Statement of the Problem
Research by Suzanne and Dorothy (2002) support the finds of childhood abuse increasing the likelihood of developing an eating disorder whether that is neglect, emotional, physical, and/or sexual abuse. According to the National Association of Anorexia Nervosa and Associated Disorders (2019), eating disorders have the highest mortality rate of any mental illness. Because there are different types of child abuse, the study will be able to conclude what types of childhood abuse and how the effect of family cohesion plays a role in eating disorders or eating symptomology among women. The research hypothesis is that physical and emotional abuse causes greater psychological distress than just sexual abuse alone thus results in a severe case in the manifestation of the eating disorder. Family Environment Scales, as well as Childhood Trauma Scales and an Eating Attitudes Test, will be explored.
Justification for and Significance of the Study
The National Eating Disorders Association (2012), states that those who have experienced traumatic events may engage in eating disorder to self-manage the feelings. The previous study has shown the concurrence between family environment and childhood abuse. According to Meyerson et al., (2001), physically abused adolescent females and sexually abused females perceived their family environment to be more conflictual and less cohesive than those who reported no abuse during their childhood.
Abuse is a significant measure in the study because it is a risk factor to many disorders including eating disorders. The DSM-5 (2018) states that one of the external factors of eating disorders is in fact sexual or physical abuse. McCauley et al., (2013) added the statistic, each year about 1.4 million children in the United States suffer from some form of child maltreatment.
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Child abuse consists of 3 different types, physical, emotional, and sexual. Physical abuse stems from an act that results in a physical injury such as broken bones, cuts, bruises, etc. Emotional abuse occurs when parent/guardian ridicules or belittles child, isolating child, denying emotional responsiveness, and/or neglecting mental health or educational needs. Sexual abuse can happen in extra-familial or intra-familial, girls are the most common victims, and children with poor relationships with their parents have a higher risk of being sexually abused.
In a study done by Mallincrokdt et al.,(1995), they wanted to know the co-occurrence of eating disorders and incest and how attachment, family environment, and social competencies play into these variables. For the study, they had 2 groups, students and clients that fit the criteria of sexually abused. Family Environment and Childhood Attachment Scales, Screening Instruments, Parental Bonding Instrument, Self-Efficacy Scale, Adult Attachment Scale, and Social Provisions Scale were used on participants. Mallincrokdt et al., (1995) had found that those with scores on the EAT-26 with 20 or greater were designated as having an Eating Disorder. The results of this study concluded that the client survivors of sexual abuse from a family member were much higher than a student survivor and that abuse, especially in incest, contributes to dysfunctional parental attachments and family environments and interferes with the development.
Eating disorders will be viewed in this case as a way to cope and manage traumatic emotions. It can also expand into different types such as anorexia nervosa, bulimia nervosa, body dysmorphic, and binge eating/compulsive disorder. Rayworth et al., (2004) states that eating disorders affect 5 to 10 million people in the United States and the risks are much higher among women. Anorexia nervosa is characterized by weight loss and difficulty retaining the appropriate body weight for the height and age. The characteristics of anorexia can be exercising compulsively, and/or purging.
The main focus will be on Bulimia Nervosa due to it being the most common. According to (Dworkin et al., 2014) states how compensatory behaviors and compulsivity compensate for negative affect and compensatory behaviors can be present in bulimia. The DSM-5 (2018) states that bulimia nervosa is a potentially life-threatening eating disorder that is characterized by a cycle of binging and purging behaviors to compensate for the effects of eating. Maltreatment was also seen as a common factor in people who engaged in binge eating. In the study done by Lejonclou et al., (2014), participants answered Experienced Traumas and Adverse Childhood Questionnaires and thus they analyzed the severity of life events and how common it was reported in eating disorder patients than in a nonclinical group of adolescent women. As well as, the problems during the early attachment relationship period and the experiences one has during a serious life-changing event during childhood that may cause difficulties in psychological development, as well as an increased risk for psychopathology.
Family functioning and its association with childhood abuse have been researched for different studies because of the negative influence in family functioning and how this may increase levels of conflicts and increase the levels of abuse that comes with the conflict. Finkelhor et al., (1985) states how a child who was previously a victim of abuse may have suffered from a disempowering dynamic before the abuse ever occurred. Mazzeo et al., (2002) found in their study the correlation of lower levels of emotional expressiveness in families among those who suffered from distorted eating compared to those who did not. In the study, they used the Family Environment Scale to measure the family functioning and also used the Cohesion and Conflict subscales to measure the anger, aggression, and conflicts within the family. The results that were concluded in this study supported the hypothesis on low levels of family cohesion and the association with childhood abuse. Present results that Mazzeo et al., (2002) found concluded that low levels of family cohesion were also correlated with physical and emotional abuse, as well as neglect.
The sample will be women over the age of 18, specifically those who have been through childhood abuse (any type of abuse) and have an eating disorder or shows symptomology of eating disorders. Because the sample will be all women, it will be open to the public where women will be able to answer the questions to see if they fit the criteria. Doing this will allow the study to have more options and have more than 4
This study will be a quasi-experimental design and participants will be part of a between-subjects experiment in a nonequivalent groups design. The purpose of this design is to test the severity of the childhood abuse and how it also affects the eating disorder each participant has. Participants who have been physically and emotionally abused but not sexually abused during childhood will be in a group and the other group will be participants who have been sexually abused and have an eating disorder. Each participant will also have to have a poor family cohesion growing up. Each participant will have 3 questionnaires to see if they match the criteria for the study. The Family Environment Scale, Childhood Trauma Questionnaire, Eating Attitudes Test, and the Bulimia Test.
Family Environment Scale (FES, Form R, Moos, 1974) will be used to measure family functioning. It is a forced choice scale composed of 90-item true or false with 10 subscales measuring interpersonal relationship dimension, growth, and maintenance. It is also used to measure family dynamic, communication, closeness, and integrity. The subscales that will be measured specifically are the cohesion subscale and the conflict subscale. Those who scored higher on cohesion and less on conflict were seen as part of the distressed family.
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Childhood Trauma Questionnaire (CTQ) (Bernstein et al., 1994) will be used to measure abuse history. It is a 28-item self-report measure that will assess different aspects of traumatic childhood experiences. It is a summated rating scale and would begin with a question such as “When I was growing up” that will be rated on a 5-point scale, to 1 being never true and 5 is very often true. The CTQ is also composed of six subscales: Emotional Abuse, Physical Abuse, Sexual Abuse, Physical Neglect, and Minimization/Denial. Each subscale also includes five items with the Minimization/Denial subscale having only three items.
Eating Attitudes Test- 26 (EAT-26) (Garner & Garfinkel, 1979) is a self-report measure that consists of 26 items to assess eating disorder symptomology. The items are rated on a 6-point frequency scale, the responses being 1 as never up to 6 as always. The higher the score, the more symptomatic the respondent is. This measure is composed of three subscales, dieting, bulimia and food preoccupation, and oral control. Those who reported a higher score on dieting and bulimia are more prevalent in experiencing distorted eating behaviors than those who scored lower on oral control.
Each subscale will be measured specifically and the higher the scores are on one subscale, it will be lower on another subscale and will show a high/low classification and symptomology.
Analysis for Results
The statistical test that will be used for this study is a Bivariate correlation because of the two continuous variables, childhood abuse, and eating disorders. This test measures the two continuous variables and expresses a positive relationship. It also shows the relationship between each subscale and the changes within each scale that affects another subscale. The study would expect to support the hypothesis that childhood abuse is a significant risk factor in eating disorders among women. The experiment also supports the severity of the childhood abuse that each participant suffered and how it affects the eating disorders from an acute eating disorder to extreme case of eating disorder and also supporting evidence on eating disorder symptomology.
- Dworkin, E., Javdani, S., Verona, E., Campbell, R.,(2014), Child Sexual Abuse and Disordered Eating: The Mediating Role of impulsive and Compulsive Tendencies. Psychology of Violence, 4(1), 21-36
- Eating Disorders Victoria. (2016). Retrieved from //www.eatingdisorders.org.au/eating-disorders
- Finkelhor, Browne, A., (1985), The Traumatic Impact of Child Sexual Abuse: A Conceptualization. American Journal of Orthopsychiatry, 55(4)
- Lejenclou, A., Nillson, D., Holmqvist, R., (2013), Variants of Potentially Traumatizing Life Events in Eating Disorder Patients. Psychological Trauma, 6(6), 661-667
- Mallinckrodt, B., McCreary, B., Robertson, A.,(1995), Co-Occurrence of Eating Disorders and Incest: The Role of Attachment, Family Environment, and Social Competencies. Journal of Counseling Psychology, 42(2), 178-186
- Mazzeo, S., Espelage, D., (2002), Association Between Childhood Physical and Emotional Abuse and Eating Behaviors in Female Undergraduates: An Investigation of the Mediating Role of Alexithymia and Depression. Journal of Counseling Psychology, 49(1), 86-100
- McCauley, J., Kern, D., Kolodner, K., (1997), Clinical Characteristics of Women With a History of Childhood Abuse. JAMA, 277(17)
- Meyerson, L., Long, P., Miranda, R., (2002), The influence of childhood sexual abuse, physical abuse, family environment, and gender on the psychological adjustments of adolescents, Child Abuse & Neglect, 387-405
- National Association of Anorexia Nervosa and Associated Disorders. (2019). Retrieved from //anad.org/education-and-awareness/about-eating0disorders/eating-disorders-statistics/
- National Eating Disorders Association. (2012). Retrieved from //www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/TraumaandEatingDisorders.pdf
- Rayworth, B., Wise, L., Harlow, B., (2004), Childhood Abuse and Risk of Eating Disorders in Women. Epidemiology. (15) 271-278