Eating Disorders
and Sexual Assault
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What
causes eating disorders?
"Some people with
eating disorders use the behaviors to avoid sexuality...It is often
said that the key to understanding an eating disorder is an appreciation
of the person's need to control.." from
ANRED
" Significantly higher rates
of sexual and aggravated assault among women with BN [bulimia nervosa]
support the hypothesis that victimization may contribute to the development
and/or maintenance of the disease. Childhood abuse, particularly sexual
abuse of a female child by her father or another adult male, may also
be associated with the development of BN." T.
Foster, M.D.
What
is an eating disorder?
"Eating disorders
involve serious disturbances in eating behavior, such as extreme and
unhealthy reduction of food intake or severe overeating, as well as
feelings of distress or extreme concern about body shape or weight."
from NIMH
The link between sexual abuse
and eating disorders is not a simple matter but one worth looking into.
Unexamined possibilities include sexual assault related victim
blame and secondary
victimization and whether they contribute to eating disordered behaviors.
Most rape survivor support
boards have separate forums for eating disorders as well as for
self injury.
Adjusting
the National Crime Victimization Survey's Estimates of Rape and Domestic
Violence for 'Gag' Factors,
1986-1990. Coker, Ann L., and
Elizabeth A. Stasny.
http://webapp.icpsr.umich.edu/cocoon/NACJD-STUDY/06558.xml
"The researchers considered
whether the type of interview (personal or telephone) and the presence
of another person (particularly a spouse) influenced or "gagged"
the reporting of rape and domestic violence in the NCVS...
It is hypothesized that
the inclusion of such yes/no questions would more easily allow victims
to report rape or domestic violence incidents in telephone interviews,
even with spouses present in the home during the interview."
Journal articles
Dohm FA; Striegel-Moore RH; Wilfley
DE; Pike KM; Hook J; Fairburn CG. Self-harm and substance use in a community
sample of black and white women with binge eating disorder or bulimia
nervosa. International Journal of Eating Disorders 32(4): 389-400, 2002.
(22 refs.)
Objective: This study evaluated rates of self-harm and
substance use in women with either bulimia nervosa (BN) or binge eating
disorder (BED) and assessed whether differences in self-harm and substance
use are related to sexual or physical abuse. Method: Alcohol abuse, self-
harm, and use or abuse of various illicit drugs were evaluated in a sample
of 53 women with BN and 162 women with BED. Results: Self-harm and substance
use generally did not differentiate BED and BN cases, but rates of self-harm
and substance use were elevated among women with a history of sexual or
physical abuse relative to women without such a history. Discussion: Elevated
rates of self-harm and substance use may not be related uniquely to BN
diagnostic status, but may be related to a characteristic shared by women
with BN and BED, such as a history of sexual or physical abuse.
Harned MS. (2002). Understanding
a link between sexual harassment and eating disorder symptoms: a mediational
analysis. (eng; includes abstract) Journal Of Consulting And Clinical
Psychology [J Consult Clin Psychol] 70 (5), pp. 1170-81.
Using data from 3 samples of working
women and men, the present study examines the association between sexual
harassment and eating disorder symptoms by studying the processes that
may underlie this relationship. The results of structural equation modeling
suggest a link between sexual harassment and eating disorder symptoms
among women and indicate that this relationship is mediated by psychological
distress, self-esteem, and self-blame. Further, sexual harassment was
found to predict eating disorder symptoms among women even when experiences
of sexual assault were included in the model. No relationship was found
between sexual harassment and eating disorder symptoms among men. The
theoretical and clinical implications of these results are discussed.
Wonderlich, Stephen A.; Crosby, Ross D.; Mitchell, James E.; Thompson,
Kevin M.; Redlin, Jennifer; Demuth, Gail; Smyth, Joshua; Haseltine, Beth.
(2001). Eating Disturbance and Sexual Trauma in Childhood and Adulthood.
By: International Journal of Eating Disorders, 30 (4), p401-412, 12p,
4 charts.
Presents a study which examined
the relationship between sexual trauma and eating disorder behavior, taking
into account the effects of developmental stage of the victim and the
effects of multiple sexual assaults. Information on multi-impulsive binge
eating; Comparisons between groups on demographic characteristics; Characteristics
of sexual abuse and rape.
Dansky BS (1997). The National Women's Study: relationship of victimization
and posttraumatic stress disorder to bulimia nervosa. (eng; includes abstract)
By , The International Journal Of Eating Disorders [Int J Eat Disord],
21 (3), pp. 213-28.
OBJECTIVE: In recent years there
has been increased interest regarding the role of crime victimization
in the development and/or maintenance of eating disorders, particularly
bulimia nervosa. METHOD: To examine the relationship among assault, bulimia
nervosa, and binge eating disorder, a national, representative sample
of 3,006 women completed structured telephone interviews. RESULTS: Lifetime
prevalence of completed, forcible rape for respondents with bulimia nervosa
was 26.6%, as compared with 11.5% for respondents with binge eating disorder
and 13.3% for respondents without bulimia nervosa or binge eating disorder.
Compared to respondents without bulimia nervosa or binge eating disorder,
aggravated assault history was significantly more prevalent in women with
bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress
disorder (36.9%). Characteristics of sexual assault experiences were not
associated with dysfunctional eating patterns. Specific types of disordered
eating such as compensatory behaviors in bulimia nervosa were associated
with higher rates of victimization. CONCLUSIONS: In sum, the significantly
higher rates of both sexual and aggravated assault among women with bulimia
nervosa compared with women without such a diagnosis support the hypothesis
that victimization may contribute to the development and/or maintenance
of bulimia nervosa.
Baldo, Tracy D. Bostwi; Baldo,
Anthony J. (1996). Intrafamilial assaults, disturbed eating behaviors,
and further victimization. Psychological Reports, Dec96 Part 1, Vol. 79
Issue 3, p1057, 2p.
Discusses the association of histories
of sexual assaults with disturbed eating behaviors. Relationship between
intrafamilial and extrafamilial assaults; Administration of Sexual Experience
Therapy to classify subjects as no assault or assaulted.
Laws, Ami; Golding, Jacqueline
M. (1996). Sexual Assault History and Eating Disorder Symptoms among White,
Hispanic, and African-American Women and Men. American Journal of Public
Health, 86 (4), p579-579, 4p, 2 charts.
Data from two Epidemiologic Catchment
Area Program sites (Los Angeles and North Carolina) were analyzed to examine
relations of sexual assault history to eating disorder symptoms. In regression
analyses controlling for age, gender, ethnicity, income, socioeconomic
status, and study site, persons with sexual assault history (n = 514)
were more likely than those not assaulted (n = 5511) to report thinking
they were too fat (odds ratio [OR] 1.6); losing = 15 lb (OR = 1.86); weight
loss to 85% of normal (OR = 2.08); one or more anorexia symptoms (OR =
1.81); and sudden weight change (OR = 2.32). Ethnicity and income modified
the relations. The data support an association of sexual assault history
with eating disorder symptoms. [ABSTRACT FROM AUTHOR]
Hall RC (1989). Sexual abuse in patients with anorexia nervosa and bulimia.
(eng; includes abstract) By , Psychosomatics [Psychosomatics] 30 (1),
pp. 73-9.
Few studies have documented the
extent and nature of sexual abuse among women who later come to treatment
for anorexia nervosa or bulimia. This comparison study reports on a sample
of 158 patients admitted to an eating-disorder unit, of whom 60 gave a
history of sexual abuse, compared to 98 with no history of abuse. Fifty
percent of the anorexic and bulimic patients had suffered sexual abuse,
compared to only 28% of patients admitted with other eating-disorder diagnoses;
this was a significant difference (p less than 0.001). Of the four types
of abuse surveyed, only those patients suffering rape were likely to have
sought help from caregivers prior to admission (p less than 0.001). The
authors report on likely perpetrators of abuse, age of first abuse, and
frequency of depressive symptoms in the abused population. The data from
this study strongly suggest that the possibility of sexual assault or
abuse must be assessed and the results included in a comprehensive therapy
plan for eating-disorder patients.
Schechter, Justin O.; Schwartz, Henry P.; Greenfeld, David G. (1987).
Sexual Assault and Anorexia Nervosa. International Journal of Eating Disorders,
6 (2), p313-316, 4p.
Two cases of sexual assault with
subsequent onset or exacerbation of anorxia nervosa are described. Features
common to anorexia nervosa and the sexual syndrome include feeling of
guilt, inadequacy, loss of control, and distortion of body image. [ABSTRACT
FROM AUTHOR]
Root, Maria P. (1991). Persistent, disordered eating as a gender-specific,
post-traumatic stress response to sexual assault. ; Psychotherapy: Theory,
Research, Practice, Training, 28(1), Spr 1991. Special issue: Psychotherapy
with victims. pp. 96-102.
Briefly reviews several separate
bodies of literature that, as a whole, make it possible to hypothesize
that the difficulty in facilitating a cessation of persistent disordered
eating symptoms may be due to how the symptoms function as a posttraumatic
response to sexual assault. By conceptualizing disordered eating in some
clients as a posttraumatic response, the therapist may understand the
addictiveness and tenacity of the symptoms. Themes and symptoms related
to disordered eating, victimization, and posttraumatic stress disorder
(PTSD) (e.g., powerlessness, low self-esteem, defensiveness) are outlined.
(PsycINFO Database Record (c) 2005 APA, all rights reserved)
Hambidge, D. M. (1988). Incest and anorexia nervosa: What is the link?
; British Journal of Psychiatry, 152, Jan 1988. pp. 145-146.
Discusses the role of sexual assault
in the etiology of eating disorders and proposes a causal link among premorbid
personality features, sexual assault in adolescence, subsequent anorexia
nervosa, and later difficulties in sexual adjustment. (PsycINFO Database
Record (c) 2005 APA, all rights reserved)
Molnar, Amy Elizabeth (2001). The
effect of college women's binge eating and sexual assault on anxiety and
social dysfunction. ; Dissertation Abstracts International: Section B:
The Sciences and Engineering, 61(12-B) pp. 6714.
Sexual assault and binge eating
have been associated in the literature and are prevalent among women attending
college. Sexual assault and binge eating are said to cause similar difficulties,
including family dysfunction, depression, anxiety, social dysfunction,
and low self-esteem. Hayes's (1987) theory of sexual assault and Lacey's
(1986) theory of binge eating both postulate that women will use avoidant
behaviors to decrease anxiety produced by these conditions. Therefore,
it can be argued that women who were sexually assaulted and binge eat
would have more anxiety and social dysfunction than would women who were
not sexually assaulted and do not binge eat. Also, women with either of
these two conditions would fall somewhere between women who were sexually
assaulted and binge eat and women who were not sexually assaulted and
do not binge eat. The participants of this study were college women from
ages 18 to 56. Three fourths of the women were Euro-American. There were
23 participants in each of the four groups: sexually assaulted, binge
eaters; sexually assaulted, nonbinge eaters; nonsexually assaulted, binge
eaters; and nonsexually assaulted, nonbinge eaters. These four groups
were matched on depression and family dysfunction to avoid confounding
the results. The measures used for the study were the Structured Interview
for Anorexia and Bulimia Nervosa (SIAB) and a demographic questionnaire
(Fichter, Elton, et al., 1991). The prevalence rate of sexual assault
among college women in this study was 29.4%, and 17.7% reported binge-eating
behavior. No significant differences were found between the four groups
on either anxiety or social dysfunction. However, it seems that matching
the groups for family dysfunction and depression reduced any effects sexual
assault and binge eating had on anxiety and social dysfunction. It was
found that family dysfunction and depression mediated between the criterion
and predictor variables. However, because of methodological difficulties
and a small sample size, no definite conclusions can be made. Regardless,
clinicians should be aware of the possible connection between sexual assault
and binge eating to anxiety and social dysfunction in order to appropriately
treat the associated psychopathology. (PsycINFO Database Record (c) 2005
APA, all rights reserved)
Faravelli C (2004). Psychopathology
after rape. (eng; includes abstract) The American Journal Of Psychiatry
[Am J Psychiatry], 161 (8), pp. 1483-5.
OBJECTIVE: This study evaluated
the psychopathological consequences of a single rape occurring in adult
women. METHOD: The psychiatric symptoms reported by 40 women who were
victims of rape during the previous 9 months as decided by a court of
law were compared with the symptoms of 32 women who underwent severe,
nonsexual, life-threatening events (car accidents, physical attacks, or
robberies). None of the raped women had experienced previous sexual abuse
during childhood or adolescence. RESULTS: The raped women showed a significantly
greater prevalence of posttraumatic stress disorder, as well as sexual,
eating, and mood disorders. CONCLUSIONS: These findings indicate that
the psychopathological consequences of a rape could be specific and may
warrant particular attention.
Rickert VI (2002). Adolescent dating violence and date rape. (eng; includes
abstract) Current Opinion In Obstetrics & Gynecology [Curr Opin Obstet
Gynecol], 2002 Oct; Vol. 14 (5), pp. 495-500.
PURPOSE OF REVIEW: In this review
we intend to examine recent literature on dating violence among female
adolescents, including prevalence, risk factors, sequelae, screening practices,
and potential interventions. RECENT FINDINGS: Dating violence is perpetrated
by both males and females and occurs frequently within heterosexual dating
relationships. Attitudes toward physical aggression, including those of
peers, and abuse by siblings predict later violence as victim and perpetrator.
Victims of childhood or dating violence may be at greater risk of developing
eating disorders. New strategies and measures to promote screening are
available. SUMMARY: Dating violence occurs among all groups of adolescents
with common and unique risk factors for dating violence found across adolescents
grouped by race/ethnicity, sex, and prior victimization. Efforts to decrease
dating violence should (1) increase the use of screening tools that measure
victimization as well as attitudes and contextual parameters that promote
dating violence; (2) increase self-efficacy to negotiate safer sex; (3)
reduce the use/abuse of alcohol and other drugs that facilitate dating
violence; and (4) eliminate the influence of negative peer behavior. Interventions
to prevent dating violence will likely also reduce rates of unintended
pregnancies, HIV, and sexually transmitted diseases among adolescents.
Ackard, Diann M.; Neumark-Sztainer, Dianne. (2002). Date violence and
date rape among adolescents: associations with disordered eating behaviors
and psychological health. Child Abuse & Neglect, May2002, Vol. 26
Issue 5, p455, 19p, 8 charts.
Examines associations between data
violence and rape and disordered eating behaviors and psychopathology.
Prevalence of date violence and rape in adolescents; Assessment of binge-eating
behavior; Associations adjusted for age, race and other abuse experiences.
Nagata, Toshihiko; Nagata, Toshihiko;
Kaye, Walter H.; Kiriike, Nobuo; Rao, Radhika; McConaha, Claire; Plotnicov,
Katherine H. (2001). Physical and sexual abuse histories in patients with
eating disorders: A comparison of Japanese and American patients. Psychiatry
& Clinical Neurosciences, Aug2001, 55 (4), p333-340, 8p.
Abstract Physical and sexual abuse
among patients with eating disorders has been a focus of attention in
Western countries, however, there is no study comparing the incidence
of these factors in Western and Asian countries. Japanese subjects consisted
of 38 patients with anorexia nervosa restricting type (AN-R), 46 patients
with anorexia nervosa binge eating/purging type (AN-BP), 76 patients with
bulimia nervosa purging type (BN) and 99 controls. Subjects from the USA
consisted of 29 AN-R, 34 AN-BP and 16 BN. The Physical and Sexual Abuse
Questionnaire was administered to all subjects. Minor sexual abuse such
as confronting exhibitionism or being fondled by a stranger tended to
be more prevalent among Japanese subjects, while victimization by rape
or incest was more prevalent among USA subjects. Conversely, physical
abuse history was similarly distributed across each diagnostic subgroup
in both countries. Events related to physical abuse, such as an abusive
family background, may contribute whether eating disorder patients are
restricting or bulimic and regardless of culture. [ABSTRACT FROM AUTHOR]
Casper, Regina C.; Lyubomirsky,
Sonja (1997). Individual psychopathology relative to reports of unwanted
sexual experiences as predictor of a bulimic eating pattern. ; International
Journal of Eating Disorders, Vol 21(3) pp. 229-236.
Examined whether family and individual
psychopathology mediate the relationship between unwanted sexual experiences
and bulimic eating behavior. 61 females (aged 16-54 yrs) diagnosed with
bulimia nervosa and 92 female students and university staff (aged 14-63
yrs) who had never met criteria for an eating disorder completed standardized
questionnaires on eating behavior, sexual abuse, individual psychopathology,
and family psychopathology. Linear regression showed bulimic eating behavior
to be significantly related to sexual abuse. However, multiple regression
analyses with family and individual psychopathology as independent variables
in addition to sexual abuse show only individual psychopathology to predict
significantly abnormal eating behavior. Specifically, depressive symptoms,
suicidality, and impulsive behavior, but not substance abuse, are the
components of individual psychopathology most directly associated with
bulimia. The findings suggest that the primary focus in treatment should
not be the traumatic events themselves, but their long-term consequences
for the individual. (PsycINFO Database Record (c) 2005 APA, all rights
reserved)
Schwartz, Mark F.; Cohn, Leigh Weiner, Edward J.; Stephens, Larry (1996).
Sexual barrier weight: A new approach. In: Sexual abuse and eating disorders.
; Philadelphia, PA, US: Brunner/Mazel, Inc. pp. 68-77. [Reprinted Chapter]
(from the chapter) an eating disorder
may have part of its roots in sexual abuse and/or trauma / studied 42
[16-61 yr old female outpatients and inpatients] with eating disorders,
two-thirds of whom gave histories of sexual trauma / by graphic analysis,
age vs weight, we [show] that fluctuations in body weight have followed
sexually significant life events / this is especially significant in victims
of rape and termination of a sexual relationship / suggest that sexually
traumatized persons may resist a specific body weight due to fear of sexual
attractiveness or impulses relating to specific sexual trauma that occurred
at that weight (PsycINFO Database Record (c) 2005 APA, all rights reserved)
A
Bright Red Scream
: Self-Mutilation and the Language of Pain (BOOK)
"A bright red scream" is how one of the subjects Marilee Strong
interviews in this chilling yet compassionate study of self-mutilation
describes the sensation of intentionally inflicting pain upon oneself.
It is a compulsion that, while shocking and bewildering to most people,
affects 2 million or more Americans and countless others around the globe--one
of whom, the late Princess Diana, also suffered from the eating disorders
that characterize between 35 to 80 percent of all cutters. Rejecting the
classic psychiatric wisdom that views self-mutilation as a species of
suicidal behavior, Strong links the phenomenon instead to the will to
live--often in the face of such overwhelming childhood abuse that the
resulting dissociative behaviors are something akin to posttraumatic stress
disorder. Strong touches on other issues as well: Why are most cutters
women? And is the current fascination with tattooing and piercing, from
its most extreme forms in the "alternative" culture to its growing
mainstream acceptance, a sublimation of the cutters' instinct? Through
interviews with more than 50 self-injurers, Strong tells the moving story
not only of their rage and self-punishment, but also of the courageous
journey towards reintegration. (The book also contains an introduction
by psychiatrist Armando R. Favazza, author of Bodies Under Seige, one
of the leading clinical experts on self-mutilation.) --Patrizia DiLucchio
--This text refers to the Hardcover edition.
Bloks, Hans; van Furth, Eric F.;
Callewaert, Ineke; Hoek, Hans W.. (2004). Coping Strategies and Recovery
in Patients with a Severe Eating Disorder. By: Eating Disorders. 12 (2).
p157-169, 13p.
Sexual
Abuse and Eating Disorders by Mark F. Schwartz (Editor), Leigh Cohn (Editor)
The
relationship between child sexual abuse and eating disorders
Sexual
abuse in patients with eating disorders
Adolescent
dating violence and date rape
Understanding
a link between sexual harassment and eating disorder symptoms: a mediational
analysis
Detection,
Evaluation, and Treatment of Eating Disorders
Prevalence
and factors associated with physical and sexual assault of female university
students in Ontario
Individual
psychopathology relative to reports of unwanted sexual experiences as
predictor of a bulimic eating pattern
Sexual
abuse in eating disorder subtypes and control women: The role of comorbid
substance dependence in bulimia nervosa
Abuse,
Bullying, and Discrimination as Risk Factors for Binge Eating Disorder
Objectification
Theory as It Relates to Disordered Eating Among College Women -
Objectification Theory
A
Longitudinal Examination of the Consequences of Sexual Victimization for
Rural Young Adult Women - Statistical Data Included
The
survivor syndrome: childhood sexual abuse leaves a controversial trail
of aftereffects - effects of childhood sexual abuse - part 2
The
Relation Between Eating Disorders and Components of Perfectionism
and
Rape trauma syndrome - how perfectionism is a way to 'become good enough'
so that the bad things won't happen, or to hide how bad we feel we really
are.
Bibliographies
CORK
Bibliography: Eating Disorders
Sexual Abuse Bibliography
http://www.paedosexualitaet.de/abuse/bib.html
Resources to research
this subject:
Journals
and articles
Google
scholar or Findarticles
Search
the NCJRS Abstracts Database
Finding
books at the library
Online
Libraries on sexual assault
Encyclopedias
and Dictionaries
Eating
disorders and rape
Related links:
Privacy, The
effects of rape / psychology, Eating
disorders and rape, Self
Injury, College
and Fraternity Rape, Multiple
victimization |
