meeting the person where they're at, acknowledging their frustrations, being there for their frustrations and looking at harm minimisation as well. So what little things can they be doing out in the community whilst they're waiting for longer term kind of psychology or inpatient, things like that.
So what we've been is a little bit of a stop gap for people that are on waiting lists, haven't been able to get in to see anybody or just experiencing symptoms for the first time and not quite sure where to go. So what we've done is kind of developed a five session model, essentially, with the hope that five sessions, whether it's over five weeks or 10 weeks or a little bit longer than that, that hopefully over that time they're able to get into the longer term supports. So for some people, if we are recognising that they're really, really quite unwell, we can certainly do some advocacy and, you know, get on the phones and try and get somebody into hospital. And we've also got fantastic nurses here as well. So we work alongside them so they can kind of liaise with GP's and we can figure out really where people are from a physical health perspective, but also the mental health perspective, and keeping an eye on both of those things.
PACFA: Why is it, Amy, that there have been more referrals for eating disorders during lockdown? Is it lockdown or is it COVID, or both?
Amy Woods: Yes, it's probably lockdown, but it's definitely the stress of COVID as well. But generally, you know, isolation is an eating disorder's best friend. So people that might have kind of had some of those tendencies to begin with or might have been going down the road of disordered eating, suddenly, they're isolated from friends and family. That might have been kind of keeping them well. They're looking for a way to exert control because we've been stuck in our homes, you know, working from home, all of that sort of stuff. So, looking for a way to exert control, looking for an activity to do as well. So people think, 'OK, well, you know, I'll try and get fit. I'll try and lose a little bit of weight during the pandemic.' Of course, we've seen all those kind of campaigns for losing the COVID kilos and all of those sorts of things, so the social pressure definitely hasn't helped. And then there's also, just thinking back to the core of it, disordered eating is a coping mechanism. So for whatever stress, anxiety, grief people might be going through, that's then exacerbated by the fact that we're in the middle of a pandemic and we're very restricted in what we've been able to do. That's going to be kind of drawing on any unhelpful coping skill that anybody has, whether it's, you know, drugs, alcohol, anything like that. And for a lot of people, that's been disordered eating because so many people do have kind of undertones of that to begin with because it's very kind of socially accepted and encouraged in a lot of ways in society.
PACFA: So what are the characteristics of an eating disorder? How is it actually diagnosed?
Amy Woods: So it really depends kind of what you're presenting with. But really, this obsession around kind of our overvaluation of weight and shape, and this could be preoccupation with what you're eating. This could be a restriction. It could be overcompensation for the food that you're eating. It could be eating large portions quite frequently. It could be eating large portions and then not eating for a certain period of time. And it could just be that, you know, there's none of those actual behaviours, but it's the distress in your mind, the constant rumination about food, about image, about weight. It's self-punishment for some people. For some people there's no kind of body image component whatsoever. And there's also ARFID, which is Avoidant/Restrictive Food Intake Disorder, which is a lot more about the sensory experience of food, which can be quite unpleasant for people. Or it can be fear of choking, fear of vomiting, fear of anaphylaxis and that kind of side of things as well. So again, not body image related, but still significant anxiety around certain foods.
PACFA: Okay, so for counsellors and psychotherapists who have clients who are not yet at that stage where perhaps an eating disorder has kind of settled in, what are some of the warning signs?
Amy Woods: So I guess, you know, expressing that increased distress around how they might look, what people are thinking about them, you know, elements of perfectionism and high anxiety around what people are thinking about them and things like that. Also, thoughts to diet as well. You know, dieting is the number one risk factor in developing an eating disorder. So even just kind of hints of diets of 'OK, I'm just going to have a go at cutting back in terms of dairy' or something like that. You know, we really see those as a slippery slope. So number one would be any indication that people are wanting to diet and and kind of engage in intentional weight loss. It's always a good sign to just go, 'OK, let me explore this a little bit further'. And what is this person's kind of connection and understanding of weight and body image? And how are they affected by our culture in terms of body image as well. So just kind of delving into things when they start to hear about weight loss, dieting, negative body image.
PACFA: You also initiated a support group for LGBTQIA+ people with eating disorders. What was behind that?
Amy Woods: So when I when I started at EDV, one of the things that I had to do was set up four different support groups. And so we didn't want to make the support groups diagnosis-specific because we didn't want to exclude anyone that had perhaps not received a diagnosis or had felt previously invalidated by receiving a diagnosis. So we actually put it out onto social media to ask the community what they wanted. So we ended up with a group of people struggling with restriction, one for people struggling with binge eating, one for people struggling with alcohol and other drug issues on top of an eating disorder. And then also one specifically for the LGBTQIA+ community as well. We didn't know that that was the first one in Australia and one of kind of only a small handful in the world. So it's been a really kind of lovely journey for us to strengthen our kind of allyship with the LGBTQIA+ community and really kind of figure out what we can be doing to support them and support them more and in a really affirming and safe way as well.
PACFA: And how is that? Are there particular issues around eating for that community?
Amy Woods: Yeah, absolutely. You know it, it varies depending on, you know, obviously what somebody is experiencing and how they identify. But generally speaking, somebody that identifies as gender diverse is going to be at a four or five times higher risk of developing an eating disorder than somebody that is cisgender. So definitely that increase. We've also got the aspect of gender dysphoria in there as well and how that intermingles with body dysmorphia as well.
PACFA: You also teach yoga for people with eating disorders. How does your approach to yoga teaching differ for people with eating disorders than for your other yoga students?
Amy Woods: So it's a trauma informed environment, so the language is very kind of neutral, (and) gender neutral. We're not kind of specific about body parts. There's no kind of cueing in terms of tightness or ‘strengthen that’ or ‘pulling the tummy in’ or anything like that. It's more about kind of exploring the possibility of safe movement and just experiencing what it's like for the body to move through space. Whereas previously, you know, being unwell, particularly with an eating disorder, we can be very sensitive to what's happening in the body, but we can also be very avoidant of what's happening in the body. So it's this gentle invitation to become aware of what's happening. Notice anything that you like or you don't like, whether it's sensations or anything like that. But then also safety to move away from anything that you don't quite like or you're not comfortable with.
PACFA: OK, so it's all about body awareness, actually, and just getting in touch more with the subtlety of sensation.
Amy Woods: Absolutely, yes. Yeah.
PACFA: And what's the theory behind that, Amy?
Amy Woods: So I mean, yoga is used for lots of different, I guess, health concerns. And also, you know, there's a growing body of work for mental health concerns as well. But you know, if we come to looking at something like polyvagal theory, you know, looking at how the body responds to stress and distress. And for a lot of people who are struggling with an eating disorder, they spend so much time in that fight or flight response. So what this does is it looks at movement that is going to help down-regulate the nervous system, but also going to just gently bring awareness to some of the sensations that they might be feeling in the fight/ flight space. And also it's perhaps building a little bit of tolerance to some of those sensations so that if they feel that down the track, whether it's, you know, a stressful situation, they might not perhaps be as distressed by it as they were because they've experienced it before. They know that it goes away and they know also how they can support themselves to move away from that sensation as well.
PACFA: Is that because many people with eating disorders have experienced a lot of trauma? Is that quite common as a trigger for an eating disorder?
Amy Woods: Yeah. Look, it is very common, but also the underpinnings of trauma-informed yoga are very kind of inclusive and very gentle and person centred. You know, the one of the main things is that you're not assuming that somebody feels safe in the here and now or feels safe in their body. And so kind of this gentle invitation to become aware, to become present, but also the option to move away from presence and awareness as well is there. So absolutely. There's a high correlation between people that experience trauma and then go on to develop an eating disorder, but in general the principles just align really nicely. You know, I personally think that going through an eating disorder is a trauma in itself and whether people associate, you know, kind of identify with the word trauma or disruption or chaos or illness. You know, it all sort of falls under the same, I guess, umbrella in some way.
PACFA: And Amy, just going back to the beginning and the work that you've been doing, in effect, sort of holding people with eating disorders before they can receive long term treatment. You were saying that you were taking a harm minimisation approach? Can you say more about that?
Amy Woods: Yeah, absolutely. So, you know, we have people that come to us at varying stages of kind of readiness. So we really take the approach that we're not going to push or force them to change. So we meet them where they're at. Some of them are very ready to start having more food or start doing some food diaries, start trying to manage, you know, whether it's binges or managed compensatory behaviours, things like that. Other people aren't quite ready to do that, but they do want to think about doing something. So I kind of come back to this concept of looking for wiggle room, so the eating disorder might be kind of giving them really strict rules of what they can and can't be having. So what I encourage people to do is think about, OK, so is there any amount of wiggle room? You're saying that the eating disorder says you have to do X amount of steps per day? Could you do slightly less than that? So it's not going to be these huge big changes. It's just going to be working within what the person feels they have capacity to do, but also reminding them of things that, you know, are some markers that they might need to, you know, go to see their GP or attend the emergency room and things like that so that they are as safe as possible and they're kind of as aware as possible of what is going on for them.
PACFA: And I notice you also use the language 'what the eating disorder says' rather than what they say. So there's that deliberate distancing?
Amy Woods: Yeah, absolutely. Externalisation is a big part of kind of eating disorder treatment. Some people really kind of don't gel with it, and that's completely fine. But a lot of people find it empowering to know that they are not the problem. It's not their fault. They're not, you know, doing this on purpose and to bring a bit of externalisation, it means that you can sometimes come up with an image of what the eating disorder is or you can, you know, it paves a really lovely way for things like narrative therapy, you know, internal family systems, setting boundaries; even, you know, using elements of the hearing voices approach to kind of dialogue with the eating disorder as well.
PACFA: Can you tell me how you came to specialise in this field?
Amy Woods: Yeah, well, it's always been an interest. I've got lived experience of recovery myself, so I was always kind of thinking I just had that in the back of my mind. And then, you know, a job at EDV popped up, and that's just kind of how it happened. And I couldn't imagine myself, you know, really doing anything else.
PACFA: And what's your background in terms of counselling? What kind of training have you done?
Amy Woods: So I did my bachelor degree in counselling and then currently I'm doing a post-grad in forensic behavioural science.
PACFA: Do you want to tell me what's your interest in that and what you hope to bring from that into counselling?
Amy Woods: Yeah. You know, for me, it's really about kind of revisiting the experience of trauma and whether that's the trauma of being a victim or the trauma of being an offender. You know, just looking at how that impacts us, how our behaviour can be shaped and changed throughout our lifetime and how then vulnerabilities kind of can sneak in there and a whether that's, you know, eating disorder or substance use, I think it just gives a really nice kind of understanding of human behaviour and how you can get from one place to another almost.
PACFA: And in terms of the work that you've been doing with people, where are people usually at after those five sessions?
Amy Woods: Yeah, look, it varies. You know, the ideal scenario is that by the end of the five, they've got an appointment ready to go so that there's some continuity. Sometimes that's not the case. But what we really try to do is have them engaged in other areas of Eating Disorders Victoria. So whether that's attending our support groups or part of our peer mentoring program or, you know, doing some of our online webinars or something so that they're staying connected with our community and can reach out, you know, when and if they need for a little bit of extra support while they're waiting.