People living with inflammatory bowel disease (IBD, Crohn’s disease, ulcerative colitis, and indeterminate colitis) may experience body image issues such as body dissatisfaction and body dysmorphia. Weight gain, weight loss, surgery, and having a baby and how they affect body image in IBD are among the topics the IBDMoms cover with University of Michigan gastropsychologist, Dr. Megan Riehl.
- Megan Riehl, PsyD Twitter: https://twitter.com/DrRiehl
- Megan Riehl, PsyD Instagram: https://www.instagram.com/drriehl/
- Megan Riehl, PsyD Publications: https://med.umich.edu/pdf/gi/Megan-Riehl-Publications-and-Media.pdf
- IBDMoms: https://blog.ibdmoms.org
- IBDMoms Facebook: https://www.facebook.com/IBDMoms/
- IBDMoms Twitter: https://twitter.com/ibdmoms
- IBDMoms Instagram: https://www.instagram.com/ibdmoms/
[MUSIC: It Started With a Hashtag]
Brooke Abbott (00:03):
I’m Brooke Abbott.
Amber Tresca (00:04):
And I’m Amber Tresca. And we’re the Co-Founders of IBDMoms. We’re moms and inflammatory bowel disease patients, and we’ve created a safe space for other moms with Crohn’s disease or ulcerative colitis to share their journeys with one another.
Brooke Abbott (00:17):
The IBDMoms Podcast will focus on topics such as body dysmorphia, sex and intimacy, how to parent through a flare up, and transitioning kids from pediatric care to adult care.
Amber Tresca (00:29):
Thanks for being with us. We’re here to help moms on the challenges they face on their journey through motherhood and chronic illness. Hey Brooke.
Brooke Abbott (00:43):
What’s up girlfriend?
Amber Tresca (00:45):
Well, we’re here at Digestive Disease Week 2022 and I’m really excited because we had an amazing guest come and talk to us.
Brooke Abbott (00:57):
Yeah, she’s a rockstar.
Amber Tresca (01:00):
Brooke Abbott (01:00):
I mean, let’s be real.
Amber Tresca (01:02):
Let’s be real. Dr. Megan Riehl, who is a clinical psychologist and she talked to us about body dysmorphia and body dissatisfaction, and how that overlaps with IBD.
Brooke Abbott (01:18):
I think that’s something that we on many different levels can all relate to, whether we’re pre-moming or post-moming or post-surgery or in the middle of a flare where we just can’t control our weight, and just some of the things that go on with living with a chronic condition and not being able to control what’s happening with your body.
Amber Tresca (01:44):
Yeah. I think that it’s something that we don’t talk about often enough or even at all, like ever.
Brooke Abbott (01:50):
Oh no, never.
Amber Tresca (01:51):
The way that she presented how we need to think about these things is really just amazing, and it opened up my eyes. So, I hope it does the same for other people.
Brooke Abbott (02:01):
Also, brought a little bit of relief. I’m grateful.
Amber Tresca (02:03):
Yeah. Coming up next, our conversation with Dr. Megan Riehl.
Dr. Riehl, I wonder if you would level set for us first and let us know what are body image dissatisfaction and body dysmorphia?
Dr. Megan Riehl (02:20):
Yes. So, we assess for this with our patients to get an idea of how they’re feeling about their body. So, body image dissatisfaction is going to be somebody that is feeling a certain kind of way about how they look, maybe how their body is feeling, and that mind lead to some emotional feelings. It might cause them stress when they look in the mirror, it might cause them to think about what they’re eating and how it might impact their body. It might have to deal with after a surgery, changes in their body. Body dysmorphia is leaning more towards more of the psychological sides of intensifying that body dissatisfaction, right?
Dr. Megan Riehl (03:09):
So, you might have body dissatisfaction and it’s something that might be normal, right? You may have had a surgery and your body has changed. You may new to an ostomy and you’re looking at your body going “I don’t know about this just yet.” And in therapy we can address that. With body dysmorphia, you’re thinking about it more intensely. It might be prompting more moods symptoms. It might be shifting your behaviors. And so, it’s also something very important that we have to really assess for and think about where are we going to go with treatment? Where we going to go with resources.
Brooke Abbott (03:49):
So, what are some signs that patients or caregivers can start looking for? Because it just sounds like this is something that is pretty normal for patients and I’m just wondering and I’m thinking back to my own time after surgery. What are some signs that we should be looking for before we make that appointment?
Dr. Megan Riehl (04:10):
We want to talk about it. It’s not just a gender thing, but women and men can both feel both instances of dissatisfaction or dysmorphia, and as providers you want to be aware of this. You want to be asking just the simple question of how are feeling about your body? How are you feeling about any changes that have happened to your body? And that’s going to lend to greater conversations, right? To normalize that you might be feeling different in your body right now. And some patients, some people are going to say “I get why I’m feeling this way and I think it’s just going to take some time and I might not be loving my body right now, but I know I’m going to start to feel better.”
Dr. Megan Riehl (04:57):
So, you might be looking at what are the outcomes, pros, cons, risk, first reward, self love, resources around who’s providing you with support, which is another question you might ask patients. How are the people around you with some of these changes? Are you talking about it with your partner or your friends? So, I think asking questions about how they’re feeling, normalizing it, letting a person feel the way they want to feel. Like if they’re not feeling great in their body, doesn’t mean we have jump to like oh well you have an eating disorder or these are abnormal feelings about your body image. I think assessing the spectrum of time from change and giving people space, and then providing resources.
Brooke Abbott (05:49):
I wish I had heard post partum.
Amber Tresca (05:52):
Yeah, you’re feeling some kind of way. You’re feeling like it’s not normal to feel that way because it feels like something that needs to be addressed. But yeah, but at the same time it’s also a normal part of that process.
Dr. Megan Riehl (06:05):
Right. And part of body image, and this is where kind of society as a whole has a lot of work to do, right? So, the body that we had at 16 is going to be different from the body we have at 29, which is going to be different from the body that we might have after having babies, and bounce back, right? The bounce back effect that is so unfair, and yet that’s what a lot of society pushes. And one thing that I talk with my patients about is finding that self love for the body that you have and embracing what your body does. And that’s the same, whether you’ve had a baby or whether you’ve had a surgery for your IBD, your body is still your vessel of like we can love it at that’s the healthy at every size ideas. Beth Rosen does a lot of work in that. She’s a registered dietician. So, it’s certainly in therapy conversations around what are the expectations that you’re feeling from maybe outside or even what your body used to look like? Why do you feel the need to go back to that? Let’s look at what’s healthy for your body right now.
Brooke Abbott (07:23):
Yeah, that bounce back is kind of interesting with IBD though because sometimes I remember that what that weight just shed, but I didn’t feel healthy. And I didn’t actually the way my body looked after I had a baby and it was so rapid. And then everyone’s complimenting you, what did you do? Hey girl, you look good. No, I don’t.
Amber Tresca (07:46):
Oh, the compliments, the I wish I was as skinny as you and things like that. And it’s a little bit like, okay, but wow, am I sick?
Dr. Megan Riehl (07:54):
So, Amber that’s like this spectrum that I also see and again, try to validate for patients. So, when you’re feeling really, really sick and you are skin and bones and you feel terrible, but yet so much with IBD can be invisible. So, you might still be going to work. You’re still dropping the kids off at school. And that person says like, “Oh, you look so great” and you are feeling so terrible. And then the other end of the spectrum, right? You’ve done a course of prednisone or you’ve been on prednisone for however long and you’ve gained a bunch of weight and I’ve worked with lots of people where they’re like, I just can’t shut it.
Dr. Megan Riehl (08:36):
I look at myself and I don’t like it, or I was on prednisone years ago and I still can’t shed that 50 pounds that I gained. We have to acknowledge and validate that and talk about yeah, that’s a shift and you could probably work out as much as you want and work with a dietician. And this just might be the body you’re living in right now. So, how do we work through the emotions of that? The grieving is another big part of this.
Brooke Abbott (09:06):
Yeah. Big part.
Dr. Megan Riehl (09:07):
And helping patients to understand what that grief process looks like. And those initial emotional symptoms of maybe depression or maybe anxiety, or maybe worry or frustration, anger, that’s all normal and healthy. And it’s probably good that we processed that and let you feel that. And then what does acceptance look like on the other end?
Amber Tresca (09:47):
My thoughts immediately go to my kids on this subject. My kids don’t have IBD but it is something that I think about a lot in terms of meal times, what they’re viewing on social media, they’re now teen and teen adjacent, so I cannot know absolutely everything. Also, trying to respect their privacy in that space a little bit. So, it’s a lot of balancing. How should we be thinking about this? And is there something that we can do as parents that can help our children navigate this kind of ridiculous situation that society has set up for us?
Dr. Megan Riehl (10:28):
So, having insight into just that is as a good starting spot because nobody’s going to do this perfectly. I’m a clinical psychologist and sometimes I’ll say things and I go, “Oh, like no, I don’t want you to have that view.” And so, I think acknowledging you don’t have to be a perfect parent, but having this idea that what people see on social media, what are kids are exposed to, what might be being said at in other people’s homes.
Amber Tresca (10:56):
Oh yeah, that’s a big one.
Brooke Abbott (10:57):
Oh, yes. Yeah, that’s huge.
Dr. Megan Riehl (10:59):
So, something I’ll say with my kids is “In our house, this is our family value,” or this is how our family looks at things, right? So, I think a big part of this is it can’t be black and white. I want my kids to be healthy. I want to try and feed them as nutritious of meals as I can, but they’re going to have Mac and cheese sometimes. I’m not kidding and frozen chicken nuggets and I’m a working mom. So, it’s about balance and it’s about me modeling. I drink water bottles. And so, I think the way we model for our kids that there can be moderation. You can have the chocolate cake and feel good about it, and then we can also have vegetables and fruits. And I know that I’m coming from a place of privilege as well.
Dr. Megan Riehl (12:01):
And so, I want to acknowledge that as well, that there are going to be families that have food insecurity and are struggling with how to navigate body image and healthy eating and access to things. And so, I think that you have to, as a parent, we have enough stress. So, knowing that you’re just doing the best you can and that you are unconditionally loving yourself is going to be the best thing that you can do for your child. And I also acknowledge that’s very hard, but I truly believe that when kids see that also how we treat other people, right?
Brooke Abbott (12:41):
Dr. Megan Riehl (12:42):
That if I’m talking about something that I think is beautiful, showing them that diversity and different races and ethnicity, and that that is all something that’s beautiful and healthy. And so, it’s a big question.
Brooke Abbott (13:02):
Amber Tresca (13:02):
Yeah, I know. I’m like Dr. Riehl, can you just solve this for me right now? Right here?
Dr. Megan Riehl (13:09):
So, my answer is that we just have to do our best and model.
Brooke Abbott (13:15):
We’re talking about having conversations and making sure that we model good behavior and inclusivity, but what would treatment look like for someone like me or an Amber who may just be completely dissatisfied with how we look or how we feel? I feel like for patients it’s more so how your body makes you feel. I will just say that I was uncomfortable with my body after having a baby, but I was very proud that I was able to have a baby. Now, my body postsurgery, I felt very defeated and I felt a little out of place. And I think that was my biggest struggle, not so much the scars and all the things that were going on and the rapid weight gain and the rapid weight loss. It was more like I had to have this big surgery because I failed myself, and that I think is the bigger thing to get over.
Dr. Megan Riehl (14:19):
So, that’s the therapeutic, that’s the roadmap, right? You knowing I’m having these feelings. I’m recognizing this about myself. It might be really helpful to sit with a licensed clinician in mental health to work through this specific issue, right? And that’s what I love about my job as a GI psychologist is that you might show up at my door just to go through that as a therapeutic process. You don’t have to be in therapy forever. We might really work through that for a couple weeks, might be a couple months giving you some tools and strategies, a safe space to talk about that, to normalize some of those feelings that you’re having.
Dr. Megan Riehl (15:04):
But then also if we need to dive a little deeper into why or how’s, you’re in the good hands of a licensed mental health provider. And then oftentimes you have the growth and the movement through that and therapy is short-ish. It’s different than a more long term therapy though, that certainly can be beneficial too. But I think that’s a big thing I talk about with people is you don’t have to be in dire straights to work with a mental health provider.
Brooke Abbott (15:39):
Okay. I think that’s important, super important.
Dr. Megan Riehl (15:43):
And also just to acknowledge that sometimes there’s body image dissatisfaction or dysmorphia without an eating disorder. But we want to be careful that how you’re feeling about your body doesn’t then start to lean into your making alterations in you eating. And we know that there’s a very big complexity around GI conditions and eating, sometimes you’re not eating because it makes you feel bad. And so, the sooner you can get yourself that support, the quicker we can get you the resources and get you feeling through. I don’t want to even say feeling better but generally speaking, getting to a place of acceptance with this is the body you have right now. And how do we get you feeling okay with that?
Amber Tresca (16:33):
Do you have any resources that you’d like to direct patients to, that they can find out more information or they can find a psychologist or someone to work with?
Dr. Megan Riehl (16:41):
There is The Rome GastroPsych Directory that’s online and we can give you a link for that. Yeah, certainly. And then if there’s not a GI psychologist in your area, I would recommend either talking with your primary care doctor or your gastroenterologist who may have a directory of local people that they have a working collaborative relationship with. And you can also use Psychologytoday.com. I do encourage you to put in there’s a way to kind of filter through and locate people and body image is one that you can click on and you can also, chronic illness is another filter that you can put on there. And you put in your insurance, your zip code and it will direct you to providers in your area.
Brooke Abbott (17:32):
Oh, nice. I mean, I love something very simple that I can pull up during carpool.
Amber Tresca (17:41):
Yeah. Dr. Riehl, you’re a mom. Tell me about your kids. What are they into right now?
Dr. Megan Riehl (17:46):
I have very active little boys, five and a half year old and a three year old. And they are buddies, but also I mean, I’m covered in bruises because when we’re playing, we’re playing hard. And that’s fun and that can be a challenge and exhausting, but they are super fun. And now that it’s starting to get warmer outside, we’re outside a lot. So, bike riding. My five year old just took his training wheels off, so that was a mom moment. I did not expect to feel like such an immense amount of pride watching this little five year old crookedly riding down the sidewalk.
Dr. Megan Riehl (18:25):
So, that’s been super fun and then I have an 11 month old daughter. And so, I went from a boy mom to now a mom of three and she is just starting to toddle around. So again, taking those I call her my scaler. She just scales through the walls. Anything she can walk to hold onto and then she’s taking some steps. So, I’m busy and there’s a lot of noise. My house is so loud, but there’s lots of love. There’s lots of love and looking forward to the summer being outside.
Brooke Abbott (19:02):
Amber Tresca (19:02):
Yeah, that’s amazing. Thank you so much for all you do for IBD patients and for saying yes to us and coming and sitting with us during a very busy time at DDW 2022 and letting us know a little bit more about body dysmorphia and body dissatisfaction and how we can be on the lookout for that. Would you please also remind us though of your social media, so that everyone can follow you? I do very much enjoy your social media by the way, especially your Instagram.
Dr. Megan Riehl (19:28):
Thank you. Both Instagram and Twitter are at Dr. Riehl, D-R-R-I-E-H-L. And yeah, engage. That’s what’s great about social media and I feel like I know you two a lot better. And so sitting here and I also want to say thank you to both of you for all the advocacy work you do. It’s a true blessing to our field.
Brooke Abbott (19:53):
Well, that just warms my heart.
Amber Tresca (19:55):
Seriously. And it was really, really great after not seeing you for three years to connect with you here today. So, thank you so very much for sitting down with us. We really appreciate it.
Dr. Megan Riehl (20:03):
Hi, this is Jax and you’re listening to my mom, Brooke Abbott and my aunt Amber Tresca on the IBD Mom’s podcast. Please don’t tell her I think she’s cool.
Amber Tresca (20:27):
All right, Brooke I have to tell you about this thing that my kids were telling me about the cool teen slang that they’re using. All right. So, they’re apparently using this thing that you say, “Oh, that’s cap.” Have you heard of this?
Brooke Abbott (20:43):
Amber Tresca (20:44):
You’ve heard of it?
Brooke Abbott (20:45):
Amber Tresca (20:46):
Brooke Abbott (20:46):
Yeah. It’s no cap. Oh, that’s cap. It does not make any sense to me.
Amber Tresca (20:56):
Well, I’m going to explain it the way that it was explained to me and it’s cap, C like Charlie, A like apple, P like patient. Okay. That’s the first thing that I needed to understand. Okay. So, my kids are telling me that it’s basically you’re lying. So, somebody will be like, “I’m going to stop drinking coffee tomorrow.” And then you would say back if you said that to me, I would say back like “that’s cap,” right?
Brooke Abbott (21:26):
Yeah, you’re capping. I don’t understand it.
Amber Tresca (21:29):
Oh, is there capping?
Brooke Abbott (21:31):
Amber Tresca (21:31):
Brooke Abbott (21:31):
Amber Tresca (21:31):
Brooke Abbott (21:32):
So, it actually started off as an urban thing with young adults.
Amber Tresca (21:38):
Brooke Abbott (21:39):
I still don’t understand it.
Amber Tresca (21:41):
Well, and then like I guess I get it. I guess I understand it. I just don’t know why they needed another thing for that.
Brooke Abbott (21:49):
Yeah, you don’t. And also, I mean, there are some sayings that I feel very confident in saying. I stumble on that one.
Amber Tresca (22:02):
I don’t think I’m going to use that. I don’t think this is for me.
Brooke Abbott (22:04):
I don’t think it’s for me either. I feel like that belongs to the children’s. I think that’s a Gen Zer thing and I’m going to let them marinate in that because capping and no cap, even my younger brothers who are also millennials like me, when they say it, I’m like, Ooh, I don’t know about that one. I think that you should leave that to the Zers.
Amber Tresca (22:26):
The younger people.
Brooke Abbott (22:27):
Yeah. Yeah. The no cap, that’s cap, capping.
Amber Tresca (22:32):
Yeah. Right. I didn’t know about the capping. Okay. But I knew about the no cap, that’s cap or yeah. So, the no cap, you’d be like, I didn’t have any coffee this morning. No cap. I’m not lying. I’m telling the truth. Okay. And then not only that, but this is what I’m told, people will then use the emoji. So, they will use the cap and what I would call a baseball hat I guess, and send that back. So, if somebody says something to you, you would send them the cap emoji back. And that would mean that you’re like, oh, you’re lying or that’s not true or whatever or you’re kidding.
Brooke Abbott (23:10):
I got that back from the kid.
Amber Tresca (23:12):
Brooke Abbott (23:13):
Yeah. So, that’s how I started really hearing it because I had said something to him or asked him to do something and he replied and then I said, “Are you sure?” And he sent a no, it was the no signs with the circle with the line and then a cap next to it. And I was like, it took me a minute. Shh, don’t tell anybody but it actually took me a minute to figure out what he was saying. And that just made me feel old. So, I don’t like capping. I want to use slang that I can use in everyday life, and I’m going to need that.
Amber Tresca (23:54):
I think I’m not going to use it. I’m not going to use it when I text you. But I think I’m going to use it incorrectly or ironically to my kids.
Brooke Abbott (24:05):
As you should.
Amber Tresca (24:06):
Because then I will get the mom stop.
Brooke Abbott (24:09):
It’s your right. Yeah.
Amber Tresca (24:10):
Yeah. So, the next time they text me with something random or a question, oh no, I’m going to wait for a question. I’m going to wait for a question that’s about something that they want or they want me to do. Take me to my friend’s house, pick me up, yada, yada. And I’m just going to text back a cap.
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Brooke Abbott (24:29):
Mom, stop. I am so grateful to Dr. Riehl for joining us today. She gave us so many great tips on how to thrive through the struggles of dealing with body dysmorphia.
Amber Tresca (24:51):
She really opened up my eyes to a lot of different things and I’m also so glad that we asked her about our kids.
Brooke Abbott (24:57):
So guys, in case you didn’t know, this was our first episode. Amazing, right? I’m super proud. And just in case you didn’t know, there are links to a written transcript, everyone’s social media handles, and more information on the topics we discussed is in the show notes, and on the episode one page on IBDMoms.org.
Amber Tresca (25:18):
And of course you can follow us across all social media as IBDMoms.
Brooke Abbott (25:24):
IBDMoms Podcast is written, produced and directed by the IBDMoms, Amber Tresca and me, Brooke Abbott.
Amber Tresca (25:32):
Mix and sound design is by Mac Cooney. Theme music is from Cooney Studio.
Brooke Abbott (25:42):
I was going to say by the IBDMoms podcast. Don’t kill me, Mac.
Amber Tresca (25:49):
I will edit all of this out, except maybe that part.