Not a Coincidence: Sexual Trauma and Eating Disorders

For many who have experienced sexual trauma, the body can stop feeling like home. Instead, it can become a site of shame, a painful reminder of violation, something to control, punish, or erase. That shame is not superficial. It is often deeply embedded in the body itself, making it difficult to inhabit, let alone care for. Disordered eating frequently emerges as an attempt to manage this internal conflict, especially when the body is the context for a traumatic experience.

Behaviors like restricting, bingeing, purging, or compulsive exercise may appear to be choices from the outside. In reality, they are often driven by a profound need to feel safe or regain control. The eating disorder becomes a private system of self-regulation that can help someone numb overwhelming feelings, avoid unwanted attention, or reclaim ownership over a body that no longer feels like their own.

One of the most lasting effects of sexual trauma is the toll it can take on body image. In the aftermath, individuals may see their bodies as damaged, dangerous, or somehow to blame for what happened. Shame plays a central role here, convincing people that their bodies invited harm or are marked by it. Some attempt to make themselves smaller, less visible, or less vulnerable in an effort to feel safer. Others engage in cycles of bingeing and purging that reflect the emotional rhythm of trauma. These patterns often include moments of overwhelm, followed by shame, secrecy, and temporary relief.

A large study found that girls who experienced multiple episodes of childhood sexual abuse were more than five times as likely to develop bingeing and purging behaviors in adolescence compared to those without such a history. Notably, this strong association did not appear with restrictive behaviors. This suggests that the emotional dysregulation and shame often associated with bingeing may align more closely with the psychological aftermath of sexual trauma.

These findings echo a broader body of research showing that trauma is not just a background factor in eating disorders. It is often a driving force. Studies have found that nearly half of adults entering residential treatment for an eating disorder also meet criteria for posttraumatic stress disorder. When PTSD is left unaddressed, even the most evidence-based behavioral interventions may fall short. Increasingly, treatment programs are beginning to integrate trauma therapies like Cognitive Processing Therapy into eating disorder care. Findings suggest that when trauma symptoms are reduced, eating disorder behaviors often improve as well.

Recovery must begin with understanding. A trauma-informed approach can help reframe disordered eating as a coping strategy that may have been protective or adaptive at one time. Instead of focusing solely on food or eating behaviors, effective treatment must include rebuilding safety, trust, and agency, especially in one’s relationship with the body.

Survivors often describe recovery as a process of returning to themselves. Practices like tolerating hunger, fullness, and other bodily sensations can help them reconnect with their physical experience and make the body feel livable again.

As a public, we need to be more honest about the role sexual trauma plays in the development of eating disorders. The link is not incidental or rare. It is widespread, well-documented, and too often ignored. When we overlook this connection, we fail the very people who most need to be seen and understood.