Obesity in adults and its possible link to experiences of childhood abuse

I was researching material on this topic of adult body weight and obesity and its link to adverse childhood experiences, in effort to support my my work with a couple of female clients who have come for therapy to work on their struggles with obesity. These clients are highly functioning individuals, and are relatively successful in life. They are baffled at how they aren’t able to take charge of their eating habits.

A usual practice I follow is to first send the clients for medical examination to exclude extra-ordinary physiological illnesses.

The study below shown as screenshot by Williamson et.al. is just one example of many linking adult obesity to experiences of childhood trauma.

CONCLUSIONS to the study: “Abuse in childhood is associated with adult obesity. If causal, preventing child abuse may modestly decrease adult obesity. Treatment of obese adults abused as children may benefit from identification of mechanisms that lead to maintenance of adult obesity.”

Binge eating and other addictive behaviors around food have a protective function for the individual. Patients do this to brace themselves against emotional hardships. This behavior actually keeps them stable and functional. It is therefore fully understandable that the eating behavior is borne out of a real need. In adult survivors of childhood trauma, the impulse to eat uncontrollably stems from the need to regulate the nervous system which has been dysregulated by the experiencing of traumatic events.

A client reported that her trigger to binge eat happens the moment she gets home. When she enters the door of her apartment, she’d feel a frantic need to eat whatever is available in the refrigerator, and very quickly. Then she would not stop eating until her stomach starts to hurt. Following that, she’d feel a sense of calmness and guilt. This client has had a childhood history of feeling unsafe in the home. Her father was alcoholic, and her mother was verbally and physically abusive to my client and her siblings. As a child, the act of returning home from school filled her with need for comfort and a dread. This conflict of feelings, she says, returns to her body every time she returns home after a hard days work.

It is possible that one or more of the other clients who come to my office for weight management coaching may be survivors of childhood trauma. I would check with the clients first if they want to explore this. If they do, then the coaching sessions will have to be converted to trauma-focused psychotherapy. Whether or not change the focus of the session is entirely the choice of the client. The client will first have to provide us with informed consent.

Bibliography

Williamson, D. F., Thompson, T. J., Anda, R. F., Dietz, W. H., & Felitti, V. (2002). Body weight and obesity in adults and self-reported abuse in childhood. International journal of obesity26(8), 1075.

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Research: Core Conflictual Relationship Theme Method (CCRT)

The Core Conflictual Relationship Theme Method (CCRT) is an instrument used in researching process of psychotherapy.  In this article, a research work is cited in which this instrument is used in psychotherapy research.

The CCRT method is a measure of central relationship schemas of a person that are revealed through his/her narratives.

The CCRT (Luborsky, 1998) is one of the most employed methods of assessing relationship patterns. Over the last decade, it has been used to study numerous forms of psychopathology and symptom impairment, as well as the process of psychotherapy.

There is also evidence that the CCRT shares many characteristics with Freud’s transference theory. The CCRT assesses interpersonal narratives in three components:

  • (1) the wishes, needs, motivations or intentions of a subject (W);
  • (2) the response of others to the subject’s wishes (RO); and
  • (3) the response of the subject to others’ response (RS).

These three components are rated using the standard categories provided by the method, which includes 35 Wishes, 30 ROs, and 31 RSs. The manual gives detailed descriptions for each Wish, RO, and RS.

The CCRT components are identified in a series of Relationship Episodes (RE) told by the subject during an interview designed to collect such narratives (Relationship Anecdotes Paradigm [RAP]). An RE is a brief story or vignette of an interaction the subject had with another person.

Table is excerpt from Bond et.al 1987

 

Table is excerpt from Bond et.al 1987

The client’s relationship pattern is studied by analyzing the recorded transcripts of the therapeutic session.

Example from Drapeau & Perry (2004) research:

Title of this research paper is: Childhood trauma and adult interpersonal functioning: A study using the Core Conflictual Relationship Theme Method (CCRT).

The interview starts with the interviewer saying: “I am going to ask you to tell me stories of interactions you have had with others that struck you as particularly important, interesting or troublesome or a combination of those. These interactions must have happened within these last 6 months.” During the interview, the interviewer inquires about the wishes or desires the subject had during the interaction, how the other person involved in the interaction felt or reacted, and how the subject felt or reacted as a result of the other person’s response. The subjects in this study freely chose which stories to report, although the direction specified three general types, specifically occupation, close relationships and any therapy or professional relationship, all within a time-frame of the past 6 months.

The narratives or relationship episodes from 119 subjects were recorded, transcribed then scored using the CCRT method, with each subject giving approximately 10 or 11 recent relationship episodes. The interviews were scored using CCRT coding procedures and the data considered quantitatively.

For any given relationship episode, the rater is required to identify :

  1. which segments represent a W, a RO, and a RS and
  2. use the definitions provided in the manual to attribute a standard category to this specific segment.

This standard category, or score, is descriptive and reflects a specific type of motive or behavior.

Considering the data quantitatively allows us to examine the proportion of each CCRT category across the entire interview in comparison with the proportions in the other categories.

Two experienced raters were used. They rated a total of 8000 relationship episodes. Consensus rating and reliability assessment were don on randomly selected cases (20% of total).

Defining Trauma: Traumatic Antecedents Interview (TAI) Scale is used to determine which of the subject have what kind of traumatic experience. These factors, together with the results of the CCRT scores were tabulated as such.



Here is an example of how the results were interpreted

Example: “Verbal abuse (see table 1). The verbally abused group reported more of the wish to be distant from others (W10; trend only). The verbally abused group experienced others as less strong (RO24) and in interpersonal interactions, they themselves more often reacted by being not open (RS8). However, none of these differences remained significant following the Bonferroni corrections.”

 

Comments

The CCRT instrument seems to give a clear quantified overview of and individual’s relationship patterns. The purpose of reading this research article was to learn about how the CCRT is applied. In addition we are also offered an insight into childhood trauma.

 

Bibliography

Bond, J. A., Hansell, J., & Shevrin, H. (1987). Locating transference paradigms in psychotherapy transcripts: Reliability of relationship episode location in the core conflictual relationship theme (CCRT) method. Psychotherapy: Theory, Research, Practice, Training24(4), 736.

Luborsky, L. (1998). The Core Conflictual Relationship Theme: A basic case formulation method. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation (pp. 53–83). New York: The Guilford Press.

Luborsky, L., & Crits-Christoph, P. (1998). Understanding transference: The Core Conflictual Relationship Theme method (2nd ed.). Washington, DC: American Psychological Association.

Drapeau, M., & Perry, J. C. (2004). Childhood trauma and adult interpersonal functioning: A study using the Core Conflictual Relationship Theme Method (CCRT). Child abuse & neglect28(10), 1049-1066.