The role of dissociation and eating disorder symptoms in facing loss, abandonment and sexual abuse trauma sequelae in the case of “Ana”

The link between eating disorder symptoms and both dissociation and childhood sexual abuse has received significant empirical support. This paper surveyed current literature regarding that relationship and examined the role of dissociation in both eating disorder symptoms and in overcoming complex trauma symptoms. The question of whether dissociation serves as a protective defense or a pathological process, particularly in individuals who have suffered chronic sexual abuse, has often been posed. To that end, case material from a three-year individual psychotherapy treatment of a young woman with an eating disorder and history of sexual abuse was used to gain understanding of the use of both conscious and unconscious dissociation, and eating disorder symptoms to defend against psychological pain related to trauma and feelings of loss and abandonment.

The study considered two central questions. First, did the patient utilize eating disordered symptoms to bring about the by-products of dissociation (i.e. soothing, numbing and self-protection from psychological pain), once she began to re-live formerly dissociated experiences in treatment? Second, in helping patients to face past traumas and to enhance their understanding of the impact of those traumas on current functioning, is it therapeutic to dismantle dissociation in treatment? Findings from case material, current research and consultation with experts were used to support conclusions regarding these questions.

Both literature and case material reviewed in this project suggest that a strong link exists between dissociation and sexual abuse trauma, and eating disorder symptoms and dissociation. Optimal treatment for patients presenting with both eating disorder symptoms and complex trauma histories would involve a relational approach, which helps patients to uncover the underlying attachment and trauma dynamics that drive and maintain symptoms. Additionally, helping patients to understand the possible dissociative aspects and symbolism of binge/purge cycles in the context of past and recurring trauma is crucial. Symptoms are dissociative in that they allow for the disavowal of painful affects and assist albeit maladaptively, in affect regulation. In many cases, tackling dissociative aspects of eating disorder symptoms in the aforementioned manner helps patients lead healthier lives psychologically and achieve their personal goals.