Dr. Teri Quatman opened the SCV-CAMFT luncheon with a discussion about eating disorders, a condition that she and Susan Martin have been treating together for over three years — people who, in DSM IV TR terms, have an Eating Disorder NOS. Martin has been working with eating disorders for over 20 years and Quatman has treated patients for 20 years and teaches at Santa Clara University.
Quatman described some of the characteristics of their patients. These patients are chronic dieters as well as compulsive over-eaters. They are people who have tried, among other diets, Optifast, Weight Watchers, and Jenny Craig. Many have gained, lost, and re-gained 100 lbs or more and have done so more than one time. Diets have failed these patients. During binge episodes, calorie consumption can be thousands of calories in a sitting. Two-thirds of their patients started using food during childhood to manage psychic distress.
Treatment modalities include providing nutritional education, group therapy and individual psychoanalytic psychotherapy. This multidimensional treatment offers a place to re-gain hope, dignity and a healthier relationship with food.
Martin discussed a case that illustrated the concept: “the food addict is born from trauma.” Food addicts learn, due to early trauma, that they will not survive if dependent upon human beings, and we all come into the world as dependents. Psychoanalytic ideas from W. Bion, Gianna William, and others detail the idea that early damage continues to have a voice if not addressed. When the relationship between the mother and the infant is one where the infant is not able to be psychically held, or contained by the mother in a safe way, the infant suffers trauma. As infants, often these patients are traumatized (not held or cared for adequately) and are unable to feel safe while dependent on their mother.
While many addictions stem from early damage to the relational system, everyone needs food in order to survive. These patients suffer from damage to the capacity to receive and regulate food consumption, as well as an inability to relate to their feelings or be conscious that they are experiencing feelings in their bodies.
As children, these patients became the container for the parent's projections rather than being able to safely project their parts of self into their primary caregiver. The case presentation discussed a patient’s fear of taking something in that was not under his or her control. Images described by clients include: drowning, losing the skin boundary, and a dream description of an invading insect.
Quatman and Martin described addiction as a relational disease. Feeding disorders, like merycism — when a child regurgitates food repeatedly — can cause the infant to starve. Quatman’s and Martin’s patients suffer a form of psychic starvation and use food to keep themselves together. Through their clinic, the presenters help people locate emotional experience — feelings in their bodies — and then learn to relate to these emotions over time. Participants learn to feel safe with other group members and the therapists. As with many early trauma cases, healing happens over time while the patient, therapist and group develop a safe, containing relationship.
For more information or to refer a patient to services, contact Dr. Teri Quatman and/or Susan Martin at the Haunted by Hunger Treatment Recovery Program for Chronic Dieters and Compulsive Overeaters, 408/366-1980.
Presented by: Teri Quatman, Ph.D., and Susan Martin, M.S., M.A., MFT
Author: Lara Windett
