Chapter 4: Skin Hunger

As someone who wants to be an eating disorder therapist, I was intrigued and skeptical of the term “infantile anorexia”. I had never come across the term while researching in the past. The psychologist’s hypothesis that Laura was secretly purging and exercising at the age of 4 was chilling. After reading the chapter, I researched the term to find out if it was an actual term or if the psychologists were just looking for something novel to publish. I found the diagnosis in a few scholarly journal articles (Chatoor, 2002 & Chatoor, 1989), but it does not have the same characteristics of the DSM-V diagnosis of Anorexia Nervosa. Infantile anorexia does not require the distinctive fear of weight gain and disturbance in body shape. Under the current DSM-V, infantile anorexia might fall under the category of Avoidant/Restrictive Food Intake Disorder (American Psychiatric Association, 2013, p. 334).

Despite the apparent validity of the infantile anorexia diagnosis, Laura does not appear to fit the criteria (Chatoor, 2002). Even though she doesn’t fit the criteria, I found it interesting that Virginia had a few of the parent characteristics associated with infantile anorexia including insecure attachment with her own caregivers and low interpersonal reciprocity with Laura (Chatoor, Egan, Getson, Menvielle & O’Donnell, 1988). Unfortunately, the recommendations of the eating disorder psychologist in Laura’s case were the exact opposite of what she needed.  

The notion that baby “cuteness” is an evolutionary adaptation was fascinating. I did not know that our brains reward us for interacting with our own children. Personally, I just think babies stink, which seems contradictory to my brain reward system being stimulated. However, my friend recently had a baby and she says it is completely different with your own child. She even said she likes the smell of her baby’s spit-up. I may or may not ever have children, but I find it comforting to know I am programmed to not think my own child’s natural smell is gross. Sadly, Virginia’s wasn’t programmed to have emotional affection for her child because of her own childhood. I was glad Virginia was able to develop an affectionate relationship with Laura by observing Mama P. and learning what it felt like to be mothered. I would imagine this concept of modeling could be very useful in parent trainings.

I loved the quote at the very end of the chapter comparing Virginia and Laura’s emotional development to learning a foreign language. I started to wonder what speaking the language without an accent would look like in this circumstance. I found the quote difficult to fully digest because of the finality of it. Would Virginia and Laura really ALWAYS be scarred by the lack of emotional connectedness in their first few years of life? I think I may have initially took the quote to be more black and white than it was intended. The mother and daughter may always speak the language of love with an accent, but that doesn’t mean they wouldn’t be able to speak it.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Chatoor, I., Egan, J., Getson, P., Menvielle, E., & O'Donnell, R. (1988). Mother—infant interactions in infantile anorexia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 27(5), 535-540.

Chatoor, I. (1989). Infantile anorexia nervosa: A developmental disorder of separation and individuation. Journal of the American Academy of Psychoanalysis, 17(1), 43-64.

Chatoor, I. (2002). Feeding disorders in infants and toddlers: diagnosis and treatment. Child and adolescent psychiatric clinics of North America.

Chapter 2: For Your Own Good

Towards the beginning of the chapter, I had a difficult time understanding why the prosecutors wanted Sandy to testify. I’m not an attorney, but the evidence against the accused sounded very strong. However, I do know a little about eyewitness testimony from my Cognitive Psychology professor. He testified in court several times regarding the effectiveness of eye witness testimony. Despite the story taking place 28 years ago, Dr. Perry still knew that Sandy’s testimony could be deemed unreliable and it would likely hurt the case. Dr. Perry mentioned how narrative memories have a tendency to “fill in” the “expected”. In my class, this concept was called false memory. Here is a video based on an experiment that demonstrates how false memories are created: https://www.youtube.com/watch?v=D5sk504Yc94&pbjreload=10

The phrase “children are resilient” is true, but only sometimes. The overuse of the phrase leads people to believe that children will be okay without support no matter what happens to them. However, as I learned in my Human and Behavior in the Social Environment class, children need buffers when they are repeatedly exposed to stress. In class we learned that resilience was the result of both internal qualities and buffering relationships. I learned that just one secure relationship can create resilience. The relationship can be an extended family member, a teacher, a coach, or anyone who forms a positive connection with the child. In Sandy’s case, Dr. Perry served as a buffer and appeared to help her develop resilience. However, we don’t know if Sandy would have developed resilience without the buffering relationship. Resilience is not an innate quality and some children do not have buffering relationships to counteract the prolonged activation of their stress response systems.

After reading Sandy’s list of symptoms (p. 42), I thought Perry had just ripped the page out of the DSM-V for PTSD in children and stuck it in his book. Her symptoms were a mirror image of the current diagnostic criteria: intrusion symptoms, persistent avoidance of stimuli associated with the traumatic event, and alterations in arousal (American Psychiatric Association, 2013, p. 273). It’s hard for me to grasp that her trauma could be dismissed as inconsequential until the trial, but the underfunding of DCFS is no small secret. Additionally, not everyone has read the DSM-V and carries a copy around in their pocket. For someone who does not have knowledge of mental health or of Sandy’s past, he or she may have no idea of what was going on or how to help Sandy.

One of my favorite quotes from the chapter was in the section on the misinterpretation of traumatized children’s responses. Perry quotes a family therapist who said, “we tend to prefer the certainty of misery to the misery of uncertainty”. In this instance, Perry was applying the quote to Sandy’s behavior in foster care. I have always found this idea interesting. I have seen how the desire to be in a familiar state can drive people’s thoughts and behaviors, even if the initial situation is positive. The result is often subconscious self-destructive behaviors. People who have always felt depressed or anxious may seek out situations that reinforce the familiar feeling if they start feeling happy or calm. Happy and calm may feel uncomfortable.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Chapter 1: Tina's World

Before I even finished the first page, my brain started screaming: ETHICAL DILEMMA. After Tina crawled on Perry’s lap and tried to open his zipper, I wondered if he considered referring her to a female clinician. However, if he had referred her to a female clinician, Tina may never have had the chance to adjust her schema of men as sexual predators. In addition, Perry did remove Tina from his lap and did not mention any other sexualized behavior. Food for thought, would he have made a different decision if it was 2018?

I appreciated Perry questioning the conclusions of his first supervisor, Dr. Stine. As a clinician in training, I am inclined to defer to my supervisor’s seasoned opinions. Hopefully, if I was in Perry’s position, I would have had reservations about Dr. Stine’s Attention Deficit Disorder and Oppositional Defiant Disorder diagnosis, as well as his interpretation of Tina’s mother’s lateness as resistance. I learned in my DSM class that African American males are more often diagnosed with a psychotic disorder than a Bipolar Disorder compared to White males. Dr. Stine’s ADD diagnosis made me wonder if he would have been more likely to consider a PTSD diagnosis if Tina was a White child. In the same realm, would he have still considered Sara’s lateness as “resistance” if she was White?

As Perry discussed the probable changes in Tina’s stress response systems, I started thinking about what I’m learning in my Treatment of Substance Use Disorders class. Last week, we discussed how drug use affects neurotransmitter levels and the central nervous system. Studies have concluded that childhood sexual abuse is a risk factor for substance use problems in adulthood (Sartor, Agrawal, McCutcheon, Duncan & Lynskey, 2008; Shin, Hong, & Hazen 2010). As we discussed in class, nature and nurture should be looked at interactively instead of as a dichotomy. In this case, I was wondering how Tina’s exposure to childhood sexual abuse affected the neurotransmitters in her brain. Perry described the effect of stress on rats’ adrenaline and noradrenaline systems and how he observed similar behaviors with Tina. I’d be curious to know if Tina were to ever use substances if she would be more likely to use “downers” to counteract the overactivation of her stress response system.

I felt disheartened when I read that Tina had continued engaging in sexualized activity. However, it reminded me that not every story will have a happy ending. I won’t be able to help EVERY client and “fix” all of their problems. During orientation, I remember my biggest fear was failure. Failure has such a negative connotation; but if we do everything right how do we learn? I learned the most during my first field placement when I made a mistake and discussed it with my supervisor. Of course, it felt better to have a successful moment that resulted in my one-person dance parties. However, failing is a part of the process and my coworkers could only handle my dancing on occasion. 

  

 

References:

Sartor, C. E., Agrawal, A., McCutcheon, V. V., Duncan, A. E., & Lynskey, M. T. (2008). Disentangling the complex association between childhood sexual abuse and alcohol-related problems: A review of methodological issues and approaches. Journal of Studies on Alcohol and Drugs, 69(5), 718-727.

Shin, S. H., Hong, H. G., & Hazen, A. L. (2010). Childhood sexual abuse and adolescent substance use: A latent class analysis. Drug and Alcohol Dependence, 109(1), 226-235.