Women with eating disorders and a history of sexual abuse: An integrative treatment approach

This chapter proposes a practice-based model for the treatment of patients with eating disorders (EDs) in the context of a history of childhood sexual abuse (CSA). Our integrated ED-CSA treatment model includes 3 phases. The first acute phase focuses on the stabilization of ED-related symptomatology and reduction of other health threatening behaviors. When this is achieved, patients move on to the second phase involving treatment of trauma-related issues. The third phase focuses on further integration of material previously elicited in the course of treatment. Treatment can be terminated if the patient is considered symptomatically stabilized and if trauma-related material has been worked through at least to some extent. Otherwise, a fourth intervention phase focusing on either general functioning or additional trauma-related work may be indicated. This model is fundamentally about the need to empower the patients. This is achieved by reducing their social isolation and sense of helplessness and expanding the range of adaptive options offered for effective coping with trauma-related issues. This model further assumes that ED symptoms have to be stabilized to some extent before trauma-related issues can be treated. It is considered that following these interventions, patients will no longer have to rely on ED-related and other health-endangering behaviors for trauma-related affect regulation. The important contribution of this model is its applicability for the treatment of ED patients both with and without a history of CSA. Further research is needed to establish the utility and implications of this treatment in the overall management of combined ED and CSA.