07 August 2005
	Help for Adult Victims Of Child Abuse. A non-profit making organisation based in the UK dedicated to provide help, support and information to any adult who is suffering from past childhood abuse.

Survivors and the Food Connection
By Suzanne Scott and Lynne M. Constantine

Many of us survived the experience of childhood sexual trauma, in part, through our relationships with food. We used treats to comfort ourselves. We compulsively stuffed ourselves with food to avoid feeling anger, grief, and frustration -- or our own sexuality. We gained weight to protect ourselves from revictimizatim. We starved ourselves, driven by an innerfear of being  ugly and unacceptable or by the belief that once we started eating, we'd be unable to stop.

Not eating. Overeating. Eating compulsively. Thinking about eating. Trying not to eat. Eating and vomiting. Eating and feeling guilty. Some version, or combination, of these behaviours troubles many survivors. Certainly not all survivors have such intense relationships with food. But for those who do, the struggle to end the process of using food in all the old familiar ways can be difficult and painful.

Ending the Guilt
Sally R. Kenler, M.S., R.D., a registered dietitian at the Frances Stem Nutrition Center (New England Medical Center, Tufts University, MA) works with outpatients in the center's eating disorder program. "Many people I see are survivors of childhood sexual abuse," she said. "The first thing I do is try to remove their guilt about eating."

According to Kenler, many survivors feel guilty because they crave carbohydrates -- pasta, potatoes, bagels. "They should, in fact, be eating those things," she said. "Sixty percent of our total calories should come from carbohydrates."

In current thinking about nutrition, carbohydrates are the heroes, not the villains. They are broken down into sugar, which the body uses as its first-line fuel for metabolic activities. Complex carbohydrates, like potatoes and pasta, are excellent foods because they are turned into sugar more slowly than simple carbohydrates (like sugar or honey). If a survivor suffers from constant, low-level anxiety, it's no surprise that she craves bagels and pasta, which provide steady, sustained energy.

"If there's one thing I try to convey, it's that there are no forbidden foods," said Kenler. "That's not to deny, however, that certain foods may trigger counterproductive eating behaviours in some people." Food Triggers High-fat foods like ice cream, cheese, chocolate, and baked goods are common triggers for binge eating. One person may be able to eat two ounces of cheese, for example, and never give it another thought. But someone else might find that eating those two ounces of cheese throws him into a cheese-eating frenzy -- and then into an anything-eating frenzy. Many people are surprised to learn that it's the fat, not the sugar, in these foods that seems to set off the problem. Many nutritionists now believe that people who think they have a "sweet tooth" may really have a "fat tooth."

It's not entirely clear why given foods should trigger overeating. Some scientists suspect a biochemical cause. In this view, the survivor's overstressed system lacks some key chemical needed for normal functioning, and desperately seeks to restore balance by demanding large quantities of foods that contain similar substances or chemical building-blocks. Other scientists, however, believe the bingeing is a behavioural adaptation to stress -- a habit -- that can be unlearned, though with difficulty.

People often are most susceptible to their triggers after a period of strict dieting. Too restrictive regimens frequently lead to feelings of deprivation, which ultimately end in bingeing. Bingeing then leads to the guilt loop: "I must be bad because I can't control myself. " This guilt can lead to an all-or-nothing despair: 'I've ruined it, so why not eat?"
A Diversion from Pain.

For many survivors, obsession with food is a way of diverting inner attention from the pain of past sexual abuse -- or even abuse in the present. Kenler worked with a young anorectic woman who, during the process of being treated for her eating disorder, remembered that her father had sexually abused her as a child. As treatment progressed, she gradually became aware that the abuse was still going on. Two years later, this woman's relationship to food is healthy, in part because of help she received in Overeaters Anonymous (OA).

Wayne Callaway, M.D., an endocrinologist in private practice in Washington, DC, often treats survivors who use food to pad themselves as a defense against future assault. "They represent a significant subset of the people I treat for obesity," he said. "The typical characteristic of that person is that she diets and loses weight, but as the pounds begin to disappear, she becomes more and more anxious."

Dangerous Physical Consequences Although food may be entangled in the complex emotional effects of abuse, the result ultimately may be serious damage to the body. According to Callaway, severely restricting food intake can lead to short-term and long-term problems.

"The person loses a lot of water in the beginning, then after three to four weeks of dieting, when she begins eating again, she begins having serious problems with fluid retention," he said. "If she is able to continue on her semi-starvation diet, her metabolic rate gets slower and slower, so she burns fewer calories and feels tired and cold."

The news is equally bad about yo-yo dieting, in which a few pounds come off, only to be put right back on. Researchers now believe yo-yo dieting can have a detrimental effect on the heart.

Making Friends with Food
When Kenler's clients ask for nutritional advice, they're often surprised by her laid-back, take-it-slow-and-easy, be-kind-to-yourself attitude. "Sometimes they say they're afraid I'm not going to let them lose weight," she said. Kenler's clients participate in a multidisciplinary program that includes group and individual therapy. In her nutritional counseling sessions, she works with them on changing small aspects of their behaviours and attitudes about foods.

In one session, for example, she might suggest that they try to not eat anything after 8:30 at night. Or she may ask them to look at their caffeine intake or their fat intake and cut back slightly "But we have to be careful here, because there are a lot of survivors who become fat-phobic and will try to avoid fats at all costs," said Kenler.

Kenler's step-by-step approach to making friends with food acknowledges that survivors often find moderation a hard road to follow. As people who were subjected to egregious violation of their internal limits, they may see life as extremes. Forsome, any restrictions may feel like they are being controlled by another's idea of what's good for them. One therapist said she dislikes the word "moderation" because it sounds like, "as much as your mother wants you to have."

Learning To Hood Our Hungers
Learning to eat when we're hungry, stop when we're not, and pay reasonable attention to the kinds of foods we eat is not easy. It involves turning all of that food-obsessed energy toward something else. It means reclaiming the natural response to food we were born with -- and acknowledging one more way  in which the natural order has been turned upside down by sexual assault. To develop new behaviours and attitudes about food, it's important to learn more about nutrition. But it may be even more important for us to learn how to listen to ourselves about our hungers -- the unmet cravings for safety, acceptance, and love that have become entangled with food. If you, too, survived, in part, with the help of your relationship with food, healing that relationship is one aspect of the larger healing process.

Suzanne Scott and Lynne M. Constantine are health and behavioural sciences
writers and co-owners of Community Scribes, a communications consulting firm
in Northern Virginia.

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