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Secret Diet Disasters of Trauma Survivors
By Dr. Angie Panos
Some people use an eating disorder as a coping mechanism. For example, an alcoholic uses alcohol to cope. Likewise, a person with an eating disorder uses binge eating, purging or restricting their food to cope with their distress. Eating disorders have complex roots and are usually related to exposure to trauma, low self-esteem, depression, loss of control, worthlessness, identity confusion, family dysfunction and a lack of coping skills (de Groot & Rodin, 1999; Nagata et al, 1999). Many people with eating disorders report a history of emotional abuse, such as being teased or ridiculed about their size, weight, or their body's sexual characteristics (Kent, Waller & Dagnan, 1999; Kent & Waller, 2000). Cultural and media pressures which place more value on thinness and appearance rather than inner qualities are factors in the growing trend of eating disorders (Wonderlich et al, 2001). There are generally three recognized categories of eating disorders: Anorexia Nervosa, Bulimia Nervosa and Compulsive Overeating/Binge eating (APA, 1994;Schneer, 2002).
Each year, millions of people in the United States suffer life-threatening eating disorders. According to the National Eating Disorders Association (www.NationalEatingDisorders.org) there are six to sixteen million people in the United States afflicted with Anorexia Nervosa and Bulimia Nervosa. There are no accurate estimates for compulsive overeating. The occurrence of eating disorders among college age women can be considered epidemic. Conservative estimates suggest between 19% and 30% of this age group display Bulimic behavior. Unfortunately, there are trends suggesting that eating disorders are affecting increasing younger children. It is estimated that currently 11% of high school students may have a diagnosable eating disorder. Athletes, dancers, gymnasts and airline employees may face a greater risk for developing an eating disorder. Women and men in "appearance" sports or dancing, like ballet, gymnastics or figure skating, state that their thin and wiry appearance plays a key role in their success. Of females who participate in these types of activities, 62% have been reported to have eating disorders.
Most people with eating disorders suffer for many years in secret. Sadly, eating disorders are among the deadliest of mental health disorders, 10% or more die as a result of starvation, cardiac arrest, or suicide (APA, 1994; Wonderlich et al, 2001).
Tara (her name is changed to protect her confidentiality) tells her story of how her eating disorder complicated her recovery from a violent rape:
I felt better when I ate foods that felt nurturing to me, like pasta, bread, desserts and heavy casseroles. I had started to dress in baggy clothes to hide my body, which helped me feel safer. In the six months after my rape, I gained 50 pounds. Although I was not happy with how I felt, I seemed helpless to do anything about it. I have to admit that being heavy did make me feel safer, and more intimidating to men.
Nearly one year after the rape, I had to go through the terrible stress of testifying in court against my attacker, who was finally caught. I started having severe headaches and went to see my doctor. I imagined that she would tell me that my headaches were due to the stress I was suffering. To my surprise, she told me I had developed high blood pressure, and would have to go on medication or undergo weight loss. She told me that I was 85 pounds overweight and at high risk for obesity related disorders. I cried as I took stock of all the losses I had experienced because of the rape.
"I was never overweight, and I loved to exercise," I tried to explain to my physician. However, at that moment I realized that if I was going to heal from the attack, I had to find other ways to cope with my feelings. I sought out a therapist that I felt I could trust. I started keeping a journal, and tried to write instead of eating when I was stressed. Following the advice of my therapist, I joined a martial arts class that met four times a week. The classes helped me take pride in myself again. Feeling physically stronger was awesome. Little by little I was able to regain control over my eating disorder, while healing from the trauma.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
de Groot, J., & Rodin, G. M. (1999). The relationship between eating disorders and childhood trauma. Psychiatric Annals, 29, 225-229 .
Kent, A., Waller, G., & Dagnan, D. (1999). A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: The role of mediating variables. International Journal of Eating Disorders, 25, 159-167 .
Kent, A., & Waller, G. (200 ). Childhood emotional abuse and eating psychopathology. Clinical Psychology Review, 20, 887-903 .
Nagata, T., Kiriike, N., Iketani, T., Kawarada, Y., & Tanaka, H. (1999). History of childhood sexual or physical abuse in Japanese patients with eating disorders: Relationship with dissociation and impulsive behaviours. Psychological Medicine, 29, 935-942 .
Ochberg, F.M. (1988). Post-traumatic therapy and victims of violence. New York: Brunner/Mazel.
Rodriguez-Srednicki, O. (2001). Childhood sexual abuse, dissociation and adult self-destructive behavior. Journal of Child Sexual Abuse, 10, 75-90 .
Schneer, A. (2002). Eating disorders: A disorder of in and out. Eating Disorders: The Journal of Treatment & Prevention, 10, 161-176 .
Steiger, H., Gauvin, L., Israel, M., Koerner, N., Ng Ying Kin, N. M., Paris, J., & Young, S. N. (2001). Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa. Archives of General Psychiatry, 58, 837-843 .
Waller, G., Meyer, C., Ohanian, V., Elliott, P., Dickson, C., & Sellings, J. (2001). The psychopathology of bulimic women who report childhood sexual abuse: The mediating role of core beliefs. Journal of Nervous & Mental Disease, 189, 700-708 .
Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Roberts, J. A., Haseltine, B., DeMuth, G., & Thompson, K. M. (2000). Relationship of childhood sexual abuse and eating disturbance in children. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 1277-1283 .
Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Thompson, K. M., Redlin, J., Demuth, G., Smyth, J., & Haseltine, B. (2001). Eating disturbance and sexual trauma in childhood and adulthood. International Journal of Eating Disorders, 30, 401-412 .
Web links for more information or referral for treatment for eating disorders:
Angie Panos, Ph.D. is a therapist that specializes in trauma and grief, she has 20 years of experience in helping survivors. She is a board member of Gift From Within.
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