Eating Disorders and Sexual Trauma, Research Paper Example

The victimization of women, both sexually and otherwise, is a very common problem addressed in feminist theories and research.  Women are held at different standards from their male counterparts, are expected to act according to a certain type of unwritten guidelines; Fatema Mernissi (2002) addresses the concept of men setting standards for women in Western culture: men “declare that in order to be beautiful, a woman must look fourteen years old” (p. 73).  That can be extended to weight, facial structure, or many other aspects of a woman’s figure.  Aside from the subtle and indirect influence men have over women, there is a startling statistic from the National Sexual Violence Resource Center (2015) stating that “one in five women” will be raped in their lifetime (as opposed to “one in 71 men”) and that a total of “91% of victims of rape and sexual assault are female” (p. 1).  When those statistics are paralleled to the findings of ANRED (2011), which state that 90% of those diagnosed with eating disorders are female, there is an obvious possibility that the two—being reports of sexual assault against women and recorded percentages of women in eating disordered groups—are related (p. 1).  By analyzing the found connections between eating disorders and sexual trauma (both direct and mediational models), I will support the idea that women victimized by sexual trauma, because of high subjugation to criticism and oppression due to their gender, are at an increased risk of developing an eating disorder.

Generally speaking, the connection between sexual trauma in any gender and control-based eating 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.

However, research has struggled directly connecting sexual trauma and eating disorders, and most statistics are found using retrospective measurements.  Retrospectively, statistically speaking, 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 trauma 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.

There are obviously many links between sexual trauma and eating disorders, and while no single path can be predicted for a sexual trauma survivor, there is certainly a link of some sort.  Emotional responses to sexual trauma and assault oftentimes result in eating disorders.  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.

Bishop, Rosenstein, Bakelaar, and Seedat’s findings were especially important when looking at the link between sexual trauma and eating disorders; women will overcompensate after violation in order to become in control.  Another angle that supports reasons women are more vulnerable to developing eating disorders comes when the media is considered.  Women are bombarded by expectations from society regarding how to look, act, or be, and because most of those expectations are out of reach for a majority of women, it might result in an even higher sense of loss-of-control.  When women have been violated and face emotional trauma following that sexual assault, their emotional strength and resilience becomes compromised, making them even more vulnerable to the pressure of the media.  That vulnerability oftentimes shifts to self-hatred, which results in eating disordered symptoms.

There are many things in play when discussing the link between sexual assault and eating disorders; a direct link is possible while other mediating pathways might be considered.  Because of that link, women are especially vulnerable to developing eating disorders due to their high chances of experiencing sexual trauma at some point in their lives; when a woman’s body is violated (which is unfortunately very likely), her need to control her life might lead to the development of an eating disorder.  If that direct link were not there, however, the pressure of the media on a woman’s already shattered esteem will likely assist in driving a woman to an eating disorder.  Women are not only dramatically more vulnerable to being victims of sexual assault (which might result in eating disorders), the heavy scrutiny regarding their looks and what perfection is considered plays a large role in the development of low self-esteem and eventually an eating disorder.

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.

Statistics about sexual violence. (2015). National Sexual Violence Resource Center. Retrieved from http://www.nsvrc.org/sites/default/files/publications_nsvrc_factsheet_media-packet_statistics-about-sexual-violence_0.pdf

Statistics: how many people have eating disorders?. (2011). ANRED. Retrieved from http://www.anred.com/stats.html

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