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On the last track, we discussed three concepts of dissociative behavior in an anorexic client. These three concepts of dissociative behavior in an anorexic client included: bizarre behavior; trances; and manipulative strategies.
On this track, we will examine three concepts related to anorexic clients who are survivors of incest. These concepts regarding anorexic clients who were victims of incest include: inability to trust; skewed sexuality; and learned defenses.
One of the societal conceptions of anorexia is the belief that the disorder is inextricably linked to sexual abuse. If a girl has developed anorexia, she must have been abused when she was younger. Obviously, when the anorexic client has survived sexual abuse, this presents certain issues to consider and treat.
However, in my own experience and in polls taken of anorexic clients, only about 1 in 5, not a majority, have been sexually abused. This number is not far off from the general population and so the myth that sexual abuse and anorexia go hand-in-hand is false. However, incest does have a significant effect on the anorexic client making his or her experience a warranted subcategory of the disorder.
Concept #1 - Inability to Trust
When the incest occurs between siblings, the client may also feel abandoned by his or her parents because they did nothing to prevent the abuse. This inability to trust will result in the client becoming more and more reliant on themselves. This can exacerbate the anorexic condition as the initial outset of the disorder for even the general client experiences a manifestation of will power, and any extra independence will prevent a client from looking for a support system which they desperately need.
Katrina, age 21, had been sexually abused by her father from the age of five to thirteen. Not only did she lose her trust in male figures, but also female ones as well. Her mother, Katrina believed, had allowed the abuse to take place, even though there was no evidence corroborating this.
Katrina stated, “I wanted to get back at the world for hurting me. The day before my sixteenth birthday, I remember my mother looking into the mirror at her stomach. I smiled, you know, maliciously, and thought to myself, ‘I’ll make her feel like an old, fat hag!’ That’s when I decided to start losing weight! I didn’t start starving until about two years ago.” Katrina had lost any feelings of security and safety around older guardian figures and had also developed a need for vengeance against the crime that had been committed against her.
Think of your Katrina. What are his or her opinions towards parental figures?
Concept #2 - Skewed Sexuality
Elizabeth, age 19, was five-foot-nine and weighed 95 pounds. When she first came into the office, she was wearing a very short min-skirt, which she constantly pulled up, and a low cut blouse. In later sessions, she would reveal that she had been raped by her father, Tom, from the age of seven to twelve. Elizabeth stated, “I want to be valued by my appearance. I want to feel interesting and attractive or else I’m not worth shit.”
I stated, “Also, I think you may be testing people to see if they will exploit you as your father exploited you. If they do respond with sexual interest or advances, you're on home ground. It means you are physically ‘used’, but you’re used to that. You don’t know whether to be so thin that men won’t want you or to get even with other women by being thinner than they are. You both want to be exploited, but at the same time trying to prevent it.” Think of your Elizabeth. How has his or her skewed sexuality resulting from incest affected his or her anorexia?
Concept #3 - Learned Defenses
The abused anorexic client will sink deeper into these layers of mental defenses and ideas, which will make “compensation” for his or her original damage unacceptable. Just as anorexia has completely usurped the client’s identity, so too does the memory of incest parasitically live off of the client and reconfirms his or her lack of self-worth.
Technique: Displacing Guilt
She stated, “It was all my fault! When we were younger, Shane had a temper and he would have mood swings. When he was angry, he would tie me down and beat me! He’s eight years older than me, so you can imagine how much his beatings hurt. When he was in a good mood, we would do ‘sex play.’ Sometimes I was aroused by it and I soon got used to the guilty feelings afterwards! I didn’t tell my parents because whenever he was in a good mood, my parents were happy too.”
Because Tonya believed it was her duty to keep her brother in a good mood, she felt an extreme amount of guilt and responsibility for allowing the abuse to take place. To help Tonya relieve her own sense of guilt, I suggested she try the exercise “Displacing the Guilt.” In this exercise, I asked Tonya to write a letter to herself and to her brother. I asked that she concentrate on lifting the blame from herself, as she was just a young child, to her brother, who was older and understood right from wrong.
Although she did not have to send the letter to her brother, I also found that this letter allowed Tonya, a people-pleasing perfectionist, to express the anger that she had bottled up inside. Think of your Tonya. Could he or she benefit from Displacing Guilt?
On this track, we discussed three concepts related to anorexic clients who are survivors of incest. These concepts of anorexic clients who were victims of incest included: inability to trust; skewed sexuality; and learned defenses.
On the next track, we will examine three manifestations of anger in anorexic clients. These three manifestations of anger in anorexic clients include: repression; acting-out; and defense mechanism.
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