I Treat Eating Disorders. There’s a Particular Behavior I Keep Seeing Among High-Functioning Women.

Medical Examiner It can be very destabilizing to experience. Photo illustration by Slate. Photos by Cat_Chat/iStock/Getty Images Plus and WendellandCarolyn/iStock/Getty Images Plus. Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily. When Sylvia reached out to start therapy, it took us nearly two months to find a time that worked with her packed schedule. Once we started working together, I quickly learned that the pace and demands of her life pulled at nearly every domain, including how she ate. “Breakfast” typically consists of coffee and a protein bar eaten as she pulls out of the school drop-off line. Lunch happens at her desk, with the camera off during a remote meeting. Dinner, prepared for her family, comes together as homework is being done and last emails are sent. Then, once everyone is finally in bed, the dishwasher is loaded, most nights Sylvia (whose name I’ve changed to protect her privacy) finds herself in the kitchen again. Chocolate-covered pretzels. White cheddar rice cakes. Vanilla honey Greek yogurt. The food changes night to night, but the consistent thread is that Sylvia has little awareness of the experience of these late-night episodes. “I honestly don’t think I make a decision to do it. It’s more like it just happens to me.” Sylvia describes eating without feeling fully connected to the experience, whether to the taste of the food, the presence of it in her body, or how it makes her feel afterward. “It’s almost like I’m in a trance. I sort of look down, and the food is gone.” There are many reasons to eat. Hunger is probably the first that comes to mind. Our bodies send signals that draw us toward food, sometimes with urgency. We can also eat because we’re craving something, when the thought or sensory memory of a specific food becomes difficult to shake. Or we can eat when we’re not hungry at all, in fact we may already be full, but other factors become more of a priority. Birthday cake at a celebratory dinner. An appetizer we rarely get to try. And then there is the type of eating that is totally untethered from hunger, desire, or possibly any awareness of eating at all. This type of consumption, often referred to as mindless eating, is frequently conflated with overeating. There is no shortage of articles, books, and social content aimed at curbing what is framed as a lack of discipline, often with a focus on self-help or weight management. Common advice to fight it includes “closing” your kitchen after dinner, keeping tempting treats out of the house, and doing meal prep at the start of the week. As a practicing psychologist and the vice president of research and clinical innovation at one of the country’s largest eating disorder treatment networks, I’ve spent a large chunk of my career treating the disconnect between eating and awareness. I see countless patients, especially high-functioning women, who follow self-imposed meal plans with perfectionistic zeal—but who also report entire eating episodes they have no real memory of. It’s a confounding and destabilizing experience for overachieving women used to being on top of every detail. And changing the behavior isn’t necessarily about exerting more willpower or coming up with a better system. Instead, we can look at the behavior from a different stance and ask: What might be driving the lack of presence in the first place? Occasional experiences of “mindless eating” or “dissociative eating” are human; most of us have zoned out with a bag of chips at one point or another. But when it happens regularly, as in Sylvia’s case, it can contribute to a total breakdown in hunger and fullness cues. Rather than understanding dissociation as a symptom of disordered eating, researchers increasingly consider how it may both emerge from and help maintain these patterns. Dissociation is a clinical term that refers to our relationship to the present. When I am fully living in the moment, I am aware of the sensory input around me as well as any thoughts, emotions, or other internal experiences coming from my body. Bethany Brand, a clinical psychologist and professor emerita at Towson University who specializes in trauma and dissociative disorders, describes dissociation as “a kind of disconnection from yourself or your experience.” Dissociation exists on a spectrum. We can zone out or become so absorbed in something like driving or cooking that we lose track of time, without it being a cause for concern. While dissociation can happen for multiple reasons, it is a well-established response to trauma. Brand notes that “dissociation can be protective when something is happening that a person cannot escape.” The mind learns that disconnecting can allow a person to get space from the sensations, emotions, or experiences that are painful or overwhelming. When people are more dissociated, “they may describe feeling numb, being on ‘autopilot,’ ” Brand says. Slipping into survival mode, going through the motions without feeling the crushing weight of the reality of a situation, can be an adaptive response when you’re in the middle of a crisis. The problem is that this disconnection does not always disappear once the danger has passed. Over time, a dissociative response can generalize to situations or triggers that are far removed from the event that made it necessary in the first place. A late-night snacking episode can be a way to disconnect from the stress of daily life as a working parent, for example. Timothy Brewerton, a professor emeritus of psychiatry and behavioral sciences at the Medical University of South Carolina and a longtime researcher on eating disorders and trauma, shares that for many people with a history of trauma, dissociated eating can be “a way to self-medicate, to numb, and to facilitate avoidance.” Sylvia’s early childhood environment was characterized by volatility and inconsistency. She learned through experience that shutting down her emotional response was a way to ride through the highs and lows with minimal impact. As an adult, a laser focus on her career and the demands of her family life became a way to stay detached from herself—a strategy that received consistent positive reinforcement. In this dynamic, her feelings, including her own hunger cues, came last. Trauma is not the only teacher who informs us that our bodily cues are inconvenient, untrustworthy, or dangerous. Our culture of ambition, output, and productivity makes pausing to have a snack, rest, or get some fresh air a luxury. In this environment, hunger can represent a giant inconvenience. Women like Sylvia can go through the whole day without hearing what their body needs, and then end up eating in a trance at night. Virginia Sole-Smith, author of Fat Talk and founder of the Burnt Toast newsletter and podcast, highlights that in today’s world, “you have to make a really conscious choice to protect your right to have hunger.” What’s more, for many hunger brings the threat of fullness. Fullness, rather than a bodily signal that food has been consumed, can be interpreted as evidence that you’ve gone too far, done too much. It can represent the possibility of losing control, a prospect, for someone with trauma, that can be very threatening. Sitting down for a filling breakfast, instead of mainlining a protein bar, can feel irresponsible. Female socialization adds another layer, teaching us that putting basic human needs last means you’re doing a good job. After everyone else is fed, taken care of, and ready to go, you can focus on yourself. Sole-Smith notes that the demands of caregiving can make basic needs feel almost optional. “Every opportunity we have to feed ourselves, it’s like the world shows up and says, ‘No, you don’t.’ ” In one session, Sylvia mentioned: “On the weekends, I usually just make a meal out of the bread crusts I cut off my kids’ sandwiches. It’s easier than thinking about what I want for lunch.” For many, the seemingly straightforward question What do I want? runs up against years of messaging. Trauma may tell us, “Don’t feel this.” Diet culture says, “Don’t trust this.” And female socialization says, “Don’t prioritize this.” But disconnection does not have to be permanent. Evelyn Tribole, co-creator and author of Intuitive Eating, describes rebuilding trust with the body as something that is always available to us and can happen incrementally. “Every time you honor your hunger, you are repairing,” Tribole says. “Just like relationships with other people can be repaired, our relationship with our body and with ourselves can be repaired one bite at a time.” Tribole recommends looking for patterns rather than pathologizing a single episode. Is disconnected eating happening once in a while, or is it the status quo for most meals? How do you feel afterward? Did you notice anything about the experience, or do you feel as though you missed it entirely? Turning each meal into a mindfulness exercise is not the goal. Sometimes we have to eat on the go, in front of the TV, or in the car. However, challenging disconnected eating can start with small acts of observation. Am I hungry? What sounds good? What would make eating feel easier right now? Tribole suggests getting curious rather than treating any single meal as a test to pass or fail. Over time, that awareness can extend beyond the plate. Hunger is one of the most basic ways the body tells us that it needs something. Hearing it and listening can create more room to notice when we’re depleted, sad, overwhelmed, or craving pleasure too. Tribole calls that capacity our “superpower.” “If we’re shutting down hunger,” she asks, “what else are we shutting down?” Eating is one of the most ordinary things that we do. Yet for Sylvia and so many others, it can become something we don’t trust ourselves to navigate. Becoming more present while eating is not about food. It’s about being willing to hear what the body is communicating and trusting what it has to say. Feminism Food Health