Jessica Ribeiro of Ribeiro Psychology On How To Support A Loved One Who Is Struggling With An Eating Disorder
Consider your own behavior. When around a loved one suffering from an eating disorder, it is important to foster an environment that facilitates developing a positive relationship with food and one’s body. Things like engaging in dieting, excessive or rigid exercise routines, and discussions about body shape and weight (your own or others’) can be especially difficult for individuals suffering from eating disorders. So, to the degree that you can, stop engaging in these behaviors, especially around your loved one you are trying to support.
Eating disorders are complex mental health conditions that affect millions worldwide, transcending age, gender, and cultural boundaries. They are not simply about food but involve a range of psychological, physical, and social issues. Supporting a loved one through this struggle can be challenging, requiring understanding, patience, and knowledge of the right approaches to truly make a difference.
In this series, we aim to shed light on the most effective ways to offer support, understanding, and hope to those battling an eating disorder. We are talking to psychologists, nutritionists, doctors, therapists, and survivors, who can provide valuable perspectives on nurturing recovery, fostering resilience, and promoting healthy relationships with food and body image. As a part of this series, we had the pleasure of interviewing Jessica Ribeiro.
Dr. Jessica Ribeiro, PhD, is a clinical psychologist and university professor with over 15 years of clinical, research, and teaching experience. She is licensed in Florida, New Jersey, and North Carolina and is certified to see patients virtually in all states where PSYPACT is effective. At her practice, Ribeiro Psychology LLC, Dr. Ribeiro specializes in treating depression, eating disorders, OCD, anxiety, and suicide risk assessment & management. Dr. Ribeiro was named a “Rising Star” by the Association of Psychological Science and Best Early Career Researcher by the American Association of Suicidology as well as Behaviour Research and Therapy. For multiple years, she has also been recognized as a “Highly Cited Researcher” by the Web of Science, which recognizes scientists whose work ranks in the top 1% of citations in their field. She has authored over 80 peer-reviewed journal articles, many of which are in the field’s leading journals. Her research has also been covered in The New York Times, The Wall Street Journal, Newsweek, Scientific American, NBC, PBS, and the BBC, among others.
Thank you so much for joining us in this interview series. Before we dive into our discussion about authentic, feminine leadership, our readers would love to “get to know you” a bit better. Can you share with us the backstory about what brought you to your specific career path?
Thanks for having me! I first became interested in clinical psychology as an undergraduate in college. I attended the University of Pennsylvania, which is home to many scientists conducting cutting-edge research in clinical psychology. I became involved in several of these research labs as an undergraduate. As I learned more about the things like suicidal behavior and eating disorders, I became increasingly curious about what caused these phenomena that caused such tremendous human suffering and, critically, how to stop them. From there, I went on to get my PhD in Clinical Psychology. After finishing my pre-doctoral residency at the Warren Alpert Medical School of Brown University, I completed post-doctoral fellowships at Harvard University and Vanderbilt University. Across these experiences, I refined my skills as a scientist and also received extensive training in leading evidence-based psychotherapies. I ultimately became a researcher and clinician focused on the understanding, treatment and prevention of some of the most devastating mental health conditions in order to produce large-scale reductions in psychopathology around the world.
I was named a “Rising Star” by the Association of Psychological Science and Best Early Career Researcher by the American Association of Suicidology as well as Behaviour Research and Therapy. For multiple years, I have also been recognized as “Highly Cited Researcher” by the Web of Science, which recognizes scientists whose work ranks in the top 1% of citations in their field. I have authored over 80 peer-reviewed journal articles, many of which are in the field’s leading journals. My research has also been covered in The New York Times, The Wall Street Journal, Newsweek, Scientific American, NBC, PBS, the BBC, among others.
As a clinician, what I care most about is delivering the best available treatments, backed by decades of science, to help each of my patients get well quickly and for the long-term. I’m determined to work with each of my patients to get them back to living their lives as quickly as possible. I feel very privileged and grateful to be able to help do that.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Anyone who knows me personally knows that I am a big fan of the show Seinfeld. One of my favorite episodes from that show is called “The Opposite”. In this episode, the character named “George Constanza” comes to the realization that the pattern of behavior has been engaging in has led to a somewhat dissatisfying life; recognizing this, he chooses to do the ‘opposite’ of his initial instincts and finds that this strategy results in really positive outcomes. I love this episode, in part, because it actually echoes a really effective technique in some of our most effective evidence-based therapies for the treatment of anxiety (e.g., exposure), depression (e.g., behavioral activation; cognitive behavioral therapy [CBT]), eating disorders (e.g., enhanced CBT for eating disorders; CBT for ARFID), OCD (e.g., exposure/response prevention), among others. Across these interventions, there is an element of considering whether your immediate response aligns with your ultimate goal or the life you want to live. If it doesn’t, in that moment the most effective thing is often to engage in the “opposite” of that impulse, even if it doesn’t feel right or is more difficult in the moment.
Are you working on any exciting new projects now? How do you think that will help people?
Right now, I am most excited about expanding my private practice to be able to scale my impact on a more personal level. For years, I have focused a lot on building a research program that would allow me to make substantive advances in our understanding of suicide and related conditions. I’m grateful to have been able to do that work and hopeful that it helps advance our ability to substantially reduce human suffering. I am excited to be able to leverage the expertise that I have to also provide direct care to individuals suffering. As a therapist, it is the most rewarding experience to make myself obsolete to a client because they have gotten to a place where they are living the lives that feel satisfying to them and confident in their skills moving forward.
According to this study cited by the National Association of Anorexia Nervosa and Associated Disorders, at least 30 million people in the U.S. of all ages and genders suffer from an eating disorder. Can you suggest 3–5 reasons why this has become such a critical issue recently?
The exact causes of eating disorders remain unclear. So it can be difficult to pinpoint the exact reasons why we are seeing a surge in eating disorder cases in the U.S. and worldwide. The likely explanation is that many things might be contributing to the increasing prevalence.
First, it is important to note that we’ve seen the prevalence of other mental health conditions also increase in recent years. So, one reason for why we’re seeing this uptick is that mental health, in general, may be declining, especially in young people. Moreover, it’s also the case that certain mental health conditions increase risk for developing eating disorders. When we see increases in these other conditions, like depression for instance, we can also expect a potential increase in eating disorders too.
Second, many people have also raised concerns about the effects of social media. Although we don’t have any definitive evidence that social media causes eating disorders, for some people who are more vulnerable or already experiencing body dissatisfaction or other risk factors for eating disorders, exposure to certain content on social media may increase risk for developing eating disorders among these already vulnerable individuals. As social media has become a mainstay in our culture, understanding how it affects certain people under certain conditions (both positively and negatively) is important.
Third, in recent years there has also been more awareness of eating disorder symptoms that may previously have been ignored or gone unrecognized. Relative to older generations, the culture among young people these days is more understanding of the importance of mental health — disclosing mental health struggles and seeking treatment has become more normalized (though there’s still a long way to go). With that, people may be more likely to report experiencing eating disorder symptoms than they would have in previous generations.
Based on your insight, what can concrete steps can a) individuals, b) corporations, c) communities and d) leaders do to address the core issues that are leading to this problem?
a) Educate yourself about eating disorders and important issues related to eating disorders, like the evidence supporting health at every size principles and the harmful effects of diet culture on society. Make sure that you’re taking time to make sure that you’re prioritizing your own mental health as well.
b) Provide eating disorder awareness training to all of your staff, especially managers and HR. Eating disorders are protected under the ADA, so make sure you’re providing reasonable accommodations for staff who have eating disorders (for example, time off to get treatment).
c) Within your community, check in with each other. We’re all vulnerable to developing an eating disorder and/or we know people who are. Check in with your loved ones about their overall mental health.
d) I think mental health leaders can focus on making eating disorder treatment as accessible as possible for everyone. There are well-researched and effective treatments out there, like Enhanced Cognitive Behavioral Therapy for Eating Disorders, CBT-E, which is what I offer in my practice, but there are still so many barriers to treatment overall.
As you know, one of the challenges of an eating disorder is the harmful,and dismissive sentiment of “why can’t you just control yourself”. What do you think needs to be done to make it apparent that an eating disorder is an illness just like heart disease or schizophrenia?
I think we as the eating disorder community can come together to strengthen messaging around this. For example, I’ve seen the OCD community rally together and fight stigmas and jokes against that condition. The more we talk about it, the louder we are, the more the message sticks that eating disorders are health conditions, and serious ones at that. There are so many professionals and influencers out there now doing that good work, but still, so many continue to make comments that are inaccurate and unhelpful.
Here is the main question of our interview. Can you please share with our readers 5 ways to support a loved one who is struggling with an eating disorder? If you can, can you share an example from your own experience?
1 . Educate yourself on eating disorders and approach the conversation. Eating disorders often come along with overwhelming feelings of shame. Your loved one may feel too ashamed to come to you first. Beating around the bush doesn’t help anyone. If you are worried that a loved one has an eating disorder, ask them about it directly. Educating yourself about eating disorders in the lead up to this initial conversation would also be really helpful. You want to make sure this interaction is ultimately a helpful one, and that can be hard to do when you have a limited understanding of what might be going on for someone.
2 . Keep the focus away from their body. Don’t say things like, “You’re just skin and bones,” or “You’ve gained too much weight.” Instead, focus on wanting to support their overall mental health. What other changes have you noticed? For example, perhaps they’ve been declining invitations to go out, or their mood seems low. Focus on these things — the ways that the eating disorder has impacted your loved ones in a deeper way.
3 . Be prepared to help connect with treatment while also anticipating there might be pushback. Eating disorders are so overwhelming that your loved one might not be in a position to look up treatment options themselves. Do the research for them if you can. Offer tangible support when it comes to seeking treatment — for example, you might offer to dig through their insurance plan’s provider list or make some calls to ask about financing. Eating disorders don’t typically go away on their own, so treatment will be important.
Equally, though, it is very common to experience ambivalence and/or pushback from a loved one suffering from an eating disorder. Many people aren’t prepared to seek help right away. Again, eating disorders come with so much guilt and shame, and it doesn’t help that there is still such a high stigma that exists against these conditions to this day. On top of that, many people with eating disorders gain a sense of control (or other perceived benefits) using disordered behaviors. The prospect of letting those things go can cause a lot of anxiety and discomfort. So go into that first conversation prepared for this from a place of understanding.
4 . Avoid doing or saying anything that makes them feel judged. There is so much shame associated with eating disorders already. It can be so painful to see a loved one go through this that you might feel an urge to say something like, “Why would you do this to yourself?” or, “Why can’t you see that you’re already beautiful?” Although these statements might be well-intentioned, they’ll likely make your loved one feel worse about themselves than they already do. Instead, try to come from a place of understanding and support.
5 . Consider your own behavior. When around a loved one suffering from an eating disorder, it is important to foster an environment that facilitates developing a positive relationship with food and one’s body. Things like engaging in dieting, excessive or rigid exercise routines, and discussions about body shape and weight (your own or others’) can be especially difficult for individuals suffering from eating disorders. So, to the degree that you can, stop engaging in these behaviors, especially around your loved one you are trying to support.
How do you navigate the balance between offering support and respecting the autonomy of a loved one with an eating disorder?
It can certainly be a tricky balance. All adults have the right to refuse medical treatment, and this is often the most painful parts for loved ones. I think the important thing is to remain steady, but not forceful. Don’t just offer to get them connected treatment once, and then give up on them when they refuse. But also, don’t push and argue with them constantly. Continue offering steady support.
Keep your focus on your concern for their physical and mental health instead of their body. For example, instead of saying, “You’re getting way too skinny and you need to go to the hospital!” you might say, “You’re just not yourself lately, and I miss you. I know people who can help, and I’ll be there with you every step of the way.”
At the end of the day, though, it’s their choice — unless the person is a minor, where a more directive approach might be necessary to protect their well-being.
Is there a message you would like to tell someone who may be reading this, who is currently struggling with an eating disorder?
Things can get better. When you’re in the darkest parts of an eating disorder, it feels like it controls your mind. These disorders take all the light and hope away from your brain, and make you feel like it could never get better. But this isn’t true. Eating disorders are health conditions just like cancer or a heart condition. It isn’t your fault and you have not done anything wrong. At the same time, it is in your power, and your power alone, to take steps toward recovery. Consider what you would say to a friend in your situation — try applying that same sentiment to yourself. You deserve to live a full life — one completely free of an eating disorder.
In your experience, what are the most effective strategies for building resilience and a positive self-image in individuals recovering from an eating disorder?
The leading treatment for eating disorders in adults is CBT-E. One of the foundations of this treatment is the assumption that individuals suffering from eating disorders experience an “over-evaluation of weight and shape”, defining their self-worth largely on the basis of their shape and weight. This usually results in people disconnecting from other domains of their life that previously defined their self-worth and also limits their ability to discover new domains that could foster a more positive sense of self-worth.
A major focus of CBT-E treatment is addressing and disrupting this over-evaluation of weight and shape. One central technique to do this is to step back and consider what domains of life you actually value. You can ask yourself questions like, “What qualities do you respect in other people?” and, “In ten years time, what kind of person do you want to be and what kind of life do you want to have?”.
In moments when an eating disorder thought occurs, it’s helpful to stepp back and consider what you actually value in the long-term. Then, make the decision to act opposite to your eating disorder, and instead engage in the behavior that actually aligns with the things that you actually value. Repeatedly and consistently acting in opposition to your eating disorder thoughts, engaging in behaviors that align with what you actually value instead, and potentially introducing new domains into your daily life can allow you to have opportunities to feel effective in domains other than manipulating your body shape and weight. Over time, this results in changes to the person’s overall scheme of self-evaluation.
What are your favorite books, podcasts, or resources that have helped people with this struggle? Can you explain why you like them?
For individuals suffering from eating disorders, some resources I would recommend are:
- Books: Health at Every Size: The Surprising Truth about Your Weight (Bacon), More than a Body (Kite & Kite), The Body is Not an Apology (Taylor), Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating (Harrison), Sick Enough: A Guide to the Medical Complications of Eating Disorders (Gaudiani)
- Podcasts: Maintenance Phase, Food Psych
- YouTube Channels: @MegsyRecovery, @TabithaFarrar
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the largest amount of people, what would that be? You never know what your idea can trigger. 🙂
There are many devastating societal issues that affect billions of people in the world. One of the most striking changes over the last couple of decades has been how advances in technology affected how we understand and connect to information about the world. We have a world of information literally at our fingertips. In many ways, this is incredible. It allows, not just a single person, but billions of people to make important impacts in the world. Yet, this has also led to a proliferation of misinformation and disinformation that can have really harmful effects. So, for me, I think inspiring a movement that would instill in people tangible skills necessary to critically evaluate and sift through information they have access to would have the potential to have powerful effects across multiple societal issues.
How can our readers continue to follow your work online?
My website, www.ribeiropsychology.com, would be the best place to connect with me and my ongoing work.
Thank you so much for these insights! This was so inspiring!
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