Tuesday, June 20, 2006

Foster Children & Eating Disorders, Part 1

Children in foster care often have very serious issues around food. This might take the form of stealing or hoarding food, refusing to eat certain foods or exhibiting an eating disorder.

Behavior does not come out of a vacuum. Rather, it stems from personal experiences and thought patterns. People behave in ways that appear logical from their perspective, even if that behavior might seem strange or even harmful to other people.

Eating Disorders and Early Insecurity
Dr. Alfonso Troisi and his colleagues have recently published a study measuring the relationship between insecure attachment/early separation anxiety and a negative body image for women. The outcome was a strong association between the two.

Children who lack a safe and secure foundation in infancy are more vulnerable to eating disorders. They are more likely to have weight concerns and low self-esteem than children with secure attachments.

Insecure Attachment
According to attachment theory, if a child is secure in his or her relationship with a caregiver, that child will feel free to explore, because he or she is confident that a secure base exists, to return to in times of need.

The secure child explores freely while the mother is present, engages with strangers, is visibly upset to see mother depart, recovers and then is happy to see her return.

The insecure child lacks that self-assurance. When a primary caregiver disappears, he or she goes through a series of three stages of emotional reactions.

1.) Protest: The baby cries and refuses to be soothed by others.
2.) Despair: The baby is sad and passive.
3.) Detachment: The baby actively disregards and avoids the parent if the parent returns.

Attachment and Self Worth
Children who have been consistently loved by their caregivers develop a perception of themselves as "loveable," whereas children who are neglected and/or rejected by a caregiver often report feeling "unworthy of love."

Early connection with the caregiver makes it possible for a child to develop a model of themselves as loveable and valued. It reassures that child that there are loving, trustworthy people available and that the world is a safe place.

Interestingly, the most damaging style of attachment is neither anxious nor avoidant, but disorganized. Avoiding pain and worrying are both active strategies for dealing with the world. Children with disorganized attachment view human interactions as erratic and unpredictable. It's difficult to plan a response to perceived chaos.

Foster Children & Eating Disorders
I plan to contact Dr. Troisi, and invite him to do a study on foster children and/or foster alumni. My rationale is the following:

-Who has more first-hand experience with separation anxiety than a foster child?
-Sexual and physical abuse are also associated with both eating disorders and foster care placement.
-Eating disorders are often an issue of control.
-Is it surprising that some foster children might use eating disorders as a way to cope with change, trauma and stress?

-Ainsworth, M. D. S., et al (1978). Patterns of attachment: A psychological study of the Strange Situation. Hillsdale, NJ: Erlbaum.
-Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. London: Hogarth Press and the Institute of Psycho-Analysis.
-Hernandez, Jeanne (1995). "The Concurrence of Eating Disorders with Histories of Child Abuse among Adolescents." Journal of Child Sexual Abuse, 4, 3: 73-85.
-Holmes, J. (1993) John Bowlby and Attachment Theory. Routledge;
-Holmes, J. (2001) The Search for the Secure Base: Attachment Theory and Psychotherapy; Brunner-Routledge;
-Miller, Katherine J. (1996). "Prevalence and Process of Disclosure of Childhood Sexual Abuse among Eating-Disordered Women." In Sexual Abuse and Eating Disorders, ed. Mark F. Schwartz & Leigh Cohn, 36-51. New York, NY: Brunner/Mazel.
-Troisi, A., et al (2006). Body dissatisfaction in women with eating disorders:
relationship to early separation anxiety and insecure attachment. Psychosomatic Medicine, 68(3): 449-5.

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Fascinating... and so true. My one niece still suffers from detachment when under stress. Luckily, my mother who is her current caregiver is a social worker and familiar with such conditions. What disturbs me is seeing a 3 year old with such a low self-image. At one point when I was fixing her ponytails, I pulled out some pretty barrettes and said "Oh, these will be so pretty." She said, "No, those will look a-sgusting in my hair." I asked her why, since they're so pretty. She responded, "Cause I look a-sgusting." Still, with constant love, care, and reminders of such, hopefully she'll gain the security she needs. Right now no eating disorders, but I can see the connection. Before this post, I never would have considered it. Thank you for posting this and bringing it to my attention. I hope Dr. Troisi takes you up on your invitation.
I can relate to this issue, all the points that are made regarding the development of eating disorders. I never used to think (at the time of living with my foster parent) that I had an eating disorder, and although it took place more than fifteen years ago, the effects still manifest themselves to this day, albeit minimised, but they're still there and they're important in relation to children, how they grow up to perceive love, the larger world outside of their own and how they go about integrating themselves with their own sense of self worth.
I was in foster care for 6 months while my birth mother tried not to surrender me for adoption. At 6 months I was adopted by a family with severe alcohol problems, especially my adoptive mother. I developed an eating disorder and always felt there was a hole in my being. It felt like a hole in my middle. As an adult I learned Transcendental Meditation and within a few months the eating disorder and the hole were healed. I would recommend Transcendental Meditation for all children who have experienced trauma.
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