'Eating Disorders through the Lens of Attachment' was the topic for Amber Schlitter, LCSW, and Nicole Ponce, LPC, LCDC, presented at this year’s annual National Association of Therapeutic Schools and Programs (NATSAP) Conference in San Antonio, TX. Their presentation on January 30th was the perfect tribute to Fulshear’s Adult Attachment Model (FAAM) and the way in which Fulshear views attachment and relationships while working with the young women's eating disorder diagnosis.
The FAAM model starts with the understanding that an aggregation of smaller traumas that happened with your primary caregiver can lead to what is known as attachment trauma and trauma in itself is a disruption in the nervous system. This is why seventy-five percent of women with eating disorders have experienced childhood trauma.
Using this quote, “None of us is born with the capacity to regulate our own emotional reactions” (Fonagy et al 2002), Schlitter and Ponce spoke at great length about solutions that help young women and clients to connect. In the FAAM, it is focused that all people have a need to connect, just as we all have a need to eat. If clients are ignoring their need for food, it doesn’t mean that need disappears, just as a need for connection with others will not just go away. An eating disorder tends to be looked at as a deactivating strategy, where a young woman may try to become numb toward her emotions rather than acknowledge them. Looking at eating disorders through an attachment lens means more than just learning to eat well again – it’s digging much deeper than that.
We are biologically wired for connection. What someone does with this urge to connect depends on their “internal working model.” Internal working models consist of how people see themselves, others and the world. The internal working models for those struggling with eating disorders tend to be along the lines of themselves believing that they are not worthy, not good enough, powerless, etc. Through the FAAM, it is changing those beliefs about themselves into positive thoughts rather than negative, by having more positive experiences with healthy connections.
With eating disorders being a secondary attachment strategy, the goal is about getting their unmet needs met; it’s not about the food. It is the treatment team’s goal to understand the client’s best intention and deepest need. Validating the problem is important, and understanding that the urge and intensity is very real for them. Externalizing the problem, educating the team and others around the disorder, would be the next steps. Balance between all of these dynamics is necessary. An example might be setting the expectation of rather than purging right after eating, to try talking with someone for 10 minutes. At Fulshear, using the FAAM teaches these young women that they have the ability to survive this thing that they are so afraid of.
"They must understand the reality of the continuation of urges to regulate emotions by way of eating disorders," stated Schlitter. "The urge will not just go away, and that’s okay; gaining the strength to not fall back into the pattern is what we practice and develop to achieve recovery." They learn, through experience, that they can be in crisis and a relationship will still be okay. The process of change is hard and there are bumps along the way, but learning about self through the lens of attachment also creates a different approach than many of the young women in treatment have experienced before coming to Fulshear.
About Fulshear
Fulshear Treatment to Transition, founded in 2003 and accredited by the Joint Commission, is located right outside of Houston in Needville, TX and Stafford, TX. Fulshear works with young adult women ages 18-25 struggling with mental health issues along with accompanying co-occurring disorders, and is known for its development of the Fulshear Adult Attachment Model.