Transcript INFANTILE ANOREXIA

INFANTILE ANOREXIA
Adrienne Trennepohl
NSCI 5373
Dr. Kennedy
October 31, 2002
HAPPY HALLOWEEN!
What is Infantile Anorexia
• Infantile Anorexia Nervosa is considered to
be a severe feeding disorder, which usually
arises during the toddler years.
• Can also be found in the infant years of life
as well as toddler age.
Overview…
• There are many factors that are associated
with Infantile Anorexia Nervosa, but much
research has been conducted concerning the
mother-to-infant interaction, and that much
conflict arises between the two.
• Therefore, this presentation focuses on the
mother-to-infant interaction and the conflict
they share.
Definition…
• Infantile Anorexia can
be defined as a serious
feeding disorder that
develops during the
infant’s transaction to
spoon- and selffeeding stage, which
can lead to acute &
chronic malnutrition.
• This can endanger the
infant’s overall
development, Maladaptive interactional
patterns between the
mother &/or caregiver.
Specific Diagnostic Criteria…
•
The specific diagnostic criteria for this
disorder are categorized in 4 areas:
1. Food Refusal for at least 1month- may
involve primarily solid foods, which
worsened or started during the transition
to spoon to self-feeding
Diagnostic Criteria…
2. Acute &/or chronic malnutrition
3. Parental concern about the toddler’s eating
•
•
•
•
expressed by coaxing the infant or toddler to eat
more
Allowing distractions or play during feeding
Frequently feeding the infant or toddler at night
Expressing worry and frustration to the infant or
toddler
Force feeding
Diagnostic Criteria…
4. Intense parent-to-toddler conflict, which is
expressed by the toddler’s/infant’s food
refusal and the parents or caregivers
negative affect or comments about the
toddler’s/infant’s refusal to eat.
Conflict: Mom vs. Infant
• Infantile anorexia can by conceptualized as
a relational disorder that arises when highly
conflicutal feeding interactions disrupt the
transition to self-feeding.
• Ex: intense conflict during feeding can be
stressful to mobilize the toddler’s
sympathetic nervous system & suppress
hunger sensations. (Chatoor 98)
Conflict & Feeding…
• Also, infants may learn to associate intense
emotions with feeding.
• This feeling of emotion may mask the appropriate
sensations of hunger and fullness.
• Not responding to the toddler’s cues can
undermine the toddler’s ability to differentiate
between hunger and emotions.
• Dyadic conflict interferes w/successful transition
to self-feeding.
Dyadic Conflict…
• Can arise if the parents or caregivers possess
characteristics that limit capabilities of responding
sensitively and contingently to their toddler’s or
infant’s feeding behaviors.
• Maternal responsiveness is influenced by one’s
current environment, mother’s representations of
past, & current relationships.
Distal Factors; #1
Maternal Eating Attitudes
• One important distal factor is Maternal Eating
Attitudes.
• Mother’s with eating disorders were more
intrusive during their toddler’s mealtime as well as
playtime.
• Toddler’s weight - related to both the amount of
conflict during mealtimes & the extent of the
mother’s concern about her own body shape.
Maternal Eating Attitudes:
• Mothers who have a great concern about
their own weight and eating style also have
a great difficulty managing feeding
situations in their own child’s eating habits.
Maternal Eating Attitudes:
• One study observed that anorexic mothers
underfeed their own children, therefore
researchers hypothesized that maladaptive
maternal eating attitudes are positively
associated with conflicutal mother-totoddler feeding interactions and the
toddler’s malnutrition.
Distal Factor #2:
Mother’s Perceptions of their earlier
Attachment Relationships
• Research suggests that adults with insecure
attachment representations are less sensitive
to the cues of their own children than adults
with secure attachment representations.
• Insecure Attachment- apparent during
feeding interactions; parents must reduce
toddler’s hunger (be nurturant) and set
limits (child stays in high chair, etc.)
Distal Factor #2
• Mothers who have insecure representations
of attachment relationships would have the
most difficulty managing the feeding
situations and would show the most conflict
during feeding interactions.
Distal Factor #3
Spousal Relationships
• Studies show that distressed marriages are
linked to maladaptive parenting.
• Marital distress may negatively impact a
mothers’ capacity to respond sensitively to
their child’s cues.
• This may lead to more problems and
increase conflict with feeding interactions.
Interventions:
• It is important to differentiate between the various
feeding disorders because what might work in one
situation, might not be as effective in another.
• Treatment for infantile anorexia is to first reduce
the infant to mother conflict interaction during
feeding.
• It is also key to target the parents in this situation.
Help them to interact in a positive and relaxed
setting as well as learn what the infant might be
telling them.
Summary…
• These factors play an important role between the
mother and her infant child or toddler.
• Conflict may arise if any of these factors are fluent
in the household.
• Studies postulate that maternal characteristics and
perceptions of their toddler’s temperament are
associated with infantile anorexia.
Summary…
• 2 Critical Symptoms of Infantile Anorexia:
1. Feeding Conflict
2. Toddler’s Nutritional Status
• Studies perceive that:
1. Toddler’s w/infantile anorexia are
negative in mood, seek attention, & are
more willful than “normal” toddlers.
Summary…
• 2. Mothers of anorexic toddlers show insecure
representations of attachment, marital conflict, &
difficulty regulating their own eating
• 3. Maternal perceptions of toddler temperament
and maternal characteristics aid in mother-totoddler conflict at feeding.
• 4. Severity of conflict at feeding is related to
severity of toddler’s malnutrition.
THE END
References:
• Chatoor, Irene., Diagnosing Infantile Anorexia: The
Observation of Mother-to-Infant Interactions.,., Journal of
the American Academy of Child and Adolescent
Psychiatry., June 2000.
• Chatoor, Irene., Maternal Characteristics and Toddler
Temperament in Infantile Anorexia., Journal of the
American Academy of Child and Adolescent Psychiatry.,
September, 1998.
• Chatoor, Irene., Observation of Feeding in the Diagnosis
of Posttraumatic Feeding Disorder of Infancy., Journal of
the American Academy of Child and Adolescent
Psychiatry., May, 2001.