Childhood sexual abuse is more common than many people realize, unfortunately. A longitudinal study of teenage girls in Australia revealed that 1 in 5 reported at least one incident of sexual abuse before the age of 16. A large random sampling of U.S. adults revealed that 14.2% of men and 32.3% of women had childhood experiences that meet the criteria for child sexual abuse. In the Northern Province of South Africa, a representative sample of teenagers revealed an astonishing overall sexual abuse rate of 54.2%, with males targeted slightly more frequently than females.
Many physical and mental disorders are associated with childhood sexual abuse, including irritable bowel syndrome and other gastrointestinal difficulties, headaches, gynecologic disorders, post-traumatic stress disorder, anxiety and panic disorders, and, in extreme cases, dissociative identity (multiple personality) disorder. Eating disorders have also been seen as strongly related to a history of sexual abuse. These include anorexia nervosa, bulimia nervosa, and binge eating disorder.
One study conducted in Australia revealed that bulimia was related to sexual abuse history, but not anorexia or binge eating. Young women who reported one incident of sexual abuse before 16 years of age were 2.5 times more likely to exhibit symptoms of bulimia than those with no sexual abuse. Women reporting 2 or more incidents were 4.9 times more likely to have bulimia.
Another study showed a connection between anorexia and sexual abuse, but only in the subtype that includes episodes of bingeing and purging, as opposed to the subtype of anorexia that only restricts caloric intake. Restricting anorexia appears to be unrelated to sexual abuse history – instead, genetic predisposition, control issues, and body image distortions take a significant role. These other causal factors also contribute to bulimia and the bingeing/purging subtype of anorexia.
Body image distortion can be an intervening factor in the relationship between eating disorders and child sexual abuse, as can control issues. A child that is being abused feels completely powerless, and may unconsciously decide that the only thing he or she can truly control is food intake. Sexual abuse can also cause the victim to feel shame about his or her body and to see it in distorted ways. However, these two factors can also occur in the absence of sexual abuse.
The association of bingeing/purging behavior with sexual abuse history is complex. Binge eating is often accompanied by a strong release of endorphins and other “feel good” chemicals in the brain. However, the rush is followed by a crash related to feelings of guilt, which lead to purging. Childhood sexual abuse is also associated with anxiety disorders and depression; many people use impulsive, addictive behaviors like binge eating or substance abuse to reduce anxious and depressed feelings.
Another possible cause for the relationship between childhood sexual abuse and the bingeing/purging cycle is the unconscious desire for a symbolic purging of the sensations connected to the abuse. Case studies of some patients with eating disorders have included direct statements of this desire. Many report episodes of vomiting after each incident of abuse, leading to the need to induce vomiting later to get rid of the negative feelings associated with memories of the abuse (conscious or unconscious).
Bingeing and purging, whether it occurs as bulimia or as a component of anorexia, has a significant relationship to a history of childhood sexual abuse. Families, friends, and physicians who are in contact with eating disorder patients should keep these findings in mind and consider the possibility of an abuse history.