Mindfulness and Eating Disorders across the Lifespan

Assessment and Intervention through the Emotion Regulation Paradigm

Gaia de Campora, Giulio Cesare Zavattini

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000376883
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

This important and well researched volume examines the clinical phenomenon of eating disorders, exploring their longitudinal risk trajectory and introducing the Mindful Emotion Regulation – Approach (MER-A) as a starting point for intervention.

The book reviews various eating problems that can originate from the earliest perinatal phase to early adolescence, and through the MER-A framework focuses on how the principles of mindfulness and the related theoretical and clinical bases underlying the construct of emotional regulation can guide the clinician to a deeper understanding of a patient's disordered eating. Featuring reflections on clinical cases, it includes coverage of patients' difficulties in regulating emotions, their relationships with various eating behaviours and their associated interpersonal features.

Mindfulness and Eating Disorders across the Lifespan represents an attempt to provide a complete appreciation of this complex and multifaceted topic, making it of great importance to psychotherapists and related mental health professionals working with eating disorders.

Part I

Regulation and nutrition

Chapter 1

From the prenatal phase to early adulthood

Risk factors and regulatory processes in the individual’s lifespan

Gaia de Campora and Giulio Cesare Zavattini

1. The meaning of nutrition

The acts of feeding and eating are gestures that contain an incredible amount of information and meaning. In fact, eating behaviour is a sophisticated sensory-motor process which, since the early stages of life, changes and evolves throughout time, shifting from the necessity of being together with a meaningful other, usually a parent on whom we depend, to complete autonomy in food collection and intake. The line that virtually connects these two extremes, dependence and autonomy, covers a person’s lifetime, and it characterizes the individual because of the constant presence of two interconnected elements that cannot be separated: the nutritional and the affective components. Because food is necessary to guarantee the survival of the child, strongly affective attitudes and behaviours are activated, especially when problems occur, for example, with food rejection. On the other hand, if during meals, both parent and child are engaged in together building the moment of food exchange, this space will become pleasant and the affective component will encourage the child to experiment with different kinds of food and different flavours.

The child’s mind starts its development in the relationship with the caregiver during the feeding process (Candelori & Trumello 2015). A long tradition within dynamic psychology has dealt with the meaning of this feeding relationship in the evolution of mental well-being since the first days of life. We find an example of this in Bion’s historical metaphor (1962), which symbolically compares the mental mechanisms of introjection/projection to the activities of the digestive systems, assimilation/evacuation. Accordingly, the state of discomfort and tension generated by the perception of hunger leads the child to experience a transient state of anguish, brought about by the child’s inability to find a solution to their problem, which then leads them to tears (Quagliata 2002). This signal activates a response from the parent that aims at alleviating this painful state, bringing the child back to a condition of homeostasis, and simultaneously leaving an important trace in their mind: thanks to the maternal intervention, the state of anguish was accepted and digested, giving it a new, more tolerable meaning that is now part of the child’s experience. According to the traditional approach of developmental psychology, these mechanisms of mental functioning represent the first attempts at building, together with the other person, the meaning of one’s own experiences, a condition which later allows the child to separate from the caregiver, thanks to the newly acquired competencies/autonomies.

The first mental and emotional experiences are therefore strongly entangled with the nutritional ones, and together they constitute the basis for the individual’s future eating habits.

2. The first nine months of life: foetal programming hypothesis

An essential contribution to the most recent scientific research consists of the observation of those factors that, at a very early stage, influence certain individual habits and behaviours, including eating habits. A considerable amount of evidence has been collected, and will be discussed in the following chapters, regarding the effects of early feeding interactions between mother and child, in defining risk or normative trajectories, following first infancy. What we define as Mother–Child early feeding interactions are those exchanges that help establish a nutritional rhythm in the infant since right after birth, whether the child is breastfed or given formula. An important part of this scientific discovery manifests itself in the re-definition of the word “early”. In 1995, Barker proposed the foetal programming hypothesis, also known as Barker’s hypothesis, which describes the existence of a sensitive period for foetal growth, which is supposed to characterize the early stages of pregnancy. In this early phase, structural and functional changes are caused by environmental stimuli. This aspect of the theory goes hand in hand with the epigenetic perspective, according to which our genes can express different ranges of physiological or morphological states in response to the environmental conditions. If the mother follows an inadequate diet while pregnant, this leads her infant towards systematically and severely impoverished long-term living conditions. The radical innovation of this scientific hypothesis is this: the conditions inside the womb do not simply represent risk factors for foetal health, but they are actual precursors of problems that will accompany the baby’s existence, placing the child at a higher risk of diseases later in adulthood.

The type of nutrition received by the foetus triggers metabolic and developmental changes that are necessary for the foetus to adapt to the quality of life inside the uterus. Therefore, a scarce supply of nutrients and calories produces long-term changes as a result of restricted growth. Similarly, when one goes from a condition of malnutrition to one of overeating, this exposes the baby to future risks, such as diabetes and obesity, which are visible in the very early stages. Fast foetal growth increases the need of nutrients. This is not yet easily observable during pregnancy, but the effects are clearly evident after birth. Barker maintains that an excessive supply of nutrients during pregnancy leads to a loss of lean body mass that is linked to the production of amino acids, which from within the placenta, in turn, promote the ejection of maternal milk.

It is no coincidence that obese women have a harder time breastfeeding, and this is not just a consequence of a C-section, but it is an expression of a subtle regulatory mechanism between mother and children, where the latter are called, from early on, to push the environment towards their needs.

The results of this hypothesis do not stop here. There are in fact intergenerational effects connected to the nutrition and the weight of the individual, which link the mother’s weight to the weight at birth of her children and grand-children. People have always been able to observe this relationship, but for the first time these effects are linked to environmental factors and not only to genetic heritage. This is why we chose an interdisciplinary approach as the only way to deeply understand the roots of eating problems.

3. Parental state of mind in relation to eating

If the mother’s choice of food quality and quantity is so important for the baby’s health from pregnancy to adult life, why are parents adopting unhealthy nutritional habits?

As is documented by multiple studies, emotional and psychological states lead people to modify and/or intensify their nutritional habits, and we now call this mechanism emotional eating. Several studies have confirmed the connection between anxiety and depression and compulsive eating rather than complete withdrawal from food, but until recently, little attention has been paid to the specific phase of pregnancy. Generally, scientists think that gestation functions as a trigger in the cases of women who show a history of eating disorders: they usually show improvement during pregnancy, but they revert to the same problems after giving birth. According to some, this improvement is due to the fact that pregnant women know that they are taking care of another being and they adopt a more caregiving behaviour. These data cannot be generalized and extended to the far more numerous subclinical population, which shows problems in this area without getting the clinician’s attention. One example appears in the studies conducted by Wildes et al. (2008), where physical and emotional neglect in infants results in inadequate eating habits. In addition to this dysfunctional pattern, a series of related risks emerged, such as symptoms of depression, low self-esteem and substance abuse. These symptoms formed a non-specific condition in relation to the onset of psychopathology, regarding which the Authors note that interventions conducted at an early age produced significantly different and more favourable outcomes in adulthood for those individuals who accessed some form of intervention. The coexistence of comorbid symptoms that is found in cases of neglect and often poorly treated, seems to appear more frequently in cases of ill-treatment and abuse, affecting multiple systems in a cross-functional way: affective, behavioural, somatic, dissociative, and relational (Zucker, Spinazzola, Blaustein, & van der Kolk 2006). The study by Ringer and Crittenden (2007) highlighted how a third of their sample subjects, who mainly suffered from food disorders, reported unresolved traumatic events in early childhood, and seemed to point to a direct connection between the mental states of their mothers and their condition. In particular, it was clear that a trauma or an abuse that did not find a resolution in the parental function led to the formation of a symptom that was the direct expression of the inability to distinguish between emotional and physical needs, a competence that directly derives from the caregiver’s inability to recognize and respond to the child’s signals.

Notably, the mother’s state of mind was characterized by a distancing attitude towards the attachment bond, which revealed itself in the tendency not to talk about the trauma or the abuse, as a strategy to protect the child from the impact of the event. In other words, the disguise of reality gave the illusion that the suffering created by those experiences could simply disappear; however, this approach caused instead the creation of a psychopathological nucleus that in the eating disorder symptoms found direct expression of the difficulties experienced by the child both individually and in the dyadic relationship.

The question at the beginning of this section seems to find some answers. A first hypothesis is that a certain attitude toward food is the answer to early childhood problems that never found a path toward resolution.

This explanation allows us to read these dynamics according to two different perspectives: (a) on the one hand, we can assume that eating problems are means of communication used by the child to signal an individual discomfort, and this, in time, will characterize his or her adult eating habits; (b) on the other hand, we can assume that food is the element through which traumas and/or mourning are transmitted from one generation to the next, allowing the passing on of the negative effects, from mother to child, and transforming food disorders into relational dysfunctions that permeate the individual’s lifespan.

4. Regulatory processes in the cycle of life

In light of these observations, the hypothesis of intergenerational transmission proceeds on two parallel lines and is based on the empirical evidence from research in prenatal and perinatal medicine and in developmental psychopathology. This creates a circular motion that activates emotional and neurobiological processes that are intrinsically connected. In the study by Jahnke and Warschburger (2008), and later in the research conducted by Sleddens, Kremers, De Vries, and Thijs (2010), it emerged that emotional eating in one parent is associated with the child’s request for food because of emotional needs, underlining the double role of genetic and behavioural mechanisms. The early acquisition of this behaviour causes an alteration in the perception of our internal signals of hunger and satiety, reinforcing the sensibility toward external factors – like availability of food and/or presence of other people – which become regulatory elements of the beginning and of the end of a meal, as supported by Tan and Holub (2011).

The developmental cycle the individual embarks upon from birth in relation to eating habits relies on the constant alternation between internal and external contexts, where other elements, such as temperament, also contribute to etiopathogenesis. Throughout time, the child faces different adaptive competences, which include the progressive transition from a state of homeostasis, which mostly deals with physiological needs, to the building of the attachment with the caregiver, up until the separation and individuation from the caregiver toward individual autonomy.

This constant interweaving of innate and learned competences develops from the tactile, visual, auditory, and proprioceptive perceptions that characterize the relation between mother and child. In the beginning, the caregiver acts to restore in the child a state of calmness, which over time extends beyond the physiological dimension to affective and social relations. Synchrony, reciprocity, and harmony in the exchanges of food are the relational parameters according to which we must evaluate harmonic development or face the presence of pathology. The interactions between parent and child are dynamic processes that are constantly reworking each other. These interactions require a flexible evaluation that takes into account possible mismatches in the relationship, and they become of central importance depending on whether or not repair of the relationship follows (Busato Barbaglio & Mondello 2011).

This constant alternating of mismatch and reparation processes is at the foundation of self-regulation and interactive regulation, and is at the basis of the formation of eating habits. As Lichtenberg wrote, the internal perception of hunger that the child experiences requires an external empathic confirmation that validates and makes sense of the existence of this state, becoming part of the child’s episodic and procedural memory and defining the event in his or her mind (Cuzzolaro, Piccolo & Speranza 2009).

Self-regulation and reciprocal regulation continue in a coordinated and alternating manner and, if this balance is maintained, the distinction between hunger (physiological state) and distress (emotional state) will be maintained. The development of the rhythm and of the ability to regulate one’s appetite evolves because of the child’s gradual achievements – like vocalizations and gaze direction – and because of the affective communication between the child and caregiver. In the early stages of life, child difficulties in communicating his or her own needs, or parental struggles in understanding and encouraging subsequent developmental stages may lead – among the other risk factors previously described – to the emergence of eating problems, of various degrees of severity, and their treatment can vary according to the theoretical model that is used to understand their roots.

5. Conclusions

The processes of self- and hetero-regulation represent multifaceted control systems and cover a role of primary importance in the different aspects of the life of the individual since birth (Graziano, Calkins, & Keane 2010). Many studies have shown the presence of a significant correlation among the regulatory processes that ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• List of contributors
• Acknowledgements
• Foreword
• Introduction
• Part I: Regulation and nutrition
• Part II: Assessment and treatment across the life course
• References
• Index