Food maintenance syndrome (foster care)

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Food maintenance syndrome is an eating disorder common in children in foster care. It is believed to develop from previous stressors and neglect. Compared to other eating disorders, little is known about the condition, so it can go undetected or be misdiagnosed.

Read on to learn about the signs and symptoms of food maintenance syndrome and how to find the right treatment if you suspect someone you know may have this eating disorder.

In this article

What is food maintenance syndrome?

Food maintenance syndrome is an eating disorder in which an individual feels compelled to overeat and/or hoard food. (1) This pattern of excessive eating and food acquisition occurs without an individual being of higher weight. This eating disorder is most prevalent among children in foster care and abused and neglected children. (2)

Those with food maintenance syndrome have a survivalist response to food. This causes them to eat excessively, often to the point of being painfully full, or to hoard food, in case they don’t have access to enough food in the future.

Diagnosing food maintenance syndrome

Food maintenance syndrome is not as well understood as some other eating disorders, and it’s not currently recognized as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). As a result, it can sometimes be misdiagnosed as an other specified feeding and eating Disorder (OSFED) or as obsessive-compulsive disorder.

Additionally, most children in foster care with disordered eating behaviors are not of higher weight. (2) Foster children who exhibit certain eating behaviors–such as overeating at mealtimes and hoarding food–should be assessed by a mental health professional who observes eating habits, how a child is fed, and the feeding environment. 

The assessment should also include a medical and psychosocial history to learn about a child’s past to determine what may have led to current eating behaviors, such as injuries or medical conditions, living conditions, family dynamics, and any trauma that may have occurred as a result.

Signs and symptoms of food maintenance syndrome

The common signs of food maintenance syndrome are triggered by the fear that food may not be available in the future. Signs and symptoms include, but may not be limited to: (3,4)

  • Overeating to the point of feeling uncomfortably full and nauseous
  • Apparent lack of satiety (feeling satisfied)
  • Eating quickly
  • Becoming upset if someone eats from their plate
  • Stuffing food in the mouth
  • Hoarding and hiding food to eat later
  • Stealing food from stores or homes they visit
  • Refusal to throw away any leftover food
  • Only eating a specific amount of food
  • Purposely not eating enough

Effects of food maintenance syndrome

The short-term effects of food maintenance syndrome are rather subtle and could be easily mistaken for something else. The overeating seen with this eating disorder commonly causes gastrointestinal issues, such as: (3,5)

  • Abdominal pain
  • Nausea and vomiting after meals
  • Indigestion
  • Swallowing difficulties

Long-term effects

The long-term effects of food maintenance syndrome may have a more significant impact on a person’s day-to-day life. Nutritional deficiencies and electrolyte imbalances may occur, particularly if an individual with food maintenance syndrome only eats a narrow range of foods.

Furthermore, eating to the point of being sick regularly can lead to rumination disorder, where a person vomits effortlessly shortly after every meal. This has some medical complications of its own, including tooth erosion, respiratory issues, and gastrointestinal issues.

Food maintenance syndrome can also have a significant effect on a person’s mental health and wellbeing, with sufferers often developing anxiety disorders and having difficulties sleeping.

Some of the long-term effects of food maintenance syndrome include:

  • Increased blood pressure
  • Impacted growth and failure to thrive
  • Rumination
  • Diabetes
  • Weight loss or weight gain
  • Nutritional deficiencies
  • Sleep disturbances
  • Anxiety
  • Hormonal changes

Related disorders

There are often co-occurring disorders with food maintenance syndrome, particularly in those who have been abused or traumatized, including: (1,5)

  • Obsessive-compulsive disorder
  • Anxiety disorder
  • Depression
  • Rumination disorder
  • Post-traumatic stress disorder

Treatment of food maintenance syndrome

Many individuals with food maintenance syndrome may have experienced years of food deprivation. Therefore, even when they are in a home where adequate food is available, the fear of future deprivation remains. 

The goal of treatment for food maintenance syndrome is to address the mental effects of previous food deprivation and neglect, to help prevent disordered food behaviors. 

Plus, it’s also important that any other co-occurring mental health conditions–such as obsessive-compulsive disorder or anxiety disorder--are addressed as well, to improve treatment outcomes.

Therapies for food maintenance syndrome

As children’s early feeding/eating environments are a powerful influence on their future eating behaviors, early intervention is important. The following therapies and interventions may be helpful in the treatment of food maintenance syndrome:

  • Cognitive behavioral therapy (CBT): CBT works to identify the triggers of food maintenance syndrome, as well as replace the disordered eating behaviors with healthier ones.
  • Family therapy: Foster families of a child with food maintenance syndrome will benefit from psychoeducation about the eating disorder, as well as healthy nutrition, family meals, and physical exercise. (6) This enables families to support their foster children in their recovery, understand why a child engages in overeating or hoarding, and address unresolved conflicts.
  • Nutrition counseling: This form of therapy teaches those with food maintenance syndromes and their families how disordered eating behaviors affect the body. A nutrition counselor can also help develop meal plans to ensure nutritional needs are met.
  • Family mealtimes:  Research suggests family mealtimes may provide appropriate modeling for healthy eating behaviors, as well as prevent problematic eating behaviors. (6) Through family mealtimes, a foster child can be reassured over time that they will never have to go hungry again.

Within Health specializes in providing personalized treatment programs tailored to an individual's needs. 

Medications for food maintenance syndrome

There are currently no approved medications for food maintenance syndrome. However, medications may be prescribed to treat co-occurring mood disorders, such as anxiety or depression. Supplements may also be administered to address any nutritional deficiencies.

Understanding food maintenance syndrome

Children in foster care often present with trauma and other pressing issues, so eating and food-related behaviors can be ignored. (6) Furthermore, those with food maintenance syndrome are usually not of extreme low or high weight, so disordered eating behaviors may be dismissed.

However, research has found past trauma, neglect, and food deprivation drive the eating behaviors associated with food maintenance syndrome. Therefore, it’s crucial to view these behaviors as signs and symptoms of this trauma. It’s also important to reassure foster children that there will always be enough food and never use food as a reward or a punishment.

Living with food maintenance syndrome

People with food maintenance syndrome live with constant fear and anxiety that they will not have access to enough food in the future. This fear of going hungry again can have a significant effect on their mental well-being and relationships. However, recovery from food maintenance syndrome is possible.

How to help someone with food maintenance syndrome

Early intervention is key in the treatment of food maintenance syndrome. Finding the right kind of medical and psychological support to address both the symptoms and underlying causes of the eating disorder is key to successful treatment outcomes. The multidisciplinary team of medical professionals at Within Health has the highly specialized expertise in eating disorders that’s essential in providing the services and support needed for a full recovery.

Call our admissions team today to find out how we can help.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Food maintenance syndrome. (2017, June 13). Disorders.org  
  2. Tarren-Sweeney M. (2006). Patterns of aberrant eating among pre-adolescent children in foster care. Journal of Abnormal Child Psychology, 34(5), 623–634.
  3. Symptoms of food maintenance syndrome. (2014, December 11) Disorders.org 
  4. Janet M. Demb, (1991) Reported hyperphagia in foster children, Child Abuse & Neglect Volume 15, Issues 1–2, Pages 77-88.
  5. Homer, E. (2020, October 15). Food hoarding. Continuum Consulting. 
  6. Casey, C. M., Cook-Cottone, C., & Beck-Joslyn, M. (2012). An overview of problematic eating and food-related behavior among foster children: Definitions, etiology, and intervention. Child and Adolescent Social Work Journal, 29(4), 307-322.
  7. Tarren-Sweeney, M; Hazell, P (2006). Mental health of children in foster and kinship care in New South Wales, Australia. Journal of Paediatrics and Child Health. 42 (3): 89–97.

FAQs

Why is food maintenance syndrome prevalent in foster care?

Food maintenance syndrome is highly prevalent in children in foster care. This is believed to be a response to maltreatment or neglect, resulting in an inadequate food supply. These children may develop heightened survival instincts toward food. Therefore, when they have access to food, they consume to excess and hoard any remaining food.

What are the signs of food maintenance syndrome?

The primary signs of food maintenance syndrome are overeating at mealtimes and hoarding food whenever possible. Other signs of food maintenance syndrome include:

  • Eating quickly
  • Stealing food
  • Refusing to throw away leftover food

How common is food maintenance syndrome?

In the general population, food maintenance syndrome is rare. However, there are certain populations where this eating disorder is common, such as children who have been abused or neglected and children in foster care. Although it’s unclear how prevalent food maintenance syndrome is, studies have suggested it could be as high as 25% in children in foster care. (7)

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