Sexual abuse in patients with eating disorders

The incidence of sexual abuse in eating disorder patients appears significant. Fifty percent of both our anorectic and bulimic patients reported a history of sexual abuse while only 28% of a non-anorexic, non-bulimic control population reported similar problems (p less than 0.01). Several patterns of behavior seemed related to previous sexual assault. In one, the eating disorder was used to change the body image of the patient and therefore to provide a defense to future abuse. Other behaviors which occurred more specifically in bulimic women dealt with a projection of repressed anger toward male authority figures. Forty six percent of the bulimic women seen in our study exhibited some promiscuous behavior, using sex either as a gauge of their own self worth or as a means of punishing men. It is essential that sexual issues be addressed early in the treatment of patients with eating disorders. Disclosure is often difficult particularly in outpatient situations where the patient lives at home with her family. It usually does not occur in such cases until the later stages of therapy, or until the patient is hospitalized. Rape is the exception since our data suggests that it is usually revealed early in the course of treatment (p less than 0.001). Once disclosure occurs, a dramatic change is usually seen in the patient and treatment becomes more effective. As the patient deals with the issues of sexual abuse, they no longer need to deny their sexuality or punish themselves or others. Issues of guilt, depression, repressed anger, low self-esteem, social isolation and inadequacy are important and need to be addressed during the course of therapy with sexually abused patients.