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Men and Eating Disorders

By Mary Anne Cohen, LCSW
Director
The New York Center for Eating Disorders

Sexual Abuse and Eating Disorders

Sadly, no discussion of sexual abuse is complete without a discussion of eating disorders as well. In my practice at The New York Center for Eating Disorders, 40 to 60 percent of the men (and women) who come for therapy for an eating problem have been abused.

"It was my father's best friend." "It was my father." "It was my brother." "It was my mother's boyfriend." "It was my mother." "It was my teacher." "It was my priest."

"And so I starved myself." "And so I binged." "And so I got fat." "And so I started using laxatives." "And so I made myself throw up."

What is the connection between sexual abuse and developing an eating disorder? The answer is guilt, shame, anesthesia, self-punishment, soothing, comfort, protection and rage.

Sexual abuse impacts the eating and body image of survivors in many different ways. It violates the boundaries of self so dramatically that sensations of hunger, fatigue, or sexuality become difficult to identify. Victims of sexual abuse often turn to food to relieve a wide range of tension states that have nothing to do with hunger.

For the man with a history of abuse, loving food can be safer than loving people. Trusting food can be safer than trusting people. Food never lies, never abuses you, never mistreats you. With food, you get to say when, where, and how much. No other relationship complies with your needs so absolutely.

Survivors of sexual abuse often work to become very fat or very thin as a way to render themselves unattractive. It is their attempt to de-sexualize themselves and thus become more protected from sexual feelings or memories. Other survivors diet obsessively, starve, or purge to make their bodies "perfect." This is their attempt to feel more powerful, invulnerable, and in control, so as not to re-experience the powerlessness they felt as children. Some large men and women survivors actually fear losing weight because it might leave them feeling smaller and childlike, ushering in memories that are difficult to cope with.

Sexual Abuse and Secrecy

Sexual abuse and emotional eating both have elements in common: secrecy and shame. Many eating disorder patients feel guilty about the sexual abuse in their childhoods, believing they could have prevented it but chose not to because of some defect in themselves. So they push their secret underground, and then distract and anesthetize themselves by compulsive overeating, bingeing, bulimia, anorexia, compulsive exercise.

In most cases, children do not tell about their abuse because they did not fully realize at the time that anything wrong was happening. Those who are dependent on the abuser cannot risk upsetting the status quo. Often, children keep the abuse secret out of fear they will not be believed or because they were threatened or bribed to keep silent.

There are many nuances to sexual abuse beyond overt touching. One father repeatedly bragged to his son about the size of his testicles and how he needed special large underwear to accommodate them. Another patient reported how his father and older brother would forcefully hold him down and tickle him all over his body until he was painfully gasping for breath.

The Fear of Remembering

Every time Paul became intimate with his girlfriend, he would later stand over the kitchen sink bingeing for the rest of the night, feeling agitated and vulnerable. Paul was aware he had been sexually abused as a boy, and he sensed a connection between this and his compulsive eating. Although he made many earnest attempts to remember, he could not get a clear memory—and so he continued to overeat.

Shortly into his therapy, Paul had the following dream: "I was sitting on my bed fishing. I had made a hole in the bed like the Alaskans do when they break through the ice to catch fish. Try as I might, I could not catch anything. Then I realized my fishing line had no hook!"

This dream helped us realize even more profoundly that Paul, in his deepest self, was terrified to "hook" his memories. Although he was fishing for memories, and it was indeed like pushing through frozen layers of ice, he had neglected to add a hook to his line. At a subconscious level, he did not want to remember. In order not to feel his pain, Paul truly wished the memory of his abuser to be "the big fish that got away." And his self destructive eating patterns continued unabated.

Paul's dream brought him to a crossroads in his recovery because he recognized that he would not be able to stop overeating until this part of his life was explored. He decided to commit himself "hook, line, and sinker" to becoming more open to the full knowledge and feelings of his abuse.

Shortly after, Paul had another dream that illuminated some crucial, hidden issues from the past. This flood of memories ushered in yet another period of out-of-control eating for him, as he once again tried to block out the unbearable pain. Over a period of time, however, Paul shared his memories and his shame in our therapy sessions, and was able to face this agonizing betrayal without needing excess food to numb and protect him.

Post Traumatic Stress Disorder

People with eating problems often suffer from symptoms of post traumatic stress disorder without realizing its origins lie in sexual abuse. Post traumatic stress is sometimes characterized by depression, feeling chronically "dead" inside, recurrent anxiety or nightmares, or feeling constantly and painfully vigilant to one's sur-roundings. Some victims of post traumatic stress also engage in self-destructive behavior by forming repetitive abusive relationships, losing themselves to drugs, alcohol, promiscuity, or self-mutilation.

Of course, none of these symptoms is absolute confirmation of abuse, but they are strong indicators of past sexual trauma. This is especially true if a person identifies several of these symptoms, since post traumatic stress disorder is usually a constellation of more than one indicator. Connecting these symptoms to an actual event of sexual abuse can be a validating experience because then symptoms of inner turmoil begin to make sense.

Healing from Sexual Abuse

What can you do to heal from sexual abuse? The first step is to recount your experience to someone you trust, someone with whom you can let yourself feel the brunt of your pain and rage. This is often a process over time. Since the experience of sexual abuse is about being out of control, you need to be in a protected setting where your feelings can reemerge and let loose. Releasing pain and guilt is not an intellectual experience, but some-thing that comes from deep within. This can be a difficult step because exposing your emotions can make you feel vulnerable like a reen-actment of the original trauma.

Although there is more media coverage than ever before about the prevalence of sexual abuse, this does not relieve the shame that many people feel over it. If you have been a victim of incest, facing the abuse means facing not only the shame that you come from the kind of family where abuse is perpetrated, but also that no one in your family protected you.

Sometimes eating disorder patients feel enormous guilt for having enjoyed the sexual contact with their abuser. Binge eating, purging or starving then becomes their ongoing self-induced punishment. When we scratch the surface of the lives of these children, though, we discover that sexual abuse may have been the only real affection or caring they received. A child who is lonely or starved for affection may revel in the attention, even if it is abuse. But the truth is that children are never the seducers, they are always the victims. The only thing a child is guilty of is the innocent wish to be loved.

Confronting your shame, releasing your pain, and experiencing rage and guilt are part of the process of reclaiming your inner self as well as your sexual self. The need to detour your feelings through destructive eating will subside when you are able to grieve for the little child who was betrayed.

Declaring Peace with Sexuality and Emotional Eating

The process of resolving sexual abuse and an eating disorder opens one's life to the enjoyment of deeper intimacy. Sexual intimacy is the opposite of emotional eating. It is about surrendering, relaxing, sharing and letting go, while emotional eating is about controlling, rigidity, fear, and isolation. No amount of cookies, dieting, throwing up, or starving can satisfy sexual longings. In order to heal an eating problem, we need to reconnect our physical hunger with our stomachs and reconnect our sexual hunger with learning to find trustworthy relationships.

Sink your teeth into life, and not into your relationship with food!

This article has been excerpted from French Toast for Breakfast: Declaring Peace with Emotional Eating by Mary Anne Cohen, Director, The New York Center for Eating Disorders (www.EmotionalEating.Org)