Study shows complex link between abuse and eating disorders

Women who were victims of childhood sexual abuse have long been assumed to be at a higher risk for eating disorders. The results of research, however, have been mixed, with some studies showing a link and others none.

A recently published study of college-age women shows there is a connection between the two, though not a direct one. Childhood sexual abuse is not a significant risk factor on its own, but it is when combined with psychological distress (depression or anxiety) and a condition of emotional disconnection known as alexithymia, say study authors Anita Hund and Dorothy Espelage, both with the University of Illinois at Urbana-Champaign.

“Those factors appear to play an important role not only in how eating disorders get started, but more importantly in how they keep going,” according to Hund, a doctoral student in educational psychology at Illinois and the lead author of the study, published in the October issue of the Journal of Counseling Psychology.

“What sends one woman over the line, and not her classmate (with a similar background), probably has a lot to do with how they experience emotions,” Hund said. If those factors can be addressed through counseling, it holds promise for reducing a woman’s risk for developing a disorder, she said.

The study’s results validate a lot of what many counselors and clinicians already believe or suspect, according to Espelage, a professor of educational psychology at Illinois and co-author of the study. The results also have consequences for the treatment of eating disorders and related behaviors on college campuses, she said.

Many women on campuses engage in disordered eating behaviors, from severe restriction or dieting, to binging and purging, Espelage said.

Among those are women who come to campus with no history of such behaviors, “but begin to feel dissatisfied with their bodies in a very competitive environment and engage in disordered eating for the first time,” she said.

But many campuses devote few resources to counseling women engaged in those behaviors, she said. And there is a movement toward sending those with fully developed eating disorders to off-campus treatment centers, in part because the treatment is so expensive.

“I think this research lends support to the idea that we can do something in college counseling centers and have a tremendous effect,” she said.

Previous research on the association between childhood sexual abuse and eating disorders had produced inconsistent and confusing results because it did not take multiple factors into account, Hund said. “In reality, the association between a history of childhood sexual abuse and disordered eating behaviors is very complex,” she said.

The researchers believe their study is the first on this topic to take those multiple factors into account, using a research technique called structural equation modeling.

Using results from previous research, including work by Espelage and Suzanne Mazzeo, now a professor at Virginia Commonwealth University, the researchers developed a hypothetical model or map of associations between various factors. The factors in the model included childhood sexual abuse, general psychological distress, alexithymia, restrictive eating behaviors and attitudes, body dissatisfaction, and bulimic eating behaviors (such as binging and purging).

Alexithymia (uh-lex-uh-THIGH-me-uh) is defined as a condition in which a person is unable to recognize or describe his or her own emotions. Hund described it as “a disconnect between emotions and the rest of you.”

Their data was gathered through a written survey administered to 608 undergraduate and graduate women at a large Midwestern university, producing 589 usable responses.

What the researchers found when they sorted out the data was that it fit their hypothetical model of how the various factors were associated and how they affected the level of risk for an eating disorder, Hund said.

“These study results fit into the idea that eating disordered behaviors actually have a purpose,” she said. “Somebody who’s abused is of course going to have some issues around dealing with emotions, and this is their solution to functioning.”

Therefore, it may be important for counselors and clinicians not to move too quickly to take away those behaviors, except when immediately life-threatening, and to deal with the woman’s “underlying emotional structure,” Hund said.

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