How Is Bulimia Related To Sexual Trauma?
Clinical studies are inconsistent in reporting the numbers of eating disorders patients that have been sexually abused, and there is some controversy about this. Figures for bulimics with a history of sexual abuse range from an astounding 7% to 70%, with a majority reporting that roughly 60% of bulimics have experienced some form of sexual abuse (Vanderlinden, 1996). Since all of these figures do not include individuals who have repressed the memories of their abuse, the actual incidence is undoubtedly higher than much of the research has shown.
It is important to be aware of the extremely sensitive nature of this topic, and that a self-help book such as this is not adequate “therapy” for healing these issues. With the understanding that victims need to work with a qualified therapist who has experience treating individuals suffering with both eating disorders and sexual trauma, I will present an overview on this subject. Also, although I am using the pronoun “she,” incest and sexual abuse occur with startlingly high incidence among males, with similar consequences.
Being sexually assaulted, especially by a “trusted” adult, parent, or sibling, is a terrifying, confusing, horrific experience for anyone. It is an act of violence and betrayal so intense that just remembering it is agonizingly painful. In order to survive not only the trauma itself but also the memory of it, a victim might dissociate from the event and from those parts of herself which were present at that time. She may even consider the person being raped to be separate from herself, because the pain is too much for her to bear. Her emotional and physical survival depend on her not remembering the events or her feelings connected with what happened.
An eating disorder works to protect, repress, complete, divert, numb, or confuse these feelings and memories. Certainly it is not within a child’s realm of possibility to blame the abuser for what happened, but even an adult will tend to blame herself for the attack, making her body the focus for hatred and control. Stuffing down food will stuff down the anger and silence the voice that cries out, “Don’t do this to me!” Planning and executing a binge will numb anxieties and deny physical needs, such as hunger or affection. Being in charge of what does, and does not, go into the body is a way to symbolically regain that control which was lost during the original trauma.
The relationship with food makes it difficult to have full relationships with others, thus eliminating the risk of another betrayal. Depending on the individual’s internal survival tools, being extremely large or thin, or even perceiving one’s self as too large or too thin, is a way of keeping potential abusers at a distance. Finally, the painful and violent act of vomiting is a way of expressing and releasing rage and self-loathing.
Many victims of sexual abuse become promiscuous, masochistic, or even fantasize about rape during consenting lovemaking without realizing that they are hooked on the “high” of relief they experience by blocking out their assault. Likewise, they can repeat this “forbidden high” by bingeing and purging. Some bulimics compulsively follow rituals which might mirror repeated incidents, such as molestation from a babysitter every Saturday night or visits from a sibling when parents are out of the house. Forced eating and vomiting also parallel the act of forced oral sex. These repetitive behaviors may be an attempt on the part of the unconscious to complete the original abuse in the present. An even more upsetting eating pattern may be the result of Satanic rituals, which could involve swallowing excrement or blood. Given the appalling scope of sexual trauma within this context, it is apparent that an eating disorder can be a crucial mechanism for survival.
Although we are defining sexual abuse here in terms of more extreme behaviors, practically every woman has suffered sexual humiliation in some form or another. Their breasts have been “accidentally” brushed up against, their virginity has been the subject of male gossip, and they have been whistled or jeered at by strangers. In all of these cases, the female is victimized by the standard line, “She was asking for it.” It is no coincidence that epidemic numbers of women also suffer from some type of food/ weight conflict, the most common of which is dieting. Sadly, women’s bodies have become their enemies instead of the natural wonder that they are.
Sexual trauma must be treated in a safe, trusted environment. Coming to terms with the experience, repressed or not, and returning the inner child to an experience of unconditional love and acceptance is a tremendous undertaking. It requires gentle understanding and patience by therapist and patient alike. Keep in mind that eliminating the binge-purge behavior without introducing healthy coping skills can result in a reliving of the original horror. Making some kind of peace with the nightmare that lies beneath the bulimic surface is best achieved with the guidance of a trained and skilled professional (Schwartz, 1996).
Working and uncovering the truth about my family, and the fact that I was incested, helped everything make sense. I saw how wounded I was, and how much pain and anger I worked dutifully to deny. I began to see that I had value, and that I was lovable and competent, but that I had not been treated that way by my parents. I realized that my eating disorder was motivated by my archaic need to protect my family, and that I was actually recreating my abuse.
When I was 12, my brother began sexually abusing me. I was overwhelmed with confusion and believed if I became fat, he might leave me alone. I think gaining 40 pounds in three months was also my way of saying, “Hey, there’s something wrong here,” without having to verbalize it.
My physical and sexual abuse began at an early age. Much of the abuse centered around food, with my father demanding favors for desserts. Some days, it was all right to leave food on my plate, others it wasn’t. Food became my lasting enemy.
My Dad used to tell dirty jokes. At the time, we all laughed, but they were all demeaning to women. I wondered if he really thought about women, my mother, in that way, but I never asked him. I had a swallowing problem due to being forced into oral sex. I would spit out all of my food, even liquids. I had been through every medical test in the book because the doctors thought there was something wrong with my throat. After four years of therapy, that problem is finally gone; but, it comes back at times of high stress or when memories surface.
It’s important for parents, therapists, doctors, and the public to know that women who were sexually abused are in a lot of pain. Their eating disorder is a way of dealing with all of the feelings— rage, anger, secrecy, fear, betrayal, powerlessness and many others. An eating disorder is a feeling disorder because it helps you handle your feelings.
Reprinted with permission from Bulimia: A Guide to Recovery
By Lindsey Hall and Leigh Cohn
To find out more about this helpful book click here.