Self-regulation Tools for ADHD Disordered Eating

Host: 00:00:00

So Thomas Midgley, welcome to the podcast.

Host: 00:00:03

Great to have you here.

Thomas Midgley: 00:00:04

Thank you very much for having me.

Thomas Midgley: 00:00:06

I feel honored.

Host: 00:00:07

Yeah.

Host: 00:00:07

So first of all, you know, this conversation we hear a huge amount about, we do hear the co occurring traits of adhd and very often if we're working in this, this sort of sphere, I hear a lot that there has been disordered eating happen know throughout childhood, adolescence into adulthood and they've been passed from pillar to post and unfortunately not had the ADHD or the autism diagnosis.

Host: 00:00:36

And I think it would be really great to kind of like go back to basics so people can understand first of all a bit of the language so we can understand, you know, the right language to be using.

Host: 00:00:48

I've always used disordered eating, but I wondered what is there a difference between disordered eating and eating disorders?

Thomas Midgley: 00:00:56

Yeah, I mean eating disorders are diagnostic criteria that people kind of like boxes that a certain cluster of symptoms fit somebody in and those boxes then enable treatment services, enables medication if depending on the individual, and also enables research.

Thomas Midgley: 00:01:21

But obviously like we find with neurodivergence a lot the boxes don't work brilliantly in lots of other ways.

Thomas Midgley: 00:01:30

It's because lots of people transition or they have bits of both and other elements and you can almost look at.

Thomas Midgley: 00:01:39

So a way to think about it almost is on a continuum.

Thomas Midgley: 00:01:43

At one end you might have individuals with a more healthy relationship with food where they find a balance between eating higher energy treat foods and let's say more lower energy colorful foods.

Thomas Midgley: 00:01:58

And they find that balance and they navigate it relatively easily.

Thomas Midgley: 00:02:02

Normal individuals are probably in the middle in our culture where people struggle between going on diets and restricting and then shifting back or narrow range of foods as we move up towards.

Thomas Midgley: 00:02:16

And then disordered eating will probably cross over as we move up the continuum.

Thomas Midgley: 00:02:19

Then at the top end you might have individuals that are more diagnosable with eating disorders and that's where those swings tend to be more extreme.

Host: 00:02:28

Okay, so that is, it's really interesting to be able to sort of see ourselves in that.

Host: 00:02:33

When you say the word normal, I'm saying that in inverted commas.

Host: 00:02:35

Are you, do you mean sort of neurotypical people who are sort of, you know, this societal sort of conditioning going on of how we're meant to be looking in a bikini and how we're meant to look.

Host: 00:02:49

Especially now with the rise of like the gym, the gym bods and all of that.

Host: 00:02:55

And are you saying that we're all susceptible?

Host: 00:02:58

But are you noticing that there is a much higher ratio of people that you are identifying as neurodivergent who are coming in with eating disorders.

Thomas Midgley: 00:03:11

Yeah, it's.

Thomas Midgley: 00:03:12

I think what's happened is almost the other way around.

Thomas Midgley: 00:03:15

We've worked in, I've worked in eating disorders now over 20 years and even at the beginning we were just waking up to the idea of autistic spectrum disorder, ASD and, and the, and the, and the links between that and anorexia specifically because the service I was working in, it was the ASD clinic was next door to our clinic and we shared clinicians and we just started really noticing the, and looking so much research on this.

Thomas Midgley: 00:03:41

No, there isn't, you know, you know these, we got clients who are sitting in both services.

Thomas Midgley: 00:03:46

Why Whereas with ADHD we've been a lot slower on the take up.

Thomas Midgley: 00:03:51

And even, you know, having ADHD myself and I was diagnosed the last few years, I've known, I've had it much longer than that.

Thomas Midgley: 00:04:01

But now I think certain clinicians and clinics are much more informed and on the ball with it.

Thomas Midgley: 00:04:08

But as lots of, as you well know, it's still, there's still a backlash in certain areas in the context of ADHD and diagnosis.

Thomas Midgley: 00:04:17

But yeah, we, I think we're just getting better at spotting some of the features and the research is just beginning to pick up a little bit with eating disorders and adhd.

Thomas Midgley: 00:04:30

If I tell you how I got into eating disorders, it was actually by chance.

Thomas Midgley: 00:04:33

I was on a low compost.

Thomas Midgley: 00:04:35

I was meant to be in it for two weeks and I was then the end there seven years.

Thomas Midgley: 00:04:41

And the reason was that I just immediately resonated with what these clients were presenting with and struggling with.

Thomas Midgley: 00:04:49

Even though I haven't had an eating disorder myself, what I probably quickly realized is that if I was not cisgendered and heterosexual, I probably would have developed bulimia.

Thomas Midgley: 00:05:00

But because I was, I.

Thomas Midgley: 00:05:02

My output was sport and other areas where, and kind of muscularity probably in that sense.

Thomas Midgley: 00:05:08

And it, and the same psychological mechanisms came out in a different way.

Thomas Midgley: 00:05:12

And those underlying bits that I resonated with was predominantly I had clients coming in with this powerful inner critic that was telling them they're stupid, ugly, fat, lazy.

Thomas Midgley: 00:05:24

And then imagine that's kind of sitting at the head of the table.

Thomas Midgley: 00:05:27

If I go a bit Harry Potter we can imagine it's got Voldemort sat there and then on our.

Thomas Midgley: 00:05:32

And then to kind of manage that the clients then kind of built this or manage this, what we call a kind of controlling part that would then set goals and try and appease their Critic by running around going, I need to be perfect, I need to set goals, I need to eat less, I need to exercise more, I need to work hard, I need to be the best parent, I need to.

Thomas Midgley: 00:05:50

And as long as it ran around trying to fix everything, it then quiet and this powerful inner critic.

Thomas Midgley: 00:05:55

But the second it either achieved the goals or stopped, the critic then would come back in and lazy and this cycle would tend to escalate.

Thomas Midgley: 00:06:06

And then when somebody was overwhelmed or didn't reach their goals, this kind of third part would come in, sat on the right and I don't know, we'll go, we'll go with Ron, but.

Thomas Midgley: 00:06:15

And that would be like right?

Thomas Midgley: 00:06:16

And put kind of headphones on screen and go right, I'm ignoring.

Thomas Midgley: 00:06:20

La la la.

Thomas Midgley: 00:06:20

We're not listening, I'm shutting off.

Thomas Midgley: 00:06:23

Give me some food or alcohol or I'm just, I'm shutting, I'm not listening to this critic or this element.

Thomas Midgley: 00:06:31

So.

Thomas Midgley: 00:06:31

And then it was within that dynamic that I was kind of like, wait a minute, I've got all of that.

Thomas Midgley: 00:06:39

I've got that in different ways.

Thomas Midgley: 00:06:41

You know, working really hard, burned out, you know, switching off, numbing, shutting down, disconnecting, then beat myself up and then back round and.

Thomas Midgley: 00:06:51

And these three parts are relatively normal, as we talked about that continuum.

Thomas Midgley: 00:06:56

So people in smaller amounts that control is really important.

Thomas Midgley: 00:07:00

It helps us get up, set goals, plan resource seek, make money, find friends, blah, blah, blah.

Thomas Midgley: 00:07:07

And our detached, this detaching part helps us at the end of the day manage our energy levels.

Thomas Midgley: 00:07:12

Now actually, I'm going to take a break, I'm going to have a cup of tea, I'm going to watch some tv, I'm going to chill out.

Thomas Midgley: 00:07:17

I'm not going to overwork.

Thomas Midgley: 00:07:18

But the more potent someone's inner critic is, the more it escalates, the bigger the critic gets, then the bigger the over controller to manage it.

Thomas Midgley: 00:07:27

And as those two escalate, get bigger and bigger and bigger, that we kind of call, consider kind of the more anorexic aspect.

Thomas Midgley: 00:07:35

And it is that perfectionist, unrelenting drive that if we stop, we feel, you know, behind that drive is a fear shaming part of us that feels ashamed or feared or not worthy.

Thomas Midgley: 00:07:50

So we have to keep striving.

Thomas Midgley: 00:07:51

And then when it's too much, we switch, we switch into the other.

Thomas Midgley: 00:07:56

And if we think about it almost as a seesaw, an individual that tends to develop anorexia sees that, you know, really escalates.

Thomas Midgley: 00:08:05

Those two, let's say 90% of the time they're in that restrictive goal setting perfectionist.

Thomas Midgley: 00:08:10

I mean, maybe 10% in the kind of detached, you know, I've switched off, I've done, I'm giving up, I'm eating, I'm.

Thomas Midgley: 00:08:17

Whereas a someone with more of a binge eating disorder is going to be 90%, they're still going to be 10%.

Thomas Midgley: 00:08:23

Right.

Thomas Midgley: 00:08:23

Today I'm not going to eat anything.

Thomas Midgley: 00:08:24

I'm going to, I'm going to set the goals, I'm going to lose weight, I'm going to do this and I'll do that for 10%.

Thomas Midgley: 00:08:29

But 90% of the time there, right, you know, I'm used to this, I might as well eat.

Thomas Midgley: 00:08:33

I've blown it anyway.

Thomas Midgley: 00:08:34

I'm fat anyway, so what's the point?

Thomas Midgley: 00:08:36

And they'll shift into that side.

Thomas Midgley: 00:08:38

And then someone with more, you know, kind of bulimia is just oscillating between those two components rapidly.

Thomas Midgley: 00:08:46

Now.

Thomas Midgley: 00:08:46

We should all be able to relate to that on some degree because that's, you know, when I talked about that continuum, there's a normality when you've got someone who's, I'm going on a diet, I'm going to do it for three weeks before my summer holiday.

Thomas Midgley: 00:08:58

They're in that exact anorexic phase.

Thomas Midgley: 00:09:01

The same for everybody.

Thomas Midgley: 00:09:02

And then when they might give up and blown it, I might as well make it eat everything today before.

Thomas Midgley: 00:09:09

Because all so and so then we switch into that other mode.

Thomas Midgley: 00:09:12

There are certain elements though that make people more vulnerable to kind of moving up that continuum.

Thomas Midgley: 00:09:19

And at the core of, in all the work I've done over the years, when you formulate anyone, it's really the major element behind it is emotional regulation.

Thomas Midgley: 00:09:28

Has somebody, when they've been growing up, been given good tools or great tools to regulate their feelings and emotions?

Thomas Midgley: 00:09:37

Have they been given average tools or is it poor tools?

Thomas Midgley: 00:09:41

So what we know about, say the treatment of anorexia is 50% of the clients have an identifiable trauma and 50% don't.

Thomas Midgley: 00:09:49

But in my line of work and all the assessments I've done, you know, pretty much all of them haven't got great tools to regulate their feelings.

Thomas Midgley: 00:09:57

So even if their traumas are lower down, let's say the extreme end, their tools for managing them leaves them very overwhelmed.

Thomas Midgley: 00:10:05

And it's that when we have to block our emotions because we haven't got the tools to manage them, then we're more likely to block them by keeping ourselves busy and purposeful.

Thomas Midgley: 00:10:14

Because if we get achievement and we're feeling achievement, we're not feeling guilt or shame or distress because we're feeling achievement and anxiety.

Thomas Midgley: 00:10:23

And then when that.

Thomas Midgley: 00:10:25

The other way of blocking is to numb and cut off and that then falls into those.

Thomas Midgley: 00:10:29

Those other areas.

Host: 00:10:31

Okay.

Host: 00:10:32

I mean, it's absolutely fascinating to hear you break it down like that.

Host: 00:10:36

So we can really understand the root, but I wonder if we able to see it from the neurodivergent lens and see the root of the emotional dysregulation and the lack of the tools combined with the potential traumas and also the way our brain works differently.

Host: 00:10:55

If there's a way of then speaking to the eating disorder through that way, as opposed to maybe the traditional way, which was maybe not understanding that there was.

Host: 00:11:07

You were working with different types of brains, does that, does that make sense?

Host: 00:11:11

Like, would you say that now that there's an understanding there, could it be that recovering from eating disorders could potentially get easier?

Thomas Midgley: 00:11:21

Yeah, 100%.

Thomas Midgley: 00:11:22

So if you look at pretty much the evidence base across the board for the treatment of any eating disorders, all starts with food.

Thomas Midgley: 00:11:30

Okay.

Thomas Midgley: 00:11:31

And you might hear this comment that eating disorders not about the food.

Thomas Midgley: 00:11:34

And that is correct in the same way, alcoholism is not about the alcohol.

Thomas Midgley: 00:11:39

But unless you tackle the alcohol first, you can't deal with the underlying issues.

Thomas Midgley: 00:11:44

And if you try and open up the underlying issues without dealing with the food or the alcohol, all it does is push somebody to use the coping strategy that they had at the beginning, which is it makes the symptoms worse so they're at higher risk.

Thomas Midgley: 00:11:56

So if we think about my metaphor of the critic, the over controller and the detached, If I say, well, that's all very good and well, it's not about that.

Thomas Midgley: 00:12:04

It's about the underlying.

Thomas Midgley: 00:12:05

Let's look at your trauma in your childhood.

Thomas Midgley: 00:12:07

All it does is it just.

Thomas Midgley: 00:12:09

All the others just up the ante and go flip.

Thomas Midgley: 00:12:12

We just shifting in those different ways.

Thomas Midgley: 00:12:15

And so actually, first off, you need to work on containment.

Thomas Midgley: 00:12:19

So all the treatments.

Thomas Midgley: 00:12:20

Reasons also about how do we.

Thomas Midgley: 00:12:21

So if someone's getting a treatment and it doesn't start with the focus around the food and managing those symptoms, then you want to be asking questions.

Thomas Midgley: 00:12:28

Why?

Thomas Midgley: 00:12:30

Because any evidence based.

Thomas Midgley: 00:12:31

Now if the alternative, if someone has had lots of those treatments and they're very complex and someone is incredibly experienced and they're.

Thomas Midgley: 00:12:39

And they're able to assess all the other elements that may be playing a role in that, then that might not be the case.

Thomas Midgley: 00:12:44

Now.

Thomas Midgley: 00:12:44

Now, if you take something like dbt, which is a CBT treatment for emotionally unstable bpd, that in that they Focus initially on skills building.

Thomas Midgley: 00:12:55

So that's the initial focus.

Thomas Midgley: 00:12:57

So actually you're looking at still regulating the different elements.

Thomas Midgley: 00:13:01

You're not dealing with the underlying past or the traumas.

Thomas Midgley: 00:13:03

You definitely don't do that.

Thomas Midgley: 00:13:05

You deal with building the containment.

Thomas Midgley: 00:13:07

So if we're talking about that emotional containment I was talking about, what you're trying in DBT is you're building those resources at the beginning.

Host: 00:13:14

Can I just interrupt and just say DBT for anyone that's not heard of it is dialectical behavior therapy.

Host: 00:13:21

Is that right?

Thomas Midgley: 00:13:22

That's correct, yeah.

Host: 00:13:23

Okay.

Host: 00:13:23

And just to kind of just give a little bit of an explanation of what it is.

Host: 00:13:27

From what I know of it, it's tools like to calm and regulate.

Thomas Midgley: 00:13:32

It is.

Thomas Midgley: 00:13:32

If we take what I said earlier, which is.

Thomas Midgley: 00:13:35

And it's probably helpful to go into more detail on this about.

Thomas Midgley: 00:13:39

Everybody thinks they're given the same toolbox for dealing with their emotions.

Thomas Midgley: 00:13:43

We definitely haven't.

Thomas Midgley: 00:13:44

Yeah.

Thomas Midgley: 00:13:45

Our experienced childhood means that some people have great tools.

Thomas Midgley: 00:13:49

A lot of people have average tools, and a lot of people have terrible tools, but they don't know that.

Thomas Midgley: 00:13:54

And what treatments like DBT are really good for.

Thomas Midgley: 00:13:58

And there are other things.

Thomas Midgley: 00:13:59

And compassion focused therapy, again, it's about building or retrofitting, improving that toolbox.

Thomas Midgley: 00:14:07

So when we can actually open that toolbox and go, you know, this is a toolbox of fixing a car.

Thomas Midgley: 00:14:12

And you've got hair straighteners, a pencil, a banana, and you're beating yourself up because you can't fix the car.

Thomas Midgley: 00:14:18

Actually, that's not your fault.

Thomas Midgley: 00:14:19

Let's, let's go and, you know, fabricate some tools that actually can do the job.

Thomas Midgley: 00:14:26

And that's what you're doing with these particular treatment models.

Thomas Midgley: 00:14:29

So you're kind of building, retrofitting that to kind of then regulate.

Thomas Midgley: 00:14:34

And then once you've built that capacity to regulate, then and only then do you want to then start.

Thomas Midgley: 00:14:41

Let's look at, let's look at some of this painful.

Thomas Midgley: 00:14:43

Let's take the bandage off and start poking at this, these painful bits.

Thomas Midgley: 00:14:47

That meant you've spent all your time, you know, taking, taking all these painkillers.

Thomas Midgley: 00:14:51

Let's try and.

Thomas Midgley: 00:14:52

And that's if we can let the wound heal.

Thomas Midgley: 00:14:54

But we need to build the capacities and the abilities to clean it up and let it heal before we try and approach that.

Thomas Midgley: 00:15:02

So any skilled, experienced, trauma focused clinician, or CBT or you're looking for regulated clinicians, hcpc, chartered psychologists, anybody with clinical experience in IT will be aware of this.

Thomas Midgley: 00:15:18

And that's what you're looking for in that treatment.

Thomas Midgley: 00:15:20

So hopefully that helps understand.

Host: 00:15:23

Yeah, yeah.

Host: 00:15:24

And I think the word retrofitting really, for me that just like slotted into place because what we're hearing a lot of now is that we, you know, people who are being diagnosed later on in life, either, you know, with autism and ADHD or, and, or is that they are then able to see where the dysfunction came from and the trauma potentially from their childhood through perhaps undiagnosed parents as well, who have been brought up by their undiagnosed parents.

Host: 00:15:55

Because we do know that it's very genetic.

Host: 00:15:59

And so now that we have this understanding, we can look at things through a very different lens.

Host: 00:16:05

Like you say when you talk about compassion focused therapy, we're able to say, I was trying to calm and regulate myself in with tools that just are not, you know, just not working for me.

Host: 00:16:17

Or I didn't even have those tools because my parents didn't even have those tools.

Host: 00:16:21

And so we're all flailing around in the dark, completely unaware of what's going on, blaming ourselves for all sorts of things.

Host: 00:16:28

And so it's just a really important, I think, note to really kind of focus on in that we've tried to probably fix ourselves in ways that are just not right for us.

Host: 00:16:40

You know, we're using tools that aren't right for us.

Host: 00:16:42

But now that we have this awareness, and I love that you're kind of giving people the tools, giving them the scaffolding, helping them in that capacity, and then saying, okay, now let's, let's tackle the darker stuff, the more difficult things where they're then going to feel more empowered because they can go, ah, okay, well I've learned that here.

Host: 00:17:04

Or understand that now.

Host: 00:17:07

Do you notice that pattern emerging of empowerment and more self compassion when they have started to learn these regulation tools?

Thomas Midgley: 00:17:17

100%.

Thomas Midgley: 00:17:18

I mean, that's the, you know, that's why I do what I do for a living really.

Thomas Midgley: 00:17:24

I, I got into, I mean there was kind of a watershed moment when I worked with a.

Thomas Midgley: 00:17:31

I actually remember where she was.

Thomas Midgley: 00:17:32

I remember the clinic room, this young girl.

Thomas Midgley: 00:17:33

And I was assessing her and she.

Thomas Midgley: 00:17:37

How old was she?

Thomas Midgley: 00:17:37

So she wasn't younger.

Thomas Midgley: 00:17:38

Sorry, she was in her 30s.

Thomas Midgley: 00:17:39

And she was talking about the school bullies.

Thomas Midgley: 00:17:42

And it was this realization that school bullies haven't gone away.

Thomas Midgley: 00:17:45

They're in her head every day in exactly the same format they were before.

Thomas Midgley: 00:17:48

And it just is this drive to not let the bullies win.

Thomas Midgley: 00:17:52

And that's kind of like, wow, so that was kind of really that watershed.

Thomas Midgley: 00:17:57

This is what I want to do.

Thomas Midgley: 00:17:58

I want to help people manage those where they've their traumas and their struggles with.

Thomas Midgley: 00:18:05

They're not, you know, there is a mental health inequality.

Thomas Midgley: 00:18:08

People aren't all given these same tools and those that aren't don't even know it and they're going to suffer and struggle as a result.

Thomas Midgley: 00:18:14

So yeah, helping people is that.

Thomas Midgley: 00:18:18

And then having, you know, measures again, this is a sign.

Thomas Midgley: 00:18:21

If you're having treatment and they're using clinical measures to test the effectiveness of what they're doing, you're doing with them, and they're testing that all the time, then pretty sure it's an evidence based treatment or at least evidence informed because they're working with you.

Thomas Midgley: 00:18:34

You know, the treatment is focused on helping people get better.

Thomas Midgley: 00:18:37

So you're measuring and checking that people are able to regulate their feelings more.

Thomas Midgley: 00:18:41

And, and in that sense it's probably helpful again to talk a bit about emotional regulation.

Thomas Midgley: 00:18:48

What is healthy ration and what's, nor I don't like term healthy.

Thomas Midgley: 00:18:53

What's more effective and less effective that leads people vulnerable to things like eating disorders and these struggles and, and then think about it in the context of neurodivergence.

Thomas Midgley: 00:19:03

So I kind of think again, a metaphor for this is if, if you think at one end healthy emotional regulator tool would be someone that, let's imagine I'm having somebody says something offensive at work.

Thomas Midgley: 00:19:16

I'd notice that I'd feel potentially initial shame and then the anger and I'd feel that within me and notice that I wouldn't become it, but I'd feel it within me and go, no, I wonder why they've said that.

Thomas Midgley: 00:19:27

How should I manage that?

Thomas Midgley: 00:19:28

And then I can proportionately allow myself to become the level of anger that's most affected.

Thomas Midgley: 00:19:34

So I might go, right, I'm going to be slightly assertive here.

Thomas Midgley: 00:19:37

I'm going to say, excuse me, you know, what did you mean by that comment?

Thomas Midgley: 00:19:39

Because I could take that different ways or I could then up the ante and be even more assertive.

Thomas Midgley: 00:19:46

I'm not going to stand for that comment in this situation.

Thomas Midgley: 00:19:48

How dare you.

Thomas Midgley: 00:19:49

I might even choose, if the situation is, let's imagine someone was attacking my family, I might choose to take it to an extreme level to protect my family and you know, maybe physically try and assert myself.

Thomas Midgley: 00:20:01

Or I could choose to actually go, you know, this isn't the best time.

Thomas Midgley: 00:20:04

I'm going to hold onto this, I'm going to go away, I'm going to calm down, I'm going to re approach this person and manage it when the emotional level.

Thomas Midgley: 00:20:12

So that's kind of a healthy way.

Thomas Midgley: 00:20:14

We have the ability of containing our emotions, but we also then have the courage to be able to then find a place and be vulnerable and talk about our feelings.

Thomas Midgley: 00:20:24

So we need both capacities to kind of shut down.

Thomas Midgley: 00:20:26

So if you imagine, do you want athletes going into a World cup final to be sitting around holding hands, talking about their feelings and all the matches they've lost?

Thomas Midgley: 00:20:36

No, you want them to contain, bury that, put their game faces on and go out and do their job.

Thomas Midgley: 00:20:41

But if we always bury our distress and bury, bury, then we end up, let's say, less helpful tool.

Thomas Midgley: 00:20:48

So if we've learned to block our feelings, then we're going to block, block, block and then we're going to become them.

Thomas Midgley: 00:20:53

So it's nothing, nothing, nothing.

Thomas Midgley: 00:20:55

Rage, nothing, nothing, nothing.

Thomas Midgley: 00:20:56

Panic attack.

Thomas Midgley: 00:20:57

Nothing, nothing, nothing.

Thomas Midgley: 00:20:58

Overwhelming sadness and tears and then stuff it all back down again and carry on.

Thomas Midgley: 00:21:03

So you can imagine there the kind of these two ends of a spectrum.

Thomas Midgley: 00:21:07

Now we've got one that's feeling the emotions in their body and content, you know, happy to do that and then choosing and the others trying to avoid their feelings until they're overwhelming.

Thomas Midgley: 00:21:18

And there's a, in that there's another version which is pretty, which is helpful to understanding from a neurodivergent perspective, which is, let's imagine a child that is doing the opposite, that's showing their feelings all the time.

Thomas Midgley: 00:21:31

And it's almost what the hell is this?

Thomas Midgley: 00:21:35

And the sad part is in our sarticos, you know, these kids get shamed.

Thomas Midgley: 00:21:40

You know, you might hear teachers, little Jimmy's a very emotional little boy.

Thomas Midgley: 00:21:44

He's wears his heart on his sleeve, doesn't he?

Thomas Midgley: 00:21:46

You know, and they might try and shame these kids into blocking and displaying when in reality what they need is someone to help them understand and contain.

Thomas Midgley: 00:21:56

And it's the same treatment for if someone's uncontained with their emotions or blocked with their emotions.

Thomas Midgley: 00:22:03

They kind of need these key six things that a child needs in order to thrive or adults in terms of emotional regulation.

Thomas Midgley: 00:22:11

And I can talk you through those six key things that will probably help.

Thomas Midgley: 00:22:16

So one that we all need is play.

Thomas Midgley: 00:22:20

And play.

Thomas Midgley: 00:22:22

You can think about it in terms of that might be just wrestling or teasing or playing with kids, but why that's so important because at its core what you're doing there is this subtle submission and dominating dance that's going on within that little Play.

Thomas Midgley: 00:22:39

And that forms the basis of all relationships going forward.

Thomas Midgley: 00:22:42

If you think what flirting is or playing or, you know, bantering or joking or having a laugh, it's that.

Thomas Midgley: 00:22:48

Or in any romantic or platonic or any relationships, there's that subtle interplay between the both.

Thomas Midgley: 00:22:53

If you imagine going on a date and someone doesn't have those skills, they might just talk at you all the time or the opposite.

Thomas Midgley: 00:23:00

They just don't say anything.

Thomas Midgley: 00:23:01

And you're doing all the hard work.

Thomas Midgley: 00:23:03

You know, the hell is this?

Thomas Midgley: 00:23:04

This is the worst day of my life.

Thomas Midgley: 00:23:05

How do I, you know, my friends just called me and it's someone that, you know, struggles with that.

Thomas Midgley: 00:23:11

And with neurodivergence, whether it's ASD or adhd, that's a struggle because there are executive functioning issues.

Thomas Midgley: 00:23:19

There are issues with picking up potential social cues or dominating conversations or feeling unable.

Thomas Midgley: 00:23:25

Next one, security.

Thomas Midgley: 00:23:26

We need to feel safe and secure, at least in a place at home so we can feel contained on a regular basis.

Thomas Midgley: 00:23:34

That, you know, if you've got a family where there's high levels of threat, people arguing, shouting, struggle with their own mental health issues, then you end up with what we kind of talked about, that intolerance of uncertainty, consistency in structures there that kids need to know.

Thomas Midgley: 00:23:49

If they do the same thing, the parents react the same way.

Thomas Midgley: 00:23:51

Again, neurodivergent parents or undiagnosed neurodivergent parents, there's substance abuse.

Thomas Midgley: 00:23:57

If they're struggling with stress or emotions, then it's going to struggle to have that consistency.

Thomas Midgley: 00:24:02

And without the consistency, this kid is going to struggle to be confident in being who you know, being who they are and within themselves because they don't know what they're going to get within that next one's affection.

Thomas Midgley: 00:24:13

So being told they're loved or physical affection, that helps us feel soothed and contained.

Thomas Midgley: 00:24:18

Oxytocin.

Thomas Midgley: 00:24:20

And in that context, next one's unconditional love, feeling loved and valued in spite of your achievements and behavior.

Thomas Midgley: 00:24:29

So you need to know you're loved even if you've smash the tv, you're loved even if you've not done any work for your test.

Thomas Midgley: 00:24:38

And then the last one, which is what I work on a huge amount, and it's one that's not really sometimes kind of left out.

Thomas Midgley: 00:24:44

But I think it's incredibly important is value placed on emotional experiences.

Thomas Midgley: 00:24:50

So the child being seen, heard and valued.

Thomas Midgley: 00:24:53

So making space to ask children what they think, how they feel and creating.

Thomas Midgley: 00:25:00

So the child learns the language of emotions, they learn how to express that and they learn that people are interested in them.

Thomas Midgley: 00:25:09

And so they learn that confidence in talking, feeling valued, the opposite of that is feeling unheard, unseen, valued within that.

Thomas Midgley: 00:25:18

And why that's so important is that if you have that done correctly, then what that means is that talking about distress, connecting with feelings becomes a positive experience.

Thomas Midgley: 00:25:29

Because when doing it, you know, you feel supported.

Thomas Midgley: 00:25:32

So if you imagine if we go through and a child goes through an adverse experience at school, if they come back and no one talks to them that experience, or they don't feel they've learned that talking about it, people don't really listen or help, then they'll just encode that as trauma and a lonely experience.

Thomas Midgley: 00:25:53

I can't cope, there's something wrong with me.

Thomas Midgley: 00:25:56

And that's how it'll be encoded.

Thomas Midgley: 00:25:57

And not to seek support and help in the future.

Thomas Midgley: 00:26:00

If on the other hand, they've learned that coming back, talking about it, and people listen, hear them, and then help them understand what emotions they're feeling or that you must be sad about that.

Thomas Midgley: 00:26:12

Oh yeah, yeah.

Thomas Midgley: 00:26:14

And I can see that in your expression.

Thomas Midgley: 00:26:16

You seem to feel you've got heaviness here to understand.

Thomas Midgley: 00:26:19

They learn the language of different emotions, you know how to express it.

Thomas Midgley: 00:26:22

That trauma gets re encoded is not a isolating experience, but a, a supported experience.

Thomas Midgley: 00:26:31

So they encode that.

Thomas Midgley: 00:26:32

When I go through adversity, it's not me on my own, it's me and my team.

Thomas Midgley: 00:26:36

So when they then next go through adversity, they, you develop that a resilience and that capacity to be contained and then the courage to be vulnerable and contained.

Thomas Midgley: 00:26:48

And now and you then with that combination, then you develop a very capable, robust human being just, just to go.

Host: 00:26:57

That, just to reinforce that.

Host: 00:26:58

The validation I hear when people get their diagnosis and when they, you know, they've gone through all of this, I think the hardest thing for so many people is when they've been unheard, they've been dismissed, they've not been listened.

Host: 00:27:13

And so I just wanted to kind of really hone in on that because when we have that validation, I mean, I see it, you know, on a smaller scale with my kids.

Host: 00:27:23

My husband is quite sort of pragmatic and if my daughter comes home, who she is, highly sensitive and quite emotional and she'll tell me about something I have since learning so much more about this over these years, I really try and give her some space and there's this fine line that I'm trying not to overindulge her by like exacerbate and I don't know if this is a thing that I could be doing, exacerbating her anxiety or me giving her that space and listening to her and saying, yes, that must have been really horrible, or yes, you must have been really worried.

Host: 00:27:56

And I can really understand, but I'm so conscious I want to validate her, that I give her that space where my husband sort of veers on the side of, you can't constantly be.

Host: 00:28:13

You know, you've kind of got to build her resilience a little bit.

Host: 00:28:16

And I just wondered if you could speak a little bit about that.

Host: 00:28:18

Like if there's parents listening now.

Host: 00:28:20

And listen, if we project our fears into our kids, and we don't want our kids to go through certain things that we may have gone through, certain traumas, or if someone's listening and they did have eating disorders growing up, and if they.

Host: 00:28:34

It may still be there, but, you know, they're trying really hard not for their children to, you know, to not see it or absorb it.

Host: 00:28:43

How do we as parents not project those fears but still give them that.

Host: 00:28:47

That validation and that space to know that they're loved, cared for, their security, the safety.

Host: 00:28:53

There's this unconditional love, this idea of.

Thomas Midgley: 00:28:57

You know, I say this, I may have misunderstood you, but it's almost this historical idea.

Thomas Midgley: 00:29:01

Well, you don't want to modly coddle them too much.

Thomas Midgley: 00:29:04

Where's the balance between, you know, treat them mean and toughen them up versus mollycoddle?

Thomas Midgley: 00:29:10

And the key bit, it's actually what we know is it is move away from it.

Thomas Midgley: 00:29:14

It is actually focusing on these needs, really being supportive.

Thomas Midgley: 00:29:18

They're containing so that they internalize that, because that's what you're trying to do.

Thomas Midgley: 00:29:22

The whole point in adolescence is to internalize your support structures.

Thomas Midgley: 00:29:26

And if you have a very containing, listening, supportive support, you know, supporter that hears and sees you, then that is only then by later adolescence, then you're going to feel contained and support enough to kind of then split and then that kind of.

Thomas Midgley: 00:29:40

You get that really more healthy independence because you're separating later on in adolescence.

Thomas Midgley: 00:29:47

If a child becomes highly independent early in childhood, adolescence, that's not a good sign.

Thomas Midgley: 00:29:52

That means they've either given up on their caregivers or, you know, they've learned that actually it's better that I don't seek support elsewhere.

Thomas Midgley: 00:30:02

And then I try and fix this on my own with the tools I've got.

Thomas Midgley: 00:30:06

So that might be something to hold within that format.

Thomas Midgley: 00:30:09

So where it can be a little bit different is that if you grow up in an environment where they call it a meshment, where a parent is over involved in a child's care that the child can't, and the parent where they begin and end.

Thomas Midgley: 00:30:25

So there is an element in parenting with support and then let the child go off on their own, fall over, make their own mistakes, get hurt, come back, be supported that you're there, you're not helicopter parenting, you're letting them go away.

Thomas Midgley: 00:30:40

But they know they can come back and be supportive because what you're trying to do is for them to internalize so that wherever they go, they feel you with them.

Thomas Midgley: 00:30:49

Without that support, they've internalized that they don't need you physically with them.

Thomas Midgley: 00:30:53

So.

Thomas Midgley: 00:30:54

And the other end of that is that what you might end up with is where children don't internalize it and then they spend the rest of their life reassurance seeking.

Thomas Midgley: 00:31:02

So they need to be around people and need to feel contained because if they haven't got those, they've internalized those key support structures, then that, you know, they might fall into that element, continually seeking that support and reassurance.

Thomas Midgley: 00:31:17

And then again, we cross that over with neurodivergence and let's say rsd, you know, you've only got a.

Thomas Midgley: 00:31:24

Where does that begin and end in the context of a genetic component versus Actually the problem being a new divergent parent is it's actually difficult to deliver those six things consistently and effectively.

Thomas Midgley: 00:31:39

And for me, I know if I've got one child, I can be a really good parent the second.

Thomas Midgley: 00:31:44

You have got two kids, you know, I struggle, I struggle to, you know, I struggle to manage those two different, you know, those different kids in the way I'd like to.

Thomas Midgley: 00:31:56

And there is a, you know, there is a middle ground.

Thomas Midgley: 00:32:00

There's a sweet, a large sweet spot in all of this.

Thomas Midgley: 00:32:02

We don't need to get it perfect, but if we're aware of those key bits, nobody gets it perfect.

Thomas Midgley: 00:32:07

I mean, that's the key point.

Thomas Midgley: 00:32:08

I do this for a living and I have my own guilt, you know, parent guilt all the time, as most parents do.

Thomas Midgley: 00:32:13

And I'm maybe more informed than most with the parent guilt.

Thomas Midgley: 00:32:16

I can see what I'm doing and seeing it happen in motion.

Host: 00:32:19

Yeah, I don't think that's hard, isn't it?

Host: 00:32:21

When, when we do work in this kind of area where, you know, awareness is key and I do, you know, try, I always say to, to, to my community is that I'm just, you know, we've got to work with our resources.

Host: 00:32:34

And we've also got to work with the energy that we've got, the resilience that we've got at the time, like what's going on externally and all these different things.

Host: 00:32:42

But essentially, if we're getting our diagnoses now, you know, whether or not, you know, we're in our 50s or 30s or you know, we are being given a key to awareness that we didn't have before and we're able to retrospectively look back and see where maybe where that parenting from, you know, from our parents kind of, you know, I don't want to be too judgmental, but maybe went wrong.

Host: 00:33:10

And we're able to look at that and learn from that.

Host: 00:33:13

And then maybe our children are going to look at us and kind of go, I'm going to learn from them for all the things that they didn't know.

Host: 00:33:17

And that's just the way it goes, isn't it?

Host: 00:33:19

Evolution and generations and everything.

Host: 00:33:21

So we've also got to be kind of compassionate to ourselves that we can't know all.

Host: 00:33:25

But from a.

Host: 00:33:27

I guess I'm just going to speak for myself.

Host: 00:33:28

You know, it's like a person that is prone to anxiety and worry that I fear that I have to know it all.

Host: 00:33:36

And now that I work in this area and I've got neurodivergent kids, I should have all the answers.

Host: 00:33:41

But actually when you break it down into those six points, am I providing unconditional love?

Host: 00:33:47

Yes.

Host: 00:33:47

Affection, consistency, the security there is play.

Host: 00:33:52

I am validating their emotional experiences and that's actually really helped me because that's helped me kind of go the key things that to hopefully for a child to thrive, I'm providing and we don't have to get it right every single day.

Host: 00:34:07

But you know, I think there is this pressure that we put on ourselves to maybe fix our past through them and maybe just to release a little bit of that pressure to know that these are the things that matter.

Thomas Midgley: 00:34:24

Just to point on yours there, which is we've been talking about these kind of things.

Thomas Midgley: 00:34:29

A child needs to thrive.

Thomas Midgley: 00:34:30

And I imagine that's going to fire up a lot of people's critics and then switch them maybe into that detached kind of give up or self attack and that sense.

Thomas Midgley: 00:34:38

But it's your point about this is what compassionate capacities are about.

Thomas Midgley: 00:34:41

It's about then noticing that and actually, you know, giving yourself a pat on the back for what you are doing and trying to figure out how we can improve.

Thomas Midgley: 00:34:48

But do it from a perspective not of, you know, attack and shame, but actually a way of helping us, getting the best from us so we can grow and have capacity to develop that as well as the other areas in our life.

Host: 00:34:59

And I know that today's conversation, we were, you know, we wanted to talk about eating disorders, but I feel that this has been a valuable conversation because we can all see different parts of what you discussed in ourselves.

Host: 00:35:13

And with ADHD specifically, you know, talking, I know how it shows up.

Host: 00:35:19

It's in a very non linear way.

Host: 00:35:22

And for one ADHD person, you know, it looks very different to another person, which is why we see addictions change, we see behavioral patterns change.

Host: 00:35:30

Somebody may struggle with insomnia, someone may struggle with sleeping too much, like we.

Host: 00:35:35

It's so different for so many people.

Host: 00:35:39

And so I wanted to kind of make this as much of an expansive open conversation where they can notice these things.

Host: 00:35:45

And hopefully we've offered some solutions as well, you know, just to begin wrapping up the conversation.

Host: 00:35:52

Where would you direct people who are, who have maybe lived with disordered eating for a very, very long time and it's maybe part of their life?

Host: 00:36:04

And this conversation is sort of, you know, highlighted actually.

Host: 00:36:07

I'm, I'm ready to let this go now and I have this new awareness of neurodivergence.

Host: 00:36:14

Where would you say for people to begin?

Host: 00:36:17

Like where do they, who do they go and get help from?

Thomas Midgley: 00:36:21

Oh, first off, us obviously.

Thomas Midgley: 00:36:23

So the Body Image treatment clinic.

Thomas Midgley: 00:36:27

You can go to G Speak, go via the NHS route and I'd also recommend going through Beat, which is the eating disorder charity.

Thomas Midgley: 00:36:36

Two More Been There is another charity that helps people and First Steps is another charity for eating disorders.

Thomas Midgley: 00:36:43

I think they're kind of key first places, NHS Beats and kind of looking in those areas because that way you're going to get registered, experienced clinicians who know what they're doing in that field.

Thomas Midgley: 00:36:57

We have had this, an increasing issue that's known within that you've got probably since COVID lots where huge amounts of eating disorders and services were overwhelmed.

Thomas Midgley: 00:37:07

So you've got this boom industry through social media of unqualified clinicians treating eating disorders and eating disorders.

Thomas Midgley: 00:37:14

These are dangerous conditions and it needs to be treated and assessed by experts in the field.

Host: 00:37:22

So can people through the Body Image clinic.

Host: 00:37:26

Is that a private service?

Host: 00:37:28

Do they need to be referred just so in case people want to get in touch with you?

Thomas Midgley: 00:37:33

It is a private clinic.

Thomas Midgley: 00:37:34

They don't need to be referred, they can self refer.

Thomas Midgley: 00:37:37

And look, if we can also help signpost for the services and in doing so make sure that they get the support they need.

Thomas Midgley: 00:37:46

We have been trying since COVID with developing a audiovisual treatment package targeted for body image but it's a lot of it is targeting these emotional regulation these all these key bits because whether as people of course have understood now whether you're targeting body image or other elements of eating sores or other conditions, it's these baseline elements we need and it's particularly neurodivergent friendly in that sense why you did it audio visual and not a book so that actually people can chunk size work on skills and different elements understanding in a format that is easily absorbed.

Thomas Midgley: 00:38:23

So that's why we've kind of designed it in that manner rather fine.

Host: 00:38:28

Well I will make sure that all the links to all of this that we've discussed and the links that you mentioned for other clinics as well are on the show notes for anybody that needs extra support after today's conversation.

Host: 00:38:41

But Thomas, I just want to thank you so much for your time.

Host: 00:38:44

Really appreciate it.

Thomas Midgley: 00:38:45

Brilliant.

Host: 00:38:46

Thank you.

Thomas Midgley: 00:38:47

Thank you.