Recently I heard an author and editor of The Atlantic magazine, Scott Stossel, talk about his severe anxiety ( Stossel, 2014). What struck me about his story were two things – his description of having had serious problems with anxiety since he was two years old, and also how terrible his anxiety was. He said that the feeling of dread was sometimes so intense that he didn’t think he could go on living. In response to an interviewer asking him what he had found that helped, Scott spoke compellingly about how the first step was accepting the fact that there is no cure, that one has to develop a repertoire of coping skills to deal with the issue and recognize that sometimes you will be OK and other times you suddenly and drastically will not. He even referred to his condition as “temperament”. This rang so true to me.
I pondered on the sweet children I have seen over the years who have had severe anxiety. Some of them have gotten better, and some of them – “stubbornly”! – have not, or at least, are still up and down. Scott Stossel correctly described the problem as a spectrum. All of us have anxiety, but whereas for some it is typical nervousness related to environmental stressors, for others the anxiety is debilitating. I will discuss the treatment of these conditions in another blog posting, since I disagree somewhat with his sense of the limitations of treatment. Right now, I want to talk about the role and the experience of parents with an anxious child.
First of all, I agree with Scott that this problem – barring cases of posttraumatic stress – is largely an issue of temperament. Jerome Kagan and Nancy Snidman talk about how the newly recognized “sensory reactivity disorder” can be seen as a feature of temperament, since both the sensory disorder and also high reactive temperament, have significant heritable features. I don’t say, “inherited”, since we know that the matter isn’t as simple as that. Environmental (and epigenetic) factors have an important role even in the womb, and certainly after birth, when anxious caregivers have a powerful effect on the developing capacity for self-regulation in the infant (Nelson, 2013) (Beebe & Lachmann, 2013). Individual differences tend to be a “blend of temperament and environment” (Snidman, 2011). It appears that the part of the brain that registers threat in response to environmental stimuli – the amygdala – has a lower threshold of reactivity in these children. It is well known that high reactive temperament and the related insufficient development regulatory competencies may complicate a child’s attempts to cope with adverse life circumstances and even everyday transitions (Kagan et al, 2007, Kagan, 1989).
What I would like to focus on here is the effect of an anxious child on his parents. I am not referring to parents just getting anxious when their child is anxious. I am referring to complex patterns of emotional communication that are initiated in infancy and become established and then have a continuing influence on future development – both of the child and of the parents – so that over time, the trajectory of development and associated behaviors become increasingly distorted (Beebe & Lachmann, 2013) . And the people involved don’t even notice it, because they are so intent on staying connected. Many parents of super anxious children tell me that they “walk on eggshells”. What they then explain is that they are afraid of triggering an explosion in their child. But, what I think they really mean is that they are afraid of losing the connection, afraid of losing the child.
Also, they get worn down. When you “lose energy”, as in all living systems (which humans are) you tend to retreat to a simpler but less complex and effective level of functioning. I don’t use the word “regress” because that could imply a global move to a previous level of functioning, whereas when I use the term “retreat” I mean that the idea that the higher level of functioning remains in the individual’s repertoire but he/she does not at that point have enough energy to attain and maintain it. In my practice, I sometimes talk to parents about “being on the front lines” in an attack. If things are not going well and you are in the front lines, you may tend to just shoot rather than – from the more protected position of the generals – plot new strategy.
So from the beginning, when the child cannot sleep or has trouble with feeding, the parents bend over backwards to help the child sleep – such as sleeping with the child – or eat – such as accommodating severely restrictive diets. These parents are trying to protect their child’s survival. However, what they can’t allow themselves to realize at the time is that they are contributing to the distortions that are developing. The child who will explode if you don’t accommodate his demands does not learn to tolerate frustration. The child who “only eats chicken nuggets” doesn’t learn to like other foods.
Before you begin to blame the parents, though, consider what it means to have a child who “will” not eat, “will” not sleep. Sooner or later, you give up and accommodate the child’s demands. That is, unless the parents have support in changing these pernicious patterns.
The support the parents need is in the form of relationships. There are many therapeutic techniques that are recommended, but I am skeptical of all of them that follow manuals and are short term. The children who get better from these techniques – and there are some that do – are on an “easy part of the spectrum”. The parents of children on the hard part of the spectrum need ongoing support to change their responses to their children. They need the support of a long-term therapeutic relationship that encompasses them and their child. I will continue with this subject in a future blog.
References
Beebe B, Lachmann F (2013). Origins of Attachment, New York: Taylor & Francis, pp. 95-139.
Nelson C A (2013). Biological embedding of early life adversity, jamapediatrics.com JAMA Pediatrics Published online October 28, 2013 E1
Kagan J (1989). The concept of behavioral inhibition to the unfamiliar, In Reznick, J, Ed., Perspectives on Behavioral Inhibition, University of Chicago Press, pp. 1-25.
Kagan J, Snidman N, Kahn V, Towsley S ( 2007). The Preservation of Two Infant Temperaments into Adolescence, Monographs for the Society of the Research in Child Development, 72 (2).
Snidman N (2011). Lecture on Temperament, U Mass Bos Infant Parent Mental Health Post Grad Certificate Program.
Stossel S (2014). My Age of Anxiety – Fear, hope, dread, and the search for peace of mind. New York, Random House.