进食障碍与多动症：特邀嘉宾Roberto Olivardia博士和Paige Kinzer

一年中最美好的时光是否让你感觉更像是最令人不堪重负的时光？

Does the most wonderful time of year feel more like the most overwhelming time of year?

如果你正为节日压力、最后一刻的购物以及对所有事情都答应而感到挣扎，你并不孤单。

If you struggle with holiday stress, last minute shopping, and saying yes to everything, you're not alone.

掌控ADHD很高兴宣布一个全新的工作坊系列，

Take Control ADHD is excited to announce a brand new workshop series,

用ADHD征服节日。从10月25日开始，四个实用课程将涵盖战略规划、管理压力、为客人整理空间以及节后重置。

conquer the holidays with ADHD. Four practical sessions starting October 25 will cover strategic planning, managing overwhelm, decluttering for guests, and post holiday reset.

每场课程包括一个六十分钟的工作坊外加一整小时的陪伴工作时段。这样你不仅能讨论，还能真正把事情完成。

Each session includes a sixty minute workshop plus a full hour of body doubling. So you actually get things done, not just talked about.

你将获得节日准备指南、所有课程的录音，以及一个真正理解你的社区的支持。

You'll get your holiday preparation guide, recordings of all the sessions, and support from a community that truly gets it.

完整系列现在仅售1.65美元。这比原价优惠75美元，或者你也可以以每场50美元的价格购买单场课程，现在比原价优惠25美元。

The complete series is on sale right now for just $1.65. That's $75 off the regular price, or you can grab single sessions for $50 each, $25 off the regular price right now.

今年，体验更少的压力，更多的快乐。立即在takecontroladhd.com/holidays注册。网址是takecontroladhd.com/holidays，让2025年成为你最好的假期季。

This year, experience less stress and more joy. Register now at takecontroladhd.com/holidays. That's takecontroladhd.com/holidays, and make 2025 your best holiday season yet.

大家好，欢迎收听《掌控生活》，True Story FM上的ADHD播客。我是皮特·赖特，和我一起的是尼基·金泽。

Hello, everybody, and welcome to Taking Control, the ADHD podcast on True Story FM. I'm Pete Wright, and I'm here with Nikki Kinzer.

大家好。你好，皮特·赖特。

Hello, everyone. Hello, Pete Wright.

这是一期特别节目。

This is a special show.

是的。

It is.

这是一

It's a

一期独特而特别的节目。

unique and special show.

是的。

It is.

你想安排一下吗？

You wanna set it up?

是的。那么，今天我们将与一位医生交谈，一位非常特别的医生，我们还将与我的女儿交谈，她对我来说是一个非常特别的人。她今天将分享她的故事。

Yes. So, today, we are going to be talking with a doctor, a very special doctor, and we're also gonna be talking to my daughter who's a very special human being to me. And she's going to share her story today.

是的，她是。我们将讨论饮食失调，所以请注意触发警告——我们会谈到许多非常复杂的事情，涉及许多人的复杂情绪和经历，在我们介绍嘉宾时你会听到很多人的故事。我们的嘉宾是罗伯特·奥利瓦迪亚医生。他是一位临床心理学家，也是哈佛医学院精神病学系的讲师。

Yeah, she is. We're talking about eating disorders and so trigger warning we're talking about a lot of very complicated things that involve a lot of very complicated emotions and experiences for a lot of people and you'll hear a lot of people as we meet our guests. Our guest is Doctor. Roberto Olivardia. He is a clinical psychologist and lecturer in the Department of Psychiatry at Harvard Medical School.

他在马萨诸塞州列克星敦维持着自己的私人诊所。他专门治疗注意力缺陷多动障碍（ADHD），特别是共病障碍、身体畸形障碍、强迫症，以及男孩和男性的饮食失调治疗。他是《阿多尼斯情结》的合著者，这本书详细描述了男性身体形象问题的各种表现。他无处不在，各位。这位专家出现在各种出版物中。

He does maintain his own private practice in Lexington, Massachusetts. He specializes in the treatment of ADHD, particularly with comorbid disorders, body dysmorphic disorder, obsessive compulsive disorder, and in the treatment of eating disorders in boys and men. He's the co author of the Adonis Complex, which is a book that details the various manifestations of body image problems in males. And he's been all over the place, you guys. This guy, he's in all kinds of publications.

他是CHAD和注意力缺陷障碍协会的顾问委员会成员。他还担任ATTITUDE的科学顾问委员会委员，是UNDERSTOOD的特邀专家，并且是马萨诸塞州解码阅读障碍小组的活跃成员。你其实在CHAD ADA见过他。这就是他今天来到我们这里的原因。他非常慷慨地贡献了自己的时间。

He's on the advisory board for CHAD and the Attention Deficit Disorder Association. He sits on the Scientific Advisory Board for ATTITUDE and is a featured expert for UNDERSTOOD and an active member in the Decoding Dyslexia Massachusetts group. You actually met him at Chad ADA. That's how he comes to us today. He is fantastically generous with his time.

你会注意到这一集有点长。坦白说，我们已经进行了对话。尼基、佩奇和奥利瓦迪亚医生已经进行了他们的谈话。这一集确实有点长。

You'll note this is a bit of a longer episode. Frankly, we've already had the conversation. Nikki and Paige and, Doctor. Olivardia already had their conversation. It's a bit on the long side.

所以我告诉你，我知道这集可能会感觉比较长，你可以暂停一下，稍后再继续。如果时间不够，或者通勤途中不方便，就先暂停，回头再听，因为Olivardia医生从头到尾都分享了很多宝贵的见解。我们非常感谢大家的耐心和理解，这次活动没有直播，因为Paige参与了。她非常出色，是一位明星，她为自己以及生活在饮食失调和ADHD阴影下的人们做出了卓越的倡导。

So I'm telling you, I know it's gonna feel like a longer episode, just pause it and come back. If you can't make it, if it doesn't fit in the commute, just pause it and come back because there's there are gems all the way to the very end from doctor Olivardia. So, we we sure appreciate your, patience for your understanding in that for for members who are there was no livestream of this event because Paige was involved. She's an incredible she's a star. She's an incredible speaker and advocate for herself and for people who are living with, the the specter of the eating disorder and ADHD.

好了，就这样吧。其他事情我们先放一放。你们都懂的流程。在patreon.com/theadhdpodcast找到我们。我就不多啰嗦了。

So, that's it. We're gonna table table everything else. You know all the drills. Find us patreon.com slash the adhdpodcast. I'm not gonna belabor all of that.

谢谢各位会员，你们太棒了。现在让我们开始，欢迎Olivardia医生。

Thank you, members. You're amazing. And now let's go ahead and get to it and meet doctor Olivardia.

非常感谢你能来，Roberto。我们非常感激。今天是一个特别的节目，有我、我的女儿Paige，以及Roberto Oliveira医生加入我们。我们将讨论一个艰难的话题，一个不容易谈论的话题。我们今天的使命是提高对ADHD和饮食失调的认识。

Thank you so much for being here, Roberto. We appreciate it so much. It's a very special episode that we are having today with myself, my daughter, Paige, and doctor Roberto Oliveiria is joining us. And we're gonna talk about a hard topic, one that is not easy to talk about. Our mission today is to shed some awareness around ADHD and eating disorders.

我们想分享我们家庭中的个人经历。我的女儿有一个故事，她想要分享她的经历。我们希望这能给一些听众带来希望，如果你正在寻求帮助或需要更多关于饮食失调和ADHD的研究与理解，我们能为你指引正确的方向。Roberto，请简单介绍一下你的经验。我知道这是你经常写作、谈论并大力阐明的领域。

And we wanna talk about our own personal experience that we have had in our own family. My daughter has a story that her story that she wants to share. And we hope that it brings hope to some people that are listening and that we can get you into the right direction if you are looking for help or need more research and understanding around eating disorders and ADHD. Roberto, tell us a little bit about your experience. I know that this is something that you write about, you talk about, you shed a lot of light around it.

当然。我是一名临床心理学家，在哈佛医学院精神病学系担任讲师。大约三十年来，我一直在研究和治疗饮食失调患者，尤其专长于与患有饮食失调的男孩和男性工作，这一群体被严重忽视。多年前我合著了一本书叫《阿多尼斯情结》，讨论了各种身体形象问题，从饮食失调到身体畸形障碍、男孩和男性使用合成代谢类固醇等，尽管我也治疗女孩和女性。

Sure. So I'm a clinical psychologist. I'm a lecturer in the department of psychiatry at Harvard Medical School. And for about thirty years have been researching and treat people with eating disorders, particularly I specialize in working with boys and men with eating disorders, which is vastly under recognized. I co wrote a book many years ago called The Adonis Complex, which talks about all kinds of body image issues from eating disorders to body dysmorphic disorder, anabolic steroid use with boys and men, although I've also treated girls and women.

至于ADHD，我自己就有ADHD，来自一个有多代ADHD患者的家族。ADHD很少单独存在，所以我治疗许多同时患有ADHD和情绪障碍、强迫症、物质滥用问题的患者，并见到很多ADHD与饮食失调共病的案例。我对这种共病特别有热情，因为它经常被严重误解。在饮食失调患者中，ADHD往往甚至没有被临床识别出来。

And as far as ADHD, I have ADHD, come from a long lineage of people with ADHD. And having this sort of intersection of ADHD, which we know rarely travels alone. So, I work with lots of patients who have ADHD and a mood disorder, OCD, a substance abuse issue, and see many patients with ADHD and eating disorders. And I feel very passionately particularly about this comorbidity because a lot of times it's vastly misunderstood. The ADHD is often not even really clinically recognized in individuals who struggle with eating disorders.

当我与同时患有这两种病症的患者合作时，当他们理解ADHD所扮演的角色时，这实际上对他们来说是一种极大的认可，他们会想，哦，好吧。现在我明白了，我的大脑是这样运作的，患有ADHD使我们面临多种不同行为的风险。其中一些行为会是良好和健康的，而另一些则不那么好。但最重要的是，当我们理解了ADHD的作用后，治疗和干预就能更有针对性，这些人就能得到帮助，康复是可能的。我经常与患者合作或进行咨询，他们很多人只是觉得，对于这种饮食失调，没有什么能帮助我。

And when I work with patients who have both, when they understand the role that ADHD can play, it can actually be very validating to them to be like, oh, okay. Now if I understand that my brain is wired this way and having ADHD lends us to run the risk of lots of different kinds of behaviors. Some of them are going to be good and healthy and some of them not so much. But most importantly, when we understand the role that ADHD plays, the treatment and the intervention can be better targeted and these people can get help and that recovery is possible. All too often, I've worked with patients or done consultations of people who just are like, I just there's nothing that could help me with this eating disorders.

饮食失调是难以治疗的病症。但当ADHD混杂其中且未被识别和治疗时，这些人感到绝望是可以理解的。而当他们理解了ADHD的作用后，治疗就有了目标，人们就会好转。这是我们大家都想听到的主要信息，你知道，希望人们从中了解到康复是可能的，并且不幸的是，很多人对此抱有极大的羞耻感。即使撇开饮食失调不谈，患有ADHD的人也更容易出现饮食失调，即使不符合饮食失调的标准，比如冲动饮食、失调饮食、限制性饮食期。

And eating disorders are difficult conditions to treat. But when ADHD is in the mix and it's not being recognized and it's not being treated, these people feel hopeless understandably. And then when they understand the role that ADHD plays, targets the treatment and people get better. And that's the main takeaway we all want to hear, you know, for people to take away from this is recovery is possible and that this is something also that a lot of people unfortunately hold a lot of shame around. And even aside from eating disorders that there are people with ADHD are just more highly prone to dysregulated eating, even if it doesn't fit the criteria of an eating disorder, of impulsive eating, of dysregulated eating, periods of restriction.

这些，你知道，是我谈到过的一些经历，你知道，在我自己的生活中，我与所有这些的关系，以及ADHD在其中扮演的重要角色。

And these are, you know, some experiences that I've talked about, you know, in in my own life of just kind of my relationship with all of that and how ADHD plays a big role in it.

所以你提出了一个非常有趣的观点，因为我知道饮食失调（eating disorder）和失调性饮食（disordered eating）是有区别的。它们之间的区别是什么？

So you bring up a really interesting point because I know there is a difference between an eating disorder and disordered eating. What is the difference there?

主要的区别在于，饮食失调（eating disorder）指的是《精神疾病诊断与统计手册》（DSM）中列出的这些可诊断的病症。所以我们有神经性厌食症，其特征是严重的热量限制，通常伴随着严重的负面身体意象。我们有暴食症，患者在短时间内摄入极其大量的食物，直到感到不适的饱腹感，之后常常感到无价值和沮丧。神经性贪食症，即有暴食发作，但随后伴有补偿行为，即所谓的清除行为。这可能包括自我诱导呕吐、使用泻药、禁食、过度运动。

So the main difference is with an eating disorder, we're referring to like the diagnostic statistical manual of psychiatric disorders, the DSM, will list eating disorders that are these diagnosable conditions. So we have anorexia nervosa, which is characterized by severe caloric restriction, often coupled with a lot of negative body image. We have binge eating disorder where people are eating an incredibly large volume of food in a short period of time to the point where they're uncomfortably full, often feel worthless and demoralized afterwards. Bulimia nervosa, which are binge eating episodes, but then coupled with compensating behaviors, what's known as purging behaviors. And that could be self induced vomiting, laxative use, fasting, over exercise.

然后是一些可能不完全符合所有这些标准但很接近的障碍。比如ARFID或回避/限制性食物摄入障碍。至于失调性饮食（disordered eating），它甚至不一定达到医学上的阈值，即不一定像其他饮食失调那样不健康或危及生命，而饮食失调确实如此。饮食失调的死亡率高达10%到15%。这是非常非常高的。

And then sort of disorders that might not fit all those criteria 100% but are close to it. Things called ARFID or avoidant restrictive food intake disorder. With disordered eating, it not necessarily even hit a medical threshold of necessarily being as unhealthy or as life threatening as those other eating disorders are, which they are. Eating disorders carry a ten to fifteen percent mortality rate. That's very, very high.

同样重要的是要注意，有很多人因这种疾病失去生命，但饮食失调也有很高的自杀率。因此，死于自杀的饮食失调患者与死于饮食失调医疗并发症的人一样多。但对于失调性饮食，它更多是指这种失调的饮食行为。所以，我可能有一个病人，他可能一顿饭吃下10,000卡路里，甚至不称之为暴食。他们就像在自助餐厅，只是无法控制自己。

And it's also important to note that just as many people lose their lives to the illness, But also eating disorders carry a high suicide rate. And so just as many people die from suicide who struggle with eating disorders as die from medical complications of having an eating disorder. But with disordered eating, it's more these just dysregulated eating. So, I might have a patient who might eat 10,000 calories in one sitting and might not even refer to it as a binge. They're just like at a buffet and they just can't stop themselves.

这是一种非常不规律的饮食模式，可能一两天不吃东西，然后进食时又只吃高糖食物，因为ADHD大脑对糖的反应更为强烈。他们去看医生时，短期内可能生命体征如血压并无异常，但他们与食物的关系非常不稳定且存在这类复杂问题。或者在认知层面，有些人可能吃得健康，但吃了一块饼干就会自责。这并不是说他们在暴食饼干，而是他们的自我认知是：哦，我不该吃那个。

It's sort of very dysregulated eating and then not eat for a day or two. And then when they eat, maybe they are eating only like high sugar foods because the ADHD brain responds to sugar in a much more enhanced way. They can go to the doctor and nothing will stand out in terms of their vitals perhaps at least on the short term, their blood pressure, but their relationship with food is very, very erratic and has sort of these complications. Or cognitively, like people could eat, let's say, healthily, but then they might feel bad about themselves if they have a cookie. So it's not that they're binging on cookies, but their view of themselves is, oh, I shouldn't have eaten that.

因此，他们与食物的关系现在呈现出这种模式，无疑增加了患饮食失调的风险。但我们知道ADHD患者——我经常谈到食物和睡眠问题——那些我们每天都必须做的事情，比如每日进食，正是ADHD更容易频繁影响的领域，因为这些是我们每天应该做的例行事务。

And so their relationship with food now takes on this sort of approach that certainly puts them at risk for an eating disorder. But we know people with ADHD, you know, I often talk about with food, with sleep, that the things that we do every we have to eat like every single day, Those are the things that ADHD can find its way into more with more prevalence are those things that we're supposed to do every day.

那么身体畸形障碍是如何相关的？它是饮食失调的一部分，还是完全不同的东西？

So where does body dysmorphic disorder come in? Is that part of the eating disorder, or is that a different thing altogether?

身体畸形障碍（BDD）是一种不同的障碍，被归类为强迫症谱系障碍。这意味着这些谱系障碍都有共同的遗传基础。你可以想象它们就像一个障碍家族，OCD、BDD、神经性厌食症等都像是彼此的表亲。大多数BDD患者并没有饮食失调，其特征是患者对身体某一部分过度关注。

So body dysmorphic disorder or BDD is a different disorder and it's classified in the obsessive compulsive spectrum disorders. And what that means is the spectrum disorders are all these conditions that share genetic underpinnings. So, if you almost imagine like a family of disorders of which OCD, BDD, anorexia nervosa, they're all like cousins of each other. And with BDD, most people with BDD don't have an eating disorder. And that's characterized by people who have a preoccupation with a part of their body.

他们可能认为多个身体部位丑陋、有缺陷或令人厌恶。这不仅仅是负面身体形象，通常还伴随着对自己外貌的真实扭曲感知，以及大量强迫性思维，如反复照镜子、过度修饰、掩饰行为或回避行为（如避免照镜子、不出门、遮盖脸部等，具体取决于关注部位）。我曾治疗过BDD患者，他们可能痴迷于几乎每个身体部位，比如手指、肌肉、头发、皮肤等。

It could be multiple parts of their body that they think looks ugly or defective or repulsive. It's more than just having negative body image. It's often characterized by people who have a real distortion of the way that they see themselves, and it's coupled with a lot of obsessive thinking about that body part, a lot of compulsive behaviors like mirror checking, excessive grooming, camouflaging behaviors, and or avoidant behaviors, mirror avoidance, not leaving the house, and covering one's face or depending on what part. I mean, I've worked with patients with BDD who could obsess about literally every body part. I mean, fingers, muscles, hair, skin, all different body parts.

对于饮食失调，许多患者确实有身体形象问题，但并非所有饮食失调患者都有。负面身体形象并非所有饮食失调的诊断标准，我们可以进一步讨论。但许多饮食失调患者确实有身体形象问题，也可能同时患有BDD。我治疗过许多患者，当他们从厌食症、暴食症或 binge eating disorder 中恢复后，发现BDD仍然存在，只是可能不再与体重相关。

With eating disorders, many people with eating disorders do have body image issues, but not all people with eating disorders have a body image problem. Negative body image is not a criteria for all eating disorders, and we can talk more about that. But many people with eating disorders do have body image issues and may also have BDD. And I've worked with many patients who when they are recovered from their anorexia or bulimia or binge eating disorder, it turns out there's also BDD that's still in the mix. It just might not be connected to their body weight.

ADHD的什么因素导致其患病率更高？我读过您在Attitude Magazine写的一篇文章，您提到ADHD女孩患饮食失调的风险几乎是非ADHD女孩的四倍。另一项研究发现，11%的ADHD女性有此问题，而非ADHD女性仅1%。我猜男孩和男性的数据应该类似，只是可能未被充分研究或讨论。

What is it around ADHD that makes it a higher percentage? So I I I was reading a magazine that you wrote or an article that you wrote for Attitude Magazine, and you had said that you found that girls with ADHD were almost four times more likely to have an eating disorder than those without ADHD. And then another study found that eleven percent of women with ADHD compared to one percent of women without. And I'm assuming the numbers have to be similar for for boys and men too. They're just not being researched maybe or talked about.

ADHD与这一成分之间有什么关联，使其更可能引发饮食失调？

What is it about ADHD and this component of of making it more likely to have an eating eating disorder?

这其中涉及许多不同因素，这是个很好的问题。我每次分享这些数据时都很兴奋，因为我希望人们在听到后会说：‘哦，当然，当我们了解ADHD时，这就完全说得通了。’首先，我们来理解ADHD的生物学成分。简而言之，我们大脑中有许多神经化学物质，其中之一是多巴胺。多巴胺与动机有关。

So there are many different factors, and and it's a great question because what I always am excited in sharing this data is I want people when they hear it to be like, oh, of course, that makes total sense when we understand ADHD. So let's first understand the biological components of ADHD. So in a nutshell, we have all these neurochemicals in our brain. One of them is dopamine. Dopamine is implicated in motivation.

它也与奖励机制相关。ADHD大脑存在多巴胺缺乏的问题。因此，作为一名ADHD患者，我认为ADHD是一种对世界的取向，即什么能刺激我。所以，一切令人愉悦的事物都具有刺激性。但也有很多不愉悦的事物同样具有刺激性，比如危险、焦虑、冲突和戏剧性事件，这些都非常刺激。

It's implicated in reward. An ADHD brain has a deficit of dopamine. So as someone with ADHD, I think of ADHD as an orientation to the world as to what is going to stimulate me. And so everything that's pleasurable is stimulating. There are lots of things that aren't pleasurable that are also stimulating like danger and anxiety and conflict and drama is very, very stimulating.

因此，当我们谈论暴食症或贪食症时，人们通常暴食的食物往往是高碳水化合物的，基本上是简单碳水化合物，比如在体内分解的糖类，高糖类食物。我从未见过有人暴食羽衣甘蓝或卷心菜。从未发生过。

So when people when we're talking about with binge eating particularly or bulimia, the kinds of foods that people typically binge on are going to be typically high carb, which basically simple carbs that break break down like sugar in the body, high sugar kinds of foods. I've never met anyone who binges on kale or in cabbage. Never happened.

如果你真的找到那样的人，你得请他们上我们的节目，问问他们，你知道，为什么？怎么做到的？

And if you ever find that person, you need to, like, get them on our show and ask us what you know, why? How?

我会对那个人非常感兴趣。

I'd be I'd be intrigued by that.

哦，真的吗？

Oh, yeah. Really?

非常感兴趣。所以这确实说得通，它是在自我调节这种多巴胺能反应。至于厌食症，这种情况较少见，通常你更常看到的是与暴食症和贪食症共病。不过，我治疗过许多同时患有ADHD和厌食症的人。有趣的是，在饥饿状态下，患者常常会报告一种与饥饿状态相关的欣快感。

Very much intrigued. So it's it's making sense that it's self medicating this sort of dopaminergic response. Now, with anorexia, which is less common, I mean, typically the comorbidity you'll often see more with binge eating and bulimia. However, I've treated many people with ADHD who also have anorexia. And interestingly, in a starvation state, patients will often report this euphoria associated with having sort of starvation state.

所以有某种因素表明，大脑是否在某种程度上适应并获得某种程度的奖励？因为患者会说他们在那种饥饿状态下感觉像兴奋了一样。所以我们知道存在那种多巴胺能反应。现在我们从认知角度理解了与进食相关的所有执行功能。我的意思是，要健康饮食，你必须计划膳食。

So there's some element that says, is the brain almost kind of adapting in some ways and getting some sort of level of reward? Because patients will say they feel like a high when they're starved in that sense. So we know that there's that dopaminergic kind of response. Now we understand from a cognitive perspective all of the executive functions that are associated with eating. I mean, to eat healthily, you have to plan meals.

你必须考虑你要吃什么，不仅仅是在你想吃的时候。所以如果我在考虑晚餐，我可能甚至在前一晚就应该考虑它。我可能需要解冻肉类。我可能需要做那些事情。这对ADHD患者来说很困难，这可能导致他们依赖快捷方便的速食、加工食品，你知道，那些更容易获取的食物，而这些通常并不总是健康的。

You have to think about what you're going to eat, not just at the time you want to eat. So if I'm thinking about dinner, I should be thinking about it maybe even the night before. I might have to defrost meat. I might need to do those kinds of things. And that's hard for people with ADHD, which could then lead them down a path of relying on quick and easy sort of fast food, processed food, know, things that are more accessible, which often aren't always going to be healthy in that way.

另外，我记得在大学时，我常用这个词——拖延——每当我拖延某事时，我就会吃东西。我意思是，研究生时期最明显的例子是，我应该写一篇40页的论文，结果我花了三个小时分析一家鸡翅店的菜单，那是我当时家附近一家做鸡翅很棒的地方。我翻看着菜单，哦，我是要蒜香帕尔马干酪味的？还是想要...甚至只是想着食物就已经提升了多巴胺。我意思是，想着它，然后下单，然后期待它，然后吃它。我吃了不知道多少鸡翅。

Also, I mean, I remember in college, I used to use this term procrastinating that anytime when I was procrastinating on something, I would eat I mean, my the most glaring example in grad school, I'm supposed to be working on this 40 page paper and I spent three hours analyzing this menu of chicken wings, this place near my house at the time that makes really good chicken wings. And I'm looking through my, oh, do I want the garlic Parmesan? Do I want and even thinking about the food is already elevating that dopamine. I mean, thinking about it, then I'm ordering it, then I'm anticipating it, then I'm eating it. And I eat I don't even know how many chicken wings.

然后我感觉自己进入了食物昏迷状态。所以就像这样，一整块时间都没完成工作。

And then I feel like I'm in food coma. So I like here's this whole block of not getting work done.

现在没法写那篇论文了。

Not gonna work on that paper now.

是啊。绝对不行。而且那食物非常令人满足。它有着，你知道，这种多巴胺能反应。

Yeah. No way. Absolutely. And that food was very rewarding. And it had, you know, it's sort of this dopaminergic response.

而且食物是触手可及的。你知道，在某些方面这非常容易，就像有些人可能会用酒精或药物自我疗愈一样。食物就是那种永远都在那里的东西。从心理层面来说，当我们理解——你知道，对许多患有ADHD的人来说，存在高度的焦虑和压力，执行压力伴随着完成任务而来。而食物是最感官化的，它是感官体验。

And food is accessible. It's very easy, you know, in some ways, in the ways that some people might self medicate with alcohol or drugs. You know, food is something that's just always there. And then psychologically, when we understand, you know, for a lot of people with ADHD, there's a high degree of anxiety and stress, executive stress that comes along with just getting things done. And food is very is is the most sensory it's sensory.

作为ADHD个体，我们是感官驱动的，是感官寻求者。还有什么比食物更感官的呢？我们闻它。我们尝它。我们触摸它。

And as ADHD individuals, we're sensory driven, sensory seekers. And what is more sensory than food? We smell it. We taste it. We touch it.

我们咬它。它调动了我们所有的感官，这对ADHD患者来说非常具有安定作用。现在，不仅仅是食物本身，我还想强调关于食物的想法。即使是那些更偏向限制性饮食的患者，他们也会谈到那种对不吃东西或思考食物的执着。这仍然具有奖励性，因为他们的思绪不再四处飘散。

We bite it. It's engaging all of our senses, and that's very grounding for people with ADHD. Now in not only the food itself, but I want to emphasize the thoughts of food also. And even with, again, patients who are more on the restrictive side, they'll also talk about the sort of fixation on thinking about not eating or thinking about food. It still has this rewarding element because their thoughts are not all over the place.

对于ADHD患者来说，能够专注于单一事物是非常强化的，尤其是当你习惯了思考15件不同的事情时。所以，如果食物是你正在思考的东西，即使是在思考不吃食物，这仍然满足了那种对单一性思维的需求。

And for people with ADHD to be focused on a singular thing can be very reinforcing when you're used to thinking of 15 different things. And so if food is the thing you're thinking about, even if it's thinking about not eating food, that's still satisfying that sort of need for the sort of singularity of thought.

几乎是超专注。

Hyperfocus almost.

一种超专注。没错。

A hyperfocus. Exactly.

是的。

Yeah.

然后就是一些伴随ADHD患者出现的自尊问题，有时饮食失调和负面身体形象是整体负面自尊的延伸。我们知道ADHD患者更容易出现这些问题。

And then just some of the self esteem issues that can come along for people with ADHD and sometimes food, eating disorders, and negative body image are extensions of overall negative self esteem. Then we know that people with ADHD are more highly prone to those issues.

在我让我女儿加入对话之前，我有一个关于诊断过程的问题。我试图回忆她确诊时的情景，是谁诊断的她，但在治疗师和医生之间有点模糊。我们还曾请过营养师介入。那么一个人是如何被诊断出饮食失调的呢？

So before I bring my daughter into the conversation, I have a question around being diagnosed. I was trying to remember when we were at that point when she was diagnosed, who diagnosed her, and it's all kind of a blur between the therapist and the doctor. And at some point, we had a nutritionist come in. So how how does a person get diagnosed with an eating disorder?

首先，很重要的一点是，只有百分之十的女性——男孩和男性比例更低——会得到治疗。正如你所说，确实如此，我与许多男性合作过，但对男孩和男性的研究确实较少。不过ADHD男性和男孩的患病率会非常相似。但说到治疗，研究显示只有百分之十患有饮食失调的女性接受了相关治疗。

So first of all, it's so important to know only ten percent of women and even less for boys and men. And going to what you said, absolutely, I work with a lot of men, and it's just there isn't as much research on boys and men. And But those prevalence rates would be very similar with men and boys with ADHD. But going to to treatment that only studies show that only ten percent of women who have an eating disorder are treated for an eating disorder. Wow.

百分之九十的人没有。而对男孩和男性来说，这个比例更高。

Ninety That's percent are not. And for boys and men, it's even more.

甚至更少。是的。

It's even less. Yeah.

甚至更少。所以能够被诊断并获得治疗，可以说你是幸运的，属于那些得到诊断和帮助的人群。但通常，可能通过医生进行诊断。比如有些人的生命体征不达标。对于女孩，如果已经开始月经却停经了——虽然这不再是厌食症的诊断标准，过去曾是。

It's even less. So to even get diagnosed and get treatment, it's like consider yourself fortunate that you're in that category of people that are getting that diagnosis and getting that help. But typically, it could be through a physician. So for some people where their vitals are not where they should be. For girls, if they have already started to menstruate and they're no longer menstruating, although that's not a criteria for anorexia anymore, it used to be a criteria.

但也可能仅仅是某些行为的存在，如暴食、催吐、从事非常不健康的行为。可能由医生诊断，也可能由患者正在咨询的心理学家在患者呈现这些症状并伴有大量负面身体形象问题时诊断。嗯。

But it could also be just the presence of certain behaviors like binge eating, purging, engaging in very unhealthy behaviors. It could be with the physician. It could be with the psychologist that someone is working with when they present with those symptoms along with a lot of sort of negative body image issues to get diagnosed with an eating disorder. Mhmm.

好的，我想欢迎佩奇。嗨，你好。我觉得让佩奇分享一下她被诊断出ADHD的经历会很有帮助。就在她被诊断出饮食障碍后不久，这些事情几乎都发生在同一时间段。

Well, I wanna welcome Paige. Hi. Hi there. And I thought it would be good for Paige to talk a little bit about what her experience was with getting diagnosed with ADHD. And shortly after getting diagnosed with an eating disorder, it all kind of happened around the same time.

所以你不妨分享一下，是什么时候意识到事情有些不对劲，然后来找我说，嘿，妈妈，我觉得我可能有ADHD。

So why don't you go ahead and share how when did you know that something was different and you came to me and said, hey, mom. I think I might have ADHD.

我当时正和我的朋友视频聊天，大概是，嗯，什么时候？八年级吧？八年级？还是七年级？我们当时在学美国50个州，就是记住它们的位置。

I was on FaceTime with my friend in, like, what was it? Eighth grade, probably? Eighth grade? Seventh grade? And we were, like, just studying our 50 states and just, like, to know where they are.

这些其实我在五年级就学过了，所以本来不应该这么难的。但她大概只学了半个小时就把所有州的位置都记住了。而我三个小时后还在努力搞清楚阿拉斯加在哪里。然后我就下楼找我妈妈，她在那里坐着，我有点像是问，我是不是很笨？我就是感觉真的很，嗯，很蠢。

And which I had learned in, like, fifth grade, so it shouldn't have been that hard. But she had, like, studied all of them and, like, knew where everything was in, like, thirty minutes. And I was there three hours later still trying to figure out where, like, Alaska was. And so I, like, walked I walked downstairs to my mom sitting there, and I was kind of like, am I stupid? I just I felt really, like, just stupid.

就像，为什么有些人，为什么这对我来说这么难？而我妈妈作为ADHD教练，立刻就说，哦，你可能患有ADHD。所以我们去做了诊断，或者先做了诊断测试，还是我们先联系了我的老师？

Like, how did some like, how is this so hard for me? And so my mom being an ADHD coach was just instantly like, oh, you might have ADHD. And so we went and got diagnosed or went to the diagnostic testing first, or do we get my teachers?

我们其实在节目中也讨论过这个，她接受治疗的过程，因为她的主治医生不相信她患有ADHD，原因是她的老师们填写问卷或表格的方式。这里我觉得拥有ADHD方面的专业知识很有帮助，因为我知道她可能是注意力不集中型，所以他们没看出来。她是个好学生，你知道，老师们都喜欢她，她很有魅力。所以我知道我们需要更深入一点，那时我们就去找了真正的精神科医生，做了诊断。是的，就是那个正式的诊断。

And we actually did talk about this on the show, her her sort of road to getting treated because the doctors her primary doctor didn't believe that she had ADHD because of how her teachers filled out the pro or filled out the paperwork. And and this is where I think having the expertise around ADHD helped because I knew that she was probably inattentive and that's why they didn't see it. And she was a good student and, you know, they loved her and she was very charismatic. And so I I knew that we needed to get a little bit deeper and that's when we went to the the actual psychiatrist that that did the Yeah. The actual diagnosis.

是的。因为就像在课堂上，我从来不是停不下来或者无法集中注意力。而是我坐在那里，看起来完全明白发生了什么。我只是点点头，但他们说的话我一点都没听进去。我们会读课本里的一段话，我得反复读好几遍才能理解我们在读的概念。

Yeah. Because like when I was in like class, it was never like I couldn't stop moving or I wasn't focusing. It's like I sat there and I totally looked like I knew what was going on. I was just kind of like shake my head, but like nothing they said would go through. We would read a paragraph in like a textbook and I would have to reread it multiple times just to understand like the concept of what we were reading.

所以单从眼睛来看，似乎没什么问题。但我从未注意到这一点，我一直以为大家都是这样的，直到我和朋友们一起学习时才意识到，这看起来不太正常。不应该花我这么长时间。

And so like from just the eyes, it didn't look like there was anything wrong And but, like, I just I never noticed that. I just kind of thought that was everyone until I was, like, with my friends studying. And I was just like, this does not seem normal. Like, this shouldn't take me this long.

嗯，我认为你指出的很多点也说明了进行彻底的多动症临床评估的重要性。这导致了一个现象——人们常认为多动症被过度诊断，但我觉得实际上是被严重低估了。因为我50岁了，在我年轻时，只有那些闹得学校鸡犬不宁的孩子才会被诊断为多动症，也就是有严重行为障碍的孩子。

Well, I think a lot of what you're pointing out too is how important it is to get a real thorough clinical evaluation of ADHD. And this is something that leads to I mean, people often think ADHD is overdiagnosed. I think it's actually vastly underdiagnosed because I'm 50 years old. So when I was younger, the only kids that were diagnosed with ADHD were kids that were burning the school down. Mean, kids with major conduct disorders.

那些孩子中有很多是我的朋友。但我在学校表现还不错，社交能力也很好。关键在于理解背后的过程，因为这些并不总是显而易见。特别是对女孩来说，我们都知道多动症中男孩比例高于女孩的说法——

And a lot of those kids were my friends. But I did well enough in school. I had good social skills. But it's the behind the scenes of understanding what's the process because it's not as observable all the time. And especially for girls, we know that ADHD, you'll still hear that boys outnumber girls.

这种说法并不准确。男孩在确诊数量上可能多于女孩，但实际患病率并非如此。就像饮食失调症，我们现在知道男性占患者总数的25%。三十年前我开始这项研究时，男性患者还被视为罕见现象。但你所说的恰恰点明了需要层层剖析，去理解：就算她没有上蹿下跳，她真的吸收信息了吗？

That's not true. Boys outnumber girls in identification maybe, but not in actual prevalence. With eating disorders, we know now that boys and men make up twenty five percent of people who have eating disorders are boys and men. And when I started doing that research thirty years ago, it was like seen as a rarity, you know, that boys and men hardly had, you know, these problems. But what you're speaking to is exactly that, that notion of needing to kinda peel back the layers and and understand, okay, just because she's not bouncing off the walls, are you taking in the information?

到底发生了什么？就我个人而言，高中时我完全活在自己的脑海里。因为我很容易感到无聊，所以内心世界和想象力特别丰富。我知道如何勉强应付过去。说实话，直到大学我才真正成为会学习的学生。

What's happening? Because I know for me, when I was in high school, I mean, I was in a world in my head. I mean, was I have a very vivid inner world and inner imagination because I got bored so quickly. And I just knew how to kinda hustle, you know, and sort of get it get through. It was really in college that I feel like I became a student, honestly.

上大学之前，我的意思是，那段日子真的不好过。

Like prior to college, I just I mean, it was not fun.

是的。差不多同时期——我会让她具体说这个——但她八年级时是个很特别的阶段，因为那时她被确诊多动症，也停止了体操训练。

Yeah. Yeah. Well, and then around the same time is and I'll let her talk about this. But she eighth grade was a really interesting time for her because she was getting the diagnosis of ADHD. She stopped doing gymnastics.

然后也是在这个时候，我认为她与食物的关系开始变得紊乱。你能谈谈为什么我们不多讨论一下这个问题吗？

And then also this is when I think her relationship with food was starting to to be disordered. And you can talk why why don't we talk about that a little bit?

是的。说实话，对于ADHD的诊断，我并不了解，我对ADHD知之甚少。就像我对自己也完全不了解一样。所以我从未想过那方面，也没想过与我的饮食有关。但现在我知道我是一个非常注重规律的人，我喜欢知道从周一到周五我要做什么。

Yeah. I think that with not honestly the ADHD diagnosis, I didn't like, I didn't know anything about ADHD that much. Like, I didn't know it about myself at all. So I never like thought about that and like with with my eating and but so I I now know that I'm a very routine y person. I like I like to know what I'm doing from Monday through Friday.

就像我知道我的日程安排，我非常按部就班。我不喜欢说我不喜欢旅行，因为我不喜欢变化。那时我并不知道这一点，但我认为那是我饮食失调开始的最大原因之一，就是离开体操的巨大变化。我习惯了放学后五个半小时的训练，现在突然之间，我会回家，吃点零食，坐在沙发上，或者就是不像以前那么活跃了。我没有意识到这个变化有多大，因为一切都变了，我不像以前那么活跃了。所以我的肌肉开始有点消失，我只是觉得非常不匀称，感觉非常……其实从来都不糟糕，我只是一个看起来正常的年轻女孩。

Like I know my schedule like I I'm very routine. I don't like saying I don't like traveling because I don't like it being different And I didn't know that back then, but I think that that is one of the biggest things that like started my eating disorder was the big change of how like of leaving gymnastics was I was so used to five and a half hour practices after school that now all of a sudden I would come home and, like, eat a snack and, like, sit on the couch or, like, I just wasn't as active as I was and I don't think I realized how big of a change that is because everything switched and I wasn't as active as I was. And so my muscles started to, like, kinda go away and I was just like, I felt very disproportional. I felt very just like and it was never bad. I was just a normal looking young girl.

我只是觉得，我习惯了强壮，习惯了那样的外表，而现在……我就像是在想，我要么强壮，要么瘦小。我无法变得那么强壮了，因为我当时十三四岁，不能开车去健身房。所以对我来说，开始不喜欢自己的外表太容易了，因为不仅退出体操是一个巨大的变化，而且我现在吃得一样多甚至更多，却没有同样的锻炼，身体的变化太剧烈了。我觉得那让我的心态真的开始崩溃，只是不再喜欢我的身体了。

I just thought that, like, I so used to being strong and that being like what I look like to now. I was just like, well, I can either be strong or I can be skinny and like I don't have what I I'm not able to get as strong because I was like thirteen fourteen. I can't drive and go to a gym. And so I just like it it was so easy for me to just start to not like how I looked because not only was gymnastics, like quitting gymnastics was a big change, but now I'm eating the same or more with not the same working out and my body changing was just too drastic. And I feel like that's kinda what my made my mind really spiral and just, like, not like my body anymore.

嗯。但你强调了一些非常重要的事情，这些对很多人来说都很重要，无论是对于ADHD患者还是我们所知的饮食失调风险因素。一个是变化和变化的过渡。体操对你来说是一种结构。而有ADHD的人，有时候我们喜欢……我有时仍然对‘结构’这个词感到不适。

Mhmm. But you're you're highlighting some really important things that are are important for a lot of people both with ADHD and what we know about the what can be risk factors for eating disorders. So one is change and the transition of change. And gymnastics was very it was structure for you. And people with ADHD, sometimes we like, I sometimes still cringe with that word structure.

我会想，哦，就像要被关进一个盒子里，但与此同时，我又喜欢它。我也类似，我喜欢在周末开始时知道我的 week 会是什么样子，比如有什么有趣的事情发生？我需要以那种方式对时间有一种形状感。否则，它会感觉非常不稳定。

I'm like, oh, like I'm gonna be put in a box, but at the same time, I like it. Like, I'm similar too. I like to know how my week is going to look when it's the beginning of the weekend, like what fun things what's happening? Like, I need to kinda have a sense of shape to time in that kind of way. Otherwise, it it can feel very destabilizing.

所以我能理解当你一天中的一大块时间被拿走时，现在就像，好吧，什么来填补这个空白？这可能会造成一定程度的失重感。而有ADHD的人非常容易受到影响。我们需要感到踏实，否则我们可能很快陷入不健康的状态。

And so I can understand when you have a chunk of your day just taken away, now it's like, okay, what's going to fill this gap? And that can create a certain level of ungrounding. And people with ADHD are highly prone. Like, we need to feel grounded. Otherwise, we can get into unhealthy places pretty quickly.

但你提到的另一点是，患有饮食障碍的人通常确实难以应对变化和过渡，以及事物失控的情况。饮食障碍背后的理论之一是，当周围一切似乎都混乱不堪时，这是一种对身体进行终极控制的方式。这确实有道理。我认为从功能性角度理解这一点非常重要，因为渴望掌控事物是人类的天性。当事物感觉失控时，你知道，它可能是我们的身体。

But the other thing you're mentioning, which can also with people with eating disorders often do have difficulty with change and with transition and things being not in control. And one of the theories behind eating disorders is it's a way of grasping having the most ultimate control of your body when everything else around you might feel chaotic. And and it makes sense. I mean, is why I think it's so important to understand it from a functional point of view is that it's human nature to want to feel in control of things. When things feel out of control, we you know it's it could be our bodies.

可能是最微小琐碎的事情，我们也会紧紧抓住不放。所以这很合理。但你提到的另一点是，作为ADHD患者，我们非常敏感，不仅是情感上敏感，身体感觉上也同样如此。事实是，如果你一直在练体操然后突然停止，你的身体感觉会不同。而且你正处于一个年龄阶段——我肯定不想再经历一次青春期。

It can be the most minute trivial thing that we'll attach ourselves to. So that makes sense. But the other thing you're mentioning too is as people with ADHD, we're very, again, sensitive, not only emotionally sensitive, but just physically in how we feel. And the fact is, is if you're doing gymnastics and then suddenly you're not, your body's going to feel differently. And you're at an age where I I certainly wouldn't want to go through puberty again.

我的意思是，你正处于身体发育和变化的年龄。饮食障碍的发病年龄通常就在这个时期，这并非偶然。正是因为身体在变化，而你无法控制这些变化。

I mean, that's like you're at an age where your body's developing and changing. And that is often the age of onset for eating disorders is around that time. And it's not accidental. It's because the body is changing. You're not in control of those changes.

它们就是自然发生。这可能让人非常不知所措。然后再加上ADHD，现在又有了所有这些执行焦虑，比如：我该怎么处理这个？我该如何思考这个问题？我能理解所有这些是如何在同一时间发生的，然后在学术上发现一些这些事情，可能就为饮食障碍埋下了伏笔，这不是双关语。

They're just happening. And that could be very overwhelming. And then you put ADHD on top of it where there's now all of this executive anxiety of like, what do I do with this? And, you know, how do I think about this? And I can see how all of that is happening, you know, at a at a time and then discovering some of these things academically that could set up a recipe, no pun intended, for, you know, for an eating disorder.

所以这非常合理。

So that makes a lot of sense.

嗯，这一切都发生在2020年2月。那么猜猜2020年3月发生了什么？

Well, and this was all happening in February 2020. So guess what happened in March 2020?

是的。

Yep.

新冠疫情来袭，我认为那才是事情真正发生转折的时候。

COVID hit, and and that was that's where it really took, I think, a turn.

是的，而且是变得更糟。在学校的时候，情况还没那么糟糕。更多时候我只是不吃东西。比如我可以晚起但准时上学，没时间吃饭，也不带午餐，回家后可能吃点零食和晚餐，那样也还行。

Yeah. Because For the worse. When I was in school, I just kind of it wasn't that bad. It was more I just didn't it was it was just, like, I didn't have to eat. Like, I I could wake up late and go to school on time, but not have time to eat and then not pack a lunch and come home and, like, maybe eat a snack and dinner and, like, that'd be fine.

但后来学校停课了两周。而且，就像你说的，在那个时候的线下上课期间，我认为那也是饮食失调的开始，就是那种控制感。我有一门很难的课，那是初中最难的课，我会每天学习三个小时准备周五的考试，但不知怎么还是得了D。所以我完全不知道是怎么回事。然后她就会……嗯。

But then, like, school shut down for two weeks. And, like and also with being in that, like, during in person school at that time, I think that's also what started the eating disorder was just like you said with the sense of control was I had one class that was hard. That was the hardest class I'd had for middle school, and I would study every day for, like, three hours for a test on Friday and somehow still get a d. And so I just had no idea what was going on. And then she would, like yeah.

我会重考并通过，但在那期间，我学了那么多却还是考不好。所以我觉得，能够控制自己吃多少和外表的样子让我平静下来。就好像，如果我不能控制我的思维和学习，也不能控制我的成绩，那我至少可以控制我的外表。比如，我可以控制我摄入什么和不摄入什么。我认为这很大程度上加剧了问题。

I would retake the test and be fine, but just during I would just I would study so much and not be able to get it. And so I think being able to control how much I was eating and what I looked like is what kinda calmed me down. Is that if I can't control how my mind is thinking and learning and I can't control my grades, that, like, I can control what I look like. Like, I can control what I'm putting in my body and what I'm not putting in there. And I think that's what, like, very much spiked it was.

嗯，我们之前为节目做准备时也谈到过，你知道，在那个年龄你开始非常在意别人以及他们在做什么。所以有很多身体上的比较。

Well, and something we were talking about too when we were prepping for the show is, you know, it's also an age where you become very aware of other people and what other people are doing. And so there was a lot of body comparison.

嗯。

Mhmm.

而且，我的意思是，社交媒体也是……是的，你知道吗？她告诉我它美化了这种情况。

And, I mean, social media was also Yeah. You know? She told me that it it glamorizes it.

他们现在在TikTok上浪漫化一切，尤其是在所有事情都停摆的时候，我发誓我看到的所有内容都在美化饮食失调和节食。但所有发布的内容都只展示了它美好的一面——比如你变瘦了，或者'哦，我一整天都没吃东西'，而不是展示饮食失调背后的真实情况。所以对我来说很难理解，因为我觉得好像每个人都有饮食失调，我没事，大家都这样，但我很困惑这些人怎么能对患有这种病症显得如此开心。

They romant like, especially, like, TikTok now for when everything had shut down, I swear everything I saw was romanticizing and eating disorders and starving yourself. But everything that was posted was, like, the the pretty part of it was they were, like, you're skinny or, oh, I haven't eaten all day and not the the behind the scenes of how an eating disorder actually is. So, like, for me, it was hard to see because I was, like, well, everyone has an eating disorder. Like, I'm fine. Like, everyone is like this, but I was kinda confused on how these people seem so happy about having order.

但我却在这里默默承受痛苦，从没感觉好过，我不知道人们怎么能在网上笑得出来。

But I was, like, over here suffering in silence and not knowing like, I didn't feel good ever. I don't know how people were able to smile online.

没错。是的。不过你提到的所有这些都很重要。我想强调你关于ADHD经历的信息，这点经常被忽略，因为ADHD总是被说成'哦，我太ADHD了'，但人们不理解它背后可能带来的痛苦，以及它有多么令人沮丧。

Right. Yep. No. But all all that, you know, you're mentioning it, and it's so important too. And and I wanna underscore your message of the experience with ADHD that often gets missed because ADHD is like, Oh, I'm so ADHD and people don't understand the pain that can be behind it is how demoralizing it can feel.

我深有同感，因为我记得那些学习、学习、再学习的日子，化学只拿了D。我女儿刚参加了化学期中考试，她化学比我当年好多了。但我记得我很多课程的期中期末都不及格，因为累积的知识量让我不知所措，感觉太挫败了。

I can relate because I remember those times studying, studying, studying, I'd pull a D in chemistry. My daughter just took a chemistry midterm and she's doing better in chemistry than I did. But I remember I failed every midterm and final for lots of classes because the cumulative knowledge was like way I was like, oh my gosh. Like, how do I, like, sift through this? And it just feels defeating.

所以希望你要么找到其他应对策略，要么有其他寄托。比如音乐对我来说一直是种治疗，是我的救赎，我可以沉浸其中。但重要的是要明白，治疗ADHD有助于防止其他问题这样连锁发生。

And so the hope is that you either, you know, find other strategies of getting through that or you have something else to attach to. Like music for me continues to be and has always been like a therapeutic thing. Like, that's my that was my salvation. I could drown myself sort of, you know, in that. But that makes a lot of understanding that when we treat the ADHD, it can help prevent some of those other issues from cascading in that way.

至于社交媒体，我对此有很强烈的感受。我有一个快18岁的儿子和快16岁的女儿，他们最近才开始用社交媒体。我态度非常坚决，我告诉他们，我们全家都是ADHD家庭，他们也有ADHD。

But to social media, I mean, I have very strong feelings with social media. And I have a almost 18 year old son and almost 16 year old daughter, and they recently got social media. I feel very, very strong. Now part of it, and I told them, is we're all we're an ADHD family. They have ADHD.

我说如果我现在是青少年，我绝对会出问题，我会是这类内容的第一消费者。有趣的是，即使在我成长的时候，我也特别想要MTV，但我父母直到我上大学那天才装有线电视，真的。他们连24小时都等不了，我还打电话给他们。

I said, if I were a teenager now, I would absolutely have a problem with it. I would be the number one consumer of all of this kind of And this is true, but it's funny is that even when I was growing up, I wanted MTV so badly and my parents did not get cable until the day I went to college, literally. Literally. They couldn't even wait twenty four hours. I called them.

我就说，妈，我都收拾好了。然后她说，我就问，你后面那是什么声音？她说，你爸装了ESPN。我就说，什么？你们装了有线电视？

I'm like, I'm all packed in, mom. And she's like and I'm like, what's that noise behind you? She's like, your father got ESPN. And I'm like, what? You got cable?

就好像，你连24小时都等不了。然后她说，是啊，但说实话，他们了解自己的儿子，因为我本来会沉迷其中的。但相反，我在写歌，和朋友出去玩，非常活跃。嗯。但真的很难期望一个正在发育、易受影响的年轻大脑去处理所有这些信息。而这些应用，这些社交媒体应用，就是设计来让人们一直停留在上面的。

Like, you couldn't even wait twenty four hours till She was like, yeah, but honestly, they knew who their son was because I would have been glued. And instead, I was writing songs and I was out with my friends and being very physically active. Mhmm. But it is really, really hard to expect a young developing impressionable brain to be taking in all of that information. And these apps, these social media apps are designed to keep people on them.

它们就是这样设计的。研究表明，而且我必须告诉你，在我的实践中，有一个明显的转折点——在我从事这项工作这么多年里，社交媒体出现前后，我看到了更年轻的孩子，甚至八九岁，因为身体形象问题和饮食失调而接受治疗。他们现在不再谈论名人（那总感觉有点遥不可及），你知道，哦，我想看起来像那个人。他们现在看的是那些影响者，你们的社交媒体影响者，这些人感觉不那么遥不可及，感觉足够 relatable，以至于让人觉得，我应该看起来像那样。我应该那样做。

They're designed that way. And studies show and I have to tell you in my practice, there is a clear inflection point having been doing this for as many years as I have before social media and afterwards. I have seen younger kids, like as young as eight or nine, treating for body image issues and eating disorders who now instead of talking about celebrities, which always felt a bit untouchable, you know, oh, I want to look like that person. They're now looking at your influencers, your social media influencers, which don't feel as untouchable, which feel relatable enough that it's like, I should look like that. I should do that.

我应该那样吃或不吃。佩奇，你说得完全正确，这些东西被以一种如此美化的方式呈现出来，以至于几乎让我工作的那些病人觉得无效，他们想，这些人真的快乐吗？那我连得个饮食失调都失败了。就好像，我连这个都做不好。因为这些人到处走动，他们很了不起，而我，我却被这个折磨。

I should eat or not eat that way. And you're absolutely right, Paige, is that it gets put out there in such a glamorizing way that it almost invalidates for people like patients I work with who are like, are these people really happy? Then I'm I'm even failing at having an eating disorder. Like, I'm not even good at this. That because these people are walking around and they're the bomb and, like, I I I'm tormented, like, by this.

所以到底是怎么回事？这就变成了一个恶性循环。社交媒体中显然有算法，如果你在看身体形象相关的内容，它就会推送更多身体形象相关的内容。所以它是自我滋养的。这相当危险。

So what is going on? And it just becomes this spiral. And there are algorithms obviously in social media that if you are looking at body image related content, it's going to send more body image related content. So it feeds upon itself. And it's pretty dangerous.

有研究表明，Instagram，特别是Instagram的使用，TikTok，与男孩和女孩的负面身体形象存在非常显著的相关性。甚至不幸的是，研究表明，即使是身体积极性（body positivity）——其本意是，嘿，让我们展示不同的身体，展示你可以为自己的任何身体感到自豪。我完全支持这个。我的意思是，我们绝不应该因为任何身体而歧视或羞辱别人。但研究表明，即使是这些图像仍然导致了很多负面身体形象，因为它仍然在某种程度上将身体客体化。

And there are studies that show very significant correlations of Instagram, particularly with Instagram usage, TikTok, and negative body image for boys and girls. And even unfortunately, studies will show even with body positivity, which the intention of body positivity is, hey, let's show different bodies and let's show you can have pride in whatever body. And I'm all for that. I mean, we should never discriminate or shame people for whatever body. But studies show even those images are still resulting in a lot of negative body image because it's putting out there this sense that the body still objectifying the body in some ways.

所以当Lizzo发布她穿比基尼的照片时——Lizzo是一位了不起的歌手和伟大的艺术家，我完全支持‘嘿，我对自己外表毫无羞耻，我不应该被贬低’的信息——但这仍然表明她的身体仍然是必须被展示出来的东西，而不是她拥有惊人的嗓音天赋。这才是，你知道，无论她是大码身材还是瘦小身材，高个子还是矮个子，你的价值和尊严是一样的。所以即使意图是好的，它仍然传递了一个信息，即以那种方式被看到仍然很重要。

So when Lizzo posts her in bikini, and Lizzo's a fantastic singer and a great artist, and I'm all for the message of, hey. I have no shame about how I look and I shouldn't be put down, but it's still showing that her body is still something that has to be put out there as opposed to she has this amazing talent of her voice. And that's what you know, like, whether she's on a large body or a thin body, a tall body, short body, your value and worth is, you know, the same. So even when the intention is meant to be good, it's still sending a message that it's still important to be seen in in that kind of way.

你知道吗，我想和正在收听的父母、伴侣或任何有担心对象的人分享一件事，这对我和我丈夫来说真的非常困难，因为我们注意到她不再带午餐去学校了。我们注意到她吃得不多。她会穿宽松的衣服，所以我们无法真正看出她真实的样子。由于新冠疫情，她确实陷入了抑郁，而且本来就非常孤立。我记得她学开车的时候，那时她15岁，是在夏天。

You know, something that I just want to share with people that are listening that are parents or or partners or anybody that might have someone that they're worried about, that was something that was really, it was really difficult for my husband and I because we noticed that she stopped taking lunch to school. We noticed that she wasn't eating as much. She would wear baggy clothing, and so we wouldn't really be able to tell, you know, what she really looked like. And because of COVID, I definitely you know, she went into a depression and was definitely isolated anyway. And, you know, I remember when she was driving, she was 15 and she was learning how to drive, and it was in the summertime.

所以她当时穿着短裤。我看到了她的腿有多瘦，这非常令人担忧。几个月后，她的眼睛下面非常红，我以为那是化妆。我真的以为是化妆，后来才意识到那不是化妆。那真的很可怕。

So she actually had shorts on. And I actually saw how thin her legs were, and that was very concerning. And then there was a few months later where her eyes were really red underneath, and I thought it was makeup. I really honestly thought it was makeup, and I realized that that wasn't makeup. And it was really scary.

那真的很可怕。就在那时，我们让她去和心理医生交谈，让她和她的医生沟通。他们都说，是的，这种情况正在发生。

It was really scary. And that was the time that, you know, we had her talking to a therapist. We had her talking to her doctor. They were like, yes. You know, this is happening.

而且你知道，她拒绝接受治疗。

And I you know, she refused treatment.

而且我对你们隐瞒了这件事。

And I hid it from you guys.

你隐瞒了。你隐瞒了很长时间。

And you hid it. You hid it for a long time.

因为我其实直到大约15岁才开始谈论这件事，虽然这一切大概是从我13岁左右开始的，但我从来没有真正说出来过。我会暗示一些事情，就像你们说的，我总是在Instagram上发布关于饮食失调意识的内容，我会发布相关的东西，谈论这方面的意识，但从来没有真正说出来。我会告诉他们关于它的事情，比如‘哦，这是这个，那是那个’，但从不直接说‘哦，我正在这样做。这就是我。那是我的问题’。

Because I didn't actually start kind of talking about it until because it all kinda started when I was about 13, and I didn't actually say anything until I was about 15, but I never actually said anything. It was very, like, I would hint at things, like, how you guys said that I would I would always post on my Instagram about, like, eating disorder awareness, but, like, I would, like, post things about it and, like, awareness about it and but never actually, like and I would tell them about it. Be like, oh, like, this is that and this is this without actually saying that, like, oh, I'm doing this. This is me. That's my problem.

我刚才只是在解释我学到的东西。所以大概就是这样，然后

I was just explaining what I learned. And so that's kind of how and then

你可以

you can

嗯，然后连我丈夫都说，我觉得她在尝试，我觉得她在寻求帮助。我觉得她需要帮助。我当时还抱着希望，因为我们有治疗师、医生，还安排了营养师要和她谈话。做研究的时候你就会知道，这就是你的团队，对吧？

Well, and then even my husband was like, I think she's trying I think she's reaching out for help. I think she needs help. And I was I had this, like, hope because we, you know, we had the therapist, we had the doctor, and we had a nutritionist that we were gonna have her talk to. And when you do the research, you know, that's your team. Right?

就像，这就是你想要的团队。我当时想，哦，太好了。我们要有这个团队了。结果和营养师见了一次面，佩吉就退出了。然后她就，接着她解雇了她的治疗师，告诉治疗师她不需要治疗了。

Like, that's the team that you wanna have. And I was like, oh, good. We're gonna you know, we have this team. One meeting with the nutritionist, and Paige was out. And then she was like, and then she fired her therapist and told her therapist she didn't need therapy.

我发邮件

I emailed

给我的治疗师，告诉她作为一个决定，我和我的家人决定我已经痊愈了。我不需要治疗了。

my therapist and told her that as a decision, me and my family decided I'm healed. I don't need therapy.

然后不。因为她未成年，治疗师说，我不确定这是否真的是家庭决定。我说，是啊，不是的。

And No. And because she's a minor, the therapist was like, I don't know if this was truly a a family decision. I'm like, yeah. No.

是的。而且我不喜欢那个营养师，因为她一开始就问我的问题之一是：你的安慰食物是什么？我当时就想，什么？我就像，呃，我不想谈论这个。我当时觉得，我不想吃东西。

Yeah. And I didn't like the nutritionist because I she would ask me like, one of her first questions was what are your comfort foods? And I'm like, what? I was like, app like, I don't wanna talk about that. I was like, I don't wanna eat food.

就像，我不想知道我的安慰食物是什么。我当时非常，就像，被冒犯了。就像，你为什么要问我这个？然后我很快就生气了，变得防备起来，甚至没有完成那次预约，就觉得，我不干了。就像，我不需要这个。

Like, I don't wanna know what my comfort foods are. Like, why would I was very, like, offended. Just like, why would you even ask me that? And I just got mad and defensive really fast and just didn't even finish the employ appointment and then was just like, I'm not doing this. Like, I don't need this.

是的。没错。有趣的是，治疗师，我们最后一次和她通话时只有我和我丈夫，因为佩吉不肯来。她说，记住，这是进食障碍，不是佩吉本人。

Yeah. Right. And what's interesting is that the therapist, our last call that we had with her was was just my husband and I because Paige wouldn't come. And she she said, just remember, it's the eating disorder. It's not Paige.

这让人感到一些安慰，你知道，看到这一点，好吧，抗拒的不是她，而是这个别的东西。试着把这个东西和她本人分开。这很有帮助。所以这是一段有趣的旅程。是的。

And there was some comfort in that, you know, to to see that, okay, the resistance isn't it's not it it is this other thing. And to try to separate this thing from who she was. And that was it was helpful. So it was interesting journey. Yeah.

不。我同意。我认为这是一个重要的观点，因为类似于，你知道，我们在成瘾问题上看到的情况，我们文化上经常将成瘾道德化，这是不应该的。有些人有成瘾行为，他们的性格可能不同。他们可能会为了成瘾做一些平时不会做的事，比如偷钱买毒品等等。

No. I agree. I think that's an important point because similar to, you know, what we would see with addiction that, you know, we culturally, we often moralize addiction, which we shouldn't. That there are people that engage in addictive behaviors and their personalities might be different. They might do things in service of the addiction that they wouldn't do otherwise, like steal money to get drugs and whatnot.

这并不意味着他们是坏人。而是这个实体某种程度上控制了他们。进食障碍也是一样的。我的意思是，特别是如果涉及到厌食或限制性饮食，你的大脑实际上没有得到——它没有清晰地思考。它只是没有得到营养。

That doesn't mean that they're bad people. It's that this entity has sort of come over them. Eating disorders are the same way. I mean, especially if it's involving more anorexic or restrictive eating, your brain is literally not getting it's not thinking clearly. It's just not getting the nutrients.

我的意思是，当我们营养不良时，我们的大脑可能会有点不正常。这是剥夺。如果我们睡眠不足，我们的大脑就无法清晰思考。我们也不能很好地调节情绪。我们知道这对于多动症患者来说更是雪上加霜，但我们本来就比常人更容易情绪失调。

I mean, when we're malnourished, our brain can get a little wacky. It's deprivation. If we are sleep deprived, our brain is not thinking clearly. We can't regulate our emotions as well. And we know this is on top of people with ADHD, but we already have a higher than typical degree of emotional dysregulation.

但是，进食障碍的本质在于，在精神病学诊断中，我们将症状称为自我协调或自我不协调。自我不协调是指患者觉得‘这其中没有任何我想要的东西’。比如，当人们抑郁时，就非常自我不协调——我不想这样感觉，这不是真正的我。

So but the nature of an eating disorder is so in psychiatric diagnoses, we refer to symptoms as ego syntonic or ego dystonic. So ego dystonic is when the person is like, there is nothing in this that I want. Like, when people are depressed, it's very ego dystonic. I don't want to feel this way. This is not who I am.

我想摆脱这种状态。康复和好转是唯一的回报。而对于成瘾和进食障碍，存在一种自我协调的特质，这意味着疾病的一部分是患者抗拒治疗，因为他们的恐惧是：如果我不这样了，那么第一，我是谁？第二，康复会让我失去一些东西。

I want to get out of this. It's only reward. Recovery is and getting better is only reward. With addiction, with eating disorders, there's an ego syntonic quality, which means the part of the disorder is people resisting treatment because the fear is if I am not in this, then a, what am I? You know, B, is I'm going to lose something with recovery.

我不是在获得，而是在失去。我失去控制，失去身体自主权，我会增重。

I'm not gaining. I'm losing something. I'm losing control. I'm losing my bodily autonomy. I'm going to gain weight.

所以即使我们谈论治疗，他们的目标、你的目标，甚至营养师的目标都是不同的。我听过很多患者这样说。即使是身体畸形障碍的患者，BDD的本质之一就是患者不认为自己有BDD，他们只是觉得自己丑陋。

I'm going to So even when we talk about treatment, their version, your version, even with the nutritionist is like, What is the goal here? Because your goal is different than my goal. And I've heard that from many patients. I mean, even patients with body dysmorphic disorder, session, part of the nature of BDD is people who don't think they have BDD. They think they're ugly.

他们真的认为自己长得不像人。所以会有患者说：‘我没有BDD，我就是真的很丑。如果你想说服我 otherwise，这是行不通的。所以我不知道该跟你说什么。’

They just think they're actually inhuman looking. And so I'll have patients that are like, I don't have BDD. I'm just really ugly. And if you're trying to convince me otherwise, this isn't going to work. So I don't know what to tell you.

我其实应该去找整形外科医生，因为你知道，如果我在车祸中脸部变形，你可能会让我去做整形手术。嗯，我就是长那样。所以这种疾病和诊断的本质就是这样。因此，必须采取非常审慎的方法，充满同情和理解，好吧，我们能在哪里达成一致？你知道，你能同意哪一部分对你不利？

I really should be at a plastic surgeon because to fix you know if I if I was in a car accident and my face was deformed, you would probably have me go to a cosmetic surgeon. Well, that's what I look like. So the nature of the illness and the diagnosis is that. And so there is it has to be in a very measured approach and an approach of compassion and understanding, okay, where can we join here? You know, what part of this can you agree is not working for you?

这可能不是周围人认为最重要的那件事，但任何一点都可以。我记得我曾治疗过的一位年轻男性患者，他患有严重的厌食症。让他开始治疗的原因是：饮食不好就睡不好觉，这两者是相辅相成的。他真的很困扰自己无法睡好。

And it might not be the main thing that everyone around, you know, her or him thinks is the most important thing, but anything that, could be. I remember with one patient I worked with, a young male, he had severe case of anorexia. And the thing that got him in was you don't sleep well when you don't eat well. They go hand in hand. And he was really bothered that he wasn't able to sleep well.

所以我在想，好吧，这不是这里最大的问题。我是说，最大的问题是你因为饮食不好而睡眠不佳。但至少这让他迈出了第一步。然后我们开始处理他的睡眠问题，我向他解释了睡眠是如何运作的，以及它如何与新陈代谢和饮食相关联。但更重要的是，一个人希望从饮食失调中得到什么？

So and I'm thinking, okay, that's not the biggest issue here. I mean, biggest issue is you're not sleeping well because you're not eating well. But at least that got him through the door. And we started working on his sleep, and then I was educating him about how sleep works and how it's coupled with metabolism and, you know, with eating. And and but more importantly, it's what is someone hoping to get from the eating disorder?

因为，你知道，饮食失调不仅仅关乎食物和体重。你刚才说的那番话中提到了一个很好的点。它是关于控制。它是关于结构。它是所有这些事情。

Because, you know, eating disorders are not just about food and weight. You spoke to that beautiful page in what you said. It's control. It's structure. It's all these things.

所以当你能告诉客户，哦，我们可以——我完全理解那些需求。想要掌控感、减少焦虑等等。但我们可以达到那些目标，同时不伤害你的身体。这就是我们试图帮助人们理解的核心信息。

So then when you can tell a client, Oh, we can get I totally understand those things. There's a being in control and having less anxiety and all that. But get we can get to those places, but without damaging your body. And that's the cell that we're trying to sort of help people understand.

嗯。嗯。因为我觉得你提到的把它比作一种成瘾也很有趣，我想这就是我当初如此抗拒治疗的原因之一，因为我有点把它当成，嗯，好像我想停就能停一样。就像，我不觉得自己病得够重。我不认为我真的是那样。

Mhmm. Mhmm. Because I think it's interesting too how you said about, like comparing it to almost like an addiction is I think that's one of the reasons why I was so against treatment because I was kind of treating it as if like, well, like I could stop if I wanted to. Like, I didn't think I was sick enough. Like, I didn't think I was, like, actually like that.

就像，我以为要等到我情况糟得多的时候才会有人对我说什么。所以我就想，嗯，如果我想吃，我就能吃。如果我想增重，或者如果我想停止，对我来说应该很容易，但事实从来不是这样。我只是说服自己我没事，然后如果我真想停就能停，但不管我尝试过多少次停止，都从未成功，我知道我根本停不下来。但我继续拒绝治疗，因为我不想要帮助。

Like, I thought I could I thought I was gonna be a lot worse before somebody was gonna say something to me. And so I just thought like, well, if I wanted to eat, I could. Like, if I wanted to gain weight, like, or if I wanted to stop, like, it would be so easy for me to, but that was never the case. I just convinced myself that I was fine and then I was able to stop if I really wanted to, but no matter if I had ever tried to stop, it never, like, worked and I knew could never actually stop. But I just continue to refuse treatment because I didn't want help.

我不想停止。就像，我知道，比如你，我妈妈会对我哭，人们会说他们担心我，但我一点都不在乎。我不是——我不是故意显得无礼或我不在乎你的感受。但是，真的，我完全不在乎她因为我瘦而难过。就像，我很开心。

I didn't want to stop. Like, I know that like you, my mom would cry to me and people would say they're worried about me, but none of that cared to me. I wasn't I didn't mean for it to come off as rude or I don't care about your feelings. But, like, truly, I didn't care at all that she was sad that I was skinny. Like, I was happy.

我当时想，很高兴你注意到了。谢了，老兄。就像，我不想要帮助，因为我还没有——我还没有完成。就像，我想继续下去。我想变得更瘦，因为直到现在我才知道自己有多瘦。

I was like, I'm glad you're noticing. Thanks, dude. Like, I didn't want help because I wasn't I wasn't done yet. Like, I wanted to keep going. I wanted to be smaller because I didn't know how small I was until now.

所以现在回头看那些照片，我从没想过自己曾经是那个样子。嗯。

And so looking back at those photos now, I never thought I looked like that once until now. Mhmm.

这正是我们发现特别是在厌食症和限制性进食障碍中，一个人体重减得越多，他们的身体形象扭曲得就越严重。所以他们实际上离目标感觉更远了。有时候，你知道，人们可能跌入的谷底是他们会想：等等，我以为20磅前我就会感到快乐，但现在我减了更多体重却更不快乐了。这怎么行不通呢。

And that that's and what we find particularly with anorexia with restrictive eating disorders is the more weight someone loses, the more distorted their body image gets. So the more farther away they actually feel from their goal. And that sometimes is, you know, the bottom that people can hit is they're like, wait a minute. I thought 20 pounds ago I was going to feel happy, and now I've lost even more weight and I'm less happy. How is this this isn't working.

你刚才提到'病得够重'提醒了我，我有一位同事写了一本很棒的书，我想推荐一下。你知道那本叫《病得够重》的书吗？

And and you've reminded me just when you said sick enough, there's a fantastic book I would recommend by a colleague of mine. Do you know that book called sick enough?

我买了。

I bought it.

是的。作者是Jennifer Gaudiani。她是科罗拉多州一位很棒的临床医生。她写了这本《病得够重》。很多人，有时阻碍他们接受进食障碍治疗的是无法完全确认自己患有进食障碍，因为他们看着电视电影里那些处于严重、生死攸关阶段的进食障碍患者，就会想：哦，我不是那样。

Yes. It's Jennifer Gaudiani. She's a fantastic clinician in Colorado. She wrote this book called Sick Enough. A lot of people, what prevents people from getting treatment sometimes for eating disorders is fully identifying that they have an eating disorder because they're looking at the TV movies of people who are in the severe, very life and death kind of stages of eating disorders that they're like, Oh, I'm not that.

我没有消瘦到整天摔倒，或者不像电影里那个角色一天呕吐10次。我一天只做一次。在那本书中，她精彩地概述了身体的所有系统。 literally goes, 循环系统、心脏系统，以及即使是被人们视为亚临床的行为——这是一个非常误导性的术语，因为我们以为亚临床就不严重，这完全不对。它同样危及生命。

I'm not emaciated where I'm falling down all day or I'm not purging 10 times a day like that character in that movie. I'm only doing it once a day. And in that book, she outlines beautifully all of the systems of the body. Literally goes, Circulatory system, the cardiac system, and how even behaviors that people might even see as subclinical, which is a very misleading term because we think of subclinical as not as serious and that's not true at all. It's just as life threatening.

但让我问你，Paige，你知道是什么让你转变的吗？你什么时候想要帮助？发生了什么变化？

But let me ask you, Paige, you know, what turned around for you? When did you want help? What changed?

我认为我饮食失调最明显的一点是我总是感到非常害怕。我的焦虑感总是处于100%。比如，我一个人在家时，非常想带狗出去散步，但我身体上就是无法让自己出门，因为我害怕被绑架或者受到伤害。而且我从不觉得自己瘦。我从不认为自己真的很娇小。

I think one of the biggest things that I noticed with my eating disorder was how scared I was all the time. My anxiety was always at a 100%. Like, I would be home alone, and I would so badly wanna take my dog for a walk, but I couldn't physically get myself to go outside because I was scared of getting kidnapped and or to get hurt. And I never thought I was skinny. Like, I never thought I was actually small.

我只是知道自己很虚弱。比如，我知道早上很难起床。我知道自己有多虚弱，我害怕如果有人看到我并抓住我，我知道我接受了那就是我的命运，我无法反抗。我看起来就很虚弱，我也知道自己很虚弱，因为我曾经很强壮。我曾经很强壮。

I just I knew I was weak. Like, Like, I knew I couldn't get out of bed easily in the morning. Like, I knew how weak I was and my fear that if somebody were to see me and grab me that, like, I know I I accepted that was my faith that, like, I wouldn't be able to fight back. I'm like, I look weak and I know I am weak because I I was used to being strong. I was once strong.

所以现在我不是了，

And so now that I wasn't,

我知道我不强壮。

I knew that I wasn't strong.

我知道自己很虚弱。所以我有几次处于那种情况，我真的什么都做不了。我就是很虚弱。我认为那些我对自己感到非常糟糕、非常害怕的时刻，让我觉得，我不知道我是否能继续这样下去。我彻底改变了我的生活，比如转到了在线学校，但在那之前的几个月，我开始工作了。

I knew I was weak. So I had a few moments where I was in a situation where it's like, really I couldn't do anything. Like, I was just weak. And I think those the like the times that I felt so bad about myself and I felt so scared is what kind of made me like, I don't know if I can keep doing this. And I had completely changed my life by like, I switched to online school, but a few months before that, I'd started working.

我注意到工作的第一周，我无法连续五到六小时不吃东西。这对我来说很难。我无法学习。我的经理试图培训我，但我无法真正理解发生了什么，因为我是

And I had noticed that my first week of work that I couldn't go five to six hours without food. I just it was hard for me. I couldn't learn. My manager would be like trying to train me and I I couldn't, like, really comprehend what was going on because I was

太饿了，太疲劳了，还有ADHD。我的意思是，是的。这些都凑在一起了，对吧？是的。

just so hungry and fatigued and ADHD. I mean, yeah. It's all fine together. Right? Yeah.

绝对是的。

Absolutely.

我无法理解，我当时就像……我身边围绕着不同的人，尤其是当时我在一个全新的工作领域，周围的人都是我一生中从未见过的。这很艰难，因为我习惯了和同样的人在一起，而现在这些人比我年长，也不了解我。甚至有一位同事（虽然现在不和她共事了），我们成了最好的朋友。她说第一次见到我时，她心里想，希望我不会因为太瘦而在学校被欺负，因为她自己就曾因此被欺负过。

I couldn't get it, and I was just like and I had surrounded myself with different people, especially now that I was at a place in a completely new area of work with people I've never met in my entire life. That was hard because I was just so used to being around the same people that now there's all these people who are, like, older than me and don't know me. And so I even one of my coworkers who I don't work with her anymore, but we became best friends. And she said that the first time she saw me that she she thought to herself that she hopes I don't get bullied in school for how skinny I was because she did. She would get bullied in school.

当她告诉我这些时，我把它当作一种赞美。这让我非常开心，她觉得我很瘦，并希望我不会因此被欺负。有趣的是，几周前我和她聊到这件事，她说这对她来说可能是一种侮辱。但对我来说，我却欣然接受。我当时说，非常感谢你。

And when she had told me that, I, like, took that as a compliment. Like, that made me so happy that she thought that I was skinny and was hoping I wasn't getting bullied for it. And it's so interesting because me and her talked about that just a few weeks ago how, like, that would be an insult to her. But for me, I took that as, like, I took that with pleasure. I was like, thank you so much.

是的。但这显示了思维可能会变得非常扭曲，这是一种非常、非常普遍的现象。即使在饮食失调的住院治疗项目中，有时——我的意思是，有时人们确实需要住院治疗。我们知道在医院项目中，人们开始比较，比如‘我不是病得最重的’，好像病得最重的人才是赢家，在某种意义上获得了‘奖项’。但我喜欢你提到的关于软弱的部分，听起来你发现了这一点，因为饮食失调所承诺的——我是把饮食失调当作一个实体来说的。

Yeah. But it shows how the the thinking can get very distorted, and that's that's a very, very common phenomenon. Like, even in eating disorder residential and inpatient programs that sometimes I mean, sometimes people absolutely need that hospitalization. And we know it's a very common effect on hospital in hospital programs where people start comparing, oh, like, I'm not the sickest one as if the sickest one is the one that wins, you know, the award, you know, in a sense. But what I like about what you said is with the the weakness part is it sounds like what you uncovered because, you know, the e what the eating disorder promises, and I'm talking about an eating disorder like it's an like an entity.

那不是你。它是你之外的东西。饮食失调承诺说，这个东西会给你一种控制感，一种力量感，一种强大感，它会给你所有这一切。而当你意识到自己有多软弱时，就像是在说，等等，我并没有感到强大。

It's not you. It's something outside you. That the eating disorder promises, you know, here's this thing that will give you a sense of control, that will give you a sense of power, that will give you strength, that will give you, you know, all of this. And when you recognize how weak you were, it was like, wait a minute. I'm not feeling strong.

实际上我感到如此软弱，以至于我觉得非常脆弱，几乎偏执地担心有人会这样绑架我。听起来就像是幻觉被揭穿了，就像《绿野仙踪》的幕布被拉开，然后说，等等，这给了我什么？某种东西突然明白了。这是我总是希望患者能够连接到的，就像是，等等。

I'm actually feeling so weak that I feel so vulnerable and almost paranoid to someone kidnapping me like this. And and it sounds like something it's almost the illusion was like the Wizard of Oz curtain was pulled away and it was like, Wait a minute. What is this giving me? Something clicked. That's often what I always hope that when patients can connect to, it's like, Wait a minute.

我记得这位年轻女性，她有注意力缺陷多动障碍（ADHD），在暴食和限制饮食之间摇摆不定。她说，我一开始这样做是因为我想让人们更喜欢我。我是个外向的人。她说，我想更 socially acceptable（社交上更被接受）。我以为如果我看起来完美，那么——她说，而现在我意识到我不出门是因为我觉得自己丑或胖，或者这样那样的原因。

I remember this young woman, she had ADHD and vacillated with bingeing and it would get restrictive and it was all. And she's like, I started this because I wanted people to like me more. I'm an extrovert. She goes, I wanted to be more socially acceptable. And I figured if I looked perfect, then and she goes, and now I realize I don't leave my house because I feel ugly or fat or this or that.

我没有和任何人社交。她说，所以这个饮食失调真的让我离我原本的意图越来越远，她说，这是个谎言。她说，它是个骗子。饮食失调就是个骗子。那一刻就像房间里突然爆开了五彩纸屑一样豁然开朗。

I'm not socializing with anyone. She goes, so this eating disorder has literally moved me as far away from the original intent of what I was and she goes, it's a lie. She goes, it's a liar. The eating disorder is a liar. And it was like confetti could have been burst in the room.

我当时就想，没错，正是这样——那就是康复的开始。这些时刻正是我一直希望人们能够共鸣的。就像是，这并没有给我我最终真正追求的东西。

And I was like, Yes, that's exactly and that was the beginning of recovery. And those are the moments that I always hope that people can connect to. It's like, This isn't giving me what I'm what I'm ultimately really looking for.

是的。而且，她昨天我们聊到这个时告诉我，重要的是——她可以更详细说说这一点——那个人必须自己愿意改变这一点非常关键。是的。因为我可以告诉她无数次我有多担心，她有多被爱，内心和外表有多美，但这些都不重要。对吧？

Yeah. Well, and something that she told me yesterday when we were talking about this is that it was important what and and she can speak more to this about how important it is that the person has to want it. Yeah. Because I could have told her a million times how worried I was, how much she was you know, how loved she was, how beautiful she was inside and out, and it wouldn't have mattered. Right?

但是，突然有什么东西触动了她——她可以多和同事们聊聊这个。她让自己身边围绕了不同的人，她从不同的角度听到了不同的观点。从一个不同的人那里。从一个不是她父母、治疗师或其他什么的人那里，而且时机正好。

And but there was something that clicked with her that all of a sudden and and she can talk more about this with her coworkers. She she surrounded herself with different people, and they and she was hearing things from a different Point of view. Point of view. And From a different person. And from a different person that was weren't her parents or a therapist or or whatever, and the timing was right.

就像，感觉不像是一个像治疗师那样的人——他们的职责就是帮助我。感觉是来自一个真心想帮助我，或者真心想告诉我食物、营养以及它们有多重要的人。就像你说的，我认为对正在与饮食失调斗争或认识这样的人来说，最重要的一点是，你必须是自己决定寻求帮助的那个人。别人可以希望你这样。

Like, it kind of felt like it wasn't somebody like a therapist who that is what like, they're there to help me. It felt like it was from somebody who just genuinely wanted to help me or genuinely wanted to inform me on food and nutrition and how important it was. And just like you said, I do. I think one of the biggest things for people who are struggling with an eating disorder or know someone is that, like, you have to be the one to decide that you want help. Like, people can want that.

别人可以希望你决定改变，但必须是你自己——如果不是我自己意识到‘我不能再这样了’，我永远不可能痊愈或开始往前走。就像，我不能再这样对自己了。我感觉很糟糕。我不快乐。无论我变得多瘦，我都永远不会满足。

People can want you to decide that, but you have to be the one that I would have never have healed or started to move on if it wasn't for me being like, I can't do this. Like, I can't keep doing this to myself. I feel terrible. I'm not happy. No matter how skinny I'm getting, I will never be satisfied.

所以，我觉得真正改变我看法的是意识到我不快乐，而且我认为我永远不会快乐。我曾以为我会一辈子与这种感受和抑郁挣扎。我从没想过事情会变好，我几乎就接受了，好吧，这就是我的人生。我是个悲伤的人。但后来我就想，我不必悲伤，因为即使在抑郁中，你也会有让你微笑、感到快乐的时刻。

And so it was all I feel like what really changed my outlook on it was realizing that I'm not happy, and I don't think I ever will be. I thought that I was gonna be struggling with this feeling and that depression for my entire life. I never thought things were gonna get better, and I kinda just accepted that, like, well, this is my life. I'm a sad person. But then I was just like, I don't have to be sad because you would have moments when you're depressed that you do make you smile and you do have joy.

我有点抓住了每一个这样的瞬间，并意识到我可以拥有更多这样的时刻。我只是没有尝试。如果我尝试，我可以快乐。比如，我想能够和朋友出去吃饭，而不必因为盯着菜单找卡路里而让自己痛苦。我想能够享受乐趣，而不为某些事纠结。

And I kinda took each one of those moments and realized that I can have more of these. I'm just not trying. That I can be happy if I try. Like, I want I wanna be able to go out to dinner with my friends and not have to make it miserable for myself by looking at trying to find the calories on the menu. Like, I wanna be able to have fun without obsessing over something.

嗯。佩吉，我真的很钦佩你的勇气和分享你的故事，因为当那些正在挣扎的人听到康复者的经历，听到那些走过这段旅程的人的故事时，会产生极其强大的影响。我认为这种可见性非常重要。而且你描述经历的方式也会引起很多人的共鸣。我认为你说的100%正确，你必须达到一个想要帮助、感觉自己值得被帮助的点，并且在某种意义上揭露饮食失调——它实际上并没有带我到达我想去的地方。

Mhmm. I just commend you, Paige, just for your courage and sharing your story because that when when people who are struggling here from people in recovery and here from people who have, you know, known that journey, it has an extremely powerful impact. I mean, I think that visibility is so important. And you're describing, you know, the experience in such a way too that will just will resonate with so many people. And I think what you said is a 100% true that you have to get to a point of of wanting the help, feeling you're worth that, and knowing and really exposing in a sense the eating disorders that this isn't actually getting me to where I want to go.

显然你从家人那里得到了很多支持，尼基，我与你感同身受，因为作为父母，天哪。这和我一起工作的父母们一样，是一种折磨。我的意思是，你看到你的孩子陷入其中，而你却不能——你不能把食物硬塞进别人的喉咙，你知道的。这需要很多的耐心、爱、信任，当然还有正确的支持。是的。

And clearly you got a lot of support from your family, it and I think and I empathize with you, Nikki, because as a parent, it's like, oh my god. It it is with the parents that I work with, it's torture. I mean, you see your child engaged in this and you can't it's not like you can shove food down somebody's throat, you know, in that way. A lot of patience and love and trust and of course the right support. Yeah.

绝对是的。我钦佩你的勇气和分享你的故事。

Absolutely. I just commend your courage and sharing your story.

我也是。我认为还有另一件非常重要的事我想说，我知道，比如对我的父母来说，他们认为自己做得不够，如果不是我继续康复，我可能就那样死了或者一直那样下去。但我认为对于可能有女儿或儿子，或者任何认识正在与饮食失调斗争的人来说，最重要的一点是，这不是你们的错，他们已经做了他们能做的一切。我没有让他们足够了解发生了什么，他们知道的事情，他们已经做得足够了。他们只是不知道所有幕后的事情，而且我当时拒绝治疗——这从来不是你们的错，也从来没有人让我觉得自己胖。

I do too. I think one of another thing too that's very important that I would like to say is that, like, I know for, like, my parents that they thought that they didn't do enough and that if it wasn't for me to to have, like, gone on with recovery that I would have just died that way or kept like that. But I think one of the biggest things for people who maybe has, like, a daughter or a son or just anyone they know who's struggling with eating disorder that is not your fault, that they're and they did everything they could. I didn't let them know enough of what was going on that the stuff that they did know, they did do enough. They just didn't know all the behind the scenes, and I was refusing treatment that it was never your guys' fault, and it was never nobody ever made me feel fat.

从来没有人让我感觉不好。

No one ever made me feel bad.

嗯。

Mhmm.

关键在于这完全是一种心理问题。进食障碍不仅仅关乎你的身体，也不仅仅关乎你吃什么。它会控制你，就像你整个脑海里都有个声音在不断地告诉你，不要吃这个。

It just that it was all it's a whole mind thing. Eating disorders are it's not just about your body. It's not just about what you're eating. It like, it takes over you. Like, your entire mind, there's this voice in the back of your head that just keeps telling you, don't eat this.

不要和这个人说话，或者不要，拒绝治疗。就像，这从来不是任何人的错。

Don't like, don't talk to this person, like or don't like, refuse treatment. Like, it was never anyone's fault.

嗯，康复过程中有趣的一点是，我很感谢你这么说，真的。因为很难不去自责，也很难不觉得是不是她病得够重而我却没注意到？对吧？尤其是在读了那本书之后，感觉就像是，总之就是这样。

Well, and what was interesting as part of the recovery piece, and I appreciate you saying that. I really do. Because it is hard not to take blame, and it is hard to not feel like did was she sick enough and I didn't pay attention? Right? Like, after reading that book, especially, it was like it was the the anyway.

是的，这很难，毫无疑问。是的。但我想，当我们开始总结并讨论康复和她现在的情况时，你知道，她之前有一些健康问题。

Yeah. It's hard. No doubt about it. Yeah. But one of the things that I think, you know, as we start to wrap it up and we start to talk about, like, recovery and where she's at, you know, she was having some health issues.

所以她必须做一些血液检查，她有一些心脏问题，还有一些其他事情。我认为，你身边那些鼓励你健康的人，不是为了减肥或增重，而是更侧重于健康和福祉。于是她开始重新去健身房，变得更强壮，也开始吃得更多。

And so she had to get some blood work done, and she had some heart issues, and there were some things going on. And you and I think with the the people that are around you that encourage you to be well, not losing weight, not gaining weight, it was more around health and wellness. And so she started kind of going back into the gym. She started getting stronger. She started eating more.

她长期吃素和纯素食。你想谈谈这是怎么改变的吗？

She was vegetarian and vegan for a long time. I was Do you wanna talk about how that changed?

是的。我大约在三、四年前开始吃素。嗯。当时我正患有进食障碍，因为我觉得那会帮我减肥。

Yeah. So I went vegetarian by about, like, three, four years ago Mhmm. While I was in an eating disorder because I thought that was gonna help me lose weight.

我本来打算

I was gonna

减少吃肉，虽然不完美，但我一直坚持到现在。我已经习惯了，并不介意。我本来吃肉就不多。然后在去年12月或1月1日，我因为一个赌约开始吃素，看谁能坚持更久，结果我赢了。之后我就继续坚持，因为我真的很喜欢这种方式。

cut meat out and not perfect, but I just kinda stuck with it even, like, now. I just got used to it, I didn't mind it. I didn't eat meat that much. So but then last year on December or on January 1, I went vegan on a bet, and it was who could go vegan the longest, and I won. And so what I just kept going because I was like, you know, I really like this.

我学到了很多关于食物的知识，素食教会了我如何采购食物，如何饮食。它告诉我该吃什么，我意识到这是一种饮食需求的限制。我需要吃东西，不能只是早上吃块肉就应付一下。我必须确保摄入足够的维生素和营养。

And I had never I was learning so much about food that being vegan, it taught me how to shop for my own food, and it taught me how to eat. It told me, like, it taught me what to eat, and I realized that was such a restriction of, like, a dietary need like that. I needed to eat food. I couldn't just eat a piece of meat in the morning and, like, be good for a little bit. Like, I had to make sure I was getting the vitamins and the nutrients.

同时我也开始去健身房，进行举重和增肌训练。所以我开始学习关于蛋白质的知识，努力通过素食摄入蛋白质，这虽然很难，但我做到了。但后来因为感觉不舒服，我去做了更多血液检查。

And and then I was also getting into the gym. I was getting into weightlifting and muscle growth. And so I was, like, I was learning about protein. So I was trying to get protein in, which is hard with vegan food, but I was able to do it. But then I got more blood work done because I wasn't feeling good.

我被诊断出患有POTS综合征（体位性心动过速综合征）。做了血液检查后，我们去咨询了我的自然疗法医生，她表示如果有充分的理由吃素可以继续，但这对我来说变得很不健康。我营养不良了。

I got diagnosed with pot syndrome. And so I got my blood work done. We went and talked to my naturopathic my naturopath about that and she was just kind of like, if you have really good reasons to be vegan, then you can stay. But it's just it became really unhealthy for me. I was malnourished.

我缺乏多种维生素，我告诉他们我现在感觉更糟了。我吃得比以往都多，体重也达到了历史最高，但感觉却比不吃的时候更差。那时候我精力充沛，现在却毫无精力，中午就会崩溃。

I was deficient in vitamins and because I had I was telling them that I feel worse now. I'm eating the most food I've ever had, and I am the heaviest I've ever been. And I feel worse now than I did when I didn't eat. Like, I had much more energy then, and now I don't have none. I crash in the middle of the day.

我们发现这全都是因为我的饮食问题。所以现在我不再吃素了，开始吃肉。过去两周左右，我感觉好多了，真的很棒。我在吃优质食物，而不是加工化学物质制成的仿肉制品。

And we kind of discovered that it was all just for my diet. And so now I'm no longer vegan, and I eat meat. And the past, like, two weeks, I feel so much better. Like, I feel great. I'm eating good food that's not processed chemicals made into fake meat.

是的。不。但你知道，不幸的是，我知道我们时间不够了，但我的一位同事詹姆斯·格林布拉特，他既研究多动症领域也涉猎饮食失调领域，就在波士顿。他最近在一个网络研讨会上强烈认为，任何处于发育期的个体都不应该成为素食主义者，因为他实际上做了很多关于营养补充、饮食和矿物质等方面的工作。有很多蛋白质之类的东西，我高中时曾是素食者，但对我也不起作用。

Yep. No. But there's something you know, unfortunately, I know we're out of time, but a colleague of mine, James Greenblatt, who does actually work in ADHD world as well as eating disorder world, he's here in Boston. Did in a webinar recently, he strongly feels that any developing individual should not be a vegan because he does a lot of work actually with supplementation and with diet and minerals and things like that. And there are a lot of proteins and things like that that I was a vegetarian when I was in high school and it did not work out for me either.

而且我当时非常热衷于动物权利。那是我选择素食的主要原因。但这并不好。就像，我当时吃很多碳水化合物，因为那时候人们认为碳水化合物不含脂肪。我吃大量的碳水化合物来弥补我没有真正摄入的蛋白质。

And I was big into animal rights. That was like the main thing that brought me to that. And it wasn't good. Like, I was eating now this was at the time where carbs were like, oh, there's no fat, in carbs. And I was eating tons of carbs to make up for protein I wasn't really eating.

这对我的新陈代谢和体重都不好。所以肉类并不是坏事。关键在于一切都要有节制、适度，以及你搭配吃什么。比如，可能问题出在炸薯条上。再次强调，并不是说我们永远不该吃炸薯条，而是凡事要适度。

And it wasn't good for my metabolism, for my weight. So meat is not a bad thing. It's just everything, regulation, moderation, and it's what you're eating with it. Like, it's maybe the french fries. And it's, again, not that we it's like, oh, I should never have french fries, but it's just eating things in moderation.

所以这真的很重要。我认为在发育期之后，比如30岁以后，如果有人想采用植物性饮食，也就是纯素饮食，研究表明可能不会那么有负面影响，但你仍然需要非常小心和意识到这一点。所以我很高兴听到你已经做出了调整，并且看到了不同。

So it's really important. I think past development, like after 30, if someone wants to be on a plant based, you know, vegan diet, studies show it might not be as negatively impactful, but you have to still be really careful and aware of that. So I'm glad to hear that you've incorporated that in it and you see the difference.

是的。我有点意识到，我宁愿健康并感觉良好，而不是仅仅因为我已经坚持了这么久就继续吃素。所以这是一个有点艰难的改变，但我做到了。

Yeah. I kind of realized that I would rather be healthy and feel good than just do some like, just continue being vegan because I've been doing it for so long. So it was kind of a hard change, but I did it.

嗯，我想最后一点我想强调的是，当我们交谈时，我和她谈到了，比如，你对你康复的看法是什么？你正在康复中吗？这感觉如何？

Well, and I think one note that I want us to leave on is is when we talked I talked to her about, like, what what do you think about your recovery? Are you in recovery? How does this feel?

并不稳定。

It's not consistent.

是的。那你为什么不谈谈

Yeah. So why don't you talk a

一点点，我那种声音。是的。某种程度上把它看作是一种悲伤的方式，它并不一致。它不像一个五阶段的过程。我现在确实吃东西，我锻炼，确保为身体补充能量，好好照顾自己，但脑海中总有一个永远不会消失的小声音。

little bit I that I kinda voice. Yeah. Kinda think of it as, like, a way of, like, grief that it's not consistent. It's not like a five stage process. And how I am I do eat now and I work out and I make sure I'm fueling my body and I take good care of myself, but there is always that tiny voice in my head that will never go away.

就像，我可能永远背负着饮食失调的重担，我不听它。它会在一天结束时说出来，当我吃了很多食物时，我必须不断提醒自己这没关系。我今天确实吃了很多食物，但我也去了健身房，工作了。就像我今天做了很多事，我确实需要这些食物，而且，你知道，尤其是看着我深陷饮食失调时的照片，我有时仍然会想，如果我当时不觉得自己瘦，那我现在是不是脑子扭曲了？就像，我会在健身房照镜子，有点想，这真的是我的样子吗？

Like, the I'm carrying the weight of my eating disorder with me probably forever that I don't listen. It will I'll it'll say it when I and at the end of the day, and I've eaten a lot of food, and I just have to keep reminding myself that this is okay. That I did eat a lot of food today, but I also went to the gym and I worked. And like I did a lot today that I do need this food and, you know, especially with looking at my photos from when I was deep in an eating disorder, I still will sometimes think if I didn't think I was skinny then, like, am I is my mind twisted now? Like, I'll look in the mirror at the gym and I kinda think, like, I don't is this really what I look like?

就像，我会反复质疑自己。我感到困惑和悲伤，有时我不喜欢我的身体看起来的样子，有时我喜欢。有时我觉得自己太胖，有时又觉得太瘦，尽管老实说，我两者都不是。所以，是的。所以我认为，康复是，我并没有完全康复，我真的不知道你是否能完全康复。

Like, I double guess myself. I get confused and I get sad and sometimes I don't like how my body looks and sometimes I do. Sometimes I think I'm too fat and sometimes I think I'm too skinny even though I'm not any of those, honestly. And so I yeah. So I think, like, recovery is I'm not fully recovered and I don't really know if you ever fully recover.

我认为你可以，但总有一小部分不会消失，因为它占据了我的整个生命。我不知道我是谁。我让那成为我的身份，就是我很瘦，我不认为那个提醒会消失，当我回顾过去时。我现在在做一些两年前绝不会做的事。我只是想，我为什么要这样做？

I think that you can, but there is always that little piece of you that won't go away because it it's took my entire life. I didn't know who I was. I let that be my identity was that I was skinny and I don't think that will that reminder will never go away that I look back. I'll be doing something now that I would never have done two years ago. And I just think, why am I doing this?

就像，我以前非常反对这个。我现在在做什么？嗯。

Like, I was so against this. What am I doing right now? Mhmm.

嗯，嗯。我认为你说到了，我的意思是，当我们思考康复时，常见的经历是，你知道，我接触过一些人，他们真的不再有那个声音在脑海里了。他们曾经有很长一段时间。但是，再次用成瘾来类比，我认为非常相似。就像，有些人这是一个日复一日的过程。

Well, Mhmm. I think that you speak to, I mean, what the common experience is when we think about recovery is and, you know, I have worked with people where it truly is they don't have that voice in their head anymore. They did for a long period of time. But, again, making that analogy with addiction, it's I think very similar. Like, are some individuals where every it's a day by day by day by day process.

即使他们已经戒酒四十年，他们仍觉得如果不注意自己的技能并努力改进需要改进的地方，就可能前功尽弃。还有一些我接触过的人，他们与那段经历完全脱节，几乎觉得那是另一个人。但我觉得重要的是要提到，情况可能各不相同。事实上，存在那种声音并不意味着你没有在康复中。对吧。

And even though they're forty years sober, they feel like it can derail if they don't watch their skills and work on what they need to work on. And then there are other people I've worked with where it's just not even it's so detached from their identity, and they almost feel like it was like a different person. But I think that's so important to mention it can be varied. And the fact is is that having the presence of that voice doesn't mean you're not in recovery. Right.

这并不意味着你不健康，因为说实话，对任何人来说，我们可以有——我是说，我们可以替换，无论是关于我们身体的声音，还是仅仅在ADHD中，关于我们自己的声音。嗯。你知道，比如‘你很蠢’或者‘你是这个’或‘你是那个’。我们可以这样想：是的，你只是一个消极的想法。

It doesn't mean you're not healthy because honestly, for anybody, we can have I mean, we can replace whether it's a voice about our bodies or just in ADHD, a voice about ourselves. Mhmm. You know, you're stupid or you're this or you're that. And we could be like, yep. You you are just a negative thought.

那没有帮助。我正在做的是为我的身体补充能量。我在健身房。我在与人联系。嗯。

That's not helpful. What I am doing is I'm fueling my body. I'm at the gym. I'm connecting with people. Mhmm.

你看看眼前的数据。但完全正确。对于饮食失调，它变得如此交织在一起，而且是在身份正在发展的生命发育期，你知道，在青春期。所以它们如此交织，以至于可能需要一段时间才能真正解开，才能意识到，哦，等等。是的。

And you look at the data that's in front of you. But that's exactly right. With eating disorders, it gets so intertwined and also at a developmental period in life where identity is just developing, you know, in puberty. So they get so intertwined that it can take a while to un to really undo that, to be like, oh, wait a minute. Yes.

这是新的我。那个去健身房、吃这种食物并说‘这就是我’的人。感觉和两年前的我有点不一样。也许，就像你说的，那些想法还会存在，只是要 counteract 它们。嗯。

This is the new me. The person that goes to the gym that is eating this food and says, this is me. Feels a little funny from who I who the me was, you know, two years ago. And maybe, like you said, those thoughts will be there and it's just counteracting them. Mhmm.

同时，你可能会惊讶地发现，有一天那个声音会变得越来越小，越来越小，因为你的生活变得越来越大，越来越大。

And at the same time, you might be surprised that one day those that voice gets smaller and smaller and smaller and smaller because your life gets bigger and bigger and bigger and bigger.

我知道人们看不到这个，但当你这么说的时候，罗伯托，她在微笑。是的。

And I know people can't see this, but when you said that, Roberto, she was smiling. Yeah.

能看到你

Can see you

看着这个

looking at the

整个事情。是的。但我能看到那个笑容，哦，你懂的，我想要那个。是的，我支持那个。

whole thing. Yeah. But I can see that there's that that smile of, oh, wouldn't you know, I'm I want that. Yeah. I'm for that.

但是，你知道，我们讨论节目时她说的一句话是，她说我准备好战斗了，我准备好对抗那个声音了。我认为这真的很能说明她当时已经准备好了。

But, you know, something that she said when we were talking about the show is that she said I was ready to fight this I was ready to fight the voice. And I think that's really, you know, telling that she was ready for it.

是的。

Yes.

我准备好过我本该

I'm ready to live a life that I was

过的生活。你爸爸和我以及你的家人都非常非常爱你，我们非常非常为你骄傲。非常感谢你分享你的故事，佩奇，因为我认为罗伯托说得对。这会帮助其他人。我希望这确实能提高人们对多动症和饮食失调的认识。

supposed to. Your dad and I and your family love you very, very much, and we're very, very proud of you. And thank you so much for sharing your story, Paige, because I I think Roberto is right. It's gonna help other people. I hope it does shed some light on awareness around ADHD and eating disorders.

还有，罗伯托，天哪。非常感谢你能来。

And, Roberto, oh my gosh. Thank you so much for being here.

不客气。

You're welcome.

很棒

It's great

听到是的。并且进行这次对话。正如我在会议上告诉你的，我只想要你来。我真的很感激你能来。谢谢你。

to hear Yes. And having this conversation. And as I told you at the conference, I didn't want anyone else but you. And I just really appreciate you being here. Thank you.

谢谢

Thank you

非常感谢。你给我这个机会来到这里，很高兴认识你，佩奇。再次，我对你的故事感到敬畏，我告诉人们，任何正在康复中的人，都要知道那需要多大的力量。我总是告诉患者，当他们遇到其他可能让人措手不及的事情时，你会说，你知道吗？我能搞定。

so much. You for the opportunity to be here, and it was nice to meet you, Paige. And and, again, I I'm in awe in of your story, and I tell people, anyone who's in recovery, to know the amount of strength that it takes to do that. And I always tell patients that when they encounter other things that might throw people, you're gonna be like, you know what? I got this.

我经历过更糟糕的事情并且都挺过来了，你知道，从中会获得成长。所以我祝愿你康复顺利，并且非常高兴能参与这次对话。

I've been through a whole lot worse and have navigated through that, and there's, you know, there's growth that comes from that. And so I I wish you well in in your recovery and and really happy to be part of this conversation.

Nikki，我必须告诉你，我知道Paige是个明星。她太棒了。嗯。她讲述自己故事的方式以及分享这些事情时所展现的脆弱性，真的非常了不起。老实说，我真的很感动，有那么多观点都与我与食物的关系经历相吻合。

Nikki, I have to tell you, I know Paige is a star. She's amazing. Mhmm. And the way she talks about her story and the vulnerability with which she shares these things is is extraordinary. I was really moved at just how many of the points were made that line up with my experience with my relationship with food, frankly.

就像，我多年来一直抱怨自己与食物的关系，完全不知道我们今天会听到这样的内容。一点都不知道。我甚至不认为我真正理解什么是进食障碍，什么是饮食失调。你提出并探讨的那个问题真是太棒了。那么，你现在做完这件事感觉如何？

Like, I've complained about my relationship with food for years and had no idea that this was the kind of thing that we were going to be hearing about today. Not even a little bit. Don't think I truly understood what an eating disorder was and what disordered eating was. That was such a great question that you asked and explored. So I I how do you feel now that you've done it?

我感觉很棒。我觉得，这已经再好不过了。你知道吗？我们俩一开始都非常紧张。作为她的妈妈，我特别紧张，因为我不知道她想分享多少，或者她对什么感到自在。

I feel great. I feel, that it couldn't have gone any better. You know? We were both really nervous going into it. And as being his her mom, I was really nervous because I I didn't know how much she wanted to share or what she felt comfortable with.

但我让她主导，而她确实做到了。她是个明星。而且我觉得如果我们有更多时间，她本可以说得更多，医生那边也是一样。我的意思是，这场对话本可以进行很长时间，因为涉及的内容太多了。不过，不，我对此感觉真的很好。

And but I let her lead, and and and she was. She was a star. And I think that there was more she could have said if we had longer time and it and and same thing with the doctor. I mean, this conversation could have gone for a long time because there's just so much to it. But, no, I feel really good about it.

我想说一件事，因为时间不够我没机会详细谈，就是Paige正在康复中。她现在在接受治疗。她没有拒绝治疗。实际上是她自己要求去看心理治疗师的。虽然不一定是专门针对她的进食障碍和多动症，不过我确信这些话题会出现，但只是，做青少年本身就不容易。

I think that one one thing that I would want to say that I didn't have a chance to really talk about because we were running out of time is Paige is in recovery. She is in therapy now. She is not refusing it. She actually asked to go to a therapist. It's not necessarily around her eating disorder and ADHD, although those things I'm sure come up, but it's just it's hard being a teenager.

而且她正在看一位治疗师。她也继续看医生，并且现在还在看一位整体疗法医生，因为她之前有一些健康问题。她在最后提到她被诊断出患有POTS（体位性心动过速综合征），这和心脏有很大关系。对吧？嗯，完全和心脏有关。

And she is she is seeing a therapist. She also continues to see a doctor and she's seeing a holistic doctor right now too because she was having some health problems. She mentioned at the end that she was diagnosed with POTS and that has a lot to do with your heart. Right? Well, everything to do with your heart.

还有那些症状，她就是感觉不舒服。所以我们很高兴她改变了饮食，增加了一些，你知道，更多的蛋白质和铁质，这些是她之前没有摄入的。所以，对的。我会说她正在康复中。我为她感到非常骄傲。

And and the symptoms, she just wasn't feeling good. And so we're we're glad that she's changed her diet to put some, you know, more protein and iron and things that she was was not getting. So Right. I would say she's in recovery. I'm so proud of her.

你知道，这是那种你只想紧紧抓住的事情。就像，我只是不想回到过去。是的。我只是希望她能继续与她每天听到的那个声音抗争，并且一直赢下去。因为现在她正在赢，我只希望她能坚持下去，因为照顾好自己真的太重要了，你知道，你的心灵、你的身体，所有的一切。

I I you know, it it it's one of those things that you just wanna hold on to. Like, just I don't wanna go back. Yeah. I just hope that, you know, she keeps fighting that that that voice that she hears every day and that she keeps winning. Because right now she's winning, and I just want her to keep doing that because it's so important to take care of yourself, you know, your your mind, your body, all of it.

非常感谢Paige和Olivardia医生，还有你，妈妈，感谢你们参与并促成这次对话，因为我认为这是一次真正有价值的交流。我知道在聆听和剪辑的过程中我收获了很多，这真的太棒了。所以谢谢你们。也感谢每一位下载和收听节目的听众。如果你听到了最后，那真是完美收官。

Well, such great thanks to Paige and doctor Olivardia and you, mom, for for doing this and for making it happen, because I think it's a it's a truly valuable conversation. I know I got a ton out of hearing it and then editing it, and, it's it's really great. So thank you. And and thank you to everybody for downloading, listening to the show. The whole thing, if you got to the end, chef's kiss.

你们太棒了。我们非常感激。再次提醒，如果你想听到任何独家内容，请加入我们的Patreon，网址是patreon.com/theadhdpodcast。了解更多

You're fantastic. We we sure appreciate that. And, again, if if you wanna hear, any of the any of the goodies, join us at on Patreon, patreon.com/ the ADHD podcast. And learn more

在你离开之前。嗯。如果你需要更多信息或帮助，无论是为你自己还是你关心的人，我们的节目备注中提供了自杀预防热线，还有饮食失调求助热线。

about before you leave. Mhmm. If you want any more information or you need help, either yourself or somebody you love or care about, we do have before the suicide hotline in our show notes, and we also have the eating disorders hotline on our show notes as well.

没错。你可以在节目备注、网站、Patreon或Discord上找到所有这些信息。我们无处不在，很希望在那里见到你。所以，我代表Roberto Olivardia医生、Paige Kinzer和Nikki Kinzer感谢大家。

Absolutely. Find all those in the show notes or on the website or on Patreon. We've got it everywhere or in Discord. We'd love to see you over there. So thanks everybody on behalf of doctor Roberto Oliveiria and Paige Kinzer and Nikki Kinzer.

我是Pete Wright。下周同一时间，我们将在《掌控ADHD播客》中再见。

I'm Pete Wright. We'll see you next week right here on taking control the ADHD podcast.