In this episode, Dr. Gutstein continues his talk on co-occurring conditions by exploring topics such as eating disorders, OCD and more!
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Kat- I am going to bring up one of the co-occurring disorders that I think kind of ties to why RDI and our focus has to be first and that is Eating disorders. Our son had a really limited diet when was little and my husband and I really pursued I think, which turned out to be a pretty, without having RDI yet , went well when we did learn about the RDI plan for him. Now, He will try anything and his diet is very vast. Still, I remember when I started thinking about this from an RDI perspective and his trust in us as his guide when he was a little boy, in working towards trying other food. I can remember one specific thing when we went in the pantry, I showed him all the different things that could go with the things he did like and trying things together, it really changed his perspective on food. And the reason I like the two is I think we get one before the other sometimes. And some of these, the co-occurring disorders, the trust in their guide has to come first in building that relationship and then you can actually address these things.
Dr. Gutstein- And that’s another example, eating disorders being another example like anxiety disorders, depression are things that are more of a result of ASD, that sort of go along, come along with it from birth so to speak. Because you point out the eating, restricted eating, think about restrictive behaviour, restrictive actions that need to want to close off and limit the world that feels overwhelming, you know, one of the powerful ways to do that is limit, you have control over what you put in your body and especially if you don’t have control over much else, you can influence that, you can not eat it and limit what you eat.
And so , the other thing is if you’re in a sort of stability maintaining mode at all costs, you don’t have the curiosity, curiosity is one of the reasons we try new things, right? Why else, I want to see, I’m interested, let me see what happens, I want to explore. And so if curiosity is not on your mental menu why are you going to start trying new things why are you not limited but again that’s because what ASD has done, which is what we believe it’s, you haven’t been able to activate that growth seeking mode that is so basic to development and as you point out, once that gets activated then you can start to approach food in different ways which is alright I’m curious, would you like to try, yeah it can’t hurt and it might be interesting to see right and so curiosity starts to become more prominent right and the desire to explore and to find out and to expand and so you know it changes the whole nature of these type of eating disorders.
And you know the same thing with anxiety disorders, there are some children who are probably born genetically with a high predisposition to anxiety but there are others where the anxiety is definitely secondary to the idea of the world being for them incomprehensible, potentially always overwhelming, always disorganizing and I use that concept, it’s not my term dis organizational, cog developmental psychologists use it, the experience of being disorganized, it’s not knowing where your papers are it’s not that type of disorganization, it’s a mental disorganization, if I can’t make sense of anything going on, it’s a horrible feeling. It’s like oh nothing’s making sense here, I’ve lost any way of anchoring what is happening to my prior experience, it’s like everything is different everything unfathomable. That’s what we mean by disorganization umm internally which is a horrible feeling and if that is a frequent state, If that’s your default state that you’re trying to deal with, that’s going to impact a lot of things.
And that’s what we believe happens in ASD, is that it becomes a default state, rather than, for us, people without ASD it’s a state that we sometimes go into when we’re challenged or stuck with something but it’s not the way we walk around every minute of the day. So when it does happen, we can bear it, we can say oh ok that’s interesting, I don’t know what’s going on here and we go forward, we have a lot of history of going forward. But if that’s your default signal, otherwise if that’s how it feels unless you take actions to avoid that, to push it away, it changes everything that you’re doing throughout the day and every aspect of your behaviour.
And so a lot, we have to look at those co-occurring things whether their restricted repetitive behaviours, rituals, ??? de like symptoms and some anxiety symptoms and we have to say, Wait a minute, Are we seeing eating disorders, are we seeing this reaction, this person’s this is their attempt to header off that default state of disorganization or is it something else, in other words, do we actually have OCD genetically ya know along with their ASD. That’s a pretty hard thing to do sometimes, you really have to figure that out.
Now one of the things RDI helps you do is, it’s interesting to me cause one the children start to be growth seeking and they start to trust their guides, then you can see if they still have these other problems or not. Then you can say ok well that’s still, that’s a separate issue, That is a co occurring condition, it’s not a reaction to having ASD. I think that’s a very important thing to learn right and to understand, Otherwise, you’re going at a way without treating things that make things worse