Dr. Mark Schwartz at Harmony Place Monterey Explains that Eating Disorders are Not Just About Food! 

Dr. Mark Schwartz approaches Eating Disorders at Harmony Place Monterey as a disorder related to attachment and Intimacy.

Eating disorders initially appear to be about preoccupation with food, but the obsessive management of the intake of food is often a frantic attempt to cope with life’s stressors, particularly intense, dysregulated emotions, also involving confusion about identity and self-esteem in an attempt to stop the feelings of aloneness and detachment from other people. This aloneness is related to a disorder of attachment.

A good example of disordered attachment is the phobia related to eating which characterizes anorexia. A phobia is frequently an expression of the failure of the attachment figure to protect the individual from the terror of trauma. Eating disordered behavior, therefore, stems from the approach-avoidance of the primary attachment figure. That is, the biological push to attach is accompanied by fear.

The attachment system is a biologically based, survival system for ensuring physical safety and metabolizing emotional stress. Young, immature, and vulnerable children seek closeness to an older, stronger, wiser, caregiver/parent for protection and care. Having an adequately functioning attachment between parent/caregiver and child allows the infant to receive emotional support from the parent/caregiver shielding them from extreme levels of fearful arousal. When the attachment figure becomes a source of danger, the individual turns to control food, often food becomes a transitional object representing safety. The mental and physical side effects of high levels of stress may be the basis of learned helplessness and post -traumatic stress common in maintenance addictive symptoms.

When individuals experience the breakdown of their attachment systems, they feel disconnected, depersonalized, alone, overwhelmed, out of control, abandoned, and longing to fill a profound inner emptiness. These are symptoms described by individuals who restrict or compulsively overeat and under eat.

Long-term recovery from an eating disorder at Harmony Place Monterey is distinguished by a form of symptom control and involves understanding the functional roots of addictive behavior. In many individuals the attachment disorder leading to difficulties with adult intimacy must be adequately resolved before the eating disorder can be reliably subdued.

As children build mental models of self, others and relationships based on their primary attachment relationships. Healthy internalized attachment models represent beliefs about the self as being worthy of love, being cared for and responded to, and the “other” as being available, caring, and responsive. These models then serve as filters and guides for how new information is processed and how new relationships are perceived. Attachment templates – especially negative ones – created in early childhood can be so tenacious that they distort interpretation of information coming from the external world for a lifetime. 

A common example is with eating disordered individuals is “otherization,” the individual becomes over-focused on “not disappointing” others, so involvement with a partner, or even parenting, becomes torturous. Such temperamentally disposed individuals often grew up with narcissistic and/or overly critical (or very emotionally fragile) parents, who demanded from the child attention and care to their own experience at the expense of seeing and nurturing their child’s internal world. The child may actively push the parent/caregiver away, becoming dismissive of attachment. These patterns influence the child’s, and later the adult’s view of others. Their lives become dedicated to not causing others distress thereby impinging upon their own “self’s” unfolding.

The significance of early experiences in defining an individual’s constructed reality cannot be viewed as equivalent to subsequent learning environments. The lack of viable, attentive, attuned primary caregivers in infancy can mean death. We imagine ourselves as being insulated from danger, but the reality of our infancy and childhood entails profound, inevitable dependency. Initially, as small, limited, vulnerable creatures, we cannot meet our own physical, psychological, or emotional needs. Physical development of strength, coordination, orientation, psychological development of meaning, making sense of self and emotional development of affect regulation capacities all unfolding within the structure of first relationships.

An infant’s right brain is hardwired by effectively charged interchanges between the caregiver and baby. In early infancy there are only basic sensations: soft/rough, warm/cold, comfort/discomfort, hunger/fullness, pressure/release, smell, taste, familiar/strange, rhythmic/discordant.

In primary relationships the child experiences and interprets these sensations and “learns” primitive lessons about whether he can inhabit his own body, tolerate discomfort, have needs met before they escalate, find balance, lose and regain it, seek and find comfort. From repeated interactions with primary attachment figures, the child develops a subjective reality of self and others, the child will interpret all subsequent relational/emotional experiences from these interactions.

When the caregiver/child attachment functions in a “good enough” manner, the results are a “secure attachment”. The caregiver anticipates and responds to the child’s needs consistency and care, helping him/her to regulate intense negative affective states such as sadness, fear, and anger and helps elaborate positive affective states. When the attachment relationship is disrupted, the impact on child development is marked and devastating. Insecure attachment injures the development of the self-system and can lead to fragmentation. Protective parts of self can create a false self, that denies crucial aspects of their own emotional experience to maintain attachment at all costs.

Mistreated toddlers display falsely positive effects that do not reflect their true feelings. When there is a mis attunement, with the caregiver the child will actively anticipate the mother’s reaction and, while measurably agitated, inhibit or minimize their external expression of neediness, resulting in avoidance of intimacy and insecure-avoidant attachment style. Other children respond by amplifying their expressions of neediness, hyperactivating the attachment system to capture the mother’s unpredictable attention, an insecure-preoccupied/ambivalent attachment style.

These inhibiting vs. amplifying expressions of neediness are the core of the anorexic-bulimic structure, i.e. “I have no needs, not even food.” vs. I am so underweight I’m on the brink of death.” In both scenarios, the child is put in the position of sacrificing true self experience to maintain loyalty and bonds with selectively attentive caregivers. Such patterns linger throughout the lifespan, as for example, the “absence of self” is often described by addictions: not feeling real, feeling like an imposter, feeling like a chameleon who will do or say what they perceive others want to see or hear.

The quality of early caregiving leads to a child adopting one of various identifiable attachment strategies. An infant’s behavioral response to stress provides a window into internal working models reflective of the relationship between the infant and the caregiver.

At Harmony Place Monterey, our focus is repaid on the attachment system, and our expertise is that becoming securely attached with self and others, results in remission of eating disorder symptoms. The techniques for this are described in the webinar on our website.