Treatment of Childhood Sexual Abuse in Anorexia Nervosa and Bulimia Nervosa: A Feminist Psychodynamic Approach *
This chapter summarizes the arguments for and against the role of sexual abuse as a specific risk factor for eating disorders. Proponents of the “specific link” hypothesis describe complex, multiple mediating mechanisms between sexual abuse and disordered eating. The equation of eating disorders with arrested psychosexual maturity has long been a tenet of theory. An eating disorder may become an adaptive effort to defend against self-regulatory deficits resulting from abuse. Our approach to the treatment of sexually abused clients with eating disorders has been influenced by the pathbreaking work of J. Herman and of C. A. Courtois. Eating disorder experts are currently engaged in a heated debate concerning the role of childhood sexual trauma in the etiology of anorexia nervosa and bulimia nervosa. The chapter discusses how sexual abuse can become the pathway for the development of an eating disorder and describes an approach to the treatment of abuse from a feminist psychodynamic perspective.