Eating Disorder and Sexual Abuse

Eating disorders refer to illnesses that culminate with individuals experiencing severe disturbances in their eating patterns and are closely associated with troubling thoughts and emotions. One of the significant symptoms of eating disorders is a preoccupation with food and body size. Individuals may experience body satisfaction where they perceive themselves as being either overweight or underweight, hence changing eating and exercising patterns to achieve a specific ideal body shape (Ekern, 2018). Notably, eating disorders are multifaceted, with factors such as trauma, abuse, and, more specifically, asexual abuse being argued to predispose individuals towards developing eating disorders.

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Sexual Abuse

Sexual abuse is defined as sexual behaviours or acts that are forced upon individuals without their consent. Notably, sexual abuse may affect men, women, and children indiscriminately. Several types of assault are classified as sexual abuse. They may contribute to individuals developing eating disorders, including sexual assault, which classifies all forms of sexual offences, incest, rape, attempted rape gang rape, sodomy, marital rape, unwanted sexual touching, and forcible object penetration (The Association of Rape Crisis Centers in Israel (ARCCI, 2020). Studies published by Cowden (2020) indicate that 30% of disordered eating patients have been abused sexually in childhood or the course of their adult life.  According to the cognitive model, people’s thoughts and perceptions can influence their lives with distress, anger, and frustrations leading to unhealthy behaviours and emotions. Although abuse is a non-classified risk factor, studies have shown that it elicits multiple psychiatric problems such as anxiety, depression, and substance abuse (Cowden, 2020).

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Types of Eating Disorders

There are so many types of eating disorders, with the most common anorexia nervosa, Bulimia nervosa, binge eating disorder, and avoidant/ restrictive food intake disorder. Anorexia nervosa affects men and women and is characterized by obsessive fats being oversight even when they are underweight. Individuals with anorexia nervosa have a distorted image of their bodies, limit their food intake, and pursue thinness (Ekern, 2018). Bulimia nervosa is prevalent among adolescents, both male and female, although men are affected more. Bulimia nervosa is characterized by frequent overeating episodes accompanied by purging behaviours as individuals develop the fear of becoming overweight. Binge eating disorder is characterized by overeating episodes as individuals feel they cannot control the binges (Ekern, 2018). Unlike bulimia nervosa, individuals with binge eating disorders do not engage in purging behaviours. Avoidant/restrictive food intake disorder (ARFID) refers to an eating disorder that arises when individuals experience disordered eating due to lack of appetite, interest, unattractive colours, tastes, or smells. Symptoms of the disorder may include weight loss, nutrient deficiencies, and restrictive food behaviours.

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Negative impacts of Eating Disorders

Eating disorders pose serious physical, psychological, and social hazards. Physically eating disorders are a threat to an individual’s health since they may cause conditions such as loss of muscle mass, weakened immunity, dehydration, malnutrition, heart problems, slowed brain function, fatigue, decreased hormone levels, and hypothermia.  While individuals hope that by engaging in eating disorders, they may experience improved self-esteem, happiness, and confidence, the reverse is observed (National Eating Disorders Association, 2012). The psychological impacts of eating disorders entail anxiety, hypervigilance, fear of discovery, compulsive behaviours, feelings of loneliness, guilt, shame, and feelings of being out of control of the problems they experience (National Eating Disorders Association, 2012). Wearing disorders also present adverse social problems as individuals close to the affected persons are affected. For instance, eating disorders bring disruption to the family as fights about diets escalate, strains on relationships as the affected persons are observed to become emotionally and physically withdrawn. Similarly, friends and family may feel anxiety, guilt, frustration, and anger as their effort may help them fail to work.

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Sexual Abuse and Eating Disorders

Notably, individuals who experience sexual abuse often perceive the environment they live in to be unsafe; similarly, they experience helplessness and loss of control over their bodies and sense of self and end up feeling betrayed. In the aftermath of sexual abuse violations, individuals respond differently. They may develop post-traumatic stress disorder characterized by nightmares, flashbacks, anxiety, depression, irritability, and hypervigilance. Similarly, individuals are prompted to engage in survival responses, with one of the strategies being eating disorders.

Multiple studies have demonstrated the existence of a direct relationship between eating disorders and sexual abuse (Opydo-Szymaczek et al., 2018). Sexual abuse leads to the development of intolerable emotions that distort an individual’s sense of identity. For instance, survivors may develop dissociative coping styles such as binge eating to make their bodies less attractive and deter potential abusers. Similarly, individuals may develop anorexia nervosa as a way of distorting their body images to make them “invisible” to the abuser (Rayworth et al., 2004). Consequently, eating disorders may arise among survivors of sexual abuse as a coping mechanism to their negative emotions; eating may be the only aspect they feel they have control over. Furthermore, survivors may also engage in self-starvation to commit suicide due to overwhelming negative emotions.

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Sexual Abuse and Overweight

Opydo-Szymaczek et al. (2018). Child sexual abuse (CSA) leads to individuals being overweight in later years and adopting eating disorders where the overweight is defined as an excessive accumulation of fat that may impair the affected person’s health.  Child sexual abuse is defined as the act of using children for sexual stimulation by adults. Child sexual abuse may include both contact and non-contact activities such as inappropriate observation of a child, kissing folding, object penetration through the vagina or anus, exhibitionism, masturbation, and children’s involvement in prostitution. Studies show that at least 95% of individuals with anorexia nervosa are women with major risk factors being a stressful situation in their life.  

For instance, individuals exposed to sexual abuse are observed to develop eating disorders to manage their trauma. They may engage in excessive eating to make sure they are less attractive to the user or as a way of deterring future occurrences of sexual abuse. Studies Opydo-Szymaczek et al. (2018) involving a group of 2461 women disclosed that most of the women classified as overweight over the age of 21 had experienced penetrative child sexual abuse. Women subjected to sexual abuse ate observed to experience immense body dissatisfaction and hence engage in pathological eating disorders as a coping mechanism. Further, childhood sexual abuse has been associated with promoting negative feelings among adolescents, such as low self-esteem and depression, culminating in eating disorders.

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It is, however, worth mentioning that child sexual abuse affects men and women differently. While childhood sexual abuse is a risk factor for women and eating disorders, it promotes externalizing behaviours among men (Opydo-Szymaczek et al., 2018). Men who experience childhood sexual abuse may be observed to practices behaviours such as substance abuse, criminal activities, and sexual risk-taking

Furthermore, it is crucial to point out that childhood sexual abuse affects women differently depending on their ethnicities. While white survivors may engage in eating disorders that promote obesity, black women are observed to engage in restrictive food disorders that make them leaner. It is worth mentioning that there exist significant differences regarding the ideal standard of beauty between Caucasian and African American cultures. While in Caucasian culture, lean women are considered attractive, in African American cultures, women with a larger BMI are considered more attractive. White women, therefore, engage in binge eating to become less attractive to abusers, while black women pursue thinness to look less attractive (Opydo-Szymaczek et al., 2018).  

Sexual Abuse and Anorexia Nervosa

Studies by Carter et al. (2006) have also investigated the relationship between sexual abuse and the development of anorexia nervosa. The studies show that individuals who experience sexual abuse manifest more significant psychiatric disturbances, which lead to self-injurious behaviour and eating disorders; for instance, in at least 48% of the study, participants who had anorexia nervosa reported having a history of child sexual abuse. Such individuals also reported experiencing high levels of depression, low self-esteem, interpersonal problems, and acute obsessive-compulsive symptoms in compassion to those who did not have any history of Child sexual abuse (Carter et al., 2006).

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Ross (2009) argues that sexual abuse does not occur in isolation but is often associated with other forms of abuse, including family violence, failures in bonding and nurturing, physical, emotional, and verbal abuse, all of which contribute to eating disorders. Ross (2009) notes that survivors of sexual abuse may develop eating disorders as a coping mechanism to assert control over their bodies, which they perceive as “depraved.” Similarly, survivors of sexual abuse may argue that their bodies are the source of betrayal since they attracted abusers and therefore engage in disordered eating habits, which may involve dieting and starvation as a way to “punish” it. Survivors may also “disconnect” themselves from their bodies (Ross, 2009).

Studies by Ross (2009) correspond with those of Opydo-Szymaczek et al. (2018), which note that survivors of sexual abuse may also engage in disordered eating such as food restriction, as a  way of “starving off” sexual characteristics. Sexual abuse may trigger self-surveillance feelings where individuals become obsessed with their appearances and employ different tactics such as food restriction to deflect external objectification (Rayworth et al., 2004). For instance, survivors may be driven by an inherent need to make their bodies prepubertal and unattractive to sexual abusers. Similarly, the pursuit for thinness may also be associated with the anxiety that having an average body predisposes them to sexual abuse; thinness, therefore, makes them feel invisible.

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Eating Disorders and Starving

Studies have associated anorexia nervosa among survivors of sexual abuse with the intent of suicide through starvation (Ross, 2009).  In many instances, victims of suicide often experience overwhelming feelings of loss of control, with death being the only aspect within their control. Survivors of childhood sexual abuse have also been argued to poses similar genetic motives due to the conflicts and negative feelings that arise following the sexual abuse experience. While the survivors may not commit suicide directly, the development of food restriction and starvation has been argued to have similar intents. A vast body of literature argues that eating disorders such as starvation may also be caused by the reenactment or undoing of childhood trauma (Ross, 2009). For instance, where a survivor of childhood sexual abuse was rewarded through candy and foods, they may restrict such food innate to illustrate defiance to the abuse through a show of defence. Similarly, survivors of sexual abuse may starve themselves as punishment to themselves or replaying the incident again.

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Eating Disorders and Distraction

It is worth mentioning that while eating disorders have negative impacts on an individual’s body, they are often well thought off and planned. For survivors of sexual abuse, engaging in disordered eating acts is a way of distracting them from the trauma they experienced. Similarly, planning for dieting and other disordered eating practices relieves them from anxiety and emotional distress by allowing them to focus on simpler issues such as food and exercise.

Limitations

It should be mentioned that eating disorders are multifaceted. While sexual abuse may cause eating disorders, other factors also contribute to the development of eating disorders; such factors may include genetics, social-cultural factors, family dynamics, and other mental health disorders.

Genetics and Eating Disorders

Some individuals are predisposed to developing eating disorders than others due to genetic factors. For instance, some eating disorders and personality traits have been argued to be inheritable. For instance, bulimia nervosa and anorexia have been argued to be genetically inherited among different families (Shaw, 2020). In some instances, anorexia nervosa and bulimia nervosa have been misconstrued to be caused by willful behaviour; nevertheless, a growing body of research has shown that anorexia nervosa can be inherited from parents. Similarly, eating disorders have been associated with other mental health disorders such as bipolar disorder, obsessive-compulsive disorder, and schizophrenia (Shaw, 2020).

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Social Cultural Causes of Eating Disorders

Culture is also a risk factor for the development of eating disorders. Daily, individuals are bombarded with images, videos, and promotions about unrealistic beauty standards, fad diets, and body image; this predisposes individuals to develop eating disorders (Miller, 1999). For instance, the media has significantly contributed to the development of eating disorders through the display and promotion of specific body shapes as attractive or ideal. For example, in the 20trh and 21st centuries, women’s thinness has been promoted as the ideal standard of beauty. This has led to increased body dissatisfaction among women who engage in different eating disorders to lose weight to match the standards set by the media.

Society also plays a role in the development of eating disorders; some cultures may label overweight individuals as being less attractive and unhealthy, while thin people are idealized as attractive. This may occur directly or indirectly as individuals in society use derogatory words to describe individuals who are obese (Miller, 1999). Such negative connotation associated with obese individuals motivates them to engage in eating disorders such as anorexia nervosa and unhealthy exercising to attain a socially accepted body size and shape.

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Acculturation may lead to the development of eating disorders. Researchers have sought to develop eating disorders among African Americans in the United States and observed that acculturation is a major risk factor (Miller, 1999). While the Caucasian culture posits that the ideal standard of beauty and success for women is thin, the African American culture regards women with thicker bodies as attractive. Consequently, African Americans have become acculturated into the American/ Caucasian culture, the dominant culture. Therefore, they engage in eating disorders as they embrace Caucasian values and seek to be accepted.

Family Dynamics and Eating Disorders

Family dynamics have been investigated as causes of eating disorders. In particular, enmeshment between family members has been identified as a major cause of eating disorders among teenagers (Engel, 2020). Healthy boundaries between family members and children promote flexibility where parents have a specific limit on their children’s influence. In such families, teenagers have the autonomy to make independent decisions about how they wish to live; this imparts them the confidence to function outside family settings (Engel, 2020). On the other hand, enmeshed families have a high degree of dysfunctionality where the boundary lines between the parent’s authority and the teenager’s autonomy are significantly blurred. In enmeshed families, teenagers lose their sense of independence as their parents are involved in all aspects of their lives, including those outside their homes.

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Therefore, teenagers in such families adopt eating disorders as a way to reassert their lost autonomy or as a way of rebelling from their parents. Similarly, children born in dysfunctional families characterized by drugs and substance use, and domestic violence have a higher likelihood of developing an eating disorder than other children. This is because such children often blame themselves for their parent’s conflict or resort to eating disorders as a distraction from their family dysfunction.

Mental Health Disorders

Anxiety-related disorders entail excessive worry that fails to go away even after the stressors are eliminated. Studies show that between 18% of adults in the United States experience anxiety disorders (Center for Discovery, 2020). Such disorders predispose them to develop body dissatisfaction and hypervigilance, which culminate in eating disorders as an attempt to regain their confidence (Center for Discovery, 2020). Borderline personality disorder (BPD) also predisposes individuals to the development of eating disorders; BPD refers to a disorder characterized by unstable moods about self-image, fear of abandonment, and feelings of emptiness. Such individuals may involuntarily adopt eating disorders such as binging and purging.

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Conclusion

Eating disorders refer to mental health conditions where individuals adopt abnormal eating habits that may negatively impact their health and wellbeing. Some of the major eating disorders are bulimia nervosa, anorexia nervosa, binge eating disorders, and restrictive food intake disorder. Sexual abuse, which entails sexual acts forced upon other individuals involuntarily, is a major cause of eating disorders. This is because sexual violations diminish an individual’s sense of self-worth, cause post-traumatic disorders, and lead to negative emotions. Therefore, eating disorders develop as a means for asserting control over their lives, coping mechanisms as a way of distorting their body image to avert future instances of abuse.

Nevertheless, it is essential to recognize that while sexual abuse is a significant risk factor for developing eating disorders, it is not the only risk factor. Other factors, including genetic predispositions, social, cultural factors, family dynamics, and history with other mental health disorders, also cause eating disorders. For instance, media and society’s shaping of perceived ideal beauty standards cause body dissatisfaction among teenagers who resort to regulating their food intake or exercising to gain acceptance. Notably, treating eating disorders also calls for addressing underlying emotional worries. This includes helping affected individuals understand behaviours, emotions, and triggers for these disorders and how they can be alleviated.

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References

Carter, J., Bewell, C., Blackmore, E., & Woodside, D. (2006). The impact of childhood sexual abuse in anorexia nervosa. Child Abuse & Neglect, 30(3), 257-269. https://doi.org/10.1016/j.chiabu.2005.09.004

Center For Discovery. (2020). Common Mental Health Disorders Associated with Eating Disorders. Center For Discovery. Retrieved 7 December 2020, from https://centerfordiscovery.com/blog/common-mental-health-disorders-associated-eating-disorders/.

Cowden, S. (2020). Eating Disorders and Physical, Emotional, and Sexual Abuse. Verywell Mind. Retrieved from https://www.verywellmind.com/the-influence-of-abuse-trauma-on-disordered-eating-1138267.

Ekern, J. (2018). Eating Disorders: Symptoms, Signs, Causes & Articles For Treatment Help. Eating Disorder Hope. Retrieved 7 December 2020, from https://www.eatingdisorderhope.com/information/eating-disorder.

Engel, B. (2020). Gulf Bend MHMR Center. Gulfbend.org. Retrieved 7 December 2020, from https://www.gulfbend.org/poc/view_doc.php?type=doc&id=11752&cn=46.

the Association of Rape Crisis Centers in Israel (ARCCI). (2020). What is sexual abuse?. ARCCI – The Association of Rape Crisis Centers in Israel. Retrieved from https://www.1202.org.il/en/union/info/what-is-sexual-abuse.

Miller, M. (1999). Culture and Eating Disorders. Psychiatric Times. Retrieved 7 December 2020, from https://www.psychiatrictimes.com/view/culture-and-eating-disorders.

National Eating Disorders Association. (2012). Health Consequences of Eating Disorders, 1-2. Retrieved 7 December 2020, from https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/HealthConsequencesofEatingDisorders.pdf.

Opydo-Szymaczek, J., rząbek-Bieleck, G., Kędzia, W., & Borysewicz-Lewicka, M. (2018). Child sexual abuse as an etiological factor of overweight and eating disorders — considerations for primary health care providers. Ginekologia Polska, 89(1), 48–54. https://doi.org/10.5603/GP.a2018.0009

Rayworth, B., Wise, L., & Harlow, B. (2004). Childhood Abuse and Risk of Eating Disorders in Women. Epidemiology, 15(3). Retrieved 7 December 2020, from.

Shaw, G. (2020). Anorexia and Bulimia: Cracking the Genetic Code. WebMD. Retrieved 7 December 2020, from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/features/anorexia-bulimia-genetic-code#1.