The Influence of Abuse and Trauma on Eating Disorders

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Abuse, trauma, and specifically childhood sexual abuse are often proposed as major risk factors for the development of eating disorders, but what is the true connection? One study found that about 30% of eating disordered patients has been sexually abused in childhood. These rates are higher among those who suffer from bulimia nervosa and binge eating disorder as opposed to those with anorexia nervosa.

However, it is important to keep in mind that correlation is not the same as causation. Abuse is a nonspecific risk factor, which means it can lead to a variety of psychiatric problems, including eating disorders but also anxiety, depression, and substance abuse. 

Additionally, it is important to keep in mind that there are certainly many people who experience abuse without developing an eating disorder, such as anorexia nervosa, bulimia nervosa or binge-eating disorder. The spectrum of traumatic experiences extends beyond sexual abuse and includes other forms of victimization, trauma, and neglect.

Research indicates that certain forms of childhood sexual abuse are particularly detrimental to mental health, specifically attempted or completed intercourse, the use of threats or force, abuse by a relative, and a negative response by someone who is informed about the abuse.

Childhood Abuse Raises Risk

Abuse of any kind during childhood can be 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 develop a pattern of cutting themselves off from emotions, rather than learning how to deal with them appropriately.

This can lead to acting out and impulsive behavior, or to completely shutting down. Survivors may engage in drug use or abuse, truancy, and/or sexual promiscuity.

Similarly, eating, bingeing, and purging can be used as coping strategies to numb or escape painful emotions. In this way these behaviors are reinforced and become self-perpetuating. However, it is important not to discount traumas experienced during adulthood, as they can play a role in eating disorder symptoms as well.

Trauma is Relatively More Common in Bulimic Eating Disorders 

Research shows higher trauma rates among women who struggle with eating disorders that include bingeing and purging than eating disorders that do not. 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.

Emotional Abuse and Negative Beliefs

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 — 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.

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.

Protective Factors

Supportive family environments can reduce the risk of negative consequences for individuals that experience abuse.

A supportive response that effectively stops the abuse can also protect against the development of future psychiatric problems. 

Treatment

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. If a patient is malnourished and engaging in significant eating disorder behaviors, usually eating and weight must be normalized before embarking on trauma work. 

Sources:

Berge, J.M., Loth, K., Hanson, C., Croll-Lampert, J., & Neumark-Sztainer, D. (2012). Family life cycle transitions and the onset of eating disorders: A retrospective grounded theory approach. Journal of Clinical Nursing, 21, 9-10.

Behar, R., Arancibia, M., Sepulveda, E., & Muga, A. 2016. Child Sexual Abuse as a Risk Factor in Eating Disorders. Eating disorders: prevalence, risk factors and treatment options, Nova Science Publishers, 149-172. 

Brewerton, Timothy D. 2007. “Eating Disorders, Trauma, and Comorbidity: Focus on PTSD.” Eating Disorders 15 (4): 285–304. doi: 10.1080/10640260701454311.

Bulik, C.M., Prescott, C.A., & Kendler, K.S (2001). Features of childhood sexual abuse and the development of psychiatric and substance use disorders The British Journal of Psychiatry 179 (5), 444-449. 

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.

Waller, G., Corstorphine, E., & Mountford, V. (2007). The role of emotional abuse in the eating disorders: Implications for treatment. Eating Disorders, 15, 317-331

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