Dr. Stanley Goldstein - Author and Psychologist

Yesterday's article on Ozempic in The Wall Street Journal ("A 12-Year-Old's Journey Into the World of Ozempic. A mother found success with a weight-loss drug after a lifelong battle. Noticing her daughter start down the same path...") aroused several thoughts.

The baby's first source of food is their mother and they later learn eating habits from their family. Children with eating disturbances tend to develop in families where food serves other purposes beside nourishment.

Anorexia (which has the highest death rate of all mental health disorders) and Bulimia develop in children where eating becomes entwined with their healthy desire for autonomy, which is resisted by their mother. Thus, control over eating for the child serves their emotional need of exhibiting their independence and, once created, is difficult to treat as it entwines with fanciful notions about beauty, nutrition, and exercise. Obsessive-compulsive exercising has its own motivation since, as reflecting an ego defense against anxiety, it serves to reduce the continuing anxiety of the anorexic/bulimic child.

Sadly, many doctors ignore the family underpinnings of these behavioral disturbances.

Though the psychodynamics of Anorexia Nervosa are well understood, it remains the deadliest of mental health disorders with the highest death rate. Its origin lies in parental failure to encourage their child's independence with the child's only possible autonomous behavior being to control what they eat.

Symptoms begin at a time of expected independence for this child who is socially immature and has little awareness of their feelings, the family power struggle around eating being a substitute for the normal developmental struggle of separating from parents and entering adult relationships. Thus symptoms arise when personal autonomy is required: beginning school, entering puberty, or leaving for college.

The initial treatment goal must be to restore and maintain the patient's healthy nutrition. Starvation affects the central nervous system causing increased irritability, hyperactivity, and an obsession with food. Individual psychotherapy can then help the patient resolve their dependency issues and rage toward parental figures, with their low self-esteem naturally rising as normal developmental goals are achieved.

One crucial task of early childhood is for a child to develop a secure sense of who they are or, as psychologists call it, a sense of self. This ordinarily occurs naturally through a child's continuing interactions with their parents but if these were inadequate, the child's poorly developed ego capacities are unable to cope with severe stress, particularly when the powerful feelings of adolescence arise.

 

Then, symptoms occur with low self-esteem being the least severe. More troubling symptoms can include confusion about their identity or even personality disintegration (psychosis).

 

Anorexic symptoms typically arise in adolescence when there is a need to integrate powerful feelings within the personality. Feeling vulnerable and the loss of control over their body, which the ego's Executive Function provides, the teenager attempts to bolster their self-esteem and gain a sense of control over their body through concrete actions: obsessive focus on their body and diet, and constant exercise.

 

Because the anorectic person lacks awareness of the connection between these behaviors and their underlying fragmented personality, they tend to resistant psychotherapy. This, despite anorexia having the highest death rate of all the mental health conditions.

A major difficulty in treating anorexia is the person's resistance to treatment for, despite their life-threatening medical symptoms, they tend to deny any difficulty apart from not being thin enough. When this is achieved, they believe that all of their life issues will be resolved.
These individuals tend to be unable to  Read More 

One crucial task of early childhood is for a child to develop a secure sense of who they are or, as psychologists call it, a sense of self. This ordinarily occurs naturally through a child’s continuing interactions with their parents. But if these were inadequate, the child’s poorly developed  Read More