Sexual Abuse and the Development of Anorexia

Research studies report that between 30 and 65 percent of individuals with anorexia have a history of childhood sexual abuse (CSA) that predates the onset of their eating disorder. The strong correlation between CSA and the development of anorexia is likely due to the survivor’s reported desire to disconnect from their physical bodies.

Anorexia offers survivors a way of coping with the psychological effects of CSA, such as internalized body hatred and a tendency toward self-destructive behaviors. While coping, anorexia also gives individuals a sense of control and autonomy over their bodies.

Providers should be familiar with the unique characteristics of individuals with both anorexia and a history of CSA so they can better support their clients in their recovery.

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What Is Anorexia?

Anorexia nervosa is a complicated eating disorder characterized by dysfunctional behaviors with food and an intense fear of gaining weight. The intense fear of gaining weight leads individuals to restrict their energy intake, resulting in a low body weight in the context of their age, sex, developmental trajectory, and physical health.

Individuals with anorexia typically begin to show symptoms during adolescence between the ages of 14 and 19 years. Without treatment, this eating disorder can continue for years, leading to both physical and psychological complications.

Due to its complicated nature, anorexia has the second-highest mortality rate of any mental illness. For this reason, early intervention and treatment are key in helping those with anorexia find recovery. Since anorexia is a mental illness that affects both the mind and the body, treatment involves a multidisciplinary team of professionals, including a therapist, dietitian, medical doctor, and, at times, a psychiatrist.

What Is Sexual Abuse?

Sexual abuse can be defined as any form of sexual activity that happens without the individual's consent. Sexual abuse is an umbrella term that includes experiences of sexual assault or sexual violence. This type of abuse doesn’t only include rape but also expands into unwanted sexual touching and other sexual acts.

In America, reports show that one in three women and one in four men will experience some sort of sexual violence during their lifetime. In children, it is reported that one in nine girls and one in 53 boys under the age of 18 experience sexual abuse at the hands of an adult. Of the children who are victims, 82 percent under the age of 18 are female.

Sexual abuse is a pervasive and tragic problem in the United States. However, stigma, shame, victim blaming, and victim disbelief keep many survivors from speaking about their experiences or reaching out for help. Without support, sexual abuse can have long-lasting effects on a person's mental health.

Survivors of sexual abuse are at risk for several mental health challenges, including, but not limited to, the following:

• Four times more likely to develop drug abuse
• Four times more likely to experience posttraumatic stress disorder as an adult
• Three times more likely to experience depressive episodes as an adult
• Four times more likely to develop an eating disorder

The Connection Between Sexual Abuse and Anorexia

Individuals with anorexia and a history of CSA typically present with greater psychiatric co-morbidities, such as the following:

• Higher levels of anxiety and depression
• More severe obsessive-compulsive symptoms
• Lower self-esteem

The higher levels of psychiatric symptoms among individuals with anorexia and a history of CSA are due to the added impact trauma has on a person both in the short and long term. Sexual abuse can cause symptoms such as these:

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• Nightmares
• Flashbacks
• Intrusive memories
• Chronic pain
• Panic attacks
• Dissociation
• Amnesia

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The intensity of these symptoms can lead an individual to develop a desire to be cut off from the overwhelming emotions, memories, or sensations associated with their physical body. Individuals may act out this desired disconnection through internalized body hatred or shame and engaging in self-destructive behaviors.

Body hatred and shame as well as a tendency toward self-destructive behaviors are key factors in the correlation between anorexia and sexual abuse. When an individual restricts their energy intake, there can be a false sense of relief from traumatic symptoms followed by a euphoric sensation of control. Anorexia gives survivors a way to disconnect from their body’s needs (food, water, rest) and focus on an aspect of their physical self that they can seemingly control (their weight or shape).

Unique Characteristics of Individuals With Childhood Sexual Abuse History and Anorexia

The diagnostic criteria for anorexia include an intense fear of weight gain, energy restriction, and a failure to maintain a proper body weight. Although these are the markers that determine the diagnostic criteria for anorexia, individuals with anorexia and a history of CSA may present with certain unique characteristics, which may include, but aren’t limited to, these:

• An intense desire to disconnect or dissociate from their physical body.
• An increased desire to eliminate body fat as a way to achieve a more androgynous physique, so as to separate themselves from the gendered characteristics associated with the abuse.
• The internalized belief that they don’t deserve to achieve health, resulting from self-blame for the abuse.
• Using purging behaviors such as vomiting or laxative abuse as a way to “cleanse” their body of the abuse.
• A fixed belief that their body is disgusting or shameful, leading to the use of eating disorder behaviors as a way to self-harm.
• Using energy restriction as a way to “turn off” or “numb” from trauma symptoms, such as flashbacks, intrusive memories, or bodily sensations.

Conclusion

Research shows a strong correlation between individuals with a history of sexual abuse and the development of anorexia. Individuals with anorexia who have a history of sexual abuse tend to present with unique characteristics, as discussed above. Due to the large overlap between sexual abuse and anorexia, it is important for eating disorder providers to familiarize themselves with the ways in which trauma can present itself among eating disorder clients.