Eating Disorders and Sexual Assault

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What causes eating disorders?

"Some people with eating disorders use the behaviors to avoid sexuality...It is often said that the key to understanding an eating disorder is an appreciation of the person's need to control.." from ANRED

" Significantly higher rates of sexual and aggravated assault among women with BN [bulimia nervosa] support the hypothesis that victimization may contribute to the development and/or maintenance of the disease. Childhood abuse, particularly sexual abuse of a female child by her father or another adult male, may also be associated with the development of BN." T. Foster, M.D.

What is an eating disorder?

"Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight." from NIMH

The link between sexual abuse and eating disorders is not a simple matter but one worth looking into. Unexamined possibilities include sexual assault related victim blame and secondary victimization and whether they contribute to eating disordered behaviors. Most rape survivor support boards have separate forums for eating disorders as well as for self injury.


Sexual Assault Eating Disorders
Self injury in sexual assault Self-Injurious Behavior in Women With Eating Disorders
Rape trauma syndrome - perfectionism The Relation Between Eating Disorders and Components of Perfectionism
Objectification Theory Objectification Theory as It Relates to Disordered Eating Among College Women
Rape is not about sex to the rapist; it has to do with control and power Eating Disorders are widely regarded as being about control issues.


Adjusting the National Crime Victimization Survey's Estimates of Rape and Domestic Violence for 'Gag' Factors,

1986-1990. Coker, Ann L., and Elizabeth A. Stasny.

"The researchers considered whether the type of interview (personal or telephone) and the presence of another person (particularly a spouse) influenced or "gagged" the reporting of rape and domestic violence in the NCVS...

It is hypothesized that the inclusion of such yes/no questions would more easily allow victims to report rape or domestic violence incidents in telephone interviews, even with spouses present in the home during the interview."


Journal articles

Dohm FA; Striegel-Moore RH; Wilfley DE; Pike KM; Hook J; Fairburn CG. Self-harm and substance use in a community sample of black and white women with binge eating disorder or bulimia nervosa. International Journal of Eating Disorders 32(4): 389-400, 2002. (22 refs.)

Objective: This study evaluated rates of self-harm and substance use in women with either bulimia nervosa (BN) or binge eating disorder (BED) and assessed whether differences in self-harm and substance use are related to sexual or physical abuse. Method: Alcohol abuse, self- harm, and use or abuse of various illicit drugs were evaluated in a sample of 53 women with BN and 162 women with BED. Results: Self-harm and substance use generally did not differentiate BED and BN cases, but rates of self-harm and substance use were elevated among women with a history of sexual or physical abuse relative to women without such a history. Discussion: Elevated rates of self-harm and substance use may not be related uniquely to BN diagnostic status, but may be related to a characteristic shared by women with BN and BED, such as a history of sexual or physical abuse.


Harned MS. (2002). Understanding a link between sexual harassment and eating disorder symptoms: a mediational analysis. (eng; includes abstract) Journal Of Consulting And Clinical Psychology [J Consult Clin Psychol] 70 (5), pp. 1170-81.

Using data from 3 samples of working women and men, the present study examines the association between sexual harassment and eating disorder symptoms by studying the processes that may underlie this relationship. The results of structural equation modeling suggest a link between sexual harassment and eating disorder symptoms among women and indicate that this relationship is mediated by psychological distress, self-esteem, and self-blame. Further, sexual harassment was found to predict eating disorder symptoms among women even when experiences of sexual assault were included in the model. No relationship was found between sexual harassment and eating disorder symptoms among men. The theoretical and clinical implications of these results are discussed.

Wonderlich, Stephen A.; Crosby, Ross D.; Mitchell, James E.; Thompson, Kevin M.; Redlin, Jennifer; Demuth, Gail; Smyth, Joshua; Haseltine, Beth. (2001). Eating Disturbance and Sexual Trauma in Childhood and Adulthood. By: International Journal of Eating Disorders, 30 (4), p401-412, 12p, 4 charts.

Presents a study which examined the relationship between sexual trauma and eating disorder behavior, taking into account the effects of developmental stage of the victim and the effects of multiple sexual assaults. Information on multi-impulsive binge eating; Comparisons between groups on demographic characteristics; Characteristics of sexual abuse and rape.

Dansky BS (1997). The National Women's Study: relationship of victimization and posttraumatic stress disorder to bulimia nervosa. (eng; includes abstract) By , The International Journal Of Eating Disorders [Int J Eat Disord], 21 (3), pp. 213-28.

OBJECTIVE: In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa. METHOD: To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews. RESULTS: Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.6%, as compared with 11.5% for respondents with binge eating disorder and 13.3% for respondents without bulimia nervosa or binge eating disorder. Compared to respondents without bulimia nervosa or binge eating disorder, aggravated assault history was significantly more prevalent in women with bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress disorder (36.9%). Characteristics of sexual assault experiences were not associated with dysfunctional eating patterns. Specific types of disordered eating such as compensatory behaviors in bulimia nervosa were associated with higher rates of victimization. CONCLUSIONS: In sum, the significantly higher rates of both sexual and aggravated assault among women with bulimia nervosa compared with women without such a diagnosis support the hypothesis that victimization may contribute to the development and/or maintenance of bulimia nervosa.

Baldo, Tracy D. Bostwi; Baldo, Anthony J. (1996). Intrafamilial assaults, disturbed eating behaviors, and further victimization. Psychological Reports, Dec96 Part 1, Vol. 79 Issue 3, p1057, 2p.

Discusses the association of histories of sexual assaults with disturbed eating behaviors. Relationship between intrafamilial and extrafamilial assaults; Administration of Sexual Experience Therapy to classify subjects as no assault or assaulted.

Laws, Ami; Golding, Jacqueline M. (1996). Sexual Assault History and Eating Disorder Symptoms among White, Hispanic, and African-American Women and Men. American Journal of Public Health, 86 (4), p579-579, 4p, 2 charts.

Data from two Epidemiologic Catchment Area Program sites (Los Angeles and North Carolina) were analyzed to examine relations of sexual assault history to eating disorder symptoms. In regression analyses controlling for age, gender, ethnicity, income, socioeconomic status, and study site, persons with sexual assault history (n = 514) were more likely than those not assaulted (n = 5511) to report thinking they were too fat (odds ratio [OR] 1.6); losing = 15 lb (OR = 1.86); weight loss to 85% of normal (OR = 2.08); one or more anorexia symptoms (OR = 1.81); and sudden weight change (OR = 2.32). Ethnicity and income modified the relations. The data support an association of sexual assault history with eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Hall RC (1989). Sexual abuse in patients with anorexia nervosa and bulimia. (eng; includes abstract) By , Psychosomatics [Psychosomatics] 30 (1), pp. 73-9.

Few studies have documented the extent and nature of sexual abuse among women who later come to treatment for anorexia nervosa or bulimia. This comparison study reports on a sample of 158 patients admitted to an eating-disorder unit, of whom 60 gave a history of sexual abuse, compared to 98 with no history of abuse. Fifty percent of the anorexic and bulimic patients had suffered sexual abuse, compared to only 28% of patients admitted with other eating-disorder diagnoses; this was a significant difference (p less than 0.001). Of the four types of abuse surveyed, only those patients suffering rape were likely to have sought help from caregivers prior to admission (p less than 0.001). The authors report on likely perpetrators of abuse, age of first abuse, and frequency of depressive symptoms in the abused population. The data from this study strongly suggest that the possibility of sexual assault or abuse must be assessed and the results included in a comprehensive therapy plan for eating-disorder patients.

Schechter, Justin O.; Schwartz, Henry P.; Greenfeld, David G. (1987). Sexual Assault and Anorexia Nervosa. International Journal of Eating Disorders, 6 (2), p313-316, 4p.

Two cases of sexual assault with subsequent onset or exacerbation of anorxia nervosa are described. Features common to anorexia nervosa and the sexual syndrome include feeling of guilt, inadequacy, loss of control, and distortion of body image. [ABSTRACT FROM AUTHOR]

Root, Maria P. (1991). Persistent, disordered eating as a gender-specific, post-traumatic stress response to sexual assault. ; Psychotherapy: Theory, Research, Practice, Training, 28(1), Spr 1991. Special issue: Psychotherapy with victims. pp. 96-102.

Briefly reviews several separate bodies of literature that, as a whole, make it possible to hypothesize that the difficulty in facilitating a cessation of persistent disordered eating symptoms may be due to how the symptoms function as a posttraumatic response to sexual assault. By conceptualizing disordered eating in some clients as a posttraumatic response, the therapist may understand the addictiveness and tenacity of the symptoms. Themes and symptoms related to disordered eating, victimization, and posttraumatic stress disorder (PTSD) (e.g., powerlessness, low self-esteem, defensiveness) are outlined. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Hambidge, D. M. (1988). Incest and anorexia nervosa: What is the link? ; British Journal of Psychiatry, 152, Jan 1988. pp. 145-146.

Discusses the role of sexual assault in the etiology of eating disorders and proposes a causal link among premorbid personality features, sexual assault in adolescence, subsequent anorexia nervosa, and later difficulties in sexual adjustment. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Molnar, Amy Elizabeth (2001). The effect of college women's binge eating and sexual assault on anxiety and social dysfunction. ; Dissertation Abstracts International: Section B: The Sciences and Engineering, 61(12-B) pp. 6714.

Sexual assault and binge eating have been associated in the literature and are prevalent among women attending college. Sexual assault and binge eating are said to cause similar difficulties, including family dysfunction, depression, anxiety, social dysfunction, and low self-esteem. Hayes's (1987) theory of sexual assault and Lacey's (1986) theory of binge eating both postulate that women will use avoidant behaviors to decrease anxiety produced by these conditions. Therefore, it can be argued that women who were sexually assaulted and binge eat would have more anxiety and social dysfunction than would women who were not sexually assaulted and do not binge eat. Also, women with either of these two conditions would fall somewhere between women who were sexually assaulted and binge eat and women who were not sexually assaulted and do not binge eat. The participants of this study were college women from ages 18 to 56. Three fourths of the women were Euro-American. There were 23 participants in each of the four groups: sexually assaulted, binge eaters; sexually assaulted, nonbinge eaters; nonsexually assaulted, binge eaters; and nonsexually assaulted, nonbinge eaters. These four groups were matched on depression and family dysfunction to avoid confounding the results. The measures used for the study were the Structured Interview for Anorexia and Bulimia Nervosa (SIAB) and a demographic questionnaire (Fichter, Elton, et al., 1991). The prevalence rate of sexual assault among college women in this study was 29.4%, and 17.7% reported binge-eating behavior. No significant differences were found between the four groups on either anxiety or social dysfunction. However, it seems that matching the groups for family dysfunction and depression reduced any effects sexual assault and binge eating had on anxiety and social dysfunction. It was found that family dysfunction and depression mediated between the criterion and predictor variables. However, because of methodological difficulties and a small sample size, no definite conclusions can be made. Regardless, clinicians should be aware of the possible connection between sexual assault and binge eating to anxiety and social dysfunction in order to appropriately treat the associated psychopathology. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Faravelli C (2004). Psychopathology after rape. (eng; includes abstract) The American Journal Of Psychiatry [Am J Psychiatry], 161 (8), pp. 1483-5.

OBJECTIVE: This study evaluated the psychopathological consequences of a single rape occurring in adult women. METHOD: The psychiatric symptoms reported by 40 women who were victims of rape during the previous 9 months as decided by a court of law were compared with the symptoms of 32 women who underwent severe, nonsexual, life-threatening events (car accidents, physical attacks, or robberies). None of the raped women had experienced previous sexual abuse during childhood or adolescence. RESULTS: The raped women showed a significantly greater prevalence of posttraumatic stress disorder, as well as sexual, eating, and mood disorders. CONCLUSIONS: These findings indicate that the psychopathological consequences of a rape could be specific and may warrant particular attention.

Rickert VI (2002). Adolescent dating violence and date rape. (eng; includes abstract) Current Opinion In Obstetrics & Gynecology [Curr Opin Obstet Gynecol], 2002 Oct; Vol. 14 (5), pp. 495-500.

PURPOSE OF REVIEW: In this review we intend to examine recent literature on dating violence among female adolescents, including prevalence, risk factors, sequelae, screening practices, and potential interventions. RECENT FINDINGS: Dating violence is perpetrated by both males and females and occurs frequently within heterosexual dating relationships. Attitudes toward physical aggression, including those of peers, and abuse by siblings predict later violence as victim and perpetrator. Victims of childhood or dating violence may be at greater risk of developing eating disorders. New strategies and measures to promote screening are available. SUMMARY: Dating violence occurs among all groups of adolescents with common and unique risk factors for dating violence found across adolescents grouped by race/ethnicity, sex, and prior victimization. Efforts to decrease dating violence should (1) increase the use of screening tools that measure victimization as well as attitudes and contextual parameters that promote dating violence; (2) increase self-efficacy to negotiate safer sex; (3) reduce the use/abuse of alcohol and other drugs that facilitate dating violence; and (4) eliminate the influence of negative peer behavior. Interventions to prevent dating violence will likely also reduce rates of unintended pregnancies, HIV, and sexually transmitted diseases among adolescents.

Ackard, Diann M.; Neumark-Sztainer, Dianne. (2002). Date violence and date rape among adolescents: associations with disordered eating behaviors and psychological health. Child Abuse & Neglect, May2002, Vol. 26 Issue 5, p455, 19p, 8 charts.

Examines associations between data violence and rape and disordered eating behaviors and psychopathology. Prevalence of date violence and rape in adolescents; Assessment of binge-eating behavior; Associations adjusted for age, race and other abuse experiences.

Nagata, Toshihiko; Nagata, Toshihiko; Kaye, Walter H.; Kiriike, Nobuo; Rao, Radhika; McConaha, Claire; Plotnicov, Katherine H. (2001). Physical and sexual abuse histories in patients with eating disorders: A comparison of Japanese and American patients. Psychiatry & Clinical Neurosciences, Aug2001, 55 (4), p333-340, 8p.

Abstract Physical and sexual abuse among patients with eating disorders has been a focus of attention in Western countries, however, there is no study comparing the incidence of these factors in Western and Asian countries. Japanese subjects consisted of 38 patients with anorexia nervosa restricting type (AN-R), 46 patients with anorexia nervosa binge eating/purging type (AN-BP), 76 patients with bulimia nervosa purging type (BN) and 99 controls. Subjects from the USA consisted of 29 AN-R, 34 AN-BP and 16 BN. The Physical and Sexual Abuse Questionnaire was administered to all subjects. Minor sexual abuse such as confronting exhibitionism or being fondled by a stranger tended to be more prevalent among Japanese subjects, while victimization by rape or incest was more prevalent among USA subjects. Conversely, physical abuse history was similarly distributed across each diagnostic subgroup in both countries. Events related to physical abuse, such as an abusive family background, may contribute whether eating disorder patients are restricting or bulimic and regardless of culture. [ABSTRACT FROM AUTHOR]

Casper, Regina C.; Lyubomirsky, Sonja (1997). Individual psychopathology relative to reports of unwanted sexual experiences as predictor of a bulimic eating pattern. ; International Journal of Eating Disorders, Vol 21(3) pp. 229-236.

Examined whether family and individual psychopathology mediate the relationship between unwanted sexual experiences and bulimic eating behavior. 61 females (aged 16-54 yrs) diagnosed with bulimia nervosa and 92 female students and university staff (aged 14-63 yrs) who had never met criteria for an eating disorder completed standardized questionnaires on eating behavior, sexual abuse, individual psychopathology, and family psychopathology. Linear regression showed bulimic eating behavior to be significantly related to sexual abuse. However, multiple regression analyses with family and individual psychopathology as independent variables in addition to sexual abuse show only individual psychopathology to predict significantly abnormal eating behavior. Specifically, depressive symptoms, suicidality, and impulsive behavior, but not substance abuse, are the components of individual psychopathology most directly associated with bulimia. The findings suggest that the primary focus in treatment should not be the traumatic events themselves, but their long-term consequences for the individual. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Schwartz, Mark F.; Cohn, Leigh Weiner, Edward J.; Stephens, Larry (1996). Sexual barrier weight: A new approach. In: Sexual abuse and eating disorders. ; Philadelphia, PA, US: Brunner/Mazel, Inc. pp. 68-77. [Reprinted Chapter]

(from the chapter) an eating disorder may have part of its roots in sexual abuse and/or trauma / studied 42 [16-61 yr old female outpatients and inpatients] with eating disorders, two-thirds of whom gave histories of sexual trauma / by graphic analysis, age vs weight, we [show] that fluctuations in body weight have followed sexually significant life events / this is especially significant in victims of rape and termination of a sexual relationship / suggest 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 (PsycINFO Database Record (c) 2005 APA, all rights reserved)

A Bright Red Scream : Self-Mutilation and the Language of Pain (BOOK)

"A bright red scream" is how one of the subjects Marilee Strong interviews in this chilling yet compassionate study of self-mutilation describes the sensation of intentionally inflicting pain upon oneself. It is a compulsion that, while shocking and bewildering to most people, affects 2 million or more Americans and countless others around the globe--one of whom, the late Princess Diana, also suffered from the eating disorders that characterize between 35 to 80 percent of all cutters. Rejecting the classic psychiatric wisdom that views self-mutilation as a species of suicidal behavior, Strong links the phenomenon instead to the will to live--often in the face of such overwhelming childhood abuse that the resulting dissociative behaviors are something akin to posttraumatic stress disorder. Strong touches on other issues as well: Why are most cutters women? And is the current fascination with tattooing and piercing, from its most extreme forms in the "alternative" culture to its growing mainstream acceptance, a sublimation of the cutters' instinct? Through interviews with more than 50 self-injurers, Strong tells the moving story not only of their rage and self-punishment, but also of the courageous journey towards reintegration. (The book also contains an introduction by psychiatrist Armando R. Favazza, author of Bodies Under Seige, one of the leading clinical experts on self-mutilation.) --Patrizia DiLucchio --This text refers to the Hardcover edition.


Bloks, Hans; van Furth, Eric F.; Callewaert, Ineke; Hoek, Hans W.. (2004). Coping Strategies and Recovery in Patients with a Severe Eating Disorder. By: Eating Disorders. 12 (2). p157-169, 13p.


Sexual Abuse and Eating Disorders by Mark F. Schwartz (Editor), Leigh Cohn (Editor)

The relationship between child sexual abuse and eating disorders

Sexual abuse in patients with eating disorders

Adolescent dating violence and date rape

Understanding a link between sexual harassment and eating disorder symptoms: a mediational analysis

Detection, Evaluation, and Treatment of Eating Disorders

Prevalence and factors associated with physical and sexual assault of female university students in Ontario

Individual psychopathology relative to reports of unwanted sexual experiences as predictor of a bulimic eating pattern

Sexual abuse in eating disorder subtypes and control women: The role of comorbid substance dependence in bulimia nervosa

Abuse, Bullying, and Discrimination as Risk Factors for Binge Eating Disorder

Objectification Theory as It Relates to Disordered Eating Among College Women - Objectification Theory

A Longitudinal Examination of the Consequences of Sexual Victimization for Rural Young Adult Women - Statistical Data Included

The survivor syndrome: childhood sexual abuse leaves a controversial trail of aftereffects - effects of childhood sexual abuse - part 2

The Relation Between Eating Disorders and Components of Perfectionism and

Rape trauma syndrome - how perfectionism is a way to 'become good enough' so that the bad things won't happen, or to hide how bad we feel we really are.



CORK Bibliography: Eating Disorders

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