Your social life, the quality of it, was wired into your gray matter by the age of 3, according to current thinking on child development. After a minute of contemplating that statement, the immense impact of early childhood caregivers becomes clear. This subject comes to mind after reading a recent news story about Artyom Saleviev.

Artyom was first in the news in 2010. He is the Russian boy who was adopted by a U.S. couple, the Hansens, 3 years ago. After being part of the Hansen family for 5 months, Artyom was put on a plane bound for Russia by his adoptive mother. Artyom carried a letter which stated the Hansen’s no longer wanted him because of his disruptive behavior related to psychological problems. The recent news article states that Artyom is now living in a foster home (in Russia) and his behavior there is not disruptive.

In the United States, the number of children in the foster care system is close to 500,000. One-quarter of them are infants when they enter the system; 15% are age 3 or younger, some only infants. The most common reasons for removing them from a parent or relative’s home are an absence of supervision (36%) and a failure to provide (31%). What affect does this have on a baby or toddler? Are they so young they will not remember neglect or abuse by early caregivers? If only that were true.

Caregiver Influence

To understand the effect early caregivers have on infants and toddlers, we can look at the implications of attachment theory. This theory, which has been substantiated by research, states that interactions with our initial caretakers determine our future capacity to build emotional bonds with others.

By the age of 3 years, children are either secure in their attachments to their caregivers or insecure. Children who are secure have the benefit of responsive caregivers that consistently meet their needs for food, safety, and affection. In adulthood, they can form lasting emotional connections with others.

There are three types of insecure attachment: avoidant, ambivalent, and disorganized.

When caregivers discourage expressions of a child’s distress or affection, an avoidant style of attachment develops. The child learns to discourage his or her own feelings, which damps down the child’s capacity to feel loved by others. Avoidant children typically withdraw from social interaction and grow into adults who are extremely uncomfortable with feelings and intimacy.

Ambivalent attachment occurs when early caregivers give comfort inconsistently. They sometimes respond to the child’s needs and sometimes do not. With this kind of care, children become unsure whether their needs will be met. As adults, they are slow to trust and at risk for mood and eating disorders.

When a child’s needs are not responded to, or the child is abused, a disorganized pattern of attachment can lead to delayed development, social withdrawal, and aggressive or disruptive behavior. Adults with disorganized attachment are susceptible to personality disorders and chronic mental health problems. Their relationships are often chaotic or short-lived.

Our attachment style sticks with us for life, although alternative behaviors and ways of thinking can be learned to improve relationships.

Not All Memory Is Conscious

When Artyom Saleviev arrived in the United States, was he secure, avoidant, ambivalent, or disorganized in relation to others? The Hansens painted a picture of a very disorganized child, although his current foster mother in Russia does not. Regardless, his experience with the Hansens, and the ill-conceived way he was sent back to Russia, are not stand-alone events. They rest on the foundation of interactions he had, or did not have, very early in life.

Even if a school-age child like Artyom is adopted or finds his way to a nurturing foster caregiver, a pattern of connection with others is already established. It begins before the child enters foster care, as a result of the child’s experience with his first caregivers, and the pattern continues after he leaves the system.

Around one-third of those 18 to 24 who age out of foster care are homeless within 18 months (in the U.S.). Up to one-half are unemployed within 4 years of leaving, and approximately 30% to 40% have a mental disorder and likely no health insurance. More than three-fourths will become parents.

Perspective

To keep these sobering numbers in perspective, we can consider that people with less than stellar starts in life can, and do, lead productive lives and find a share of happiness. Humans are highly adaptable and resourceful. It is also a fact that people from “good” homes enter adulthood with mild to severe attachment issues, usually the avoidant or ambivalent type.

Difficulty trusting and connecting with others is not just a single family issue. It is part of the human condition and drives the drama we call history.

The foster care system is imperfect, but it is a nested problem. Looked at as a whole, the problem begins with the child’s experience of insufficient early caregiving and is later aggravated by the lack of support for these children during the transition to adulthood. The system is situated in a disorganized world where, unfortunately, such institutions are necessary. The best we can do is to strive to keep making improvements based on what we continue to learn about the special needs of these children.

References:

1. Child Welfare Information Gateway. Available from: http://www.childwelfare.gov
2. U.S. Department of Health and Human Services, Administration for Children and Families. Abuse, Neglect, Adoption & Foster Care Research: National Survey of Child and Adolescent Well-Being (NSCAW), 1997-2010. Available from: https://acf.gov/opre/project/national-survey-child-and-adolescent-well-being-nscaw-1997-2014-and-2015-2024
3. Radia, K. Adopted Russian boy rejected by U.S. mother adjusts in foster care. Available from: http://gma.yahoo.com/blogs/abc-blogs/adopted-russian-boy-rejected-u-mother-adjusts-foster-110037054–abc-news-topstories.html

Related articles:
Patterns of Attachment in Adults
Understanding Difficult Behavior – For Foster and Adoptive Parents

Adderall (dextroamphetamine and amphetamine) is one of the preferred treatment options for adults with attention-deficit hyperactivity disorder (ADHD). The medication works by increasing an individual’s ability to pay attention and control impulsive behaviors. In people without ADHD, abuse of Adderall generates a euphoric sensation, included elevated feelings of confidence and power. When taken as prescribed, Adderall carries a risk of several unpleasant side effects. These include difficulty sleeping, nervousness, restlessness, and headache. Chest pain, rapid heartbeat, and shortness of breath are all signs of a potentially serious condition, warranting immediate medical attention.

Although the risk is small, there have been several documented cases of young people experiencing sudden heart attacks after taking Adderall without a prescription. The dosages were not especially high in many of these cases. In one such example, a young male suffered an acute heart attack after ingesting 30 mg of Adderall and drinking an unspecified amount of alcohol. He had no history of heart abnormalities. Still more troubling, cardiac events are possible even in the absence of abuse. A 15-year-old boy in otherwise good health experienced a heart attack in response to his usual dose of Adderall. He fully recovered, and terminating the prescription removed any signs of heart irregularities. Doctors are not certain what causes these effects in people. Currently, there’s no test to determine who will or will not develop cardiac side effects when taking Adderall. The best practice right now is to monitor an individual’s symptoms closely and intervene at the first sign of trouble. In addition, a history of heart issues may argue for a treatment plan that does not include a powerful stimulant like Adderall.

The extended-release formulation of Adderall was removed from the Canadian market for several years out of concerns about heart attacks and rampant abuse of the medication. It was eventually reintroduced with stricter guidelines for attending physicians. As always, those who abuse prescription medications like Adderall face far greater risks of dangerous, even lethal, side effects. Heart rhythm problems and heart attacks are the most troubling potential consequences of Adderall abuse. Even those who take the medication according to a doctor’s prescription face the small but real threat of cardiac problems. As research into ADHD and stimulant medications continues, safer drugs and drugs less prone to abuse will most likely be introduced.

References:

1. Centers for Disease Control and Prevention. (n.d.) Facts about ADHD. Retrieved from http://www.cdc.gov/ncbddd/adhd/facts.html
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
3. Jiao, X., Velez, S., Ringstad, J., Eyma, V., Miller, D., Bleiberg, M. (2009). Myocardial infarction associated with Adderall XR and alcohol use in a young man. Journal of the American Board of Family Medicine, 22(2), 197-201.
4. Sylvester, A.L., Agarwala, B. (2012). Acute myocardial infarction in a teenager due to Adderall XR. Pediatric Cardiology, 33(1), 155-157.

According to Randy P. Auerbach of Harvard Medical School, McLean Hospital, positive feelings and feelings of happiness are the result of intrinsic pursuits. “Intrinsically-motivated goals are thought to be inherently interesting, pleasurable, and/or meaningful,” said Auerbach. “In contrast, extrinsically-motivated goals are typically sought in order to attain a reward (i.e., material goods or money) or to avoid punishment.” Research has shown that pursuing both intrinsic and extrinsic goals can be beneficial, but not when one is at the expense of the other. Auerbach said, “Guided by self-determination theory, the research posits that the neglect of intrinsic goals ultimately thwarts the satisfaction of core, inherent psychological needs for relatedness, competence and autonomy, which in turn contributes to negative psychological outcomes including depressive symptoms.” Additionally, people who value extrinsic goals over intrinsic goals may neglect their interpersonal relationships and exert all of their time and energy in the pursuit of material objects and money. Another concern is that children whose parents value extrinsic goals above intrinsic ones may not foster sufficient interpersonal skills in their children, creating maladaptive relationship models for them as adults.

To test how the prioritization of values affected the psychological well-being of adolescents from various cultures, Auerbach and his colleagues studied over 600 teens from Canada and China. They found that the teens with the highest motivation toward extrinsic goals had elevated levels of interpersonal stress. “Further, consistent with past research examining the relationship between stress generation and prospective depressive symptoms, dependent interpersonal stress predicted higher levels of depressive symptoms over time.” The team added, “In conclusion, the present study highlights the relationship between aspirations, stress, and depressive symptoms in culturally distinct samples of adolescents. Traditional prevention and treatment programs primarily target cognitive and interpersonal vulnerability factors. However, the findings in the present study suggest that clinicians must also understand a patient’s core values as they may play an important role in shaping stress generation and subsequent symptoms.”

Reference:
Auerbach, Randy P., Christian A. Webb, Meghan Schreck, Chad M. McWhinnie, Moon-Ho Ringo Ho, Xiongzhao Zhu, and Shuqiao Yao. “ExaMining the PathWay through Which Intrinsic and Extrinsic Aspirations Generate Stress and Subsequent Depressive SyMptoMs.” Journal of Social and Clinical Psychology 30.8 (2011): 856-86. Print.

An estimated 40% of students who begin college don’t graduate from their initial school within six years. While some take longer or transfer to a different institution, a great deal of these students drop out altogether. Seeking to learn the causes behind college dropout, Michigan State University analyzed surveys of over 1,000 college freshmen from ten different schools. Students were asked whether they’d recently experienced twenty different “critical events” (ranging from poor grades and money troubles to job recruitment and inheriting money) and were asked whether they planned to withdraw. Of the twenty critical events, depression was the factor most frequently linked with academic withdrawal. Other leading experiences included roommate conflicts, unexpected bad grades, recruitment to a job or different school, and increased financial burden (either losing financial aid or experiencing a drastic hike in tuition or living costs).

Depression has been on the rise in college campuses for the past several years, so it should come as little surprise that it’s influencing students’ decision to drop out of school. University counseling resources are being tapped by an increasing number of undergraduates, many of whom site financial strains on their family as a primary cause of personal angst, pressure and even guilt. The slow economy also serves as a metaphorical cloud over these students’ future plans, who fear meager job prospects upon graduation. (more…)

What is the relationship between having a problem with your significant other and not having individuated successfully?

Successful individuation means that you have navigated into young adulthood and developed a sense of your unique self. Moreover, you have developed a comfort with that self, and are not easily swayed when faced with the pull from your parents and early significant others to be someone other than who you are. This means you can tolerate the feeling that others may not fully agree with or approve of your choices, feelings, desires, actions, or beliefs.

If you have not successfully individuated—and this is always a matter of degree—you will have difficulty asserting yourself in significant relationships and may experience anxiety and lack of self-esteem or self-confidence as you engage in your life.

There are many ways that problems can arise between couples when one or both partners have had problems individuating. “Dan” and “Laura” are a composite couple, based on the couples I work with in couples therapy. Their relationship illustrates the kinds of dynamics that can interfere with optimal functioning in a relationship.

Dan and Lara’s Relationship

Dan and Lara are both 24 years old. They met during their senior year of college. After dating casually for about three months, they thought of themselves as a couple and agreed to an exclusive relationship. They describe themselves as happy together; they share interests, and assume they will marry in the coming year. They entered couples therapy when Lara started to feel anxious about getting married. Dan was surprised by Lara’s feelings and feared that Lara would leave him. He couldn’t make sense of why, when they didn’t fight and they seemed so compatible, Lara would have any worries.[fat_widget_relationships_left]

As we talked in couples therapy, Lara began to express some of her worries. She worried about the fact that Dan always agreed with her. He never expressed any wishes for different friends, entertainment choices, or political ideas. At first Lara thought it was great that they didn’t fight and she always got what she wanted. When Dan and Lara moved in together, Dan was fine with anything Lara wanted to do to decorate the apartment.

After a while, Lara began to wish for more collaboration. When she asked Dan what he would like, he always replied, “Whatever you want is okay with me.” In our sessions, Lara realized that this left her feeling uneasy and wondering, “Where is Dan? Who is Dan?”

Dan was surprised to learn about Lara’s feelings. He said he felt that Lara had very clear ideas about what she wanted and he didn’t, so it was fine with him. He said he sensed that the choices that Lara made were very important to her and that she would not like to be required to do things or choose things that were different from her own wishes.  This was okay with Dan. His thinking was that there was no point in making Lara angry if the choice was of no consequence to him.

Let’s look at Dan and Lara’s individuation experiences so we can see what sense of self each person brought into the relationship, and how the interaction between these selves plays out to create the ways Lara and Dan relate.

Dan’s Individuation Experience

Dan described his relationship with his parents as very close. He felt they appreciated and approved of his choices. But as we explored his early life, it became apparent that Dan’s parents were very controlling and had very definite ideas about the right and wrong ways to do things. For example, they insisted that Dan go out for sports, even though he recalled that he really preferred to play music.

Thinking back, he remembered that he didn’t want to fight with his parents. When he would express his own wishes, they would respond to him in a dismissive way, leaving him uncertain about his ability to make good choices for himself. Over time, he learned to enjoy his parents’ admiration for being the son they wanted, rather than risk their negative feelings to become his own unique self.  In our work together, Dan realized that as long as there was no conflict in his relationship with his parents, he could feel good about himself. Conflict made him question the validity of his ideas and jeopardized his feelings of self-confidence and self-esteem.

He soon recognized how this pattern was repeating itself with Lara. The sense of self that predominated in his relationship with Lara was that he was loveable and admirable as long as he didn’t create conflict. He believed that she, like his parents, seemed to know what was right. If he could rely on her to make choices for him, there would be no conflict. He could maintain feelings of competence and self-worth as long as Lara was happy with him. With any sense of unhappiness on her part, Dan’s self-esteem diminished and he became anxious and self-critical.

Lara’s Individuation Experience

Lara’s experiences with individuation were very different from Dan’s. Lara’s parents were also very controlling, but unlike Dan, she didn’t become the person her parents wanted her to be. She remembers being 8 or 9 and getting into fights with her mother over her power to chose what to wear to school. She decided to stop fighting, wear her mother’s choice, and then bring what she wanted to wear and change at school.

Over time, she developed strategies to avoid conflict with her parents and to do what she wanted. She didn’t share her feelings with them, and relied on friends and her grandmother to be able to express what her parents didn’t want to hear. Her friends and grandmother played an important role in her development of self-confidence and self-worth. Her grandmother admired her take-charge approach to her life, and they became confidantes. By the time she was in high school, Lara’s grandmother was turning to her for advice. This had a large influence on Lara’s belief that she had good ideas, could trust herself to know what she wanted and that the things she wanted were right. The sense of self that predominated in her relationship with Dan was that she was competent and knew what was right. She felt loved and approved of when this perception was validated.

Long after eating patterns and weight have stabilized, many women  with an eating-disorder continue to struggle with issues of body image. In fact, body dissatisfaction has become so prevalent, many authors propose it has sadly become simply part of the female experience. Body dissatisfaction is believed to be one of the highest predictors in adolescent girls who go on to develop an eating disorder.

The National Eating Disorders Association (NEDA) defines negative body image as:

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• A distorted perception of your shape—you perceive parts of your body unlike they really are
• You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure
• You feel ashamed, self-conscious, and anxious about your body
• You feel uncomfortable or awkward in your body

I am a psychotherapist who specializes in the treatment of adolescents and women with eating disorders. For several years I have been leading body-image therapy groups in my outpatient practice. What follows are some of the group topics we cover as well as resources and activities I have found useful for helping people with their body image.

Generally, the group therapy series is focused on improving body image and runs for eight to ten sessions, as outlined below:

Session 1: My Body Relationship.

How do I feel about my body? To introduce this topic, group members participate in an art activity exploring how they feel about different parts of their bodies—from head to toenails. When asked to voice to the group the body part they like most, frequently the women will speak about a part that allows them to pleasantly experience some aspect of life, for example: “My hands—because I love to play the piano.” This activity allows members to recognize that some parts of their body are just fine, in their eyes. It’s not all body hatred. Great! We can build on this.

Leslea Newman’s book SomeBody to Love: A Guide to Loving the Body You Have (1991) has journaling exercises to help people creatively work toward repairing a broken relationship with the body. She recommends writing love letters, having dialogues with body parts, speaking compliments into the mirror, and more.

Session 2: Create a Vision.

How do I want to feel inside this body? If I felt this way, how would I move differently, how would I interact with others differently, what would this free me to do and experience? Using guided visualization, to step into and experience this vision, allows each person to plant and hold in their awareness a goal to guide them in the work ahead.

Session 3: Contributing Factors.

How did I come to define beauty? What experiences and messages contributed to my personal body opinions? Using a time-line, each group member looks at significant life events and paralleling patterns of weight and feelings about the body. The women in group often speak of having felt “different” from their peers. They feel dissimilar in their relationships with one another and with food. They also feel ambivalence about their developing bodies. We take a critical look at the media and the conflicting messages received from advertising. NEDA offers a number of handouts useful in facilitating this discussion.

Session 4: Body Talk.

What’s being said inside my head? How we talk to ourselves and what is said has a powerful effect on how we feel. Thomas Cash, PhD, in The Body Image Workbook: An eight-Step Program for Learning to Like Your Looks (2008) tells us this talk is often self-defeating, derogatory, and distorted rather than realistic. His book and audio program provide people with specific steps and tools to help them become aware of their negative body talk and begin to transform these messages.

Session 5: Body as Camouflage.

What do I hide with my body? To explore this dynamic, each group member creates a collage with magazine clippings portraying the “inside me/outside me.” People have used this activity to explore their beliefs about what others assume and expect of them, the image they try to portray, and then what they really feel like on the inside. We explore how they have used their bodies to protect or distract them from certain feelings and what it has been like to live with such a dichotomy.

Session 6: Body as a Vehicle.

What can I do and experience, thanks to my body? Sondra Kronberg, RD, writes, “True body power is the power of the body to accomplish tasks and be the vehicle through which to experience life” (Fall, 2002). As a group, we meet for a nature walk, adapted from the chapter called “Sensual Walk,” in Working with Groups to Explore Food & Body Connections: Eating Issues, Body Image, Size Acceptance, Self-Care (1996). In silence, we mindfully pay attention to the titillation of all of the senses: “Notice the smell of air, the feel of the elements, the textures beneath your feet, the views along your route, the taste on your lips, the ever-changing sounds in the background or foreground” (1996). In processing the experience, we talk about beginning a new relationship with our bodies by celebrating all the amazing things our bodies do for us and allow us to experience. Using Thomas Cash’s chapter called “Adult Pleasant Activities List” (1996), members are asked to mindfully and joyfully experience something from the list each day for the next week.

Session 7: Body as Container.

What is this spirit, this essence-of-me that lives inside my body? Kronberg goes on to write about the importance of helping our clients find their “real beauty,” that is the beauty “stored inside of them” (2002, Fall). During this session, group members create a word and picture collage of favorite things, causes they passionately believe in, relationships that matter most, compliments received, qualities of character they admire in themselves. This activity is often a favorite and reminds participants that they are so much more than the size of their clothes.

Session 8: Body as a Rich Source of Wisdom.

What can I learn if I slow down and listen to my body? This session opens with a deep-breathing exercise to practice being still, quiet, and focused. We then explore “gut instinct”—where and how we experience it in our bodies and how we have used this information to reliably guide us. Members are also invited to explore feeling states in the same way. Using a body outline on paper, members draw where in their bodies they feel anger, sadness, or loneliness, noting the size, color, and shape of each, and what distinguishes one from the other.

Session 9: Body Respect.

I can honor and take care of my body. This is a brainstorming session of all the things we can do to take care of and nurture our physical selves. Belleruth Naparestek’s affirmations are used from A Meditation for Relaxation and Wellness.

The following is excerpted from her beautiful work:

• I thank my body for all it has done for me in the past and all it will do for me in the future.
• I am learning to trust my body and to make good use of the information it offers me.
• More and more I will save my energy for what truly matters to me.
• I am aware that with each breath in I am sending precious oxygen and rich nutrients to the places in my body that need them.
• I welcome my ability to listen to the wisdom of my body and sense what it needs—telling me to rest, pace my energy, and take gentle good care of myself.
• More and more I can understand that my body is my ally, my oldest friend, and steadiest companion.

Body image work is a critical step in full recovery from an eating disorder.

Recommended Reading:

• The Body Image Workbook by Thomas Cash, PhD
• The Body Myth by Margo Maine, PhD & Joe Kelly
• Eating in the Light of the Moon by Anita Johnston, PhD
• A Meditation for Relaxation & Wellness (CD) by Belleruth Naparstek
• SomeBody to Love by Leslea Newman
• Transforming Body Image: Learning to Love the Body You Have by Marcia G. Hutchinson, EdD
• Working with Groups to Explore Food & Body Connections by S. Christian, Editor

References:

1. Kronberg, Sondra. (2002, Fall). Nourishing a Healthy Body Image: A Nutritionist’s Perspective.  Perspective.
2. Levine, Paula. (1993). The Meaning of the 3D’s, Eating Disorders & Awareness Prevention. Perspective.
3. Naparstek, Belleruth. (2002). A Meditation for Relaxation & Wellness. Akron, OH: Health Journeys.
4. Ressler, Adrienne. (2006, May) A Body to Die For: Advanced Training in the Treatment of Eating Disorders & Body Image Disturbance in Women. Perspective.
5. Hawkins, Nicole. (2009). Battling Our Bodies: Understanding and Overcoming Negative Body Images. Center for Change. Retrieved from: http://centerforchange.com/content/battling-our-bodies-understanding-and-overcoming-negative-body-images