Eating Disorder Treatment of Anorexia and Bulimia

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International Eating Disorder Referral Organization

 

Sexual Abuse and Eating Disorders by Mary Anne Cohen, CSW, Director – The New York Center for Eating Disorders

In my eating disorder practice, 40 to 60 percent of the men and women who come to therapy for an eating problem have been sexually or physically abused. “It was my father’s best friend.” “It was my father.” “It was my brother.” “It was my mother's boyfriend.” “It was my mother.” “And so I starved myself.” “And so I binged and purged.” “And so I got fat.” “And so I started using laxatives.”                 

 

What is the connection between sexual abuse and developing an eating disorder? The answer is guilt, shame, anesthesia, self-punishment, soothing, comfort, protection and rage.

 

Sexual abuse can have many different effects on the eating habits and body image of survivors. Sexual abuse violates the boundaries of the self so dramatically that inner sensations of hunger, fatigue, or sexuality become difficult to identify. People who have been sexually abused may turn to food to relieve a wide range of different states of tension that have nothing to do with hunger. It is their confusion and uncertainty about their inner perceptions that leads them to focus on the food.

 

Many survivors of sexual abuse often work to become very fat or very thin in an attempt to render themselves unattractive. In this way, they try to de-sexualize themselves. Other survivors obsessively diet, starve, or purge to make their bodies “perfect.” A perfect body is their attempt to feel more powerful, invulnerable, and in control, so as not to re-experience the powerlessness they felt as children. Indeed, some large men and women, who are survivors of sexual abuse, are afraid to lose weight because it will render them feeling smaller and childlike. This, in turn, may bring back painful memories that are difficult to cope with.

 

A patient described how she gained 30 pounds at the age of 8. Her mother accused her of eating too many raviolis at the school cafeteria. She was scared to tell her mother that her uncle was sexually molesting her. Another patient had been abused by her alcoholic father starting at age 7. As a teenager, she binged and made herself throw up before going out with her boyfriend because she felt dirty, anxious, and guilty about her sexual feelings.

 

Sexual abuse and emotional eating both have one element in common. It is secrecy. Many eating disorder patients feel guilty about the sexual abuse in their childhoods, believing they could have prevented it but chose not to because of some defect in themselves. So they push their secret underground, and then distract and anesthetize themselves by emotional eating.

 

Children do not tell about their abuse for a variety of reasons. Sometimes they don’t realize that anything wrong was happening at the time, or they don’t want to believe anything is wrong. Sometimes a child is dependent on the abuser, so he or she may not want to risk upsetting the security of the status quo. Sometimes children keep the abuse secret for fear they will not be believed. And sometimes they keep the abuse secret because they are threatened or are bribed to keep silent.

 

Sexual abuse can come in many shades of nuance beyond overt touching. One father repeatedly bragged to his daughter about the size of his sexual organs and how he needed special large underwear to accommodate them. Another patient reported how her father and brother would forcefully hold her down and tickle her all over until she became hysterical and was gasping for breath.

 

People with eating problems often suffer from symp­toms of post traumatic stress disorder without realizing that its origins lie in sexual abuse. Post traumatic stress may be characterized by depression, feeling chroni­cally “dead” inside, having recurrent anxiety or nightmares, or feeling constantly and painfully vigilant to one’s sur­roundings. Victims of post traumatic stress disorder may begin to en­gage in self-destructive behavior such as entering into repetitive abusive rela­tionships, losing themselves to drugs, alcohol, promis­cuity, and even self-mutilation. Self-mutilation refers to inflicting bodily harm on themselves, such as cutting, burning or even excess body piercing. 

 

Of course, none of these symptoms is absolute confirmation of abuse, but they are strong indicators of past sexual trauma. Connecting these symptoms to an actual event of sexual abuse can be a validating experience because the symptoms of inner turmoil begin to make sense.

 

What can you do to heal from sexual abuse? The first step is to recount your experience to someone you trust, someone who can witness the full brunt of your pain and rage. Since the experience of sexual abuse is about be­ing out of control, you need to be in a protected setting where your feelings can re-emerge and let loose. Releasing pain and guilt is not an intellectual experience, but some­thing that comes from deep within the heart. This can be a difficult step because exposing your emotions can feel like a repetition of the original trauma.

 

Although there is more media coverage than ever before about the prevalence of sexual abuse, this does not relieve the shame that many people feel about it. If you have been a victim of incest, facing the abuse means facing not only the shame that you come from the kind of family where abuse is perpetrated, but also that no one in your family protected you. Additionally, men who have been sexually abused as children, either by a male or by their mother, have distinct shame issues related to feelings of passivity and weakness.

 

Sometimes eating disorder patients feel enormous guilt for having enjoyed the sexual contact with their abuser. Binge eating, purging or starving then becomes their ongoing self-induced punishment. When we scratch the surface of the lives of these children, though, we discover that sexual abuse may have been the only real affection or caring they received. A child who is lonely or starved for affection may revel in the attention, even if it is abuse. But the truth is that children are never the seducers—they are always the victims. The only thing a child is guilty of is the innocent wish to be loved.

 

Confronting your shame, releasing your pain, and experiencing rage and guilt are part of the process of reclaiming your inner self as well as your sexual self. The need to detour your feelings through destructive eating will subside when you are able to grieve for the little child who was betrayed.

 

Lately much has been written about “false memory syndrome” in which a person “remembers” sexual abuse that never occurred. This, indeed, can happen in certain vulnerable people. Therefore, it is crucial that you not work with a therapist who “leads” you to a false memory of the experience. Memories of the abuse, if present, should evolve over the course of therapy rather than being planted in your head for you to “try on for size.” If you sus­pect that something may have happened to you, trust your perception and let your inner “knowing” be your guide.

 

Mary Anne Cohen is director of The New York Center for Eating Disorders. This article is adapted from her book, French Toast for Breakfast: Declaring Peace with Emotional Eating.

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