Faith Born of Seduction. Jennifer L Manlowe

      3

      A Pyrrhic Victory: Contemplating the Physical Cost of Surviving

       Eating Disorders and Incest

      Anorexia and bulimia are multilayered problems that have no singular cause. Psychological and social factors are generally thought to play key roles in their development. Many psychologists and psychiatrists believe these disorders arise in the context of a process of growing up which has gone awry. A young woman’s response to biological maturity and the psychological and social demands of sexual development are widely invoked as being especially relevant.¹ Child sexual abuse is now recognized as a common occurrence² with consequences that affect self-esteem, sexual identity, personal competence, and potential for intimacy. A link between such experience and later eating/body-image preoccupations is therefore highly plausible.

      As I have said earlier, sporadic accounts³ in the psychiatric literature of eating disorders reveal that as many as five out of six patients in anorexia nervosa treatment programs⁴ and seven out of ten bulimic⁵ college women revealed histories of sexual abuse before age twelve. Of the self-selected sample of incest survivors with eating disorders whom I have interviewed, all were initially sexually abused before age eight and all have revealed that this history has set the stage for their distorted relationship to appetite cues (for both sex and food), a sense of autonomy and personal agency, and body-size and shape perception. There are in fact important links of meaning in the survivor’s mind between her incest experience and her subsequent eating disorder.⁶

       Post-Trauma Manifested along Gender Lines

      A persistent problem with eating may disguise a post-trauma response to sexual assault in adolescent girls and women, and as such, can be a gender-specific symptom of Post-Traumatic Stress Disorder (PTSD).⁷ PTSD is a relatively recent term first defined in Diagnostic Statistical Manual-Ill (or DSM-III) (APA, 1980) and redefined in DSM-III-R (APA, 1987) as follows:

      1. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone;

      2. the traumatic event is persistently reexperienced in at least one of the following ways: intrusive recollections of the traumatic experience; recurrent distressing dreams of the event; sudden action or feeling as if the traumatic event were recurring (flashbacks); intense psychological distress at exposure to symbolic aspect of traumatic event;

      3. persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness;

      4. persistent symptoms of increased arousal (i.e., sleep disturbance, hypervigilance, easily startled); and

      5. duration of the disturbance at least one month.⁸

      More women than men have eating disorders for physiological and socio-emotional reasons. Women are socialized to find value through appearing culturally attractive (“model thin”), a cultural ideal that increasingly demands technological assistance.⁹ Two-thirds of adult women report in response to surveys that one of their greatest worries is that they will get fat. Two-thirds have an inaccurate and injurious body image (nearly 95 percent overestimate their body size); 75 percent of adult women within the “ideal” range of weight for their heights still think they need to be thinner.¹⁰ Disorders of eating are so common among women that they could be considered norms rather than disorders.

      Cross-culturally, from birth, girls have 10-15 percent more body fat than boys. At puberty, male fat-to-muscle ratio decreases as the female ratio increases. The increased fat ratio in adolescent girls is the medium for sexual maturation and fertility. The average healthy twenty-year-old female has 28.7 percent body fat. By middle age, women cross-culturally have 38 percent body fat.¹¹ Efforts to be thin are so stubbornly resisted by a healthy body that one who desires cultural value/beauty must police her appetite assiduously.

      Social judgment regarding a woman’s psychological well-being and essential “goodness” is largely determined by how she looks. Psychologist Ellyn Kaschak maintains, “Becoming a woman involves learning a part, complete with costumes, makeup, and lines.”¹² We learn our gender roles through imitation and validation.¹³ A female’s “beauty” and body size are her cultural currency. Learning to behave like a woman involves learning to sit, stand, and talk in the appropriate (non-demanding) ways that do not take up too much space. Paradoxically she must act her part in a way that appears natural.¹⁴ The ability to diet successfully, as marked by achieving thinness, has been held as a gender-specific key to power, acceptance, and control—a triad that is shattered by sexual assault.¹⁵

      One symptom of sexual abuse is low self-esteem, which often facilitates a personality that seeks to please, for survival’s sake. In combination with female socialization, sexual abuse increases the chance that a woman will attempt to resolve a physical boundary violation by attempting to control her body. Some psychologists specializing in eating disorders believe that the psychological and physiological stress created by overvaluation of norms of thinness (which are not consistent with biological disposition) creates a context for restrictive dieting, fasting, compulsive exercise, and even purging. These behaviors that produce caloric deficits inevitably lead to binge eating and/or compulsive eating; purging sometimes develops as a desperate attempt to reverse the error of the binge eating and the fear of further loss of control over the self, and symbolically the environment.¹⁶

      Too often helping professionals and the woman with an eating disorder are distracted by the symptom—the behaviors of the eating disorder—and consequently miss the historical roots of incest that set the symptoms in motion. If counselors and the survivor herself remain distracted by the symptoms the behaviors will intensify. Because this posttraumatic response is cloaked in “normal” female behavior (that is, dieting and/or binging), it is often difficult for both survivor and helping professional to see clearly the connections between her history of abuse and her eating disorder.¹⁷ This connection is vital and must be made if the survivor is to be helped, for a survivor will have a very difficult time giving up any of these behaviors without finding alternative and functional ways of addressing the intrusions and expressing the pain that is the result of her haunting memories. Moreover, she must find tangible ways to feel power in order to let go of her dieting methods—her only physical symbol of power.

      Shared Traumatic Themes Manifested in Eating Disorders

       Shame

      Shame is a common experience of all victimization. It consists in a sense of being brought low, being made unworthy or unfit in the eyes of another.¹⁸ There is a profound sense of self-loathing that is a direct result of being sexually violated. A survivor’s attempt to shrink her own body may signal a sense of deeply imbedded shame. At times one is so overwhelmed with the shame feelings that one becomes passive, unable to take action on one’s own behalf to put an end to the real sense of shame.

      For the survivor of incest, her body is the site of that first shameful experience of abuse.