User:SV194/Sexual Assault and Eating Disorders

Sexual Trauma and Eating Disorders
Sexual trauma has many impacts on an individual’s psychological, emotional, and physical well-being. It puts individuals at risk for the development of serious psychological problems. Childhood sexual abuse, sexual harassment, sexual assault, and rape are known risk factors for eating disorders and other psychiatric conditions, such as depression, anxiety, and posttraumatic stress disorder (PTSD), among others.

Prevalence of Sexual Trauma in Eating Disorders
Most individuals with eating disorders report having experienced interpersonal trauma, including sexual trauma. Women with eating disorders have higher rates of sexual trauma compared to women without eating disorders. This pattern is particularly apparent in individuals who engage in bingeing or purging behaviors. About 26.6% of women with bulimia and 11.5% of women with binge eating disorder reported a forcible rape in their lifetime, compared to 13.3% of women without either disorder. Individuals with anorexia and other non-bulimic spectrum eating disorders are less likely to have experienced trauma than individuals with bulimic spectrum disorders. Similar patterns exist in children and adolescents, as well as in men.

Path Between Sexual Trauma and Eating Disorders
Following sexual abuse, girls are almost two times and boys are nearly five times more likely to engage in disordered eating behaviors, such as restricting, bingeing, intentional vomiting, or use of diet pills, laxatives, or diuretics for weight loss. Veterans who experience military sexual trauma are two times more likely to develop an eating disorder. This likelihood is even higher for male veterans.

Body dissatisfaction following sexual trauma is a potential reason why rates of eating disorders may be higher in individuals who have experienced sexual trauma. Sexual trauma changes how a person relates to and views their body. An individual’s perception of their body may trigger trauma-related memories, thoughts, emotions, and behaviors. Following sexual trauma, a survivor may view their body as shameful, disgusting, or dirty. They may seek to avoid, forget, or harm their body through engaging in disordered eating or other self-harming behaviors. Body dissatisfaction following sexual trauma occurs in both women and men.

Compared to those who have not experienced sexual trauma, survivors of sexual trauma may maintain more difficulties with body image, such as feeling more self-conscious, experiencing greater body dissatisfaction, and having a greater desire to be thin. There are a few components in this intersection of sexual trauma and body image that can increase maladaptive symptom severity for survivors. Research has found that greater trust in the perpetrator of the trauma is related to more severe body image distress following an assault. Feelings of shame following sexual trauma are also common and can increase feelings of body hatred. Fear of future sexual assault may also cause individuals to hate their bodies for being attractive to others. This fear can lead to the desire to minimize secondary sex characteristics, such as breasts, to become less attractive. And overall body dissatisfaction may lead to individuals attempting to change their appearance and developing disordered eating behaviors.

In addition to difficulties with body image, survivors of sexual trauma may use food to feel in control, manage overwhelming emotions, or otherwise cope with the memories and aftermath of the traumatic experience. Typically, individuals who develop eating disorders have increased sensitivity and less adaptability to stress and trauma. For example, binge eating and purging appear to temporarily reduce hyperarousal and anxiety associated with the traumatic experience. These behaviors also contribute to feeling numb, avoiding the trauma, and temporarily forgetting the traumatic experience. The behaviors prevent individuals from fully processing and recovering from traumatic experiences. Because binge eating and purging decrease the negative emotional and psychological consequences of trauma, individuals get stuck in these behavioral patterns and cannot stop engaging in them on their own.

PTSD and Eating Disorders
PTSD symptoms are a known risk factor for eating disorders, particularly bulimia and bulimic symptoms. PTSD also occurs at higher rates in individuals with bulimia, binge eating disorder, or binge eating behaviors than in individuals who do not have disordered eating. Over half of individuals who binge and/or purge have PTSD symptoms, and 38% to 44% of individuals are diagnosed with PTSD in their lifetime. Research has found that the trauma response (i.e., the occurrence of PTSD symptoms), not the occurrence of sexual trauma, predicts eating disorder development.

PTSD symptoms and eating disorders share some overlapping psychological features, as well as overlapping biological and genetic components. Dissociation, difficulty identifying one’s own emotions (alexithymia), and emotion dysregulation can occur in both disorders. Additionally, hypothalamic-pituitary-adrenal (HPA) axis dysfunction as well as variation in dopamine, glucocorticoid, neuropeptide Y (NPY), and serotonin functioning occur in both PTSD and eating disorders. These features suggest that high rates of the co-occurrence of PTSD and eating disorders may be due to shared biological and psychological vulnerabilities.

Other Comorbid Disorders
Trauma exposure in individuals with eating disorders is associated with additional co-occurring disorders, including major depressive disorder, anxiety disorders, and substance use disorders. Additionally, specific symptoms and maintaining factors of eating disorders, such as body dissatisfaction, are linked to co-occurring disorders. Body image distress following a traumatic event is related to increased depression, and body dissatisfaction following sexual trauma can lead to non-suicidal self-injury.

Treatment
Treatment for co-occurring eating disorders and trauma requires an integrated, trauma-informed approach, as unresolved trauma and/or PTSD can prevent individuals from achieving full eating disorder recovery. Typical treatments for trauma can be effective in individuals with eating disorders, provided enough nutritional rehabilitation has occurred so that the individual can fully process their trauma. The most effective treatments for PTSD are cognitive behavioral therapy, cognitive processing therapy, cognitive therapy, and prolonged exposure. Other therapies that may be effective are brief eclectic psychotherapy, eye movement desensitization and reprocessing (EMDR) therapy, narrative exposure therapy, and some medications, including sertraline, paroxetine, fluoxetine, and venlafaxine.