Eating Disorders and Sexual Trauma: A Mixed Relationship, Research Paper Example

Many individuals with eating disorders report having experienced some form of trauma, usually as a child. As a result, a great deal of research has been conducted to determine if eating disorders can be directly correlated with sexual trauma. Many hypotheses have been made to explain why those who were victims of sexual trauma consequently developed eating disorder. One explanation is that eating disorder behaviors are used as coping mechanisms to deal with the prior abuse. Often those abused strive to obtain unrealistic body shapes as a way of dealing with the low self-esteem they may have due to the abuse. Also, the relief of binge eating or purging is a way of numbing the memories of what they felt when they were sexually assaulted. Moreover, inducing vomiting, restricting food intake, and using laxatives provide a sense of empowerment to the victims because they feel they have control of their bodies. Having a sense of control over their bodies provides the victims with a temporary sense of empowerment. Also, many victims believe that if their bodies are not sexually appealing, they are prevented the possibility of another attack. The function of the eating disorder varies from one victim to the next. Nevertheless, for each victim of trauma, the disorder serves as a coping mechanism to maintain psychological stability.  The focus of this paper will be the use of eating disorders as a coping mechanism to endure the mental anguish of being a victim of sexual abuse.

Many victims who suffer from eating disorders have reported being sexually abused as children. Sexual abuse of a child is defined as any coercing of a child into sexual behaviors or acts(  ).  The child may not fully understand the act or behavior, be unable to give consent, or is not mentally developed enough to understand that what they are being asked to do goes against laws, culture, or even religious beliefs. Nevertheless, the violation or abuse can occur between a child and an adult or even two children. Usually, one person seems to be in a position of power or authority over the other. The act that is completed is intended to please the abuser, not the victim.

The relationship between eating disorder development and sexual trauma that may have occurred earlier in life has been a mystery to psychologists and researchers alike, and research has yielded mixed results.  Because of the many factors behind developing and upholding eating disorders, it is impossible to link a single experience to the development of disordered eating; some researchers believe that genetics are more to blame for eating disorder development than any environmental or traumatic experience (for instance, Treasure, Claudino, and Zucker (2010) assert that “twin and family studies suggest that . . . the estimated heritability ranges between 50% and 83%” (p. 585)) while others tend to point the blame toward experiences.  Because of the difficult nature of mental disorders and any type of trauma, it is virtually impossible to get any concrete link between a disorder and what caused it; a vast amount of factors, including genetic, situational, and attitude play a part in the development of mental disorders.  Nevertheless, the link between trauma and eating disorders is very concrete.

In one article, Sexual Abuse and the Problem of Embodiment, the researcher discusses trauma, sexual abuse, and the potential long term effects that can be suffered as a direct effect of abuse. Young conveyed that sexual abuse can lead to an array of psychological distress, dissociation, eating disorders, drug and alcohol abuse, but the most common disorder is self-mutilation and suicide. So, it is evident that eating disorders are a display of another underlying mental condition.   According to the research, people who suffer the most psychological effects have suffered intrusive penetration anal, oral, or vaginal. The researcher, Leslie Young, sought to determine if people who are sexually abused suffer from certain psychological disorders more often than people who were not sexually abused. Yet, that data remained inconclusive. Yet, she did conclude that eating disorders or the tactics that victims use are mechanisms of coping with the trauma of the incident. One common characteristic of abused people is to pretend that the incident did not happen or block it from their memory. One way to block the incident from memory is to engage in another activity whenever the memory becomes an issue. The most common way to suppress the issues is through over eating or starving oneself.

Young also sought to show a connection between the extents of psychological disorders due to the relationship the abused had with the abuser. For example, a person who has been abused by an immediate family member (brother or father) will have more psychological effects than a person who has been randomly attacked. Researchers believe that this is so because of the breach of trust that is caused when the attacker is someone the victim knows. Young also conveys that the traumatic stress level is greater when the abuse is ongoing, rather than just a onetime event. Often when the abuser is known or a relative the abused, the abuse can occur for years.

Of all the psychological effects, self-mutilation and suicide attempts are the most common among survivors. According to Young, many of the abused feel that their bodies have betrayed them by being too small or too weak to protect them from their attacker. As a result, when the abused attacks his/her own body, they feel they have somehow gotten even with their body for not being able to save them and their attacker. One study that Young looked at discovered that 39 percent of people abused practiced self-mutilation, 16 percent had attempted suicide at least once, and about 17 percent had ongoing eating disorders.

Those suffering from the trauma of sexual abuse displayed symptoms of anorexia nervosa or bulimia nervosa; both are very serious eating disorders that can include binge eating. Both illnesses are brought on by the preoccupation that the victim is unhappy with his/her body. The victims of anorexia set very strict limits on how much food to intake, while those with bulimia have very little control over the food they intake. Consequently, they over eat and then vomit as a mechanism of guilt. Nearly two of every 100 teenage girls are affected by anorexia. However, the onset of the disease can be experienced later in life. The causes of eating disorders are very complex, but are often linked to prior sexual abuse. Most eating disorders are directly linked to trauma. Up to forty-percent of eating disorder victims attribute their disorder to sexual trauma(  ). Both men and women suffer from eating disorders, but the disease is more prevalent in women than men. When a person experiences a stressful experience such as rape or ongoing molestation, which leaves the victim feeling powerless, they must find another outlet to take control of.  Both diseases have various physical effects that can be life threatening if left untreated. Some of the problems may include: harm to kidneys, urinary tract infections, dehydration, seizures, loss of menstruation cycles in women, and inability to concentrate and think rationally(  ).

Theoretically speaking, the connection between sexual trauma and control-based disorders seems plausible; Fairburn and Harrison (2003) attribute several motivational factors to the development of eating disorders, one of which is “a need to feel in control of life, which gets displaced onto controlling eating” (p. 411).  Given the level of violation involved when any type of sexual trauma is forced upon a victim, any control a victim might feel is minimal, if not non-existent, which makes Fairburn and Harrison’s assertion especially relevant.  Perhaps a victim will, in an attempt to regain the control that was taken from them during any sexual attack, attempt to overcompensate by controlling food intake.  Root (1991) elaborates on this theory, saying that “the violation of physical space endured during a sexual abuse and rape epitomizes the height of loss of control over one’s body”; this loss of control oftentimes results in an attempt to take control of what can be controlled, which generally equates to food intake and physical size (p. 98).  Root continues to discuss other theories regarding a possible connection between eating disorders and sexual trauma, even going so far as to say that purging and fasting is a victim’s attempt at purification after the incident.  By taking a look at factors such as a need for control, which are found in many types of eating disorders, any link found between eating disorders and sexual trauma seems theoretically logical.

There is obviously a connection between general trauma and eating disorders, which Harned and Fitzgerald (2002) discuss; by interviewing women who had already been diagnosed with an eating disorder, Harned and Fitzgerald found that “29%-64% of women with eating disorders [reported experiencing childhood sexual abuse . . . 11%-27% have been raped at some point in their lives” (p.1170).  In comparison, Rape, Abuse, and Incest National Network (RAINN) (2012) reports that 7% of general-population, underage girls experience sexual abuse and 18% of general-population women were victimized by rape or attempted rape in their lifetime.  When comparing the general population percentage of childhood sexual abuse (7%) to the much higher percentages found in women with eating disorders (29%-64%), a clear red flag is seen; such a great difference between the two percentages is significant and suggests some type of relationship between childhood sexual abuse and the later development of eating disorders.  Whether that relationship is direct or mediated is unknown, but because of the great difference in percentages (between 12% and 57%, with women with eating disorders having far more) it is obligatory to explore how those numbers could come to be so different.

Holzer, Uppala, Wonderlich, Crosby, and Simonich (2008) attempt to explain this connection using a meditational model that links sexual trauma, PTSD from that trauma, and eating disorders discovered later in life.  Rather than questioning subjects that were already receiving treatment for eating disorders, thus looking at the retrospective relationship between sexual trauma and eating disorders like previously mentioned researchers had, Holzer et al. interviewed victims of sexual trauma using questionnaires that assessed “eating disorder psychopathology and posttraumatic stress disorder symptomatology” (p. 561).  Holzer et al. compared the results of the sexually traumatized group with a non-victimized group and found that there was a significantly higher amount of PTSD symptoms in the victimized group than the control; they also discovered that the prior showed increased eating disorder psychopathology than the latter (p. 564).  While Harned and Fitzgerald’s research focuses on finding histories of sexual assault within patients already diagnosed with eating disorders, Holzer et al. do the exact opposite; they look for eating disorder and PTSD symptoms within a group of women that had already reported sexual assault.

Holzer,  et. al reasons that PTSD is a more “natural consequence” of sexual trauma, and because of the symptoms and demands of PTSD, it is not a stretch for an eating disorder—or at least a mix of symptoms that appear to be one—to portray itself over time.  A common part of PTSD is “arousal,” which is characterized by alertness and easy emotional excitement, which Holzer et al reasons to be difficult to manage; as a coping strategy, victims might use eating disorder symptoms to manage aversive emotional arousal cause by the PTSD (p. 565).  The connection between sexual trauma, PTSD, and bulimia nervosa—a specific type of eating disorder—is supported by Dansky et al (1995), who discuss the connection between sexually- and nonsexually-traumatized women, and eating disorders; by measuring the victimizations separately, Dansky et. al got a better look at how general trauma is related to eating disorders. Dansky et. al’s results show a strong correlation between PTSD and bulimia nervosa, which supports Holzer et al.s’ findings and further suggests that PTSD acts as a mediator between sexual trauma and eating disorders.

Similarly, Dworkin, Javdani, Verona, and Campbell (2014), discuss a second mediation model regarding the relationship between sexual trauma, impulsive and compulsive tendencies, and disordered eating.  Because impulsive and compulsive tendencies “have been identified as sequelae of CSA victimization in some survivors,” Dworkin et al reason that impulsive or compulsive tendencies could potentially mediate the relationship between sexual traumas and disordered eating (p. 22).  By having subjects complete an online survey that asked about child sexual abuse severity, impulsive tendencies, compulsive tendencies, and disordered behaviors, Dworkin, et al. found stronger relationships between compulsive tendencies than impulsive when explaining the relationship between sexual traumas and disordered eating (p. 30).  The relationship between impulse control disorders (ICDs), which are marked by failure to resist an urge to do something, and disordered eating is illustrated as being very strong by Fernàndez-Aranda, et al. (2008), who ran a similar experiment that yielded similar results.

Sexual trauma is an especially specific type of abuse, and while eating disorders are oftentimes underlined by a history of general trauma and abuse, it is not always sexual.  Because records of abuse generally show that sexual trauma and abuse is usually correlated with other types of abuse, such as physical or emotional, it is safe to correlate eating disorders as a coping mechanism.  Kent, Waller, and Dagnan (1999) suggest the importance of looking at different types of abuse as they relate to eating disorders and claim no relationship between sexual trauma and eating disorders after their research regarding all types of abuse and the relationship to eating disorders.  Kent, Waller, and Dagnan recorded self-report measures of “abuse, eating psychopathology, and psychological function” along with many “regression analyses” in order to gather information from more than two hundred women (p. 159).  By gathering information on many types of abuse (including physical, sexual, and emotional), Kent, Waller, and Dagnan were able to broaden their view and see which of the abuses were more impactful on women’s lives; their findings state that emotional abuse in childhood is the only predictive type of abuse (p. 166).  Because the different types of abuse commonly overlap (meaning that a child experiencing sexual abuse may also be experiencing emotional abuse) it becomes difficult to decipher whether the relationship between abuse and eating disorders later in life is because of the sexual abuse, or because of emotional abuse associated with it.

Kent, Waller, and Dagnan (1999) found that “the effects of CEA on eating psychopathology were mediated entirely through anxiety and dissociation,” with anxiety being the stronger mediator (p. 166).  They go on to suggest that the relationship between eating disorders and any type of trauma must have several mediator links rather than a direct cause-and-effect relationship (such as that between childhood emotional trauma and eating disorders), which is in line with the findings and discussions of both Holzer et al. and Dworkin et al.  Because of the less defined definition of emotional abuse and because of its non-substantial wounds, a victim of emotional abuse is likely to feel “perceptions of vulnerability (linked to anxiety in the cognitive literature), rather than with clear perceived loss” (p. 166). This vulnerability is oftentimes unwelcomed by those suffering abuse, and it is not a far stretch to assume that those suffering from feelings of vulnerability will want to do whatever possible to stop feeling that way.  As a result, victims of emotional abuse might overcompensate and try to take control of what they can; because food intake is one of the only things they can certainly control, victims might take advantage of the fact.

Shafran, Fairburn, and Cooper (1998) discuss the relationship between control and anorexia which they, like Kent, Waller, and Dagnan, attribute more so to emotional trauma and socially dysfunctional relationships than any type of physical or sexual abuse or trauma.  Anorexia, Shafran, Fairburn, and Cooper claim, support the idea that anorexia is a show of “direct and immediate self control” that might result from an over controlling environment under the “rule” of others (p. 4).  Bishop, Rosenstein, Bakelaar, and Seedat (2014) provide an in-depth discussion of what is included in emotional abuse, and one of the primary factors of a parent-to-child abuse system is the parents’ overwhelming need to control every part of the child’s life; that control can extend from clothing choice, to friend choice, to time management (p. 10).  Given that emotional abuse victims feel vulnerable and want control, it becomes even more necessary for them to take the control that they can get, wherever they can get it.  Eating disorders have a very deep, emotional drive, which makes the likelihood of the true trauma culprit being emotional trauma rather than sexual trauma even larger.

The connection between eating disorders and any type of trauma is not complicated, but rather very evident.  Because of the nature of mental illness, memory, and personal history, it is nearly impossible to get an “accurate” understanding of the relationships between illnesses, genetic things that help bring that illness about, and environmental and social components that either develop or help keep the illness strong.  While many theoretical connections between sexual trauma and eating disorders can be made—such as the loss of control while being sexually violated relating to the over-compensation of control found in anorexia nervosa—they have yet to be scientifically proven.  Several researchers have attempted developing mediating theories that provide links between eating disorders and sexual trauma (such as PTSD or impulsive and compulsive behaviors), but those links are not direct in nature.  Emotional abuse is far more easily connected to eating disorders than sexual abuse is, but that still leaves a very important point: there are many things that cause eating disorders, and while different types of traumas may play a role in an eating disorder’s development, those traumas are in no way predictive. Yet, in all cases, the disorder is used as a coping mechanism for the onset of a trauma.

References

Bishop, M., Rosenstein, D., Bakelaar, S., & Seedat, S. (2014). An analysis of early developmental trauma in social anxiety disorder and posttraumatic stress disorder. Annals of General Psychiatry, 13(16), 1-13.

Dansky, B. S., Brewerton, T. D., Kilpatrick, D. G., & O’Neil, P. M. (1995). The national women’s study: relationship of victimization and posttraumatic stress disorder to bulimia nervosa. International Journal of Eating Disorders, 21(3), 212-228.

Dworkin, E., Javdani, S., Verona, E., & Campbell, R. (2014). Child sexual abuse and disordered eating: the mediating role of impulsive and compulsive tendencies. Psychology of Violence, 4(1), 21-36.

Fairburn, C. & Harrison, P. (2003). Eating disorders. The Lancet, 361(1), 407-416.

Fernàndez-Aranda, F., Pinheiro, A. P., Thornton, L. M., Berrettini, W. H., Crow, S., Fichter, M. M., . . . Bulik, C. M. (2008). Impulse control disorders in women with eating disorders. Psychiatry Research, 157, 147-157.

Harned, M. S. & Fitzgerald, L. F. (2002). Understanding a link between sexual harassment and eating disorder symptoms: a meditational analysis. Journal of Consulting and Clinical Psychology, 70(5), 1170-1181.

Holzer, S.R., Uppala, S., Wonderlich, S. A., Crosby, R. D., & Simonich, H. (2008). Mediational significance of PTSD in the relationship of sexual trauma and eating disorders. Child Abuse & Neglect, 32, 561-566.

Kent, A., Waller, G., & Dagnan, D. (1999). A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: the roles of mediating variables. International Journal of Eating Disorders, 25(2), 159-167.

Root, M. P. P. (1991). Persistent, disordered eating as a gender-specific, post-traumatic stress response to sexual assault. Psychotherapy, 28(1), 96-102.

Shafran, R., Fairburn, C. G., & Cooper, Z. (1998). A cognitive behavioral theory of anorexia nervosa. Behavior Research and Therapy, 37, 1-13.

Treasure, J., Claudino, A. M, & Zucker, N. (2010). Eating disorders. The Lancet, 375, 583-593.

Who are the victims?. (2012). Rape, Abuse, and Incest National Network. Retrieved from https://rainn.org/get-information/statistics/sexual-assault-victims

Young, L. (1992). Sexual abuse and the problem of embodiment. Child Abuse & Neglect 16(1), 89-100.