Although research has shown little conclusive evidence of the correlation between eating disorders and sexual trauma, it is a different story in my psychotherapy office. I will always explore any potential link between a client’s struggle with food, weight and body image issues and their history of sexual trauma. Below are a few clinical examples of how my clients’ struggles with their eating disorders were directly related to their sexual trauma.
The story of Anna and how anorexia provided the perfect “asexual solution”
Anna was hospitalized for anorexia at age 16. She had been struggling with her eating disorder since the age of 12, and she realized she was queer when she was 19. She talked about the stormy period between ages 12-16 as her attempt to be as “asexual as possible” because, as she said, “I didn’t want boys to be attracted to me.” She was thrilled when her anorexia stopped her breasts from developing and eventually stopped her periods, because with that came less unwanted attention from boys.
It wasn’t until Anna realized she was [gay] that her anorexia started to make more sense to her:
What better way to stop the problem of boys and all that pressure to be a heterosexual than to stop eating? Once I got control of my eating I suddenly had control of everything! My period stopped, my breasts stopped growing and best of all, no more unwanted attention from boys. I didn’t realize why at the time, but I do remember feeling such a huge relief!
Part of Anna’s healing process from anorexia was to embrace her [homosexuality], suppressed by growing up in a heterosexual and homophobic environment. Once she realized what she was saying no to, her body didn’t have to do it for her.
The story of Margaret and how she used her weight to keep away sexual attention
Margaret came to me because she suffered from compulsive binge eating. She had a history of yo-yo dieting—gaining and losing weight over and over again. Her self esteem was at an all time low. She couldn’t understand why despite having the will power to lose the weight, she always put it back on.
After only a short time of working with me, Margaret went on a six-week trip to India and came back 25 pounds lighter. Part of the reason for this rapid weight loss was that she had caught a stomach bug, but mostly it was due to her friend Debbie’s eating patterns: Debbie ate when she was hungry, stopped when she was full and didn’t eat again until she was hungry. Margaret, who had lost her ability to read her hunger signals from repeated yo-yo dieting, followed Debbie’s rhythms and found that her own eating stabilized. With time Margaret discovered her own cues for hunger and satisfaction; this further helped to improve her relationship with food and her body.
Everything was fine until Margaret returned to the States and started to put the weight back on. We explored what had shifted for Margaret now that she was back in America. She confessed that she was binge eating again. When I explored with her what was triggering these binge episodes, it seemed that the main trigger for Margaret was feeling more attractive and getting more sexual attention. It unnerved her.
Margaret began to tell me about a rape she had survived 10 years ago. She started to piece together that she was putting weight back on because she was uncomfortable with the sexual attention and still suffered trauma from her rape.
The rest of Margaret’s treatment was focused on healing from her rape trauma and learning how to voice her need for boundaries so that her body didn’t have to do it for her. Once Margaret was more conscious about the need to establish sexual boundaries, her weight came off and stayed off!
Sue’s bulimic cycle and how it mimicked her childhood abuse cycle
Sue had suffered from bulimia for 15 years. She was scared about the effect it was having on her teeth, hair and skin. She wanted to get healthy again. Sue had also been repeatedly incested by her father from ages 5-9 years old. At the time it was the only attention she got from an adult. Her mother was an alcoholic and neglected her. When Dad gave her attention, it was confusing; some of it felt good and some of it felt really toxic.
The turning point in Sue’s recovery happened when she realized that the relationship she had with food mimicked the relationship she had with her Dad as a girl. Sue barely ate all day and when she did she usually binged, then purged. In a similar way, she got little attention growing up, and when she did, it was usually in the form of sexualized attention from her Dad that was overwhelming and confusing.
On the one hand I was getting the attention I so desperately needed, but at the same time it felt really toxic. I do this with food; I overwhelm my body with too much food and then throw it up because it feels toxic.
Once Sue identified the cycle of abuse she was inflicting on her body and how it mimicked the abuse she suffered growing up, she was able to start healing her bulimia.
Each of these clients had different stories and suffered from different trauma, yet all of them suffered from a battle with food, weight and negative body image that had its roots in sexual trauma. Once the roots were discovered, their healing began. This is why when working with clients I always have enormous respect for “the problem.” Problems don’t persist unless they serve a function. Once we discover the function the problem serves, we can develop more choices for healthier ways to replace that function.
For Anna it was learning how to say no to the pressure to be heterosexual so that her body didn’t have to do it for her.
For Margaret it was learning how to create sexual boundaries so that she didn’t need the weight to make the boundary for her.
For Sue it was making the connection between the abuse she suffered as a girl and the abuse she was inflicting upon herself as an adult.
More research is needed to fully understand the correlation between eating disorders and sexual trauma. For now, I will continue exploring the link client by client.
R. Oppenheimer, K. Howells, R. L. Palmer and D. A. Chaloner (1985). Journal of Psychiatric Research 19(2-3), 357-361.
Seventy-eight eating disordered patients were asked systematically about any history of adverse sexual experience. About two thirds gave such a history. The events reported were often distressing and significant to the subject. It is unclear what role such events play in the causation of later eating disorder.
2) Reported sexual abuse and eating psychopathology: A review of the evidence for a causal link.
Joanne Everill B.Sc., Glenn Waller D.Phil. (1995). International Journal of Eating Disorders 18(1), 1–11.
It has been claimed that there is no specific link between a reported history of sexual abuse and the eating disorders. In particular, studies and reviews investigating the relationship between reported sexual abuse and the eating disorders have concluded that the prevalence rate of abuse among eating-disordered women is similar to the rates found in other psychiatric groups and in the general population.
However, it is argued in this review that such a conclusion is based on an inappropriate level of analysis of the phenomena of sexual abuse and diagnosable eating disorders. When these two relatively blunt constructs are considered in finer detail, there appears to be a complex link between the nature of sexual abuse and specific bulimic symptomatology.
This relationship is discussed with particular reference to important mediating factors (including dissociation, self-denigration, borderline personality disorder, and disclosure experiences), the functions of the bulimic behaviors, and the particular cognitive schemata that the victims of abuse may develop. The clinical implications of this relationship are considered, and suggestions are made for further research. © 1995 by John Wiley & Sons, Inc.
3) A meta-analytic examination of the relationship between child sexual abuse and eating disorders.
Linda Smolak, Sarah K. Murnen (2002). International Journal of Eating Disorders 31(2), 136–150.
Objective–> This study had two goals. The first was to assess the magnitude and consistency of the relationship between child sexual abuse (CSA) and eating disorders (ED). The second was to examine methodological factors contributing to the heterogeneity of this relationship.
Method–> Meta-analysis was used to examine both questions. Fifty-three studies were included in the analysis.
Results–> A small, significant positive relationship between CSA and ED emerged. The relationship was marked by heterogeneity. Effect sizes were largest when CSA was the grouping variable, the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT) was used as the measure of eating disorders, and nonclinical groups were compared with clinical samples.
Models of CSA and ED need to more clearly specify what aspects of ED (e.g., body image or binge eating) are most influenced by which types of CSA. These specific relationships then need to be examined empirically. © 2002 by Wiley Periodicals, Inc. Int
4) Childhood sexual experiences with adults reported by women with eating disorders: an extended series.
R.L. Palmer, R. Oppenheimer, A. Dignon, D.A. Chaloner and K. Howells (1990). The British Journal of Psychiatry 156, 699-703.
A total of 158 women presenting with clinical eating disorders have been investigated using a self-report questionnaire and subsequent interview concerning their recollections of sexual experiences with adults before the age of 16 and later adverse sexual experiences. About a third reported events in childhood and over half described some adverse experiences. It may be that these experiences are relevant to the subsequent illness in some cases, but greater certainty must await further research. In the meantime, inquiring about such matters would seem to be advisable in the assessment and therapy of eating-disordered patients.
About the Author: Ondina Nandine Hatvany, MFT is Director of the Eating Disorders Program at Community Institute of Psychotherapy in San Rafael, CA. She also has practices in Mill Valley and San Francisco. She works with food, weight and body image using a health at every size approach (HAES) This approach encourages developing a non-diet lifestyle to end the battle with food, weight and our bodies. One of the biggest ways Ondina sees particularly women dis-empower themselves is through the constant battle against their bodies and appetites.