17 Jul 2010

Sample Essay: Sexual Abuse and Eating Disorders

Some of the common eating disorders in women are anorexia nervosa and bulimia nervosa. There are theories that have been put across to clarify the development of these disorders. One of the theories is that of childhood sex abuse the relationship between sexual abuse and the development of eating disorders has been an area of attention in the last couple of years. Researchers have tried to make a clarification of this potential connection using a wide range of population samples and research methods. The results of these methods have also varied and almost inconclusive. Many research designs have been functionally applied by different researchers but the results of their research have been dogged by methodology problems.  This paper will look at some of the research designs that have been used to try to explain the connection between these two variables.

The relationship between sexual abuse and the development of eating disorders has been an area of attention in the last couple of years. Researchers have tried to make a clarification of this potential connection using a wide range of population samples and research methods (Finkelor, 1979). The results of these methods have also varied and almost inconclusive. Many research designs have been applied by different researchers but the results of their research have been dogged by methodology problems. In most cases, women who were sexually abused when they were young tend to have emotional problems and they tend to exhibit some behaviors that are aimed at fighting back at the perpetrator of the act or as a way of managing the problem. This research is very important because it can help in the psychological treatment of the eating disorders using the cognitive behavioral therapy method, should it be conclusively established that there is an overt relationship between the eating disorders and childhood sexual abuse. This is because cognitive behavioral therapy is the best method of treating any cognitive behavior that may be exhibited in a human being. But is it is not conclusively found out that there is a relationship between childhood sex abuse and eating disorders like bulimia nervosa and anorexia nervosa, then application of cognitive behavioral therapy to treat the eating disorders may be misguided. In the literature review below the complicated connection between sexual abuse and eating disorders will be examined at the same time discussing the methodological defects of the various research designs used. The paper will end with a conclusive critique of the whole research exercise and give a way forward.

Review of Literature

Anorexic Samples

Steiger and Zanko compared the levels of incestuous abuses and extra familiar abuses among women with eating disorders who met the DSMR-111 criteria, women with psychiatric disorders and normal women (Garner & Garfinkel, 2009). The researchers were interested in the psychological effects of maltreatment and this interest led them to examine psychological defenses which are known to filter effects and perceptions. These differences were vital to the researchers because victims of incest usually have maladaptive defenses which have a self victimizing quality where if they angry with others, the resort to act that are self sabotaging. Secondly women with eating disorders usually use defenses that are primitive as compared to psychiatrically disturbed ones or the normal ones. This study was designed in order to make a determination of how traumas like sex based abuse might have effects on the development of the defense styles. So as to compare the rates between the disorders subtypes the women were divided into various groups. These groups are the anorexic restricters, anorexic bingers, bulimic anorexics and bulimics without anorexia. To make this comparison a group of 20 women was formed within the age range of 18-25. There was a normal control group of 24 women from diverse backgrounds who were of the same age range with the women who had eating disorders. A defense style questionnaire was used to make an assessment of the defense styles and in order to make a study of the sexual schemata, a self report questionnaire was used where the respondents indicated the following information about their sexual abuse during their childhood and adolescence: The perpetrator, the victim, frequency of the sexual abuse, the nature of the sexual abuse and the age at which the sexual abuse took place. The researchers also administered an eating attitudes test in order to establish the existence of eating disorders amongst the subjects used as a control (Garner et al, 1983). The researchers noted that 30 percent of the women with eating disorders reported sexual abuse, however; this trauma was prevalent among those bulimics with no recounting of anorexia. It was found that the condition was infrequent among the anorexic restrictors. Moreover, the subjects showed prevalence of effects of sexual trauma between the restrictors and the bulimics. In making the conclusion, the researchers said that sexual abuse and incest should not always be viewed as variables that cause the development of sexual disorders, because they can also be markers of developmental features, family histories, or any other pathogenic effects.

Bulimic Samples

Welch and Fairburn made a study of the connection linking sexual abuse and the development of bulimia nervosa. There were three main objectives in the study. The first objective was to make a determination of whether sexual ill-treatment leads to an increase of the risks of the development of bulimia nervosa and the researchers used 40 subjects who had bulimia nervosa and 80 normal subjects for comparison. The other objective of the study was to determine whether there was any risk increase identified that is particularly related to bulimia. Nervosa or whether there was a reflection of an increased risk of general psychiatric disorders. This was achieved by examining the 40 subjects anguishing from bulimia nervosa and 40 others with different psychiatric disorders. The third objective was to determine whether patients with bulimia nervosa had a difference with a community group as far as the history of sexual abuses was concerned. This was carried out by examining 50 community subjects who had bulimia nervosa and 50 clinical cases of the same condition.

After the research, the researchers found out that a very minor proportion of the subjects had a history of sexual abuse and they also found out that such a history was just as usual as in the group with the psychiatric disorders generally which means that sexual abuse cannot be considered as a particular risk factor that can lead to the development of bulimia nervosa. The other study used 700 bulimic women to determine whether there is a considerable involvement between bulimia and sexual abuses during childhood. A relationship between family environments was also studied and this study used the questionnaire method. A series of chi square and one way analysis were conducted and the researchers found out that bulimia with self reports of significant childhood abuse, sexually and the seriousness of the abuse was directly proportional to the severity of the bulimia. The contribution of the family environment was also noted where the family variables had an additive combination that increased the risk of bulimia. However, the researchers said that other factors still came into play like personality type, biological dispensation and other contextual factors because 38 percent of the women who had no childhood sexual abuse also displayed bulimic symptoms.

Psychiatric Inpatient Samples

The third group of researchers attempted to examine the connection between eating pathology and any form of abuse. They looked at the nature of this connection using a clinical sample population. In their hypothesis, they stated that patients with sexual abuse histories often show high levels of severe pathological eating disorders as compared to the women who did not suffer from nay type of sexual abuse. The study involved 140 psychiatric women patients, 90 of whom had a history of sexual abuse while 50 did not have such a history. The sample population was given self report questionnaires that had items that were behaviorally defined with a description of sexual abuse and an inventory of eating disorders. The researcher’s findings suggest that there is a relationship between general patterns of symptoms that are linked to sexual disorders (Welch and Fairburn, 1994).

Those patients with a history of childhood sexual abuse scored highly in this study as compared to the other group. However the subjects who had histories of childhood sexual disorders and were not diagnosed with any eating disorder still had some features bulimia nervosa and anorexia nervosa. This research shows that there is a very close association between sexual abuse and eating pathology and the patients with a history of childhood sexual abuse are bound to exhibit a higher level of eating pathology than the patients who did not suffer from childhood sexual abuse.

Student Samples

Student’s samples are also very important in the determination of the relationship between childhood sex abuse and the growth of eating disorders though this sample population ahs some limitations. The fourth research group used a sample of 150 female undergraduates in order to make a determination of a potential link between childhood sex abuse and eating disorders especially the onset of bulimia nervosa. It also investigated the role of family environment in the development of bulimia. The hypotheses that this group put across was that teenagers diagnosed as bulimics would report a higher rate of childhood sexual abuse than the ones that were not diagnosed with bulimia. To each of the participating subject, the following research protocol was provided: Subjects family background, sexual life events questionnaire, Dissociative experiences scale, childhood mealtime questionnaire and the bulimics investigatory test. The hypothesis of the researchers had tentative support form the bulimic group because it reported higher incidences of sexual abuse with a close relative or a family member after they were 12 years old and also reported more cases of sexual abuse with an adult before they were 12. The researchers say that high sexual abuse rates among the bulimics explains why they tend to have negative perception of their bodies (Henderson &Freeman, 1997).

The bulimics who reported sexual abuse, according to the research tend to significantly dissociate more that the bulimic women who had not been abused meaning that the binge purge cycles may create emotional numbness and psychological dissociation. As it was found in all the previous studies, it was not all bulimics that were found to have a history of sexual abuse. There were non bulimics who reported sexual abuse and some other bulimics who did not experience childhood sexual abuse. This means that there may be other factors that are operating outside the sexual abuse experience that lead to eating disorder development. The cases of bulimia would be more aggravated in women who have experienced both sexual abuse and other events that cause food disorders. The researchers also conducted another study suing the same sample population where it was revealed that any unwanted sexual experience would lead to a higher score on a scale measuring eating disorders. Dieting and bulimia were found to be connected to sexual experiences that used force especially where a close family member was involved. The researchers concluded that dieting or self starvation was a defenses mechanism, a way of gaining control over the family member with whom the sexual experience occurred, while bulimia may occur in situations where a person outside the family was involved. This is because the victim is not in a position to gain control over this perpetrator. Once again this fourth research has shown that sexual abuse has a high probability of triggering sexual disorders.

Incest Samples

The fifth research was carried out by wonderlich who used 40 women who were involved in an incest treatment program to make an exanimation of his hypothesis that victims of childhood sexual abuse show greater levels of eating disorders than the control subjects. The control subjects were 29 in number (Hastings &Kahn, 1994). The researcher had predicted that the victims of childhood stress disorders would have some other behaviors that reduce tension like substance abuse and the magnitude of the emotional reaction is directly related to the developing of eating disorders. This means that victims of childhood sex abuse often engage in dangerous self destructive behaviors aimed at minimizing the emotional stress that comes our of the abuse. They also found out that this bulimic behavior was related to the development of the symptoms of post traumatic stress disorder suggesting that bingeing, dieting and purging are some of the efforts that are employed by childhood sexual; abuse victims to manage their sensitive emotional; state that is usually imbalanced by memories of the abuse. The eating disturbances are related to reactions that are affective because of the travails of the abuse. The conclusion is that bulimic behaviors are purposely meant to create affective regulation and not reactions to thought of the abuse and memories of the ordeal.

Methods and Methodological Problems

Most of the studies aforementioned have succeeded in finding a connection between eating disorders and sexual abuse. The research designs used in the studies above present some methodological problems. One of the methodological problems is the size of the sample populations because may be somewhat different results on the negative or positive would have been gotten if the samples were large secondly the samples varied in their backgrounds, ranging form college students to psychiatric patients and this hinders making of generalizations in research because it is bnot known whether these problems are unique to those groups. The other problem is  lack of standard definitions of eating disorders and sex abuse which may affect the validity and the reliability of the research.  The studies did not use the same criteria for making the determination of whether eating disorders are cause by sex abuse meaning that it was difficult to make a conclusion using results got across different studies (Calam & Slade, 1989). The gathering of the retrospective information also posed a big problem because there was a potential bias in recall. This means that the individuals are more often than not, selective in the amount of information they are willing to give out especially things that happened in the past especially if the memory of those things hurts. The questionnaires used had also not been well validated and, measured to determine their reliability and validity. The questionnaires may also create a potential data bias.

Finally, the causal relationship between the histories of childhood sex abuse and the eating disorder development cannot be effectively determined though this kind of data gathered. This is because there is a serious lack of attention given to the timing of the abuse and the growth of the bulimia and anorexia nervosa and nothing is pout across to determine whether there were symptoms of eating disorders that existed before the sexual abuse (Benstein&Putnam, 1986). These researches conducted do not also pay attention to other potential factors such as the family environment that may lead to the development of the eating disorders. There are other victims of sexual; abuses that do not develop eating disorders meaning that the relationship between these two variables is very complex. All these research and methodological base problems act as a hindrance towards the understanding of the impact of sexual abuse on the development of eating disorders.

Conclusion

In all the research aforementioned that has been trying to analyze the relationship between eating disorders and sexual abuse, the data overwhelmingly suggests that there is a relationship between bulimia nervosa and sexual abuse. However, the data does not indicate that there is a relationship between sexual abuse and anorexia nervosa. Moreover, this relationship between childhood sex abuse and bulimia only exist in some forms and not others meaning that a causal relationship is yet to be established. It is very possible that any traumatic happening has the potential of developing an n eating disorder given that sexual abuse occurs in environments that may engender such a development (Bond et al, 1983). The relationship between eating disorders and childhood abuse is not overt and it cannot be conclusively be said that the cause of eating disorders in women is childhood sex abuse because there are  those who experienced abuse and do not exhibit symptoms of eating disorders and others that have eating disorders and yet there were not sexually abuse while young. This means that there is more to eating disorders than just sexual abuse.

Future research ought to analyze the effects of the adjacent environment like family on the development of such disorders. This is because there are other traumas in the environment that may aggravate the eating disorders. These include physical and mental abuse. It is until some of the methodological shortcomings are mentioned above are resolved in the research designs of the future that the relationship between eating disorders and childhood sexual abuse will be established otherwise it would be fallacious to say that there is an overt relationship between the two variables. Despite all the reports of the above research designs, the connection between childhood sexual abuse and bulimia nervosa remains a mystery.

Statistical interpretations of the results

The Correlation between Child Sexual Abuse/Incest and Eating Disorders.

The independent variable: Child sexual abuse/no child sexual abuse.

The dependent variable: Eating Disorders.

The number of categories in my independent variable or my continuous independent variables are as follows: In the eating disorder dependent variable category; Anorexia Nervosa (Restricting) with a given value of 1.00, Anorexia Nervosa (Purging) with a given value of 2.00, Bulimia Nervosa with a given value of 3.00, ED (NOS) with a given value of 4.00, Obesity with a given value of 5.00 and no eating disorder reported with a given value of 6.00.  In the sexual abuse independent variable category child sexual abuse with a given value of 1.00, sexual assault with a given value of 2.00, attempted child sexual abuse with a given value of 3.00 and no sexual abuse reported with a given value of 4.00.

The statistics that I plan to run on my data would be the Correlate Spearman Rho as my categories don’t completely fall within those defined by Pearson are simply because both distributions are highly skewed.

The data output in comparing Eating Disorders with Sexual abuse using the Spearman Rho is as follows:

Descriptive Statistics
Mean Std. Deviation N
Eating Disorder 4.1538 1.77229 13
Experience 2.6923 1.37747 13

Nonparametric Correlations

Correlations
Eating Disorder Experience
Spearman’s rho Eating Disorder Correlation Coefficient 1.000 .816**
Sig. (2-tailed) . .001
N 13 13
Experience Correlation Coefficient .816** 1.000
Sig. (2-tailed) .001 .
N 13 13
**. Correlation is significant at the 0.01 level (2-tailed).

Discussion of results

Most researchers have found out that just a small proportion of the subjects had a history of sexual abuse as they also found out that such a history was just as normal as in the group having psychiatric disorders thus considered as an independent variable. This shows that sexual abuse cannot be taken as a risk factor that can effectively lead to bulimia nervosa development thus a correlation coefficient of 3 which shows very minimal significance.

Students samples used in the determination of the relationship between growth of eating disorders and childhood sex abuse had some shortcomings and more so during the start of bulimia nervosa. The hypotheses that was forwarded was that teenagers diagnosed as bulimics would report a higher rate of childhood sexual abuse than the ones that were not diagnosed with bulimia thus non significant correlation.

The researchers were able to conclude that dieting or self starvation was a defense mechanism, a way of gaining control over the family member with whom the sexual experience occurred, while bulimia may occur in situations where an individual who is not part of the family member may get involved as the victim may not be in a situation to gain control over the perpetrator. The research based on Pearson’s correlation coefficient shows a value of 1 meaning that sexual abuse has a very high chance of bringing about eating disorders.

The research carried out by Wonderlich using women who were involved in an incest treatment program showed greater levels of eating disorders than the control subjects. As earlier predicted the victims of childhood stress disorders would engage in some behaviors in order to reduce tension such as substance abuse and the extent of the emotional reaction has a direct relation to eating disorders development thus potentiating a correlation coefficient of 3. This then shows that victims of childhood sex abuse most of the time engages in weird self destructive behaviors that are geared towards lowering the emotional stress.

The findings which show that this kind of bulimic behavior was significantly related to the emergence of the symptoms of post traumatic stress disorder hence suggesting that dieting and purging are amongst the efforts employed by childhood sexual and victims of abuse to effectively manage their emotional; state that is usually imbalanced by memories of the abuse. The eating disturbances owed some relation to eventual reactions as a result of the abuse.

The attempt by some researchers to examine the link between any existing form of abuse and eating pathology by looking at the nature of the connection using a clinical sample population. The hypothesis stated that most patients with histories of sexual abuse do exhibit elevated levels of extreme pathological eating disorders as compared to the women who did not suffer from any type of sexual abuse.

In relation to a study where the sample population was given self report questionnaires containing items with behavioral definition and description of sexual abuse with an inventory of eating disorders. The findings suggest that there is a relationship between symptoms that are associated with sexual disorders thus a correlation coefficient of 1. It shows that there is a very close association between sexual abuse and eating pathology and most individuals with a history of childhood sexual abuse are most likely to exhibit higher levels of eating disorders than individuals who were not victims of the same in childhood.

The statistical data showed a lot of similarity with the correlation significance thus the findings reflects true picture of the relationship between Child Sexual abuse, incest and eating disorders. However the results can not be conclusive because of human errors as some respondents can not reveal the truth.

References

Bernstein, E.M., & Putnam, F.W. (1986). Development, reliability, and validity of a

dissociation scale. Journal of Nervous and Mental Disease, 174, 727-735.

Bond, M., Gardner, S.T., Christian, J., & Sigal, J.J. (1983). Empirical study of self-rated

defense styles. Archives of General Psychiatry, 40, 333-338.

Calam, R.M., & Slade, P.D. (1989). Sexual Experience and Eating Problems in Female

Undergraduates. International Journal of Eating Disorders, 8, 391-397.

Finkelhor, D. (1979). Sexually victimized children. New York: Macmillan.

Garner, D.M., & Garfinkel, P.E. (2009). The Eating Attitudes Test: An index of the

symptoms of anorexia nervosa. Psychological Medicine, 9, 273-279.

Garner, D.M., Garfinkel, P.E., & Shaughnessy, M. (2005). The validity of the

distinction between bulimia with and without anorexia nervosa. American Journal of

Psychiatry, 142, 581-587.

Garner, D.M., Olmstead, M.A., & Polivy, J. (1993). Development and validation of a

multidimensional eating disorder inventory for anorexia nervosa and bulimia.

International Journal of Eating Disorders, 2, 15-34.

Hastings, T., & Kern, J.M. (1994). Relationshipd Berween Bulimia, Childhood Sexual

Abuse and Family Environment. International Journal of Eating Disorders, 15, 103-111.

Henderson, M., & Freeman, C.P.L. (1997). A self-rating scale for bulimia: The “BITE.”

British Journal of Psychiatry, 150, 18-24. .

Welch, S.L., & Fairburn, C.G. (1994). Sexual Abuse and Bulimia Nervosa: Three

Integrated case control comparisons. American Journal of Psychiatry, 151, 402-407.

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