Double Despair: Four Simple Steps To Help Those Trapped in the Trauma of Abuse & An Eating Disorder
Laura Sabin Cabanillas, MA, LMHC, NCC
It is no secret in the field of eating disorder treatment that there is a strong correlation between trauma and eating disorders. Some individuals develop an eating disorder as a way to cope with the pain of unresolved trauma, particularly the trauma of abuse. October is Domestic Violence Awareness Month. I can think of no better time to explore how to best help those trapped in this double despair.
Unresolved trauma equals untreated trauma. Just as proper identification of signs and symptoms of an eating disorder are crucial to developing a comprehensive treatment plan, so it is with traumatic events. A traumatic event is an incident that causes physical, emotional, spiritual, or psychological harm. Trauma takes many forms, from witnessing a violent incident to a child getting caught in the middle of his parents’ contentious divorce. Abuse is considered a traumatic event – there are various forms of abuse, including physical, sexual, and psychological/emotional.
According to the National Coalition Against Domestic Violence (NCADV), “On average, nearly 20 people per minute are physically abused by an intimate partner in the United States. 1 in 5 women will be raped in her lifetime. 4 in 10 women and 4 in 10 men have experienced at least one form of coercive control by an intimate partner in their lifetime.” When we cross reference those statistics with studies such as a recent study which found that “the vast majority of women and men with anorexia nervosa, bulimia nervosa and binge eating disorder, reported a history of interpersonal trauma” (Mitchell et al. 2012); and another study conducted by the National Institute of Mental Health reporting, “PTSD prevalence in Eating Disorder patients is about 24.3%”, we have a recipe for double despair. These statistics and studies only mirror what’s been documented. Experts agree that incidents of abuse, trauma and eating disorders are much higher, but are unreported.
The research is clear that there are strong correlations between eating disorders and unresolved trauma caused from the aftermath of abuse. Due to the shame and stigma our culture attachs to abuse victims, including not believing a victim, it often goes unreported, making it difficult to treat. Psychological or emotional abuse is often the most difficult to identify because there are no visible marks.
I vividly recall counseling a young woman in her 30’s whom I had identified was in an emotionally abusive relationship with her boyfriend, per her report of a pattern of controlling behaviors. However, she was having difficulty identifying that this behavior was unhealthy for her, even though she was able to pinpoint the simultaneous start of her decreased eating, increased anxiety and depressive symptoms on a timeline that correlated with the start of his increasingly controlling behavior. I knew she needed to see for herself how unhealthy the relationship was for her. At our next session, I placed a copy of the Power & Control Wheel (https://www.thehotline.org/is-this-abuse/abuse-defined/) in front of her, along with a yellow highlighter. I asked her to highlight any behaviors that she had experienced in her relationship with her boyfriend. She looked down at the paper for several minutes, and then with tears streaming down her cheeks, hand trembling, she began to color the sheet a bright shade of yellow, as she highlighted example after example of his controlling behavior. “I thought I was going crazy,” she whispered, her head buried in her hands. “He had me convinced his behavior was ‘normal’, and that I was just being ‘difficult’.”
Similar to the path of recovery from an eating disorder, healing begins when we help those who are suffering to identify unhealthy behaviors and show them that there is a better, healthier way to live. That starts with a conversation. Ignorance thrives in silence, as does shame, so the antidote is to talk about it. The #MeToo and the #ididntreport movements have increased awareness of the prevalence of sexual assault. We need to continue speaking out, because against the glare of the statistics, we still have much work to do to shine the light of truth on the harm that all forms of abuse cause. Only when we speak truth, can victims begin to heal and recover, and move from being a victim to becoming a survivor. Like all recovery, it’s a process. #MeToo.
When an eating disorder is entangled in the roots of abuse, the trauma resulting from the abuse needs to be treated, along with the eating disorder. As a Certified Domestic Violence Victim Advocate, I’d like to share four simple steps you can take to help individuals begin to heal from the trauma of abuse.
- BELIEVING the victim is step one. If someone tells you she has been the victim of abuse – any kind of abuse – how you respond can impact the choice she makes next; to move forward toward recovery, or slink further down into the black hole of isolation and shame. The power held in these three words can be life transforming for a victim: I BELIEVE YOU. Nothing more, nothing less. Countless abusive incidents go unreported every day because the fear of not being believed is stronger than the fear of coping with the abuse. Fear is a powerful motivator. But so is hope. And telling a victim you believe her gives her hope.
- VALIDATING comes next. Abuse robs the victim of his sense of value and worth. Affirming to a victim that his thoughts, feelings, opinions and experiences matter – that he matters – can be the catalyst for another layer of healing. Validation is a form of love and acceptance, and at the soul core of every human being, lies the desire to be loved and accepted for who we are. Abuse robs victims of their identity, and in an abusive relationship, the sense of self is damaged. Validation begins to awaken the soul of victims to the realization that they are worthy of love and acceptance.
- EDUCATING someone who has been victimized is paramount to healing because knowledge produces understanding and wisdom. You don’t know what you don’t know. If a young woman thinks that jealousy, rage, and violence is “normal” in a dating relationship because someone taught her that’s how men act when they truly care about you, how will she know any different if she isn’t educated on what a healthy relationship looks like? We all have the right to make informed decisions. Many people do not know the many subtle forms that power & control take. Educational resources like the Power & Control Wheel mentioned above are free and downloadable on the NCADV website: https://ncadv.org/resources
Education includes victims understanding and accepting that they don’t have to stay victims – they can become survivors.
- EMPOWERING survivors is the deepest, widest, and longest part of the healing process; there is no magic bullet or timeline. It seems like an impossible dream for those who have been on the opposite end of the spectrum, having felt completely powerless in the face of abuse. Empowerment is a process that evolves one step at a time, taken by making informed decisions from a place of love and acceptance. The survivor gets stronger and more confident every day. You can be a part of the empowerment process by simply walking alongside of her, continuing to believe, validate and educate her, while helping her build a support network that will continue to be a part of her empowerment process long after she leaves your care.
If you or someone you know has been the victim of domestic violence, call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE).
Laura Sabin Cabanillas, MA, LMHC, NCC is the Director of Communications at KellerLife Center for Eating Disorders. She is a Licensed Mental Health Counselor, a Certified Domestic Violence Victim Advocate, and a Certified Crisis Response Therapist. She has worked in outpatient clinical settings, as well as residential, partial hospitalization, and intensive outpatient programs, specializing in eating disorders. Her background is a unique composite of experience that includes broadcast and written journalism, motivational speaking, clinical mental health work, collegiate education and program marketing. She is also a published author and active blogger.