19.1 Eating disorders
Eating disorders are usually
characterized by severe disturbances in eating behavior; principally the
refusal to maintain a minimally normal body weight and an intense fear of
gaining weight (anorexic symptoms), and recurrent episodes of binge eating accompanied
by purging, excessive exercise, or other inappropriate methods of preventing
weight gain (American Psychiatric Association/APA 1994; Williamson, Baker and Norris
1993). Brach (1973) argues that these are symptoms that reflect the
individual’s doubt about their own worth and value. Talking about ones eating
disorder in a focus group, as in this study, can in my opinion, be seen as an
ethically proper way of exploring this subject, because the participants’
self-worth and self-value are strengthened rather than weakened because of the
solidarity felt in such a group.
Burney and Irwin (2000) have
investigated the eating-disorder reality described above by Dagny, Camilla,
Bodil and Anne, in a sample of 97 women, and their results show that shame
associated with eating behavior was the strongest predictor of the severity of
an eating-disorder. Other effective predictors were guilt associated with
eating behavior and body shame. Eating disturbances were unrelated to proneness
to shame and guilt in a general sense. Feelings of unworthiness and inadequacy
were consistent with the phenomenon of shame in their investigation. The
results of the regression and correlation analysis they have carried out show
that the severity of an eating disorder is not related to a general proneness
to shame or guilt but rather to shame and guilt in eating contexts and to shame
about the body. Women with eating disorders tend both to condemn their
disturbed eating behavior (guilt) and to condemn their own inadequacy in this regard
(shame).
Burney and Irwin (2000) argue that
it seems plausible to believe that eating disorders are a consequence of shame
and not the cause of shame. In my opinion, eating disorders are like
self-harming also a consequence of shame and not from sexual abuse in it self.
Being sexually abused, may lead to shame, and it seems to me through this
study, that it is shame which is the basis of both self-harm and eating
disorders. Participants in this study, who have been sexually abused without
feeling shame afterwards or give reports of others in this situation, do not
seem to have developed either self-harming activities or eating disorders. The
opposite seems to be the case for those feeling shame after being sexually
abused. This finding might suggest that helping victims of sexual abuse to
overcome their feelings of shame, instead of focusing directly on the sexual
abuse in itself, might be a proper manner of treating both conditions of
self-harm and eating-disorders.
Being sexually abused has of the
consequence of feeling a loss of body control, and victims tend to try in
various ways to take this control back again. Margaret explains that denying
oneself food or eating too much has to do with control; both having control and
losing control.
Margaret_1: Those
who stop eating, they deny themselves food. They see themselves as ugly and
horrible; they have absolutely no self confidence, why in the world should they
eat? And it has to do with control. Those who eat too much and throw up
afterwards, they have so much to control, they make an image of themselves, and
if they go too far, they lose control and panic ((Twists her hands together
in front of her)).
Those with eating disorders might
according to Margaret have a distorted self-image. The relation between shame
and self-image has already been discussed in this study, showing that those
feeling most shame also have the lowest evaluation of self-image. Goodsitt (1985) argues that anorexics may
feel guilty about the act of eating and this serves to exacerbate feelings of
self negation. Fairburn (1997) argues that bulimics’ episodes of overeating are
marked by a profound sense of loss of control that evokes guilt and self
disgust. There seems to be a diversity of opinions as to the place of shame and
guilt in the aetiology of eating disturbances. Some see shame-proneness and
guilt-proneness as causal factors in the psychodynamics of eating disorders,
while others view these affects more as consequences of having an eating
disorder. Whether they are a cause or consequence of eating disorders seems to
have been subjected to limited empirical study (Sanftner, Barlow, Marschall and
Tangney 1995). The finding in this study seems to support in my opinion that
sexual abuse may lead to shame and that it is shame which is the foundation for
developing eating disorders, not sexual abuse as such. But validating this finding
will demand further investigation.
The way one relates to
food, can be seen as a form for self-harm and according to Gunhild and Helga, but Helga also
argues that eating helped her and was the factor that kept her going. Even
though eating was a helping factor in her life, she was ashamed of it.
Gunhild: There
are many different ways one can harm oneself, intoxication, not eating.
Helga: Or
eating
Gunhild: Or
eating too much
Helga: Compulsive
eating… I can eat and eat, I eat a lot. Sometimes I eat until I throw up. I
don’t have a normal relation to food. I can eat a whole loaf of bread… I eat
everything. I don’t enjoy eating food. I eat till I have to lie down, I become
feeble and fall asleep…it’s a kind of intoxication. Yeah I think it gets me
high… I’m ashamed of it… But it was eating that kept me going.
All these interviews show the vast
amount of different ways which victims of sexual abuse may use food, but in my
opinion, it is the shame which is induced by the sexual abuse and not the
sexual abuse in itself which is the basis for their relation to food. Moyer,
DiPietro, Berkowitz and Stunkard (1997) have carried out a study of the
relation between child sexual abuse and eating disorders in a sample of 68
sexually abused girls between 14 and 18 years old. Their results showed
significantly higher degrees of depression, control, and binge eating in the
sexually abused girls than in the control group used in the study. Eating
disorder and sexual abuse has also been studied by Nordbø, Espeset, Gulliksen,
Skårdrud and Holte (2005) who have carried out a qualitative study of patients’
perception of anorexia nervosa in a sample of 18 women between the ages of 20
and 24. Their results suggest the psychological meanings given to anorectic behavior
may have to do with eight constructs: security, avoidance, mental strength, identity,
care, communication and death. Anorexia can be seen as a psychologically purposeful
form of behavior for many patients. They argue that it is important to encourage
patients to express their personal values and to explain how their eating disorders
both fulfil and compromise these values. Neither of these studies has focused
on the importance of shame for the development of eating disorders, but instead
tried to find a relation directly to the experience of sexual abuse. The
finding from this study seems in my opinion to be that shame should be viewed
as a necessary link between sexual abuse and eating disorder, although I am
aware that this assertion will demand further examination.
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