May 30, 2013 Jeanne Rust

Domestic Violence and Eating Disorders

Defining the Problems

Domestic violence (DV) and eating disorders (ED) have enough repercussions by themselves, which may contribute to why they are not often thought of as related.  However, troubled family and personal relationships and a history of physical or sexual abuse are two of the greatest interpersonal factors which cause people to develop eating disorders (National Eating Disorder Association (NEDA), 2012).

Domestic violence can be defined as a pattern of abusive behavior used by one partner to gain or maintain power and control over another intimate partner (Office of Violence Against Women (OVW), 2012). The abuse can be physical, sexual, emotional, economical, or psychological, and includes any behavior, or threats of behavior, that intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, blame, or hurt someone (OVW, 2012). Compare this to a definition of eating disorders. Similar words from the DSM-IV-TR (2000) diagnoses of ED include "intense fear," and "lack of control." Also, ED can be defined as serious emotional and physical problems than can be life-threatening (NEDA, 2012). The same threats to life and consequences of ED can be seen in victims of DV.

Victims of DV and ED

Further, think of the women treated at Mirasol. Some of them may be victims of DV. Even if they are not, many of them, like victims of DV, have been "stripped of their power and have very little to no control over their own lives or actions," (NEDA, 2012).  They also feel inadequate, have low self-esteem, and may suffer from severe depression, anger, anxiety or loneliness (NEDA, 2012). They may feel physically and emotionally abused.  In the same way DV abusers often isolate their victims from their families and friends, so do ED behaviors (NEDA, 2012). The root of both DV and ED is control.  In DV, control comes from needing to feel superior, and with ED, food is used as a means of gaining back the control lost in other aspects of life (NEDA, 2012). Victims of DV, like women with ED, do not feel like they have control over their lives, or the things that happen to them.

The Research

The research supports the relationship between DV and ED. A meta-analysis of 41 studies worldwide found that women who did have disorders were more likely to have been victims of DV (Paddock, 2012). Other than ED, this also includes depressive disorder, anxiety disorder, PTSD, obsessive compulsive disorder, schizophrenia, bipolar disorder, and common mental health problems (Paddock, 2012).  Because disordered eating represents a form of maladaptive emotion regulation, it is not surprising that diagnoses of ED are often comorbid with depression and anxiety (Hudson, Hiripi, Pope, Jr., & Kessler, 2007). Neumark-Sztainer et al. (2000) and Mitchell and Mazzeo (2005) also agreed that depression partially explains links between direct victimization and disordered eating.

Adolescents

When working with adolescents, it is important to keep in mind the potential links between family violence, regulation of emotion, and disordered eating since adverse family environments can exacerbate disordered eating (Wonderlich et al., 2007). Adolescents are impacted by both direct victimization and witnessed violence in the home evidenced by ED symptomatology (Brady, 2008). Some adolescents may engage in disordered eating to regulate feelings of depression and anxiety subsequent to family violence exposure (Brady, 2008).  Notably, physical victimization is associated with greater likelihood of meeting criteria for PTSD and bulimia (Dansky, Brewerton, Kilpatrick, & O'Neil, 1997).

Summary and Treatment

Although we may think of DV and ED as separate issues, in society and in the clients we serve, the correlation between them is too significant. The first step is increased awareness of the potential impact of DV, including the development of ED.  The next step is treatment planning.  Emotion regulation strategies may be a critical part of the process to alleviate ED symptoms (Clyne & Blampied, 2004) and can also be helpful among individuals who have been witnesses or victims of DV.

References:

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.

Brady, S.S. (2008). Lifetime family violence exposure is associated with current symptoms of eating disorders among both young men and women. Journal of Traumatic Stress, 21 (3), 347–351.

Clyne, C., & Blampied, N. M. (2004). Training in emotion regulation as a treatment for binge eating: A preliminary study. Behaviour Change, 21, 269–281.

Dansky, B. S., Brewerton, T. D., Kilpatrick, D. G., & O'Neil, P. M. (1997). The National Women's Study: Relationship of victimization and posttraumatic stress disorder to bulimia nervosa. International Journal of Eating Disorders, 21, 213–228.

Mitchell, K. S., & Mazzeo, S. E. (2005).Mediators of the association between abuse and disordered eating in undergraduate men. Eating Behaviors, 6, 318–327.

National Eating Disorders Association. (2012). Retrieved from www.nationaleatingdisorders.org.

National Domestic Violence Hotline. (2012). Eating disorders and domestic violence: Is there a correlation? Retrieved from www.thehotline.org.

Neumark-Sztainer, D., Story, M., Hannan, P. J., Beuhring, T., & Resnick, M. D. (2000).Disordered eating among adolescents:Associations with sexual/physical abuse and other familial/psychosocial factors. International Journal of Eating Disorders, 28, 249–258.

Office of Violence Against Women. (2012). Retrieved from www.ovw.usdoj.gov.

Paddock, C. (2012). Mental health disorders linked to domestic violence. Medical News Today.

Wonderlich, S. A., Rosenfeldt, S., Crosby, R. D., Mitchell, J. E., Engel, S. G.,Smyth, J., et al. (2007). The effects of childhood trauma on daily mood lability and comorbid psychopathology in bulimia nervosa. Journal of Traumatic Stress, 20, 77–87.