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.
I appreciate that you went out of your way to do additional research on the topic of infantile anorexia. When I encountered the term in the chapter, it seemed so ridiculous on its face that I didn't consider that it could potentially be a real condition, and so didn't bother to explore further; though, from what you seem to have found in the Chatoor research, the impression that I'm getting is that infantile anorexia isn't a disorder, in the strictest sense that it is not a form of anorexia, but is rather better classified perhaps, at least in this case, as a symptom of something more global. You mention avoidant/restrictive food intake disorder, which as I read the diagnostic criteria seems to be a better fit than anorexia nervosa, but I'm not entirely sure it's an appropriate diagnostic label either. Consider criterion D, which states that “the eating disturbance is not attributable to a concurrent medical condition [which we know it is not] or not better explained by another mental disorder.”
ReplyDeleteIn the differential diagnostics discussion of avoidant/restrictive food intake disorder, one of the rule-out disorders is reactive attachment disorder – a symptom of which may manifest as avoidant or restrictive eating habits. Laura seems to meet all criteria for both diagnoses, and since the feeding disturbance is the focus of clinical intervention, she can be given both: reactive attachment disorder with avoidant/restrictive food intake disorder.
As our understanding of attachment theory improves and our diagnostic capabilities grow to adapt to those improvements, I hope that we will see greater flexibility in our clinical language such that we can describe the situation above more succinctly in the future.