Psychology

Edited by Schwartz  Cohn (1996), the book, Sexual Abuse and Eating Disorders focuses on the relationship between sexual abuse and eating disorders.  The book provides statistics revealing that there is sufficient evidence to support the theory that many of the sufferers of eating disorders have been sexually abused either in their childhood or as adults.  But, there is contradictory evidence, too, that the book does not shy away from revealing.  Vanderlinden  Vandereycken, two of the contributing authors, note that in a systematic study of 112 consecutive referrals of normal-weight bulimic women, Lacey (1990) found that only eight patients (7) mentioned a history of sexual abuse involving physical contact (Schwartz  Cohn, 18).  However, evidence for a relationship between sexual abuse and eating disorders outweighs evidence for no such relationship (Schwartz  Cohn, 20).
   
The first part of the book, Sexual Abuse and Eating Disorders, is dedicated to women, and the second part is dedicated to children.  False memory and dissociation are also discussed.  Dissociation as a topic is especially relevant to very young victims of sexual abuse.  Cognitive development is a gradual process, and a child may not be in the position to understand let alone explain sexual abuse, which is why countless child sexual abuse incidents go unreported.  But, an eating disorder in a child could be a symptom of sexual abuse for a psychotherapist to understand.  After all, children may develop eating disorders after being sexually abused because eating is often associated with family meals, nurturing, and proof that parents care for children.  Thus, feeding and then abusing the child are incongruent, confusing, and difficult to assimilate and integrate (Schwartz  Cohn, xi).  Van den Broucke  Vandereycken (1997) note that an eating disorder is akin to a scar of a violated body (89).  Despite cognitive underdevelopment, therefore, children are able to convey by means of their eating disorders that they have, in fact, been sexually abused.
   
In grown women, sexual abuse may lead to eating disorders as abused women deliberately leave scars on their bodies to fend off further sexual attacks through unattractiveness (Schwartz  Cohn, xi).  Even so, the fact remains that all women and children do not suffer from eating disorders after being sexually abused.  The book, Sexual Abuse and Eating Disorders, is limited in scope for this reason.  From what I have learned as an intern at the Sexual Assault Center of Family Services, I can be certain that although all victims of sexual abuse require therapeutic support, most of them do not complain of eating disorders.  Then again, I only have experience with the adult and child victims that approached me through the Sexual Assault Center for a limited period of time.  I was answering their crisis hotline for crisis intervention, supportive counseling as well as referrals to psychotherapists.  I also worked with the victims at the hospital with empathetic listening, emotional support, and accompanied victims as they went through medical screening.  I had the opportunity to help the victims make informed choices through the medical process as well.  Furthermore, I supported them through the legal process, including police reporting and court procedures.
   
My experience as a case manager at the Sexual Assault Center teaches me that most victims of sexual abuse are, indeed, women and children, and so Schwartz  Cohn are correct to dedicate entire parts of their book to these victims.  However, the book does not cover all types of psychological problems that sexual abuse may result it, which is why it is more appropriate for an investigator of the effects of sexual abuse to refer to general books on psychological disorders with reference to this form of abuse.  Most of my clients at the Sexual Assault Center seemed to be suffering from post-traumatic stress disorder rather than eating disorders.  Adopted by the American Psychiatric Association as part of its official diagnostics as recently as 1980, post-traumatic stress disorder (PTSD) or post-traumatic stress syndrome is a mental disorder that follows an occurrence of extreme psychological stress (Young, 1995, 3).  None of my clients appeared as though psychotherapy would not help them cope with the stress they suffered by way of sexual abuse.  Even the process of discussing the incidents of sexual abuse appeared difficult for some clients.  There is no doubt in my mind for this reason that cognitive impairments like memory problems or dissociation may follow this form of abuse.  After all, many of my clients were sexually abused by people they were familiar with.  
   
As Schwartz  Cohns book, Sexual Abuse and Eating Disorders, increased my knowledge of sexual abuse, my rewarding internship experience solidified my faith in working in the field of social work.  Still, I believe that a book on sexual abuse and mental disorders in general, instead of eating disorders alone, would have been more relevant in the context of my experience.  Schwartz  Cohns book is especially important for those that are investigating eating disorders rather than sexual abuse.  As a matter of fact, none of my clients reported having approached the Sexual Assault Center because their eating disorders were becoming unmanageable.  Sexual abuse was the focus of my internship experience, which is why Schwartz  Cohns book leaves me longing for further knowledge about psychological problems associated with sexual victimization.  Schwartz  Cohn write,
          When sexual abuse has occurred, the body and sex organs become the enemy in the
          context of the distorted survival strategy of children who must maintain the belief that
          adults are good (safe) and therefore they (the body) must be bad and deserve to be
          punished. (Schwartz  Cohn, xi)

It appears as though sexual abuse manifests itself as eating disorders through a process that psychoanalysts would understand best.  I was not granted permission to sit through psychotherapeutic sessions during my internship at the Sexual Assault Center.  Then again, if I had the opportunity to sit through psychotherapeutic sessions with my clients, I would increase my understanding of various other psychological disorders resulting from sexual abuse to boot, for example, post-traumatic stress syndrome.  Schwartz  Cohens book, Sexual Abuse and Eating Disorders, has led me to consider studying psychotherapy in depth.  Naming psychological problems apart from eating disorders, the book reveals that there is much to be learned about my clients problem and how to help them.
   
After all, I would like all victims of sexual abuse to recover as criminal justice systems are charged with the responsibility to punish the abusers.  As a psychotherapist, I would be the principle overseer of my clients process of recovery.  But even in that case, Schwartz  Cohens book, Sexual Abuse and Eating Disorders, would only provide me with relevant information to work with clients who are suffering from eating disorders as a result of sexual abuse.  In the case of children, however, it would further help to identify the abusers as children may not report incidents of abuse until after a trained psychotherapist has identified sexual abuse as the leading cause of eating disorders before asking the child for more information.  Regardless of whether I pursue psychotherapy as a subject of interest, however, the fact remains that perusing Schwartz  Cohens book is an essential step in the recovery process of victims of sexual abuse  just like a member of the support staff attending the crisis hotline at the Sexual Assault Center.  Neither the book nor a telephone attendant at the Sexual Assault Center makes a significant difference in the recovery process yet we are vital parts of the same.