Sexual Trauma and Eating Disorders

By: Kristin Lore, LCSW

There has been much written in the past twenty years about the connection between sexual trauma and the development of eating disorders. Researchers have presented evidence both supporting and refuting the idea that sexual trauma is causal in those with eating disorders. Some early studies including one by H.G. Pope Jr. and J.I. Hudson, (1992) expressed that the evidence did not support sexual trauma as a causal factor in the development of eating disorders. Their data was later questioned and felt highly selective, (Wooley, 1994). Many researchers who refuted the relationship between sexual trauma and eating disorders based it on a direct cause-and-effect link. There are too many variables involved and it cannot be concluded that because sexual trauma is not the only factor that it is not a factor at all.

With a myriad of studies it remains unclear as to a definite statistical relationship. Exact data about the incidence of sexual trauma affecting women with body image and eating disorders is impossible to attain because such violence is underreported, (Maine, 2004). At times the literature has favored a strong link between the two while other studies seem to indicate that the incidence of sexual trauma is as high in non eating disordered populations as in eating disordered populations. What seems to be more accepted is not the generalization that those with eating disorders have likely been sexually abused but rather that those with sexual trauma are vulnerable to developing an eating disorder. The eating disorder symptoms have a metaphoric meaning to the person who has suffered sexual trauma.

While researchers argue about sexual trauma being a risk factor to developing an eating disorder, it is important for clinicians to explore any abuse history and to understand how the symptoms serve the patient. To this end, it is vital in treating one with an eating disorder to understand that the symptoms serve many purposes. Specifically with those who have been sexually traumatized we can look at the functions of the eating disorder as serving different purposes:

• self-punishment
• expression of anger
• exerting control over what goes in and out of the body
• purification
• escape into a world without the abuse
• numbing
• avoidance of intimacy

It is very helpful to explore and listen to the way patients describe their eating disorder symptoms connected to their sexual trauma. Many describe using their symptoms in a violent manner. One patient described using the back of a knife to induce purging. She said it often did not work initially and she had to repeatedly push it down her throat. She felt like she was punishing herself as she blamed herself for being “weak” and “letting” the abuse happen. In this there is a reenactment of the abuse but this time she is the abuser and the victim. With this act though she has control over the abuse which she did not have previously.

Many patients with eating disorders have difficulty dealing with anger. Often in their families anger was discouraged and many times these women did not learn the emotional language to describe these strong

feelings. Starvation and self-induced vomiting can be viewed as an expression of anger. This is particularly profound with women who have been sexually traumatized. As many describe it is their way of releasing the rage they feel.

Often we hear that eating disorder sufferers have issues with control. They describe their eating disorder symptoms as a way of exerting control over their lives. The use of binging and purging by vomiting, laxatives and diuretics is a way of controlling what goes in and out of their bodies. As one patient described it is a way of controlling pain, of being able to hurt yourself more than anyone else can hurt you. Sexual abuse also intensifies body shame in many women creating a need for “purification” that may be served by self-starvation or induced purging.

The eating disorder itself creates a separate world for a person. It is a world where very little can be thought about outside of calories, food intake and body image. Therefore it is a world of escape from the trauma and from the painful thoughts and feelings that accompany it. It is a powerful way of numbing oneself.

People with Anorexia and Bulimia describe their symptoms at times as a way of avoiding sexual intimacy and as a mean to keep potential perpetrators from finding them to be sexual beings. Returning to a pre-pubescent body through starvation and/or building “armor” through binging brings the fantasy that a perpetrator will not find the woman to be sexual.

Helping patients understand how their symptoms have served them and helped them to survive sexual trauma is an important part of helping them let go of those symptoms. They need to process and ultimately not feel shame about their eating disorder symptoms but rather begin, in the context of a healing relationship, to build more adaptive ways to deal with the trauma and learn how to effectively soothe and nurture themselves.