Sexual abuse in childhood

Sexual abuse in childhood is one of the most significant factors in the development of mental problems in adulthood, including eating disorders. Despite the increase in awareness of the issue in recent decades, there is still a lot of denial and the phenomenon is often hidden from the public eye. The numbers are chilling – about a quarter of girls and up to a fifth of boys are sexually abused at some point in their childhood. The consequences of this early trauma on mental health are devastating and lasting.

The roots of insight: from Freud to the present day

The connection between childhood sexual abuse and eating disorders has been known since the beginning of modern psychology. Sigmund Freud, in his treatment of women who were then called “hysterics”, recognized the connection between a traumatic sexual experience in childhood and neuroses in adulthood. In his early writings, he clearly argued that the sexual abuse was the main cause of the hysterical symptoms. However, at some point Freud withdrew from this theory, perhaps due to social pressure and the difficulty of accepting the extent of the phenomenon. Today, research shows that up to 70% of women suffering from eating disorders experienced sexual abuse in their childhood. Despite the clear evidence, there is still much resistance to recognizing sexual trauma as a major factor in the development of eating disorders.

Eating disorder: an unspoken language of pain

In many cases, the eating disorder is used as a disguised language, a way to express the dark secret of the injury without mentioning it in words. It is a desperate attempt of the mind to communicate the pain and distress, when the victimized girl is unable to conceptualize or understand what she has been through. It carries within it an unimaginable experience that has no words or mental representations. Through the obsessive preoccupation with food and the body, she tries to tell the untold story.

Eating disorder as a survival strategy

The eating disorder sometimes constitutes a kind of survival and coping mechanism for the victim. Like “chemotherapy” or self-medication, it is used to dull the feelings of filth, guilt and shame. Through the reduction and control over the body, the victim tries to regain a sense of strength and resilience in the face of an experience of complete loss of control. While behaviors such as starvation, vomiting or compulsive exercise are destructive to the body, they provide temporary relief from the unbearable mental pain.

Dissociation: The Hidden Challenge in Therapy

One of the significant challenges in treating victims is the phenomenon of dissociation. A significant percentage of women with eating disorders due to sexual abuse do not remember the injury due to a mental defense mechanism that disconnects memory from awareness. Often the injury surfaced only years after it occurred, when the woman was already developing symptoms. Therefore, it is very important that therapists in the field be alert for signs of sexual trauma even when the patient does not explicitly report it. Seeing the disorder as part of the PTSD complex (complex post-traumatic stress disorder) can significantly improve the ability to locate and treat the root of the problem.

The limitations of the standard treatment of eating disorders

Unfortunately, many protocols for the treatment of eating disorders do not take into account the traumatic history and therefore may cause additional harm to the victims. The traditional approaches focus on the symptom – the obsession around food and weight – instead of referring to the whole person and the experience at the root of the difficulty. Forceful techniques, such as forced hospitalization, forced feeding and punishment are common in treatment and may trigger re-traumatization in those who have experienced injury and penetration of their body in the past. In this way, the system may inadvertently create a repetition of the injury and perpetuate the cycle of disorder.

Towards a new therapeutic model: trauma-oriented and inclusive

The first step towards more effective and beneficial treatment is to change the perception – moving from a focus on the eating disorder to looking at the complex reality of trauma and its effects. Instead of focusing on symptoms, one should invest in creating safe, empathetic and inclusive therapeutic relationships. When the patients feel understood, appreciated and valuable beyond their disorder – the door opens to process the pain and real recovery.

The trauma-oriented treatment model emphasizes the importance of inclusion, stability and partnership in the therapeutic relationship. Instead of strict and punitive methods, therapists learn to listen to the inner voice and the emotional needs of the patients. The emphasis is on strengthening the sense of self, developing emotional regulation skills and building coping resources. Within a safe and supportive space, the patient can gradually reveal her life story and weave it anew.

Adopting a holistic view of eating disorders and the underlying trauma is not an easy task. A change in professional thinking and therapeutic infrastructure is required, as well as specific training for teams. But this is the necessary direction if we want to offer real healing to so many women who carry deep pain in their bodies and souls. Continuing to ignore the connection between sexual abuse and eating disorders will only continue the destructive cycle and leave hidden bleeding wounds.

Acknowledgment, understanding and compassion: the path to change

Ultimately, the ultimate cure lies in our ability as a society to create a space for open discourse about childhood sexual abuse and its long-term effects. The more we allow the stories to be heard, the pain to be contained and the silence to be broken – the more we can ease the suffering of many. We need wider awareness, accessible support services and skilled professionals who know how to identify the link between trauma and disorder. This is a big challenge, but one with huge potential for healing and change.

In a dark world of shame and concealment, recognition is a ray of light. When we are able to look at the hidden wounds with compassion, listen to the whispers of the suffering body and see the person in full – we open a door to hope. For every woman struggling with an eating disorder and past trauma, the message must be clear: you are not alone, there are those who understand and there is a way forward. Let’s walk in it together, with courage and love.