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Over the course of my 35 years in practice I have seen a distinct connection between sexual abuse and disordered eating in my clients. This is not to say that all people with eating disorders have abuse history, nor do all people with abuse histories have eating disorders.  But food, among other substances like drugs and alcohol, is an easy and convenient vehicle for stuffing down painful emotions that are prevalent in the survivor’s psyche as well as giving the individual a sense of control or mastery over his/her body where they previously had none.

According to Mary Anne Cohen, CSW, Director of the The New York Center for Eating Disorders, “The connection between sexual abuse and developing an eating disorder is guilt, shame, anesthesia, self-punishment, soothing, comfort and rage.”

Sexual abuse can have many different ways of impacting one’s eating habits and body image.  With sexual abuse so severely violating one’s boundaries, people find great difficulty in identifying such things as true physical hunger, comfortable satisfied or fullness, sexual feelings, fatigue, and different emotional states.  People will turn to food as a coping strategy to deal with a wide range of disturbing feelings as a way of soothing and comforting their distress. 

The use of food serves multiple purposes for many sexual abuse survivors.  Apart from the comfort food brings, it is also a way of controlling the body.  I have treated clients who starve themselves to deny their sexuality as well as others who gain weight to protect themselves from intimacy and thereby, render themselves unattractive.  Others are caught in the never ending cycle of dieting, bingeing, purging, or starving as a means to create the “perfect” body in order to feel empowered, in control, and invulnerable.  In fact, they feel just the opposite.

Secrecy also plays a role in the survivor’s psyche.  Depending upon the circumstances of the abuse, the abuser may have threatened the victim or bribed him or her “not to tell.”  There is a great deal of shame and guilt that one can feel as a result of the abuse.  Furthermore, many survivors internalize a variety of negative beliefs about themselves such as “It was my fault this happened.” “I’m a bad person.”  “I am unworthy of good things happening to me,” and “I deserve to be punished.”

So how does one emerge WHOLE when so much of the inner self has been damaged, violated, and broken?

The case of Andrea is one of bravery, resilience, and illustrative of the fact that one cannot only survive sexual abuse but can also thrive and be whole again.  Andrea first came to see me at 19 years old, a student at a local university.  A beautiful, bright, engaging young woman with dreams of becoming an actress, she struggled with food over the years, starving herself in search of the perfect body.  At the point that she came to see me, she was bingeing, starving, over exercising, and occasionally using laxatives, all in an attempt to control her body. 

An alcoholic, disconnected mother and a workaholic, absent father, complicated her family history.  Her oldest sister, whom she adored and looked up to, was left to take care of Andrea and her two younger sisters.  Receiving no love and attention from her home environment, Andrea sought comfort in playing with the local neighborhood boys.  Andrea’s sister resented having the responsibility of caring for her younger siblings and was physically and emotionally abusive to them.  As a result, Andrea spent more and more time outdoors and began to be sexually abused by the boys in the neighborhood by the age of six. 

When Andrea finally gave voice to her abuse story in our session, something she had held in for 13 years, she began her journey toward healing.  She had never dared tell anyone her story.  The boys had threatened to hurt her if she did.  She never felt her mother was emotionally available, her father was unapproachable and working all the time, and her sister would only hit her and reinforce that it was her fault. 

So she felt alone, abandoned, and full of guilt and shame.  In addition, she divulged another truth that she felt was the most shameful—that it felt good and she thought the boys loved her; they treated her special.

As Andrea’s path to healing unfolded, we began to work on identifying and sitting with uncomfortable emotions as well as recognizing the negative beliefs she had about herself. She began to keep a journal to chronicle her thoughts and feelings.  Through journaling she realized that she had held herself responsible for the abuse.  She viewed herself as a “bad person” who needed to be punished causing her to want to starve herself or binge and purge either by over exercising or by using laxatives. 

Furthermore, having always been a people pleaser, she realized that she was using this as a strategy for getting love and attention.  However, people pleasing had instead robbed her of the ability to know what she wanted and needed.  She either focused on the needs of others, or did things she should do, not what she wanted to do.  I gave her homework assignments noting and practicing taking care of her own needs and identifying her own wants.

Since journaling was so useful to her, I began to have her keep a food journal and trained her to eat mindfully.  As she gradually began to recognize and decode her body’s hunger language, she realized that she was bingeing to stuff down her feelings of shame and guilt, to quell her anxieties, and to protect herself from the strong sexual feelings she had for her boyfriend. 

This was the first of many crucial steps in her learning to differentiate between her emotions and her feelings of hunger.  The abuse had caused her to misread her emotional and physical signals.

We worked through her feelings of guilt and shame and the negative beliefs she held.  Her deeply held shame about feeling the pleasure during the abuse, disappeared as I explained that it was natural for her body to feel pleasure when it was stimulated and that she was not a bad or her body wasn’t betraying her. It was her body’s natural response.  This also led to a lot of anger work toward her parents for not being “available” emotionally and physically and for not protecting her from the her sister or the neighborhood boys.

As time went on she felt more and more empowered using her voice to speak about her needs and feelings instead of stuffing them down.  She was able to tolerate difficult feelings and felt less fearful sexually.

 A big turning point though, was when Andrea told her boyfriend her abuse story.  As a result, she felt safe being intimate with him and was willing to be open about what forms of sexual touch she felt comfortable with and what she didn’t.  Their intimacy improved.

Twenty years later, I received a call from Andrea.  She was happily married to the man who was her boyfriend at the time, had a peaceful relationship with food and her body, and had a successful career as a teacher.  She realized that acting was her mother’s dream, not HERS!

She had truly found her voice, her self, and became whole again.

Most of all, she had become strong in the broken places.

Allyn St. Lifer has been a therapist in private practice for over 30 years and specializes in teaching clients mindful eating to determine physical hunger and the point of satisfaction.  She is the founder and director of Slimworks, a mind/body, non-diet approach for managing weight and transforming one’s relationship with food, body and self.  To find out more about Allyn, please visit her website: www.slimworks.com.  She is a regular ShareWIK.com columnist. 

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