S4 E8: Erica Trocino on Eating Disorders

Released November 9, 2021

The shame piece becomes a barrier coming into treatment because they want to believe that they’re not that sick, that maybe they’re trying to present that way to their family or their friends that have expressed concerns. Or maybe the friends and family have no idea that they’re as ill as they are, because they don’t want to be categorized as weak or whatever those messages might be. So being able to do the opposite, which would be coming into treatment, even if they don’t feel like they’re sick enough, could be a lifesaving decision because if they continue to hide and live in that shame, the consequences are just going to continue to add up.   

Podcast Transcript

Welcome to Beyond Theory, a podcast powered by Meadows Behavioral Healthcare that brings you in-depth conversations with firsthand insights from the front lines of mental health and addiction recovery. I’m Dominic Lawson. 

For a long time, it was believed that eating disorders only afflicted a certain demographic. Some have even gone on to believe disorders like binge eating are not disorders at all. However, Erica Trocino, Clinical Director of The Meadows Ranch, says those disorders are real but that their complexities are seen in many different groups and backgrounds. So how do you handle the many complex scenarios and provide the best possible care to achieve lasting recovery? 

Let’s get out of the abstract and see how this applies in the real world. It’s time to go Beyond Theory.  

Dominic: Erica, thank you so much for coming on the Beyond Theory podcast. It’s a blast to have you here. 

Erica Trocino: Thanks for having me. 

Dominic: Of course. Erica, if you would, just share with us your background. 

Erica Trocino: Well, I’ve been clinical director at The Meadows Ranch for three years now and I was a clinician up to that point for seven or eight years before that, working in eating disorders. I did graduate from ASU and thought I was going to go into more substance abuse, and then eating disorders just continue to amaze me with how complex and unique they are. 

So, I have dug my heels in and became a certified eating disorder specialist and supervisor. I’m now supervising all the therapists here at The Ranch so that they can work towards their certification in eating disorders as well. 

Dominic: Erica, if you will, will you talk about being fascinated with the complexities of eating disorders, can you talk about some of those complexities if you would? 

Erica Trocino: Eating disorders, typically they’re stereotyped as a young, white female issue, and, thankfully, the research has shown that this is not something just for females. It is for males. It’s for athletes. It’s the LGBT community. It’s for midlife and beyond issues. Just the fact that there’s no longer this small margin that it affects really opens up the opportunity to help so many people that may have been living in hiding with their eating disorder because they didn’t fit that mold of being a young white female. 

We are seeing those issues coming up in so many different fashions, and the fact that our facility only treats females is just one aspect, but I know that there’s a lot of other facilities that treat males and maybe more specifically athletes. So, there’s a lot more coverage and opportunity to get the help than there ever has been before. 

Dominic: Erica, just a quick follow-up. Where do you think that, “it’s a young, white female disorder,” what do you think that stems from?

Erica Trocino: I see it coming from more of that diet culture and the mainstream media. Because for the past 20 to 30 years, there’s been a lot of focus on changing your body to look like a celebrity or some person that’s on the face of a brand. But as it continues to evolve, we are seeing so many different areas of the fear of being vain prevents them from coming forward. 

They feel like it’s “a stupid issue” because it’s just about my looks or my appearance and then as they start to do the work to really find the seeds of where this came from, they’re learning that there’s more messages from family, friend’s influences around them that go even deeper, and I think the diet culture and the media just bring it out, if that makes sense. 

Dominic: That makes complete sense. But on the flip side, it also seems as if we’re also starting to see that narrative is changing a little bit. You see supermodels like Ashley Graham and the like who are taking it in a different direction. What’s your opinion on that Erica, if you don’t mind me asking? 

Erica Trocino: I love it. I think there is a need for more body positivity out there in just the media as a whole, and so having people who have a platform already to speak out and say, “My body is great the way that it is,” there is a movement going through the eating disorder community right now of promoting Health at Every Size because there are a lot of stigmas that come from larger bodies that there’s assumptions being made. 

There’s discussions about opportunities being lost if their bodies are not “of the standard for somebody.” So, I think it’s really good that there [are] more discussions that bodies come in all shapes and sizes and there’s no wrong way to have a body. 

Dominic: You just made me think about something because it seems like now that messaging is going towards young girls and young girls of all shapes, sizes, colors, backgrounds, things of that nature, because you start to see different dolls have different shapes and things of that nature. So, thank you for sharing that. 

In that same vein, I came across an article in Forbes that talked about during this pandemic that more and more young people … the pandemic is fueling eating disorders in young people. Are you seeing that? Give some commentary on that, Erica, if you don’t mind me asking? 

Erica Trocino: We are seeing that, and it’s pretty heartbreaking because the pandemic is already hard enough to adjust to. But then you have the added components of the isolation at the beginning of COVID when people were going through hoarding at the stores, taking every resource that they could, people were starting to panic. 

So, our young people who have never lived through something like this, they’re scared, they’re seeing their family members being nervous about what’s going on, they hear those discussions, they’re trying to figure out a way to cope with that as well and, like many people, they find that their easiest access to something they can control is the foods that they consume or don’t consume. 

They were limited in terms of the social interactions with friends that may have been a buffer to something like an eating disorder or substance abuse. It was harder to get in contact with providers. You may see them over the computer, but just that connection piece was not there for so many, and those cries for help really came in and we saw a tremendous influx of teens looking for help, their families are looking for help to the point where at one point we had a waitlist over two months to get their child some care, and that’s consistent through all levels. Whether it’s inpatient or outpatient, there’s just a great need for treatment right now because people are still trying to figure out, “How do I navigate this new life that really has transpired from COVID?”

Dominic: Absolutely. You talked about a lot of people are seeking out treatment and the two-month waitlist and things of that nature, and I imagine that it’s quite difficult as a clinical director because you want to help everybody. 

Let’s say somebody’s listening and they’re trying to get treatment at a facility, whether it be The Meadows or somewhere, and they’re on the waitlist. What are some of those things that they can do now that can possibly, as they wait for treatment, to build that bridge until treatment is available to them? Does that make sense? 

Erica Trocino: Yeah, it does and we would strongly recommend, if they are able to find an outpatient provider in the meantime, working with some kind of therapist, dietician, psychiatrist, so that they still have support people around them until there can be that exchange of hands to get them the care that they need. Just because the concern is the longer they go without care, the more the disease progresses. They may start to have second thoughts about coming into treatment the longer that they wait. 

And so, if they aren’t able to get access to providers because maybe they are booked out far in advance, looking at local resources like Eating Disorder Anonymous groups, even reaching out to local universities. They have counseling centers as well. 

We just want them to be able to have a safe place to start talking. Again, like you said, that bridge until they can come into a facility like ours and then dive in with all the resources right in front of them. 

Dominic: Erica, I’m curious about something. I saw you on a Facebook live a while back. You talked about the stigmas. You also talked about that sometimes there’s shame involved when it comes to seeking treatment, not seeking treatment. Can you talk about that a little bit? 

Erica Trocino: The shame piece becomes a barrier coming into treatment because they want to believe that they’re not that sick, that maybe they’re trying to present that way to their family or their friends that have expressed concerns or maybe the friends and family have no idea that they’re as ill as they are because they don’t want to be categorized as weak or whatever those messages might be. 

So, being able to do the opposite, which would be coming into treatment even if they don’t feel like they’re sick enough, could be a life-saving decision because if they continue to hide and live in that shame, the consequences are just going to continue to add up. 

Whether it’s medical, could be social, could be impacting work and their relationships, we continue to encourage them that you don’t have to be at your rock bottom to come into treatment. That’s essentially what shame is telling them is, “You’re not sick enough, you’re not good enough to go get that care. Just keep waiting. It’s not that bad.” And we say, “Please come in where you are right now. Don’t let it get worse in order for it to get better.” 

Dominic: Now, I’m curious about that part. You talked about maybe not being sick enough to get treatment, and I’m going to circle back to that part a little bit, but you said also not good enough. Talk about that, and that’s a new one for me. 

Erica Trocino: Not good enough to come into treatment? 

Dominic: Yeah. 

Erica Trocino: One of the roots, so to speak, of eating disorders is that self-esteem, it’s been damaged, it’s been impacted, and this idea of not being good enough can be a reflection in how they take care of themselves. It could be daily living tasks. It could also be that, “I’m not worthy of medical care. I don’t need that many people to help me.” 

Dominic: Thank you for sharing that. Like I said, I want to go back to that part, sometimes we don’t want to wait for patients to hit that rock bottom. Let’s say I’m a family member and I suspect that there may be an eating disorder. 

I don’t want to have that jarring moment and just ambush him and just say, “This is what’s going on. I think you need to do this.” As that person who is like a family member or spouse or something like that or maybe it’s me, how do I know what those early warning signs are to say that this is one thing as opposed to an actual issue? Does that make sense, Erica? 

Erica Trocino: It does and that is a difficult position for a person to be in because they’re going to want to believe, even for themselves, that it’s not that bad. This idea of having to step out of your life is a jarring experience. 

But warning signs, we look a lot at the preoccupation. How much of your day is being spent thinking about food, your weight, your body, and if you’re spending more than 50% of your day thinking about those things, there’s going to be a natural ripple effect throughout your life where you’re less present for your family. You’re less present for the social relationships that you have. You’re spending a lot of time. 

Maybe it’s going to different grocery stores. Maybe it’s avoiding family functions because they have food. So, looking at where are those areas that have shifted over the course of going deeper into the eating disorder where people can put those into the forefront of, “I’ve noticed something’s different. You’re not coming to the social functions anymore” or “I noticed when you do you, you don’t eat. Is everything okay?” For so long there was this impression that you could tell by looking at somebody that they had an eating disorder and that was way back when anorexia was really the only eating disorder that people knew about. But now with so many different ways that eating disorders present, you can’t tell just looking at somebody the severity of their illness. 

So, we’re looking for those other elements of their life that have been impacted, that hold value to that person and that could be a way to signal to them that, “I’m noticing something’s different. You’re not yourself. I want to support you. I want my friend back, or I want my loved one back, so how do I help you?” 

Dominic: Thank you for sharing that. Erica, you often talk about, when people are in treatment, having affirmations and mantras, and this is to help with positive thinking. You talked about how your brain or your body is listening to you as you talk, as you think and stuff like that. Can you talk about that part because I think that’s interesting? 

Erica Trocino: We do talk about affirmations as soon as people start coming in. It’s funny because that’s probably the hardest time for them to be able to hold onto this idea that there are positive things about them and that they’re capable and they’re smart because they’re in such a low place when they come in, but we ask them to continue to use those affirmations every hour, every minute, maybe when that negative thought comes up, to really challenge it. 

Because there is that mind-body connection, and the language that we use to talk about ourselves or about an experience that we’re having can really shape how we feel and continuing to remind them that it’s okay for you to be here today or it’s okay for you to be struggling when they might have this pressure that I have to do everything right or I’m failing. 

We give them those gentle reminders that it’s not going to be perfect, you don’t have to be perfect for you to be in recovery. So, affirmations are important and they’re a stepping stone towards being able to present different ways of thinking when they come in with distorted thoughts. It can be really hard to challenge those if they don’t have a concept that there could be a better way of thinking or maybe they’ve tried it and it hasn’t worked for them. 

We keep encouraging them to find experiences to really enhance those affirmations so that they stick and they feel possible. From there, if they can’t even entertain the idea that it’s possible that I could love myself, they can work up to even just being okay with themselves. It doesn’t have to be this all or nothing, I either hate myself or I love myself. 

Dominic: Finding that gray area that you often talk about. One of the things you also have to work through is sharing that not everybody’s path to recovery has to be the exact same. Can you talk about that a little bit? Even if it’s not eating disorders, we all fall into that trap sometimes. 

Erica Trocino: Absolutely. Comparing is just a natural human experience. However, when it comes to recovery, it can be in my opinion a bit detrimental because like you said there’s so many different ways to find that recovery and everyone looks different that there isn’t this checkpoint that you hit and then all of a sudden you’re there and it looks the exact same as your peer. 

So, we talk a lot about that here because naturally our patients are talking about the work that they’re doing with their peers and they might get hung up on the idea of, “You’re doing this work and I’m not quite there yet. Does that mean that I’m not as far along, I’m not doing it as well?” 

We talk a lot about how it’s not a linear process — it’s not just the series of checkboxes, where you’re hitting all those points, you’re almost to the finish line — and having those realistic expectations, discussing that when you leave treatment, you’re not going to be cured. You’re just going to have a really solid foundation to then be able to go back out into life and then apply what you’ve learned such as skills or maybe it’s learning how to regulate your emotions when life starts to pop up again because we are in a bubble. 

That’s intentional because we want them to get grounded, get focused, do that hard work in a safe place, but we know when they go home  there are some transition bumps that come up and we want to remind them that’s normal, that doesn’t mean that your whole path is destroyed and you’re never going to get there. It just means expect that there’s going to be times that are harder than others and go back to what you learned on your foundation and start again. Because comparing can be really hard on especially those that are more perfectionistic. They are really quick to throw it all away and we really want to caution against that. 

Because with eating disorders, you have to face the food to survive versus more of the substance abuse, the abstinence approach works for many because they know, “I’m just going to avoid going to the bar. I’m going to avoid doing this because that’s a huge trigger for me” versus food, you have to you have to consume it to live. So, how do we change that relationship? It’s a process. 

Dominic: You said two things I actually want to highlight. When you talked about earlier about that process not being linear, I think that’s very important to highlight for our audience. When you talked about that juxtaposition between substance abuse and eating disorders like you said you need food to survive, it is energy for the body and stuff like that. You can’t really take the abstinence approach and that goes to that complexity that you were talking about earlier. So, I appreciate you highlighting that for sure. 

You are the clinical director at Meadows Ranch. You talked earlier about being a therapist. Can you talk about that transition from therapists to leadership, if you will, and still having that same goal of treating patients or treating them in a different capacity? Because I imagine that it looks extremely different than when you were at the ground level at the front lines of it. Does that make sense? 

Erica Trocino: Yeah, it does. Being a therapist is my passion. I love working with the complexity. Naturally, working in an inpatient setting, I’ve got people coming in every 45 days and leaving and there is just this intensity in the work which I love being able, for people to just come in, do that deep dive, feel better when they leave. 

When I was working with the adults, I saw so many opportunities for them to go back into their life and follow their goals and do what they want to do. When I switched over to the adolescent unit that was a whole different experience because I’ve got most kids that don’t want to be in treatment, totally different mindset. 

We’ve got parents that are anxious and concerned. So, that presented a lot of new challenges for me, and I ended up loving working with adolescents, which I didn’t think I would. But then as I moved up into leadership, I moved into a program director position and took more of a crisis management and operations position not totally disconnected from therapy, but I didn’t have a caseload anymore.  

I stayed in tune with my team and heard the challenges that they were experiencing. As I moved into the clinical director position, my caseload essentially became my therapist. So, not only hearing what they’re struggling with because of issues coming up with their patients but just the constant shuffle of inpatient can be really exhausting. 

When COVID hit, we were all going through this, “How do we do self-care in COVID?” That was humbling for me to essentially be in the trenches just like my therapists of how do we take care of ourselves, and then how do we help these patients along the way when we’re all trying to figure it out? 

So, I like the fact that in this leadership position, I still feel like I’m able to be connected to the patients but in a different way. Because I trust that their therapists know what they’re doing and then if they don’t, they can ask for help and I can just give my experience with them. We can talk about what’s coming up for them and get back to that ultimate goal of how do we help the presenting issues in front of us. 

Dominic: Absolutely. Like you say, COVID really just throw a wrench in a lot of people’s endeavors, so I definitely can’t even imagine when you talk about the work that you do for sure. I want to ask you this now. Erica, I know that you’re a pretty awesome clinician but I know that’s probably the most popular there at Meadows Ranch is Cowboy there. Can you talk about Cowboy a little bit and the role that animals have in recovery, if you don’t mind? 

Erica Trocino: We love Cowboy and Cowboy has been such an asset since coming on board. He has this calming presence and there’s just something about animals. The fact that we have the horses here as well so we can do equine therapy, and they’re an incredible animal, which I didn’t realize until I worked in this area just how intuitive horses are. 

So now that we have Cowboy, he’s very similar in that regard. He can sense what’s going on. He takes that comforting role, where sometimes our patients just want to hold him and hug him, and there are other times where we’re practicing setting a boundary and being assertive, and he will wait for you to be assertive. I know one of my clinicians just talked about that this week, how they’re trying to empower their patient to have a voice and to set these boundaries. They were so quiet, and Cowboy wasn’t having it. Finally, they said, “Come on, tell him to bark” and the patient used it with some force and then finally he did. 

Just helping that patient in a non-threatening way, build up some of that confidence of, “Even this animal isn’t taking me seriously without my boundary unless I really assert myself.” So, we can translate that to who in your life do you struggle to set boundaries with and how do you stand with more confidence and assertiveness that what you’re saying has value. Practicing on animals can be less threatening and then they get to cuddle at the end. It’s this happy little package that we get to have, especially during crisis situations where somebody is really struggling to bring down their emotions, he can just walk up and there’s a shift. So, there is some magic in that canine therapy or animal-assisted therapy, and we find that to be very beneficial here at The Ranch. 

Dominic: For sure. Just to say, Cowboy isn’t just walking around. He’s professionally trained in everything. I wanted to highlight that as well. 

So, Erica, before we wrap up here on Beyond Theory, I just want to say thank you so much for coming on the Beyond Theory podcast. It’s been a blast to learn about the work that you do and the things that are going on at The Meadows Ranch. 

I want to ask you this. There’s somebody out there who’s listening to this and they want to get treatment but they’re not sure about how to go about it, they’re afraid, too, of that stigma that we talked about earlier. Can you talk to that person a little bit, Erica, as we wrap up today? 

Erica Trocino: I would just say that if you’re thinking about getting help to do it this time in the therapy world where services are available virtually as well as in-person, there really is a way to help no matter what your situation is. 

You don’t have to be so sick before you come into treatment. Call admissions. Have a conversation with these people where they want to help, they’re going to get information. Maybe this is the right time. They’re going to help you walk through that process of “how do I decide to take a leave of absence from work?” Prioritizing health can lead to doors opening in their personal lives that they maybe aren’t even able to conceptualize right now because they’re just focused on what’s in front of them and the struggle that they’re in. 

So, we want them to take that time for themselves. Who else gets an opportunity to improve how they feel about themselves and their relationships in 45 days and walk out being their old self again or maybe a new version of themselves? So, taking that opportunity, there really is no downside to that. 

Dominic: I want to ask a follow-up question because you talked about coming in for the 45 days and becoming their new selves. How often does it happen where a person goes in for an eating disorder issue and you actually uncover other things, that dual diagnosis if you will? Can you talk about that a little bit, Erica? 

Erica Trocino: I would say dual diagnosis is way more common than just having an eating disorder. Like I mentioned earlier, there’s just so many seeds that get planted throughout our lives that they may come in with eating sort of being the focus and realize, “Wow! I’ve had some untreated … maybe it’s depression, anxiety, some kind of mood disorder … for a long time.” And they never could really put their finger on it because they were just trying to cope with it. 

So, more often than not, they’re leaving here with more insight into, “This makes more sense why I’ve been feeling this way or trying to cope in my own ways.” Because they may have been told, “Don’t worry about it. Everybody’s anxious. You’re not that special.” The messages from our culture and our families can be really harmful if we don’t have that ability to push through and say, “This doesn’t feel right” or “I just don’t want to live this way anymore, so I’m going to go talk to somebody about it and see what they think.” More often than not, they’re going to leave here with more awareness of why they feel the way that they do and how to do something about it. 

 Erica Trocino is a licensed professional counselor and supervisor in the state of Arizona, a certified eating disorder specialist and supervisor, and a certified alcohol and drug abuse counselor, as well as being EMDR-trained. Find out more about her work at meadowsranch.com.  

Beyond Theory is produced and hosted by me, Dominic Lawson. You can discover more, including videos of some of our conversations, at BeyondTheory.com. 

Finally, thank you for listening and I hope you join us next time for another episode of Beyond Theory. 

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