Food Maintenance Syndrome

Food maintenance syndrome is a mental health disorder in which people afflicted perform overeat and/or food hoarding.  Food maintenance syndrome is very prevalent amongst children in the foster care system though it has also has a high prevalence amongst abused and neglected children.  Currently, food maintenance syndrome is not recognized as a mental health disorder under the DSM IV though many cases of food maintenance syndrome could be diagnosed as obsessive compulsive disorder or an eating disorder not otherwise specified.

Characteristics:

People with food maintenance syndrome have a survivalist reaction to food which requires them to eat excessively (often to the point of painful overeating) and to hoard food. Studies found that children with food maintenance syndrome showed evidence of severe stress.  Stress is linked to the “fight or flight” instinct inherently found in humans. It causes bodily changes from stress such as increased blood pressure, gastrointestinal problems, and hormonal changes, amongst others.  Even though people with this disorder may excessively overeat, the physical stress on their body interferes with the digestion process and they are not overweight.

Food hoarding can manifest in various ways but commonly involves hiding food in stashes, such as in drawers or underneath the bed. Food hoarding may also commonly involve refusal to throw away food or stealing food and storing it.  If only food hoarding occurs as a symptom, then a diagnosis of obsessive compulsive disorder may be appropriate.

Causes:

Incidences of food maintenance syndrome have been linked to acute stress, particularly from personal traumas such as abuse or maltreatment. In many cases, children with food maintenance syndrome have undergone periods of neglect where they did not have access to adequate amounts of food.  The child then develops a heightened survival instinct related to food; whenever the child has an opportunity to consume food, he or she does so in excess and hoards any remaining food.

In situations where food is not consistently available to meet basic needs, overeating and food hoarding are natural reactions to fight off potential future starvation.  However, these habits can continue even when food has become readily available thus causing food maintenance syndrome. The characteristics of this disorder are a sign that the person afflicted still feels insecure about whether his/her basic needs will be met.

Prevalence:

Food maintenance syndrome is rare in the general population but there are certain demographics where it is very common.  In particular, foster children are prone to food maintenance syndrome.  Abused or neglected children who are not in foster care also frequently display symptoms of food maintenance syndrome.

Treatments:

As most cases of food maintenance syndrome (which are brought to attention) are foster children, treatment of the disorder typically is done by the foster family.  The first step is for the caregivers to understand why the symptoms of food maintenance syndrome occur, even though the child afflicted has adequate food available.

Unlike many other mental health disorders and types of OCD, food maintenance disorder is not often treated with behavioral therapy.  Some behavioral therapy methods – like locking pantry doors  – could worsen the condition by reinforcing the idea that food is inaccessible to the child and he/she should thus hoard it when available.  Some behavioral therapy methods are effective though, such as establishing set times for eating and set periods of “breaks” between eating.

Nurturing techniques are often the best treatment for food maintenance syndrome, though it can take a long period of time before all of the symptoms of the disorder are alleviated.  Caregivers should reinforce the idea that food is always available and that the child’s needs will be met.  Some fostering care agencies advise making food baskets or special food packages for the child.  This food can serve as a reserve for the child so he/she has a sense of security.

There are often other comorbid conditions associated with food maintenance syndrome, particularly if the person afflicted has been abused or traumatized.  It is imperative that any other mental health conditions are also treated along with the eating disorder.  Depending on the severity of the food maintenance disorder and the prevalence of other mental health conditions, medications and therapy may be needed for a full recovery.

Prognosis:

Because food maintenance disorder is not recognized as a mental health disorder in the DSM IV, there have been few studies into the disorder and its prognosis.  However, evidence does show that people afflicted can make a recovery, particularly if they are provided with a long-term stable environment where food and nurture is readily available.  Unfortunately, many cases of food maintenance disorder occur in foster children who may move frequently between foster homes.  This instability can hinder progress or worsen the condition.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.

Joyce, Charley, LICSW, and Rick Delaney, PhD. “Child neglect and food hoarding.” Caregiver Connection. Feb 2011. Retrieved from www.dshs.wa.gov/pdf/ca/Caregiver_Connection_Feb11.pdf.

Tarren-Sweeney, Michael. “Patterns of Aberrant Eating Among Pre-adolescent Children in Foster Care.” Journal of Abnormal Child Psychology. 34.5: 621-632. Retrieved from www.springerlink.com.