Prior to becoming Physician General for the Commonwealth of Pennsylvania in January 2015, I served as Chief of the Division of Adolescent Medicine and Eating Disorders at Penn State Hershey Children’s Hospital-Milton S. Hershey Medical Center. In this capacity, I observed first-hand what a growing body of medical research is confirming: For some patients, there is a correlation between sexual trauma and the development of an eating disorder.
Here is a typical case study: A 19-year-old woman sought medical care for an specific eating disorder, bulimia nervosa. Her recurrent bingeing and purging symptoms led to esophageal inflammation, internal bleeding and involuntary vomiting. She also suffered from depression, self-harm behaviors, substance abuse, and, at that point in her treatment, undiagnosed post-traumatic stress disorder (PTSD). It wasn’t until well into her therapy that she disclosed she had been sexually abused as a young adolescent. Today, after years of medical care and eating disorder and trauma therapy, she has recovered.
Eating disorders are serious mental health illnesses that can cause significant medical complications, and even death. Not every patient who has experienced trauma develops an eating disorder, just as not every patient with disordered eating has a history of sexual abuse. That said, patients benefit when therapists treating sexual abuse survivors and physicians treating patients with eating disorders are aware of the potential connection.
The three most-common eating disorders are:
- Anorexia Nervosa, in which patients restrict food (sometimes to the point of starvation) and have an intense fear of gaining weight or becoming fat, even if they are already underweight. Anorexia Nervosa has two peak points: young adolescents, and older adolescents and adults.
- Bulimia Nervosa, in which patients have recurrent episodes of eating large amounts of food with a sense of a lack of control over their eating during the episode. Patients then purge to compensate for overeating. Bulimia Nervosa is most commonly seen in older adolescents and adults.
- Binge Eating Disorder, in which patients eat large amounts of food and experience a feeling that the overeating cannot be controlled. Binge eating disorders are most commonly seen in older adolescents and adults.
Eating disorders are caused by factors that converge — almost like a perfect storm. Emotionally, many people are negatively impacted by today’s cultural obsession with thinness, which is exacerbated by the media and sets an unrealistic picture of health in a person’s mind. People with disordered eating experience psychological issues as well — whether related to body image, personal challenges, or family or social issues. There is also a genetic component. A person with disordered eating has a chemical imbalance of neurotransmitters in the brain that can be impacted by environmental influences.
Research and clinical experience support the observation that patients with anorexia nervosa demonstrate a low self esteem and a pervasive sense of ineffectiveness. They are often depressed, anxious, obsessive, perfectionistic. Patients with bulimia nervosa or binge eating disorder are more likely to be impulsive with more risk-taking behavior.
Eating disorders require early and aggressive treatment, because, untreated, they can lead to serious medical conditions and can affect every organ in the body. Some conditions are reversible, but others can cause long-term, irreversible complications. There is a four percent mortality rate associated with anorexia, which can cause severe electrolyte disturbances and heart arrhythmias.
Recovery from an eating disorder is possible. Treatment requires a multidisciplinary approach that addresses medical stabilization, nutritional rehabilitation, control of abnormal eating behavior, psychological treatment, and prevention of relapse. Treatment options differ, depending on the type of eating disorder and also the patient’s medical and psychological history. Medical stabilization and some nutritional rehabilitation must occur before significant psychological progress can be made.
When an individual with a serious eating disorder discloses sexual trauma, the medical team must deal with the eating disorder symptomatically before the person can begin serious work on the trauma. For example, neither a patient with anorexia nervosa whose heart has been affected or a patient with bulimia with a serious gastrointestinal condition would be physically capable of making significant progress in trauma therapy until the medical symptoms are under control.
Research studies indicate that trauma contributes to the development of an eating disorder for some people because it leads to psychological conditions such as PTSD or depressive symptoms, which, in turn, are related to the development of an eating disorder. As mentioned previously, much depends on the individual’s genetic disposition and environmental influences.
We live in a culture preoccupied with thinness, which places a tremendous burden on people in our society, particularly adolescent females and women. In a vulnerable person, these pressures can interact with other biological, psychological, and familial factors to lead to an eating disorder. Professionals working with a trauma patient can enhance patient care by being aware of this potential pathway, by discussing specific concerns if disordered eating is suspected, and by sending the patient to the appropriate medical specialist or clinic.
Likewise, sexual assault prevention specialists across the country can enhance their messaging by including information about eating disorders in presentations and written materials. Similar to sexual assault, eating disorders often are misunderstood and their effects are underestimated. By bringing this information to light, we have the potential to improve the care for and lives of sexual assault survivors.