Written by Pamela K. Orgeron, M.A., Ed.S., BCCC, ACLC
As an overcomer of an eating disorder and as a survivor of sexual abuse, I developed an interest in how the two topics relate. Thus, in writing this blog my intent is to share what I have learned through my studies, research, and personal observations.
Does sexual trauma influence eating behavior? If so, how and why? I have explored these key questions in my research of literature that linked sexual abuse and disordered eating, including etiology, treatment, and prevention. In this article I will cover etiology and treatment, saving the topic of the prevention of sexual abuse and disordered eating for another article.
In reviewing the literature, “common themes” were sought out. For example, a common theme is that sexual abuse predisposes a victim to developing disordered eating. Rader Programs (2004), the first to ascertain a significant link between sexual abuse and disordered eating, reported that over 80 percent of their clients recall some form of abuse.
Throughout my literature reviews over the years I have considered sexual abuse as defined by Allender (1990). He reported that in addition to sexual contact, sexual abuse can be verbal, visual, or psychological. Any violation of a child’s physical/sexual boundaries is considered abuse. This includes actions ranging from very severe contact (genital intercourse and oral or anal sex—forcible or non-forcible) to least severe contact (sexual kissing and sexual touching of buttocks, thighs, legs, or clothed breasts or genitals); exposure to or use for pornography; and, even use of a child as a spouse surrogate.
I considered disordered eating throughout this literature review as being on a continuum. Flot (2002), as cited by Orgeron (2017), described this continuum where persons who do not display dieting, bingeing, purging, or other eating disorder (ED) behaviors as being on the lower end. Persons hospitalized with clinically diagnosed eating disorders fall on the upper end. Figure 1 illustrates classifications along this continuum, according to Vohs, Heatherton, and Herrin (2001), ranging from the nondieter to persons with clinical eating disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published by the American Psychiatric Association (APA) (2013).
Etiology Linking Sexual Abuse and Disordered Eating
Researchers have explored associations between sexual abuse and disordered eating for years. Smolak and Murnen (2002) explored such research and conducted meta-analysis on their findings. Results reflected a positive correlation between sexual abuse and disordered eating. Schwartz and Gay (1996) used existing research linking sexual abuse and disordered eating, along with information from their clinical experience, to compile a table of the functions, or purposes that ED symptoms can serve. The “Adaptive Function of Eating Disorder Symptoms” (Schwartz and Gay, p. 95) are listed in the Appendix.
The Self-Medication Hypothesis
Gurze (2003) reported the self-medication hypothesis stipulates that eating binges may be an attempt to manage anxiety and depression, which stem from sexual abuse. According to this hypothesis, in an attempt to deal with the abuse the anticipated sequence of the disorders follows: abuse; anxiety or mood disorders, and then bulimia nervosa (BN) or substance abuse disorders. Research by Schoemaker, Smit, Bijl, and Vollebergh (2002) supports the self-medication hypothesis. Schoemaker et al. tested the hypothesis by comparing BN cases with four mutually exclusive diagnostic control groups: psychiatric controls, substance abuse controls, dual diagnosis controls, and healthy controls. Results indicated that a history of psychological or multiple abuse was a specific risk factor for dual diagnosis disorder and for BN.
Posttraumatic Stress Disorder (PTSD) Response
Root (1991), as cited by Schwartz and Gay (1996), reported that ED symptoms are a masked PTSD response for some clients. Root found that for some clients who gave up the ED symptoms before they dealt with the abuse, other trauma-related symptoms such as flashbacks, self-mutilation, or suicidal tendencies increased.
Unhealthy Body Image
“Body image disturbance is a primary feature of eating-disordered, sexually abused individuals” (Costin, 1996, p. 125). Studies by Tripp and Petrie (2001) and by Van den Berg, Wertheim, Thompson, and Paxton (2002) support this link. Tripp and Petrie studied 330 female undergraduates to compare relationships among sexual abuse, eating disorders, bodily shame, and body disparagement. The researchers found that body disparagement explicitly predicts eating disorder symptoms. Van den Bern et al. studied 410 Grade 10 girls comparing body mass index, body dissatisfaction, teasing history, global psychological performance, dietary restraint techniques used, and bulimic behaviors. The researchers concluded from the results that body dissatisfaction influenced the occurrence of bulimic behaviors.
Sexual Barrier Weight
Weiner and Stephens (1996) surveyed 42 female ED patients, two-thirds reporting sexual trauma histories. Using graphic analysis, age versus weight, Weiner and Stephens found that body weight fluctuations followed sexually significant life events, especially for those study participants reporting experiences of rape and sexual relationships that ended. From the study results, Weiner and Stephens proposed “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” (p. 68).
Desire to Self-Injure
Schwartz and Cohn (1996) reported disordered eating as one form of self-injury in victims of sexual abuse. Because sexual abuse violates such extreme boundaries and disrupts attachment and bonding, Schwartz and Cohn pointed out that some clients display self-injury symptoms.
Control and Dysfunctional Issues
Dinsmore and Stormshak (2003) investigated the possible mediating significance of adolescent intra-personal aptitude, gauged by self-control and coping, on the connection between ED symptoms and family functioning in early at-risk adolescents. Results revealed a correlation between weight concerns and both self-control deficiencies and negative coping skills. Furthermore, family factors, such as cohesion, significantly correlated with adolescent self-control deficiencies and negative coping skills.
Miller (2003) reported that sexual abuse victims struggling with weight issues use food and other related behaviors to cope with the emotional upheaval resulting from the abuse. According to Miller,
Eating can be used as a way to express emotions. Eating soothes the “soul”. People eat when they are depressed, discouraged, lonely, scared, anxious, tired, and bored and for many other emotional reasons. Relieving the pain of negative emotions through eating can cause obesity and present a barrier to weight control once the client decides to lose weight (p. 82).
One study by Murray and Waller (2002) indicated that significant levels of internalized shame exist in clients reporting sexual abuse and bulimic symptoms. According to Murray and Waller, the shame results from the sexual abuse with the bulimic attitudes and behaviors as coping methods to deal with the shame.
A Multifactorial Model
Rorty and Yager (1996) proposed that the development of eating disorders in victims of sexual abuse is a complex process composed of many facets, including child temperaments, vulnerability to comorbid conditions, affect regulation, and family and peer influences. Figure 2 depicts the complicated genesis developed by Rorty and Yager (p. 26).
Other Related Studies
I found two studies linking sexual harassment, a form of sexual abuse, to ED behaviors. Harned and Fitzgerald (2002) surveyed 472 active-duty military women, 254 active-duty military men, and 1,853 women with a lawsuit against a national corporation for sexual harassment. The survey questions assessed unwanted sex-related experiences at work, job satisfaction, ED symptoms, psychological distress, and health status. Results indicated a link between sexual harassment and ED symptoms in women. No correlation existed between sexual harassment and ED symptoms among men in the study. A case study by Gati, Tenyi, Tury, and Wildmann (2002) supports the results of the Harned and Fitzgerald study. Gati et al. reported about an adolescent female diagnosed with anorexia nervosa. The diagnosis significantly correlated with being sexually harassed via the Internet.
Worth noting are key statements by Schwartz and Cohn (1996):
Certainly some eating-disordered clients were not sexually or physically abused or neglected, and many sexually abused clients do not have eating disorders. Eating disorders are determined by a multitude of factors, and there are many syndromes associated with eating disorders, some of which are directly and indirectly influenced by sexual trauma (pp. IX-X).
Other factors in addition to sexual abuse that could precipitate ED symptoms researched by Striegel-Moore, Dohm, Pike, Wilfley, and Fairburn (2002) are bullying and discrimination from peers. Striegel-Moore et al. found that physical and sexual abuse, bullying from peers, and discrimination are all risk factors for developing binge eating disorder.
The assessment process to determine whether a person has an ED should include both a thorough physical examination and a complete family and individual history of eating behaviors and other related disorders. Additionally, patients may be given one or more available tests used in the screening process.
ED Assessment Tools
Eating Attitudes Test (EAT-26). EAT-26 (2017) reports that this test developed by Dr. David Garner is probably the most popular measure of symptoms and issues related to eating disorders. This test may be taken on-line at http://www.eat-26.com/.
Other on-line testing. The website psychcentral.com (Grohol, 2018) offers free on-line screening tests for eating disorders. These tests include Binge Eating Disorder Quiz; Eating Disorder Screening Test; Do I Have an Eating Disorder? Quiz; and the EAT-26 mentioned previously.
Cambridge Eating Disorder Center (CEDC) and Screening for Mental Health, Inc. (SMH) partnered to offer a free on-line screening tool for eating disorders. (CEDC, 2017). This screening tool is available at http://www.mybodyscreening.org/
Other Tools for Diagnosing
In addition to the ED self-report instruments, personality tests may be used with persons diagnosed with eating disorders to identify factors such as anxiety, depression, and impulsivity commonly associated with EDs. Psychcentral.com also offers a number of personality assessments available at https://psychcentral.com/quizzes/personality-tests/ .
To establish an official diagnosis, criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013) must be met. The DSM-5 contains diagnostic descriptions for anorexia, BN, binge eating disorder, and other related eating disorders; PTSD, and other mental illnesses, such as substance use disorders often associated with disordered eating.
The use and effectiveness of treating individuals diagnosed with eating disorders using medication depends on the type of ED, such as AN, BN, or BED; and on whether co-existing diagnoses, such as depression, obsessive compulsive disorder, alcohol or substance abuse, anxiety disorders, PTSD and attention deficit disorder, exist. Regarding pharmacological treatment for anorexia, Mayo Clinic Staff (2016a) and WebMD Staff (2017a) reported that no medications have been approved by the FDA as treatment for anorexia, as no medication used has been very effective. David T. Tharp M.D., M.Div., Medical Director and founder of Stonebriar Psychiatric Services (n.d.b) and a former “staff psychiatrist at the Remuda Ranch Center for Anorexia and Bulimia in Arizona, a treatment program for women with eating disorders and dual diagnoses,” (Stonebriar Psychiatric Services, n.d.a, ¶ 2) reported in treating AN:
Some studies have found Periactin and other medications which stimulate appetite to be helpful. However, many of these young women already live with constant hunger, and the idea of a medicine that tries to “make them eat” is frequently terrifying for them. If depression is present, anti-depressants may be helpful if one understands that you cannot achieve full therapeutic benefit until there has been some weight restoration. Some of the newer “antipsychotic” medications have also been helpful in low doses, and it is felt that this is partly due to alleviating some of the body image anxiety and possibly some of the distortion, which at times almost seems to take on delusional proportions. (Tharp, 2006a, p. 2)
A study by Kaye et al. (2001) offers evidence that Prozac is effective in treating anorexia. Subjects of the study were 35 people with anorexia discharged from the hospital after regaining weight. Sixteen of the 35 patients received Prozac while the remaining 19 received a placebo. After a year of outpatient treatment, results showed that 10 of the 16 individuals treated with Prozac maintained a healthy body weight without relapsing, as compared to 3 of the 19 patients treated with placebo.
Bulimia Pharmacological Treatment. Mayo Clinic Staff (2016b) and WebMD Staff (2017b) report antidepressants in conjunction with psychotherapy are helpful in the treatment of BN. WebMD Staff report “Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) – including Prozac, Zoloft, Celexa and Lexapro – in combination with psychological therapies, are now a mainstay in bulimia therapy.” (Medications for bulimia section, ¶ 1) However, Mayo Clinic Staff report Prozac is the only antidepressant approved by the FDA to treat bulimia.
BED Pharmacological Treatment. Tharp (2006b) reported:
There are a number of antidepressants, as well as some anti-obesity agents and anticonvulsants which have shown to be of some benefit with BED. However, these have generally not yet been approved for the treatment of BED by the FDA. These would include Meridia (sibutramine) and Xenical (orlistat) as anti-obesity agents, along with Topamax as one of the anticonvulsants that has at times been helpful. Fluoxetine (Prozac) in its higher dose ranges of 60-80 mg per day has frequently been helpful in reducing the frequency of binges and often with accompanying weight loss. Other medications in the SSRI group, such as the Zoloft, Celexa, and Luvox have shown similar trends. (p. 2)
Nutrition education and intervention, by a registered dietitian, is a key element of treating eating disorders, according to Ozier, Henry, and American Dietetic Association (2011). Ozier et al. (2011) notes the responsibilities of the dietitian as assessing the nutritional status, knowledge base, motivation, and current eating and treatment plan; developing the nutrition section of the proposed treatment; implementing the treatment plan and supporting the patient in achieving his or her goals. The dietitian continuously relates with the patient throughout the course of treatment and assists the primary medical provider with monitoring lab results, vital signs, and any physical symptoms related to malnutrition.
Although concerns exist for using exercise to treat ED, especially in those individuals who exercise compulsively, Hausenblas, Cook, and Chittester (2008) concluded that exercise may be beneficial as an intervention for ED. Hausenblas et al. (2008) reported
Theoretical justification suggests that by improving physical fitness through regular healthy exercise, patients with ED may experience improved self-esteem, body image, and mood, as well as a reduction in the uncomfortable sensations of bloating and distention during eating [Fossati, 2004]. Additionally, exercise promotes self-regulation. Therefore, exercise may reduce bodily tensions and negative mood and increase tolerance to everyday stress, which are all triggers for binging and purging [Alpers & Tuschen-Caiffier, 2001]. (p. 44)
Another vital member of the treatment team for a person with an ED is a psychologist. Treatment procedures that are recommended by any one therapist will reflect his or her treatment philosophy, according to Freeman, Miller and Mizes (2000). In treating eating disorders psychologists often need to fill the role of educator as well as help the client deal with the broader problems that led to the disorder. Most professionals, according to The Something Fishy Website on Eating Disorders (1998-2018), adopt an eclectic approach that combines cognitive, behavioral, and psychodynamic models with family therapy and psychoeducation.
Cognitive-behaviorists presume the primary vehicle for permanent recovery is cognitive; although, they assume lasting change occurs at many levels, including behavioral, cognitive, and emotional. The goal of cognitive-behavioral therapists is to have the patient change overrated concepts about the desirability of thinness and to overcome fears about weight gain (Williamson & Netemeyer, 2000).
Cognitive techniques. Ridding the patient of self-defeating attitudes and beliefs that precipitated the disorder is the goal of cognitive therapists treating eating disorders. Old beliefs and attitudes are replaced with realistic, healthy ones.
The integrative cognitive therapy (ICT) treatment method for eating disorders proposed by Wonderlich, Peterson, Mitchell, and Crow (2000) differs from other cognitive and interpersonal models by placing a greater clinical emphasis on cultural factors, self-oriented cognition, interpersonal schemas, interpersonal relationship styles, and affect regulation. In this multifaceted treatment method, multitudes of strategies for overcoming eating disorders exist but the authors focus on three, which they consider crucial to recovery. The first goal of the ICT therapist is to promote behavioral change in food consumption, meal planning, and poor nutritional habits. This goal is accomplished through teaching clients about the maladaptive nature of dieting, the cultural factors that encourage it, and providing healthy alternatives to eating behaviors which can be implemented into the client’s lifestyle. The second mechanism of change advocated by ICT is to modify the actual self-perception and improve self-esteem. Finally,
helping the patient to adopt an interpersonal stance that allows her to be interpersonally attached to others, but very much aware of boundaries and limits, is considered optimal. Helping the patient to identify and express her thoughts and feelings in relationships is considered an essential element to the healthy functioning of an autonomous self. (p. 279)
Behavioral therapy. Many hospital and day programs incorporate behavior therapy into their programs. This approach is tailored to the needs of each patient individually and involves the gradual increase in activities with weight gain or loss.
Psychodynamic models. Psychodynamic therapists focus on early experiences that may have contributed to the course of development in an ED. The goals of psychodynamic therapists include: understanding the different purposes that maintaining eating disordered symptoms serve for a client, improving the client’s self-esteem, increasing the client’s self-differentiation, improving the eating disorder symptomatology, and improving social functioning. Mechanisms of change that psychoanalysts use include corrective emotional experiences, making the unconscious conscious, gaining insight, and internalization (Fallon & Bunce, 2000).
Self psychology therapy is a psychoanalytic theory reported by Sands (2000) to treat eating disorders. Self psychology theory emphasizes the inner world of the patient. Sands separated “out four mechanisms of change offered either explicitly or implicitly by self-psychology over the years which, in their most simplified form, can be called forms of (1) internalization, (2) resumption of development, (3) desomatization, and (4) integration.” (p. 203) Kohut (1971, 1977, 1984), as cited by Sands, describes the way clients change as “transmuting internalization process.” (Sands, p. 203) For this process to be successful an empathic relationship must exist between the client and therapist, as the client internalizes behaviors, such as self-calming, learned from the therapist. The second method of change “resumption of development” “suggests that empathic understanding serves as a facilitating medium reinstating self-developmental processes.” (Sands, p. 204)
As cited by dictionary.com, psychiatrists define somatization as “the conversion of anxiety into physical symptoms.” (Somatization, n.d.) Using desomatization as a way to help clients change, the client learns to express emotions verbally rather than stuffing them to manifest in the form of physical symptoms.
As cited by dictionary.com, psychologists define integration as “the organization of the constituent elements of the personality into a coordinated, harmonious whole.” (Integration, n.d.) According to Sands (2000), “it is the empathic responsiveness of the therapist which allows disowned domains of the self to become recognized, understood, and slowly integrated into the patient’s central self-structure.” (p. 205)
Psychoeducation. Treasure, Schmidt, and Troop (2000) view AN not just as a dieting disorder but also as a form of stress response to severe life events or problems. Initial treatment sessions focus on answering the questions “where is the patient at; where is she coming from and how can we help her move in the direction of sustained change?” (p. 284). Therapy goals include teaching the patient that the “cons” of maintaining AN outweigh the “pros”. Self-esteem is monitored during the entire treatment process. The techniques of motivational interviewing are utilized, which requires the therapist to express empathy, develop discrepancy, avoid arguments, and roll with resistance and support self-efficacy.
Bryant-Waugh (2000) described family therapy as an approach to treating eating disorders that integrates developmental psychology, Bowenian systems theory, and feminist ideology. Exploring the patient’s developmental history and analyzing past patterns of response to life changes and stress manifest the influence of developmental psychology in this approach.
Bowenian therapists view therapy as an opportunity for people to learn more about themselves and their relationships, so that they can assume responsibility for their own problems. This is a process of active inquiry that helps family members get past blaming and fault-finding in order to face and explore their own roles in family problems. Understanding, not action is the key to solving dysfunctional behavior. Treatment involves placing the problem in a multigenerational framework through a timeline and a genogram, lowering anxiety in the patient, increasing differentiation, and using process questions and relationship experiments. (Nichols & Schwartz, 2001, as cited by Owens, 2002)
For treating eating disorders, DeGiacomo and Antonietta (2000) proposed the Elementary Pragmatic Model that evolved out of general systems theory and has a strong focus on family participation and intervention. This approach also embraces intensive, multidisciplinary Day Hospital treatment that includes psycho-education on eating disorders, group therapy, nutrition therapy, creativity groups, and physical rehabilitation.
“Group therapy is just as effective as individual therapy – for treating a wide range of symptoms – and … group participation offers a unique therapeutic advantage.” (Rosenfeld, 2017, ¶ 3) The advantage is group members can identify with each other, they can learn from each other, and support one another. As members interact, group therapists also can offer insight to members on how to improve one’s boundaries or communication skills. Furthermore, “Group therapy offers a cost-effective alternative to individual therapy, and group treatment allows access to a larger population of individuals, who might not otherwise receive care.” (Rosenfeld, ¶ 5)
Eating Disorder Hope (2012) defines equine therapy as
a form of psychotherapy in which horses are utilized as tools for a man or woman to develop greater self-understanding and assist in emotional growth. Equine Therapy is a form of animal assisted therapy, an aspect of mental health that acknowledges the bond between animals and humans in addition to the opportunity for emotional healing that can occur when a relationship is initiated between two species, such as human and horse. (What is Equine Therapy? Section, ¶ 1)
According to Eating Disorder Hope (2012), “many eating disorder therapists and professionals recognize the benefits of equine therapy as a method of improving lives and refer patients to riding programs.” (What is Equine Therapy? Section, ¶ 2)
“Founded in 1999, the Equine Assisted Growth and Learning Association (EAGALA) is the leading international nonprofit association for professionals incorporating horses to address mental health and personal development needs.” (Welcome section, ¶ 1) The website of EAGALA (2009-2010) sites the goals and opportunities offered by the organization. Among these objectives and opportunities are training and certifying therapists in the field of Equine Assisted Psychotherapy (EAP); annual conferences; and providing educational, training, and support resources. In addition, EAGALA offers a map and search options to find where their programs are located.
EAP patients learn about themselves when they participate in activities with horses and then discuss feelings and behavior patterns learned. Canopy Cove (2016) and Remuda Ranch (2014, 2016) are located in settings that allow them to utilize Equine Therapy as a part of the recovery process for patients. Horse care, grooming procedures, saddlery, and basic equitation (horseback riding) may be a part of eating disorder treatment for patients at Remuda Ranch. Research from Remuda Ranch indicates a number of benefits to EAP. These benefits include:
- Enhanced self-esteem
- Overcoming fears
- Impulse modulation
- Renewed self-efficacy
- Feelings of belonging
- Reaching out
- Improved body image awareness
- Development of trust
- Outward direction of focus
- Improved communication skills
- Improved emotional awareness
- Improved emotional regulation
- Improved self-control
- Healing relationships
- Freedom from inhibitions
- Spiritual growth.
Expressive Creative Therapy
As a part of their multi-disciplinary treatment program, the staff of Remuda Ranch (2017) offers expressive arts therapy as a component of treating eating disorders. Through expressive arts therapy patients explore their identities and problems using their personal creativity. Self-worth, self-concept, and a sense of individual purpose may be discovered using therapeutic music, dance/movement (DMT), art, and creative writing. Relationship systems also are examined through the expressive therapies. (Owens, 2002)
Remuda Ranch (2017b) lists the benefits to expressive arts therapy:
- Patients share their perceptions and viewpoints that might otherwise be difficult to express through more traditional therapies.
- Promoting a sense of freedom allows patients to unearth and dissect their inner feelings during the healing process.
- Using images to express their feelings may be easier than conveying these feelings in words. (Healing Through Art section, ¶ 1)
Music/DMT. According to Wennerstrand (2002), as cited by Owens (2002), research shows that many individuals with eating disorders have alexithymia, “defined as difficulty in putting feelings and fantasies into words (Zerbe, 1995).” (Wennerstrand, ¶ 2) Through DMT patients express that which cannot be expressed with words. Dance/movement therapy practiced by trained dance/movement therapists certified by The American Dance Therapy Association is a body-based therapy that combines interpersonal, object-relations theory, movement analysis, and dance technique.
Art/writing. Many researchers and practitioners recommend that persons recovering from eating disorders keep daily food journals and a journal to uncover and express both stuffed and current feelings. I have found journaling helps to release pent-up emotions, to discover one’s trigger foods and situations, and to facilitate in positive self-talk. DeGoede and Drews (1998) recommend 15 to 20 minutes of journaling daily.
When you use your daily journal, allow yourself to write without worrying about grammar, sentence structure, or spelling: it doesn’t even have to make sense. This is an exercise in beginning to get to know the “inside” you from the “outside” you. (p. 17)
Restoring Powerlessness, Betrayal, & Ambivalence from Sexual Abuse
Persons who were sexually abused will find no quick answers, no easy cures, and will struggle with some issues related to the abuse all their life, according to Allender (1990, 1995, 2008). He described the effects of sexual abuse and what is necessary to heal from these effects. Allender identified powerlessness, betrayal, and ambivalence resulting from the sexual abuse as the effects that must be overcome on the journey to healing. The three things Allender pointed out that are keys to overcoming these effects are honesty, a willingness to change, and a desire to help others. By honesty, Allender means not living in denial, accepting the damage done, and grieving over the losses. Furthermore, persons who were abused need to look at how they have harmed themselves and others by living out the effects of the abuse. Repentance is crucial to this process. The willingness to change may result in the abused confronting the abuser; although, Allender pointed out that confrontation is not a must for healing to occur. In some instances, confrontation is not possible. Furthermore, Allender reported that a major key to moving ahead on the journey to healing is allowing the abuse to open the heart to want to do good for others.
Wholistic Approaches to Disordered Eating
There are two wholistic approaches to healing that I endorse. One of those wholistic approaches to healing that I recommend to others is that of Dr. Phil McGraw, which he discussed in the book The ultimate weight solution: The 7 keys to weight loss freedom (Free Press, 2003). For those without access to Dr. McGraw’s book, feel free to visit the blog I wrote entitled The Solution to Disordered Eating: Do Diets Work?, where I briefly discuss Dr. McGraw’s 7 keys to successful weight loss and weight maintenance.
The other wholistic approach to healing that I recommend to others is that of Dr. Gregory Jantz. His wholistic, or “whole-person approach is not a quick fix. It is a long-term, life-changing strategy for recovery and healing.” (Jantz, 2010, p. 2) Dr. Jantz founded The Center: A Place of Hope that utilizes a whole-person approach to treating disordered eating that is personalized to each individual’s needs. For more information on Dr. Jantz’s program, I recommend reading the chapter entitled “A Wholistic Model in Treating Disordered Eating” in the book Food as an Idol: Finding Freedom from Disordered Eating (ABC’s Ministries, 2017).
Improving Body Image
“The creation of a positive body image is not only a worthwhile pursuit, especially for persons who’ve experienced an eating disorder, it is also an objective that’s really possible to achieve” (Cash, 2003, p. 13). Cash reported about an 8-step cognitive behavioral approach that he developed and published as The Body Image Workbook (New Harbinger Publications, 1997). This approach to developing positive body image includes techniques such as taking personal inventories, journaling, using positive self-talk, and avoiding individuals who lead to feelings of self-consciousness and negative body image.
After reviewing the literature linking sexual abuse and disordered eating, I am more convinced that sexual abuse sets individuals up to develop disordered eating. This conclusion parallels my personal experience where I attribute many of my food and body image issues with having been sexually abused at an early age. However, my conclusion may not be applicable to men as most of the study participants were females. The one reported study that used males found no link between sexual abuse and disordered eating. Further study using male victims of sexual abuse would be needed to determine if a link between sexual abuse and disordered eating exists in males.
I can identify with many of the theories presented linking sexual abuse and disordered eating. For example, I used to eat to self-medicate and to express emotions. Several psychiatrists and psychologists have diagnosed PTSD in me. I also identify with body image problems having been teased all through school for being “short” and “fat”. Above all, I recognize a lot of truth in the Sexual Barrier weight hypothesis because I know that I used to sabotage weight loss efforts by overeating when I got to a certain point because I feared being raped again.
Of all the alternatives for treatment to maintain a healthy weight, I recommend those with sexual abuse and disordered eating issues try one of the wholistic approaches. However, I do want to stress the importance of not traveling the journey to healing alone. Seek professional help.
Allender, D. (1990, 1995, 2008). The Wounded Heart: Hope for adult victims of childhood sexual abuse. Colorado Springs, CO: Navpress. Available for purchase at https://www.amazon.com/Wounded-Heart-Victims-Childhood-Sexual/dp/1600063071
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Available for purchase at https://www.amazon.com/Diagnostic-Statistical-Manual-Mental-Disorders/dp/0890425558
Bryant-Waugh, R. (2000). Developmental-systemic-feminist therapy. In A. Freeman (Series Ed.), K. J. Miller, & J. S. Mizes (Vol. Eds.). Springer series on comparative treatments for psychological disorders. Comparative Treatments for Eating Disorders (pp. 160-181). New York: Springer.
Cambridge Eating Disorder Center. (2017). Online screening & helpful resources. Retrieved March 25, 2017 from http://www.eatingdisordercenter.org/eating-disorder-education/helpful-resources.html
Canopy Cove. (2016). Using equine therapy to treat anorexia, bulimia, and other eating disorders. Retrieved Feb. 28, 2018 from https://www.canopycove.com/equine-therapy/
Cash, T. F. (2003, Summer). Body image: Learning to like your looks and yourself. Eating Disorders Today, 1, 1, 12-13.
Costin, C. (1996). Body image disturbance in eating disorders and sexual abuse. In M. F. Schwartz & L. Cohn (Eds.), Sexual abuse and eating disorders (pp. 109-127). Bristol, PA: Brunner/Mazel.
DeGiacomo, P., & Rugiu, A. S. (2000). The Elementary Pragmatic Model. In A. Freeman (Series Ed.), K. J. Miller, & J. S. Mizes (Vol. Eds.). Springer series on comparative treatments for psychological disorders: Comparative treatments for eating disorders (pp. 236-257). New York: Springer.
DeGoede, D. L., & Drews, D. (1998). Belief therapy: A guide to enhancing everyday life. Lake Elsinore, CA: E. D. L.
Dinsmore, B. D., & Stormshak, E. A., (2003). Family functioning and eating attitudes and behaviors in at-risk early adolescent girls: The mediating role of intra-personal competencies. Current Psychology: Developmental, Learning, Personality, Social, 22(2), 100-116.
EAT-26. (2017). Eat-26 self-test. Available: http://www.eat-26.com/
Eating Disorder Hope. (2012). Equine therapy. Retrieved March 27, 2017 from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/types-of-treatments/horse-equine-therapy
Equine Assisted Growth and Learning Association, Inc. (2009-2010). Welcome. Retrieved Feb. 28, 2018 from http://home.eagala.org/
Fallon, A., & Bunce, S. (2000). The psychoanalytic perspective. In A. Freeman (Series Ed.), K. J. Miller, & J. S. Mizes (Vol. Eds.). Springer series on comparative treatments for psychological disorders. Comparative Treatments for Eating Disorders (pp. 82-127). New York: Springer.
Freeman, A., Miller, K. J., & Mizes, J. S. (2000). Springer series on comparative treatments for psychological disorders. Comparative treatments for eating disorders. New York: Springer.
Gati, A., Tenyi, T., Tury, F., & Wildmann, M. (2002). Anorexia nervosa following sexual harassment on the Internet: A case report. International Journal of Eating Disorders, 31, 474-477.
Grohol, J. M. (2018). Psychological tests & quizzes. Available: https://psychcentral.com/quizzes/
Gurze Books (2003, May/June). Bulimia nervosa and child abuse. Eating Disorders Review, 14, 7. Website available: http://eatingdisordersreview.com/category/eating-disorders/
Harned, M. S., & Fitzgerald, L. F. (2002). Understanding a link between sexual harassment and eating disorder symptoms: A mediational analysis. Journal of Consulting and Clinical Psychology, 70(5), 1170-1181.
Hausenblas, H. A., Cook, B. J., & Chittester, N. I. (2008). Can exercise treat eating disorders?. Exercise & Sport Sciences Reviews, 36, 43-47.
integration. (n.d.). Dictionary.com Unabridged. Retrieved March 28, 2017 from Dictionary.com website http://www.dictionary.com/browse/integration
Jantz, G. L. (2010). Hope, help & healing for eating disorders: A whole-person approach to treatment of anorexia, bulimia, and disordered eating. Colorado Springs: Waterbrook Press. Available for purchase at https://www.amazon.com/Hope-Help-Healing-Eating-Disorders/dp/0307459497
Kaye, W. H., Nagata, T., Weltzin, T. E., George Hsu, L. K., Sokol, M. S., McConaha, C., et al. (2001). Double-blind placebo-controlled administration of restricting- and restricting-purging-type anorexia nervosa. Biological Psychiatry: A Journal of Psychiatric Neuroscience and Therapeutics, 49 (7), 644-652.
Mayo Clinic Staff. (2016a). Anorexia nervosa. Retrieved May 28, 2017 from http://www.mayoclinic.org/diseases-conditions/anorexia/diagnosis-treatment/treatment/txc-20179528
Mayo Clinic Staff (2016b). Bulimia nervosa. Retrieved May 28, 2017 from http://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment/treatment/txc-20179842
McGraw, P. (2003). The ultimate weight solution: The 7 keys to weight loss freedom. New York: Free Press. Available for purchase at https://www.amazon.com/Ultimate-Weight-Solution-Keys-Freedom/dp/147675764X
Miller, W. C. (2003). Emotional distress and weight-related issues. Healthy Weight Journal, 17(6), 82-85.
Murray, C., & Waller, G. (2002). Reported sexual abuse and bulimic psychopathology among nonclinical women: The mediating role of shame. International Journal of Eating Disorders, 32, 186-191.
Nichols, M. P., & Schwartz, R. C. (2001). The essentials of family therapy. Boston: Allyn and Bacon. Updated edition of book available for purchase at https://www.amazon.com/Essentials-Family-Therapy-6th/dp/0205249000
Orgeron, P. K. (2017). Food as an idol: Finding freedom from disordered eating. Nashville, TN: ABC’s Ministries. Available for purchase at https://www.amazon.com/Food-Idol-Finding-Freedom-Disordered/dp/0997956534
Owens (aka, Orgeron), P. K. (2002). Eating disorders: Etiology, treatment, and prevention. Unpublished manuscript. Morehead State University at Morehead, KY.
Ozier, A. D., Henry, B. W., & American Dietetic Association (2011, August). Position of the American Dietetic Association: Nutrition intervention in the treatment of eating disorders. Journal of the American Dietetic Association, 111(8), 1236-1241.
Remuda Ranch. (2014). Equine therapy and eating disorders. Retrieved March 27, 2017 from https://www.remudaranch.com/blog/item/26-equine-therapy-and-eating-disorders
Remuda Ranch. (2016). Horses are helping patients overcome eating disorders. Retrieved March 27, 2017 from https://www.remudaranch.com/blog/item/143-horses-are-helping-patients-overcome-eating-disorders
Remuda Ranch. (2017). Expressive arts therapy. Retrieved March 27, 2017 from https://www.remudaranch.com/about/types-of-therapy/expressive-arts-therapy
Rorty, M., & Yager, J. (1996). Speculations on the role of childhood abuse in the development of eating disorders among women. In M. F. Schwartz & L. Cohn (Eds.), Sexual abuse and eating disorders (pp. 23-35). Bristol, PA: Brunner/Mazel.
Rosenfeld, S. (2017, May 5). Why group? Retrieved May 16, 2017 from http://www.oliverpyattcenters.com/why-group/
Sands, S. H. (2000). Self Psychology Therapy. In A. Freeman (Series Ed.), K. J. Miller, & J. S. Mizes (Vol. Eds.). Springer series on comparative treatments for psychological disorders: Comparative treatments for eating disorders (pp. 182-206). New York: Springer.
Schoemaker, C., Smit, F., Bijl, R. V., & Vollebergh, W. A. M. (2002). Bulimia nervosa following psychological and multiple child abuse: Support for the self-medication hypothesis in a population-based cohort study. International Journal of Eating
Disorders, 32, 381-388.
Schwartz, M. F., & Cohn, L. (1996). Sexual abuse and eating disorders. Bristol, PA: Brunner/Mazel. Available for purchase at https://www.amazon.com/Sexual-Abuse-Eating-Disorders-Schwartz/dp/1138883751
Schwartz, M. F., & Gay, P. (1996). Physical and sexual abuse and neglect and eating disorder symptoms. In M. F. Schwartz & L. Cohn (Eds.), Sexual abuse and eating disorders (pp. 91-108). Bristol, PA: Brunner/Mazel.
Smolak, L., & Murnen, S. K. (2002). A meta-analytic examination of the relationship between child sexual abuse and eating disorders. International Journal of Eating Disorders, 31, 136-150.
somatization. (n.d.). The American Heritage® science dictionary. Retrieved March 28, 2017 from Dictionary.com website http://www.dictionary.com/browse/somatization
Stonebriar Psychiatric Services. (n.d.a). About our Medical Director, board certified in psychiatry, Dr. Tharp …. Retrieved July 1, 2017 from http://www.stonebriarps.com/DrTharp.html
Stonebriar Psychiatric Services. (n.d.b). Home page. Available: http://www.stonebriarps.com/Home.html
Striegel-Moore, R. G., Dohm, F. A., Pike, K. M., Wilfley, D. E., & Fairburn, C. G. (2002). Abuse, bullying, and discrimination as risk factors for binge eating disorder. American Journal of Psychiatry, 159, 1902-1907.
Tharp, D. T. (2006a). Anorexia. Stonebriar PsychiatricService News & Views, 2(11). Retrieved March 28, 2017 from http://www.stonebriarps.com/files/August_2006_Anorexia.pdf
Tharp, D. T. (2006b). Binge eating disorder. Stonebriar Psychiatric Service News & Views, 2(11). Retrieved March 28, 2017 from http://www.stonebriarps.com/files/November_2006_Binge_Eating.pdf
The Something Fishy Website on Eating Disorders. (1998-2018). Types of treatment. Retrieved March 27, 2017 from http://www.something-fishy.org/reach/treatmenttypes.php
Treasure, J. L., Schmidt, U. H., & Troop, N. A. (2000). Cognitive analytic therapy and the transtheoretical framework. In A. Freeman (Series Ed.), K. J. Miller, & J. S. Mizes (Vol. Eds.). Springer series on comparative treatments for psychological disorders. Comparative treatments for eating disorders (pp. 283-308). New York: Springer.
Tripp, M. M., & Petrie, T. A. (2001). Sexual abuse and eating disorders:
A test of a conceptual model. Sex Roles, 44(1/2), 17-32.
van den Berg, P., Wertheim, E.H., Thompson, J. K., & Paxton, S. J. (2002). Development of body image, eating disturbance, and general psychological functioning in adolescent females: A replication using covariance structure modeling in an Australian sample. International Journal of Eating Disorders, 32(1), 46-51.
Vohs, K. D., Heatherton, T. F., & Herrin, M. (2001). Disordered eating and the transition to college: A prospective study. International Journal of Eating Disorders, 29, 280-288.
WebMD Staff. (2017a). Understanding anorexia – – Diagnosis and treatment. Retrieved May 28, 2017 from http://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/understanding-anorexia-treatment
WebMD Staff.. (2017b). Understanding bulimia: Treatment. Retrieved May 28, 2017 from http://www.webmd.com/mental-health/eating-disorders/bulimia-nervosa/understanding-bulimia-treatment#1
Weiner, E. J., & Stephens, L. (1996). Sexual barrier weight: A new approach. In M. F. Schwartz & L. Cohn (Eds.), Sexual abuse and eating disorders (pp. 68-77). Bristol, PA: Brunner/Mazel.
Wennerstrand, A. L. (2002). Dance/movement therapy in the treatment of eating and body image problems. [On-line]. Available: https://www.edreferral.com/movement-therapy
Williamson, D. A., & Netemeyer, S. B. (2000). Cognitive-behavior therapy. In A. Freeman (Series Ed.), K. J. Miller, & J. S. Mizes (Eds.). Springer series on comparative treatments for psychological disorders. Comparative treatments for eating disorders (pp. 61-81). New York: Springer.
Wonderlich, S. A., Peterson, C. B., Mitchell, J. E., & Crow, S. J. (2000). Integrative cognitive therapy for bulimic behavior. In A. Freeman (Series Ed.), K. J. Miller, & J. S. Mizes (Vol. Eds.). Springer series on comparative treatments for psychological disorders. Comparative treatments for eating disorders (pp. 258-282). New York: Springer.
Zerbe, K. J. (1995). The body betrayed: A deeper understanding of women, eating disorders, and treatment. Carlsbad, CA: Gurze. Available for purchase at https://www.amazon.com/Body-Betrayed-Understanding-Disorders-Treatment/dp/0936077239
Adaptive Function of Eating Disorder Symptoms
Attention—Cry for Help
Identity and Self-Esteem
Control and Power
Predictability and Structure
Establishment of Psychological Space
Reenactment of Abuse (Repetition/Compulsion)
Self-Punishment or Punishment of the Body
Containment of Fragmentation
Dissociation with Intrusive Thoughts, Feelings, Images
Cleanse or Purify the Self
Attempt “to disappear” (Anorexia)
Create Large Body for Protection
Create Small Body for Protection
Avoidance of Intimacy
Release Tension Built Up From Hypervigilance
Symptoms Prove “I am Bad” Instead of Blaming Abusers