With Special Interview: Dawn Theodore, MFT, Clinical Director Eating Disorder Center of California
Many people who suffer from eating disorders report that they have experienced physical, emotional and/or sexual abuse prior to developing a disorder. In fact, some studies estimate that as many as 50% of eating disorder sufferers have experienced some type of physical or sexual abuse or assault. While there are certainly many people who experience abuse without developing an eating disorder, such as anorexia nervosa, bulimia nervosa or binge eating disorder, it is well-accepted that trauma can place a person at higher risk.
Abuse during childhood is thought to be especially problematic, since children process information in a different way than adults. They are developing their sense of self and their core beliefs about how the world around them works. When someone is told over and over again that they are not loved or that they are a problem, eventually they begin to believe it and take it on as their identity.
Survivors of abuse often learn how to cut themselves off from emotions, rather than learning how to deal with them appropriately. This can lead to acting out and impulsivity or completely shutting down. Examples of this may be drug use/abuse, truancy, and/or sexual promiscuity. Eating disorder behaviors can be used as a way to numb or escape painful emotions. However, it is important not to discount traumas experienced during adulthood, as they can play a role in the development and exacerbation of eating disorder symptoms as well.
Research has shown that women who struggle with bulimia nervosa report higher rates of childhood sexual abuse than women who do not have bulimia nervosa. It has also been shown that people who have experienced childhood sexual abuse report higher rates of bulimic symptoms than those who do not have that experience. Women who have experienced both childhood sexual abuse and adult rape have extremely high levels of eating disorder symptoms.
It is thought that emotional abuse can result in negative beliefs about oneself, such as “I am unlovable.” It can also result in difficulty in expressing emotions because emotional expression in the past may have resulted in critical or negative responses, setting up this expectation. People who have experienced emotional abuse may struggle with emotions in a way that could lead to chaotic and impulsive behaviors, which are most often associated with bulimia nervosa. Or, they may become detached and restricted in their emotions, which is associated more with anorexia nervosa.
Other Traumatic Events
Research is also beginning to show that traumatic transitional life events, such as the divorce of one’s parents, the death of a close family member or friend, or a difficult transition, also often precedes the development of an eating disorder. Although these events are different than physical, sexual and emotional abuse, this research underscores the idea that adequate support is needed when difficult things happen in a person’s life.
Because of the correlation between abuse and eating disorders, there are many people with eating disorders who are also suffering from symptoms of post-traumatic stress disorder, or PTSD. The psychological pain that is often experienced after abuse includes nightmares, intrusive thoughts and emotional numbing. Treatment for someone who has an eating disorder and is also a survivor of abuse must take all of these issues into account. “
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Connors, M.E., Morse, W. (1993). Sexual abuse and eating disorders: A review. International Journal of Eating Disorders, 13(1), 1-11.
Fischer, S., Stojek, M., Hartzell, E. (2010). Effects of multiple forms of childhood abuse and adult sexual assault on current eating disorder symptoms. Eating Behaviors, 11, 190-192.
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Zerbe, K. (1993). The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment. Carlsbad, CA: Gurze Books.
With permission by About.com Updated May 11, 2012 Reviewed by a board-certified health professional on the About.com advisory board