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Childhood sexual abuse is thought to have a significant influence on the cognitive behaviors of individuals later on in life. Some researchers have in the past concentrated on the psychological impact of such experiences on women (Waller & Smith, 1994, Beth & Lauren, 2005). However, others have adopted a gender-neutral position in their studies (Murray & Sophie, 2008, Rohde, 2008, Holzer, 2008). Many women who suffer from eating disorders claim to have suffered sexual abuse while they were children (Waller & Smith, 1994, Waller, 1995). However, current research has not revealed a relationship between eating disorder and gender.
According to Brewerton & Abbott (1997), sexual abuse normally has many diverse effects on the eating habits on survivors as well as the way they perceive their body image. Between 40% and 60% of all men and women who seek therapy for eating problems have been abused either sexually or physically at one point in their lives (Lena et al, 2008). Elsewhere, Molinari (2008) provides additional information on the relationship between eating disorders and CSA.
The effect of PTSD as a mediating variable in eating disorder following childhood sexual abuse is unclear. The negative experiences that affect men are thought to be less severe compared to the ones that women experience. However, such differences have not been clearly defined in the current research.
Posttraumatic Stress Disorder is an anxiety disorder that occurs after an individual has experienced a traumatic event. The traumatic event may be anything that scared the individual or caused an undesirable emotional and physical response. During such an event, an individual perceives a danger to his life.
In a study of children and adolescents with eating disorder, Kreipe (2005) found out that both bulimia nervosa and anorexia nervosa constitute an extreme manifestation of weight-related problems. However, when these problems manifest themselves in children, they are associated with severe family or psychiatric dysfunction. These conditions should not be framed as purely psychiatric problems; rather, they should be approached in terms of their development (Kreipe, 2005). In this way, a pediatrician can address different psychological, biological and social issues present in individuals.
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Eating disorders require months, possibly years in order to be treated completely, owing to the psychological aspect that has to be addressed holistically (Kreipe, 2005).Sexual abuses are a powerful traumatic event that has the potential to create severe repercussions on individuals. Such repercussions can exist both in the form of self-harming behavior as well as development of maladaptive behaviors such as self-harm (Murray & Sophie, 2008). For a long time, researchers have been attempting to determine whether there is an association between sexual abuse and eating disorders among middle-aged and old people.
The researches that are being done on CSA as a risk factor for the development of bulimia nervosa are of considerable clinical and theoretical significance. Since only few prospective studies have been done on this topic, (Murray & Sophie, 2008), the only viable alternative has been to focus on retrospective studies. In these types of studies, the prevalence of CSA is assessed in the general population.
Such studies also have to be fitted, as much as possible, into the methodologies that have been used in the existing studies. In such a type of study, Pope & Hudson (1992) found out that bulimic patients did not show a significantly higher prevalence of symptoms compared to the control group made up of children who had not experienced CSA. This observation was reinforced when an allowance was made for various methodological effects. Furthermore, both controlled and uncontrolled bulimia nervosa studies detected higher rates of CSA compared to studies of the general population.
Since the 1980s, seminal reviews of the effects of childhood sexual abuse have become a popular area of interest among researchers (Polusny, 1995). However, these researchers have been constrained by lack of any empirical association between CSA and eating disorders. This is mainly because it takes a long time for such a research to be completed. Additionally, there are many confounding factors that have to be assessed in the course of such a long-term study. It is not surprising, therefore, that literature that assesses the association between eating disorder and CSA is difficult to find (Polusny, 1995).
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According to Beth & Lauren (2005), eating disorders comprise one of the most commonly reported disorders among women. There is little information on the underlying causes of this problem. In a case-control study involving a population-based sample of women aged between 36 and 44, Beth and Lauren established additional evidence linking preadolescent trauma to psychiatric morbidity.
The cases in the study done by Beth and Lauren involved women who met the criteria for bulimia nervosa, anorexia nervosa after diagnosis. A structured clinical interview was conducted; it was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The history of sexual abuse of the child was assessed through a self-administered questionnaire.
Murray & Sophie (2008) examined the differences existing between self-harmers with a history of being sexually abused and those without such a history. The examination was done with regard to many other associated behaviors and risk factors in the research literature involving issues of self-harm. Self-harmers who had a history of sexual abuse have a higher likelihood of experiencing eating disorders, emotional neglect, and suicide ideation (Murray & Sophie, 2008).
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According to Rohde (2008) childhood sexual abuse doubles the odds for both obesity and depression in adulthood. However, Rohde’s study was limited to the potential long-term impact of these negative experiences on women. The data obtained in the research was based on a survey of 4641 women whose mean age was 52 years. The factors assessed in the telephone survey included depressive symptoms, obesity, childhood sexual abuse, body dissatisfaction and binge eating (Rohde, 2008).
Childhood sexual abuse (CSA), according to Sanci & Coffey (2008), is one of the risk factors for bulimic syndrome, although it is not necessarily mediated by severe dieting or psychiatric morbidity. Sanci and Coffey arrived at these conclusions after assessing later onset of anorexia nervosa and bulimia nervosa among females who had been subjected to CSA before the age of 16. Bulimia nervosa is another name for eating disorder, whereby an individual binges and purges. An individual may eat excessive food and then try to get rid of all of it through vomiting. The individual may also try to get rid of this food using laxatives, or over-exercises.
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The longitudinal cohort study involved an observation of adolescents between August 1992 and March 2003. Self-reported CSA was considered in the 1936 participants while they were aged 24 (Sanci & Coffey, 2008). The association persisted even after adjustments were made for possible confounding or mediating factors after 6 months, including dieting and psychiatric morbidity. On the other hand, little evidence was established for an association between CSA and syndromes of incident anorexia nervosa.
Moreover, researchers have sought to examine the mediational significance of PTSD (posttraumatic stress disorder) and the development of symptoms relating to eating disorder following experiences that are sexually traumatic. For instance, Holzer (2008) surveyed 71 sexual trauma victims and 25 control subjects in order to assess PTSD symptomatology and eating disorder. Holzer’s findings turned out to be supportive of the idea that individuals with an eating disorder following sexual trauma have a high likelihood of experiencing PTSD symptomatology. Following these outcomes, Holzer (2008) concluded that focus on PTSD is necessary in clinical interventions involving individuals with eating disorder, who suffered childhood sexual trauma.
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The relationship between eating disorder symptoms and sexual trauma was significantly reduced when PTSD symptoms were incorporated in the regression analysis of Holzer’s study. This is an indication that PTSD has a mediational influence on eating disorder among people who suffered sexual abuse during childhood.
Metcalfe (2009) did a study on 100 male psychiatric patients who gave out their recollections of the sexual activities they were involved in before they were aged sixteen. Twenty three men defined the sexual activities they engaged in during this time. They described these activities mainly in negative terms, saying that they were distressing. However, Metcalfe (2009) was unable to relate these experiences the experiences that they were experiencing later in life.
The current study assessed the association that exists between childhood sexual abuse (CSA) and eating disorders. Although such an association has been appreciated by researchers, the different confounding factors that influence this association are yet to be clearly defined. The issue of differences among male and female vulnerability to eating disorders following CSA is yet to be addressed conclusively.
Today’s research on eating disorders and CSA are largely hampered by methodological problems. Although longitudinal cohort studies and prospective studies are the most commonly preferred methods, some scenarios make it difficult for them to be employed. This forces researchers to resort to retrospective studies.
This research has found out a sense of agreement among researchers that PTSD is a significant mediational risk factor in the prevalence of eating disorder. In most cases, PTSD among these patients is as a result of the traumatic sexual experiences encountered during childhood. Future research should focus such confounding factors as PTSD and their influence on the courses of treatment that are adopted. In addition, possible associations between the degree of severity of bulimia nervosa and the nature of CSA should be assessed. As a final point, the possible discrepancies in the way men and women with eating disorders are influenced by childhood sexual abuse need to be analyzed.
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