M. Rorty et J. Yager, HISTORIES OF CHILDHOOD TRAUMA AND COMPLEX POSTTRAUMATIC SEQUELAE IN WOMEN WITH EATING DISORDERS, The Psychiatric clinics of North America, 19(4), 1996, pp. 773
The tenacity of eating disorders found among women abused and neglecte
d in childhood becomes comprehensible when they are understood as desp
erate attempts to regulate overwhelming affective states, and to const
ruct a coherent sense of self and system of meaning when internal stru
ctures are lacking. In this article we use conceptualizations of compl
ex posttraumatic stress disorder to make sense of the troubling and so
metimes paradoxic facets of disturbed eating behaviors in the traumati
zed patients: their symbolic and metaphoric meanings; their intensity,
repetitiveness, and tenacity; their dissociative qualities; their use
as agents of self-soothing as well as self-harm; their resistance to
traditional treatments; and the particular nature of accompanying symp
toms and syndromes, including self-mutilation, borderline pathology, s
uicidality, depression, substance abuse, and sexual acting out or avoi
dance. Treatment of the traumatized eating disorder patient is multifa
ceted, complicated, and often demanding. It may involve individual tre
atment, group therapy, family interventions, and/or pharmacotherapy. A
s survivors connect past traumas with current symptoms and reenactment
phenomena within a safe interpersonal context, they gain an increased
capacity to relinquish their symptoms of eating disorder and to modul
ate disruptive internal states in a manner that soothes rather than in
tensifies past wounds.