The triad of emotional abuse-freezing-anorexia in the identification of hidden traumatic events
The triad of emotional abuse-freezing-anorexia is very frequent and refers to early traumatic experiences related to pathological communication styles of the parental figures. In particular, the alternation between psychological manipulation and neglect carried out in childhood produces devastating effects on the nutrition and body of girls.
Emotional abuse, according to the National Association of Adult Survivors of Child Abuse, is one of the forms of “child abuse” (Montecchi, 1998). It involves the systematic use of behaviors capable of dominating the affective sphere and of negatively affecting emotions and self-esteem, depriving the child of the care and protection he needs. Parents, instead of offering closeness and empathy, deny the emotional needs and constantly invade the psychological and physical spaces of the child. We can speak of “hidden trauma” (Lyons-Ruth et al., 1999) when invisible conditions of neglect are created with respect to the child’s basic needs for safety, recognition, accompanied by communication dysregulation on the part of the parental figures.
The damage to cognitive and affective development is, unfortunately, underestimated, as psychological abuse is commonly considered to be much less serious than physical violence.
Emotional abuse occurs mainly through accusations, insults and criticisms, threats, devaluation and manipulation and through forms of neglect of psychological needs, accompanied by declared rejection and physical isolation of the child, especially in the case of disobedience (neglect).
In this regard, the psychoanalyst JG Goldberg, in her work The dark side of love (1993), has analyzed the precocious self-aggressive tendencies, particularly in the child, as a form of reaction to the psychological manipulation carried out systematically by one or another. of both parents, through pathological communication styles.
The manipulative action is exercised in three stages, according to a repetitive and continuous pattern of behavior. At first anger is intentionally provoked through the constant frustration of requests to listen; in a second moment the expression of hostility, determined by frustration, is blocked through verbal language or through non-verbal language (looks, facial expressions, tears), paralyzing any form of emotional protest, with the consequence of favoring, in a third moment, the progressive displacement of anger, originally addressed to the abusive parent or parents, onto the body.
The “emotional invalidation” is, therefore, the real focus of the problem (Waller, 2007): those who suffer emotional abuse perceive the personal psychological condition minimized or treated with indifference and, therefore, get used to perceiving less and less their physical needs and to consider the body as a scenic place for the representation of emotional abuse, through anorexic diaphanisation as a strategy for survival.
According to JG Allen (2008),
L. Terr divides the traumatic experiences into Type I and Type II and Mixed Type I and II.
Type I trauma refers to episodes usually caused by limited and unexpected events, such as earthquakes or environmental disasters.
Physical, sexual and emotional abuse prolonged over time are part of Type II trauma: after the first unexpected traumatic episode, the succession of other episodes creates a mental predisposition that mobilizes attempts to preserve the mind through particular defenses and coping strategies such as denial , repression, dissociation, identification with the aggressor and aggression directed against oneself, with dramatic consequences on emotional and affective development. To these psychological defenses is added a mode of physical reaction called freezing, frequent in reptiles and higher mammals, in the presence of serious danger. It causes a detachment from the modes of attack / flight behavior and can even induce dissociative amnesia with respect to the experiences that accompany traumatic events,
According to the Polyvagal Theory of S. Porges (2018), the dorsovagal circuit of the autonomic nervous system responsible for freezing is connected with the regulation of vegetative processes and the functioning of the organs located below the diaphragm (stomach, small intestine, colon and bladder ). In higher mammals this condition of immobilization is linked to loss of sense of control and mental numbness, accompanied by sadness, disgust, embarrassment and fear. When the dorsovagal circuit is active, a slowing of the muscular and skeletal responses is produced, with a reduction in oxygen supply. Furthermore, the dorsovagal state is frequently associated with depressive conditions.
The reverse transition from a dorsovagal state to an activation of the sympathetic system (from immobilization to mobilization of the body) is difficult: the autonomic nervous system is configured to lower rapidly in case of need, not as easily to rise again if a state of safety occurs. . The nervous system of a child who has suffered an emotional trauma remains trapped in the continuous state of dorsovagal alert, as if danger were always imminent, with inevitable consequences as regards the perception of the stimulus of hunger and the search for food.
Research conducted in recent times at an international level is increasingly addressing the correlation between childhood abuse and the appearance of AD (Eating Disorder), often of a relapsing nature.
A. Vajda (2013) was particularly interested in the role played by emotional abuse and neglect in the genesis of eating disorders (anorexia and bulimia). The psychologist has launched an alarm signal on the possibility that the emotional dysregulation, resulting from the trauma, over time becomes a habitual communication modality of malaise.
According to M. Teicher (2003), neglect or other psychological abuse determine a cascade of stress responses that organize the brain according to a specific structure selected to facilitate survival in a dangerous environment, characterized by deprivation and struggle. This altered development is costly as it is associated with an increased risk of developing serious psychiatric disorders and in any case leads to maladjustment in more favorable situations.
Furthermore, stress resulting from traumatic events cause a volumetric reduction of the left hippocampal portion which leads to a defect in the coding and storage of spatial, temporal and semantic information in explicit memory (Zennaro, 2011).
In the most serious cases, a real somatoform dissociation occurs, that is to say a disintegration of memory, consciousness and body identity, to the point that the same body functions can be subjected to dissociation.
In some girls, the self-destructive tendency through food restriction should be diagnosed not only as DCA, but also as early DTS (Traumatic Developmental Disorder) (Van Der Kolk, 2014), to be placed in the research area that is lately investigating the long-term consequences of psychological trauma on the maturation of some brain structures and affectivity.
According to R. Matrullo, (2005)
According to Kestemberg (1972), the psychic organization of the parents contributes to the formation of the child’s psychological structure. Thus the quality of the interactions of which the child has been the object is reflected in the way the child is invested in her own body (Jeammet and Corcos, 2002). Emotional abuse interrupts the construction of the relationship of trust with the parental couple and the body, object of neglect by the parents, is less and less loved by the child who progressively disinvests self-care, to the advantage of more appropriate defensive reactions.
The anorexic is afraid of being metaphorically swallowed (and, for this reason, she is unable to swallow); she can only defend herself by blocking any reaction (freezing) to become a tiny target and totally leaving her parents to occupy a physical space that she previously occupied.
Even the cross-cultural studies by H. Ullrich (2017) consider female passivity as a protective factor in family contexts of physical and psychological abuse, especially for women living in South India.
Anorexia could be partially overcome after adolescence, thanks to a partial detachment from the family and an increase in the external spaces of autonomy, but it is often relapsing because anorexics keep their conflicts at a latent level. Only a few girls manage to orient themselves early towards a partner who is the opposite of the abusive parent, that is, capable of feeling tenderness and deep feelings.
Since it is an “interpersonal trauma”, the likelihood that it will persist or recur in new and different contexts, particularly in the choice of dysfunctional partners, such as those with narcissism problems, is therefore considerably high and must be taken seriously consideration. The Psychoanalyst S. Ferenczi (1932), in this regard, quotes an interesting metaphor on the effects of mistreatment:
In fact, the Narcissist has often been the victim, in turn, of the same styles of emotional abuse and neglect on the part of the parental figures, but with the involvement of opposing modes of defense, such as identification with the aggressor. The coexistence of the same emotional traumas in both partners predisposes to the recurrence of the conditions of abuse, with a high risk of retraumatization and reappearance / exacerbation of symptoms for the anorexic.
The serious traumas were considered by S. Ferenczi as tragic events that predispose the individual to the search for extreme solutions of adaptation, to avoid death.
These are behaviors that have the purpose of helping the person to get out of the condition of danger: on the one hand there is the alloplastic solution that intervenes to change the conditions external to the self and on the other the autoplastic solution that pushes the subject to change if itself, through the dissociation of parts of the self or through attempts at self-destruction. According to the author, the dissociated parts can be projected onto an imaginary figure, modeled on the personality of the subject, which takes the name of Orpha. Orpha is a rescuing figure of abused children who takes on the difficult task of
Madness can become a conservative solution that tends to seek a partial adaptation within a situation with no way out.
In the case of emotional abuse, the exclusion of the original feelings of hostility and the parental prohibition of crying the pain of feeling mistreated leave room for a body that deeply lives the trauma and a mind that refuses to mentalize the suffering in order not to go mad .
Psychological abuse, of all the different types,
For the anorexic, who has suffered a traumatic attachment, it becomes essential to bring to light and accept the hostile impulses originally addressed to the parental figures, in order to interrupt the destructive actions hitherto diverted on the body.
This ability must be taught by a therapist capable of mentalizing his own experiences and providing the patient with a secure attachment, a difficult task due to the resistances put in place, in the transference, by the patient not accustomed to the psychological availability of the Other.
It is a path that identifies specific treatment methods tuned to the patient’s self-regulation times. The psychotherapeutic intervention on trauma and anorexia is implemented according to a three-stage model. (see table 1 – in Italian) or (Fig. 1 – in English).
Table 1 – Three-stage model
Figure 1 – Three-stage model
Following a series of emotional traumas, the anorexic has developed an altered neuroception, in the sense that she has an inappropriate perception of the environment on a body level and always has the impression of being in danger. Even a simple change in the therapist’s tone of voice can be mistaken for disapproval. It is important to consider prosody as an important indicator of acceptance, in order to generate a sense of security and lead the patient towards calm and slow abandonment of the freezing mode.
Through “limited reparenting”, the therapist tries to counteract the negative influence of the parenting style through eye contact which becomes an essential tool for satisfying the unmet needs of childhood and for building a therapeutic relationship of trust. It is important to make a constant comparison between the traumatic situation and the new treatment situation, through a gradual empathic listening. In the setting, it is necessary to give space to the transmission of bodily sensations that favor a process of co-regulation of emotional states.
Autogenic training (Schultz, 1932) and breathing exercises improve neuroception and perception of the body in a relaxed state. S. Porges underlines the importance of bringing the patient back to tune with his own somatic experiences and with the emotions connected to them in order to get out of the dorsovagal state and begin to perceive the need for nourishment differently, the first step for adequate self-care. It is advisable to make the energy flow by directing it upwards and outwards (make the person stand up, make him push or grab something, stimulate arms and legs, support movements, even very small ones, of active reaction).
This is an extremely delicate stage to deal with, in particular due to the possible appearance of intrusive and trigger thoughts throughout the day. The term “trigger” indicates the metaphorical trigger that is triggered in front of certain stimuli capable of reviving a traumatic memory, in the form of a photogram, which solicit suffering and pain already experienced in childhood. The risk of interruption of therapy in this second phase is very high, due to the suffering to which the patient is again exposed. The Psychoanalyst S. Bolognini (2008) argues that those who have been a victim of neglect can try to transfer their experiences of inadequacy and unworthiness to the therapist, through a defense mechanism defined as “identification with the exclusor”,
In J. Young’s Schema Therapy, (2004), indicated as cognitive psychotherapy also for anorexia, the analysis of early maladaptive schemes (Mode), understood as a set of memories, thoughts, emotions and sensations, learned during the childhood in contact with abusive parental figures.
In the case of emotional abuse, dysfunctional patterns of abandonment, deprivation, dependence and submission correspond to specific dysfunctional beliefs that orient growth towards the perception of a negative world from which to defend oneself.
In adult life, when faced with certain stimuli, the same dysfunctional patterns are automatically reproduced which, in turn, trigger certain styles of coping.
Therefore, the goal of Schema Therapy will be to correct and transform a maladaptive schema into a more adequate one, with the aim of also facilitating the learning of new adaptation strategies and more appropriate coping styles. To achieve this goal, memories of abuse need to be brought to light by revisiting events and reconstructing the trauma.
The “Imagery Rescripting” exposure technique is an experiential strategy of Schema Therapy that facilitates the recovery of memories and the rewriting / redefinition of a new ending to be attributed to the traumatic event. The psychotherapist himself inserts himself into the scene evoked by means of suitable verbal stimuli, helping and defending the child against parental attacks, in order to attribute a positive and, above all, different ending to what happened. Thus the patient recovers the presence of an emotional support and moves away from her image as a helpless victim.
According to the Ellert RS Nijenhuis approach, some people subjected to severe abuse and emotional neglect in childhood generate three prototypical dissociative subsystems called “parts”: Apparently Normal Part, Fragile Emotional Part, Controlling Emotional Part. Phobias that are developed by the parts dissociated from each other maintain the symptoms. Enactive Trauma Therapy is based on the assumption that the patient and the therapist represent two organism-environment systems that co-create a common world and actively undertake to treat and overcome somatoform dissociation, without however referring to cognition and elaboration. information. Hypnotic techniques inspired by the analogies and metaphors of M. Erickson are preferred, with the aim of guiding the anorexic patient towards the progressive integration and symbolization of traumatic episodes, also through indirect physical contacts during the sessions (Nijenhuis, 2017). The Therapist, defined as a tolerant Witness, accompanies the patient’s suffering with empathic warmth, helping her to remain in the present time and to re-establish an emotional connection with herself, with others and with the world represented in the traumatization (Van Der Hart-Nijenhuis, 1999) .
If it has been possible to re-elaborate the traumatic memories, in the last phase of the therapy the therapist will urge the patient to reconcile with herself and to have positive feelings about her own treatment, through a psychoeducation that considers the body worthy of love. The attainment of an intimacy with one’s self predisposes to the identification and transformation of one’s emotional world, making possible new healthy relationships marked by a newfound trust.