INTRODUCTION

It is suspected that disordered eating behaviors and obesity are common in sexual abuse victims due to the desire of victims to protect themselves from re-victimization. Palmer et. al (1990) reported that eating disorders and morbid obesity are four times more frequent in childhood sexual abuse survivors than in non-abused individuals. Additionally, in a study conducted by Ackard and Neumark-Sztainer (2001), it was suggested that disordered eating behaviors may be a way for sexual abuse victims to try to manipulate the body into becoming "unattractive" to others, and thus hope to reduce the likelihood of repeated experiences. However, no follow-up research has been done to study the correlation between intentional weight gain as a technique used by sexual abuse victims to avoid re-victimization.

It was found by Briere and Runtz (1988) that sexual abuse victims experience loss of self-esteem and often blame themselves for the abuse. Briere and Runts also reported that self-blame can be a motivator for self-destructiveness and powerlessness. It is suspected that intentional obesity by victims of sexual abuse is not necessarily intended to be a way for victims to punish themselves for the abuse due to self blame, however self-destructive intentional obesity may be. It is also suspected that obesity in survivors of sexual violence is intentional as a self-protection measure resulting from to the powerlessness that victims feel in the ability to protect themselves in future sexual situations.

Wind and Silvern, (1992) concluded that the impact of sexual abuse can not be appropriately studied without taking into account other childhood traumas. In addition, Thompson, Wonderlich, Crosby, Mitchell, (2001) concluded that knowing the perpetrator characteristics, duration of victimization, and severity of victimization helps to give more predictive power. These conclusions were taken into account in the development of an online survey used to gather the data in this study and in the data analysis process.

The current study seeks to determine the association between severe sexual abuse and the
use of obesity as a self-protection mechanism to avoid unwanted sexual experiences. Also being studied
is the relationship between the use of obesity as a method of self-protection and overeating behaviors in severe sexual abuse victims and those experiencing concomitant physical abuse and
re-victimization.

METHOD

A total of 30 men and women, between the ages of 19 and 53, from the State of Minnesota completed the survey. Data from five of the 30 participants was unusable due to missing data. Of the 25 participants taking part in the study, four participants were male and 21 were female. Two of the participants described their race as African American, one as Asian, twenty-one as Caucasian, and one as Native American.

A 158 question, self-disclosure survey was developed to gather the data necessary to measure the relationships being studied. The survey was made available on the Internet. Two versions of the survey were used. Both surveys contained the same sets of questions; however, the order of questions was counterbalanced to control for order effects.

Imbedded in the survey were a number of subscales and content-relevant questions. Respondents were asked to indicate their weight and height, which was used to calculate Body Mass Index and determine obesity. Obesity is defined by having a BMI of 30 or above. Respondents were also asked various questions to determine the severity of abuse they experienced. The Morrell, Mindel, and Fischer (2001) method was used to define severity of sexual violence with severe being: oral, anal, or vaginal penetration, moderate: genital contact or fondling, not resulting in intercourse, and mild: exhibitionism, voyeurism, exposure to pornography, sexual invitations or requests, kissing or hugging in a sexual manner. Childhood sexual violence is defined as sexual violence experienced before the age of 18. Adult sexual violence is defined as sexual violence experienced after the age of 18. There were no significant differences present between participants who had never experienced sexual abuse and those experiencing mild sexual abuse.

All of the surveys were completed individually in private office spaces containing one computer and a closing door to ensure privacy. When each participant entered the room a consent form was already loaded on the computer screen and instructions were left for the participants on the keyboard of the computer. Reading the consent form was required prior to accessing the survey online. Participants clicked a button stating that they had read the consent form and the survey became viewable on
the screen.

After completion of the survey each participant submitted the information by clicking a submit button. The participants were then thanked for their time, reassured that the information they submitted would be valued, and were informed of when and where they could learn about the results of the study. The participants then followed the written instructions to return the computer screen to the consent form for the next participant.

Twenty-two of the twenty-five participants used the online self-disclosure survey. Eleven of the participants completed Survey 1 and eleven of the participants completed Survey 2. Three of the Participants were interviewed in person, due to inaccessibility to the Internet in a private location. Participants who were interviewed were informed about the study verbally and gave verbal consent prior to participation.

RESULTS

Associations were assessed using the chi-square statistic evaluating significance at the .05 level. Severe and None/Mild were compared with differences in dependent variable values to assess significance in relationships between severely abused individuals and weight manipulation and assertiveness variables. Cross-tabulations were conducted to obtain significance values for individuals who experienced repeated victimization (by more than one perpetrator) and who experienced childhood physical abuse. Additional analyses were conducted to control for severity of sexual violence, childhood and adult onset of sexual violence, and childhood physical abuse.

As predicted, individuals who have experienced severe sexual abuse had a higher tendency toward obesity than those experiencing no sexual abuse or mild sexual abuse (p<.025). Individuals who have experienced severe sexual abuse also have a higher tendency to use their weight as a self-protection mechanism in avoiding unwanted sexual experiences than controls (p<.025) and have a higher tendency to use weight to prevent sexual situations from going too far than controls (p<.025). However,
re-victimized individuals were not found to use their weight to avoid sexual experiences at a higher rate than those experiencing severe sexual abuse without re-victimization.

Differences in difficulty with assertiveness in sexual situations was not significant between individuals experiencing severe sexual abuse and those experiencing none or mild sexual abuse. However, individuals who experienced concomitant severe sexual abuse, childhood physical abuse, and re-victimization had a greater tendency to have difficulty with assertiveness in sexual situations than controls (p<.05).

Those who experienced severe sexual abuse were more likely to have been physically abused as children than individuals who experienced no sexual abuse or mild sexual abuse (p<.01). Concomitant physical abuse and severe sexual abuse was found to increase the tendency of individuals to struggle with
overeating than controls (p<.05). A higher tendency to overeat was found in those experiencing concomitant physical abuse and severe sexual abuse than those experiencing severe sexual abuse
alone (p<.05).

Overall, 68% (n=17) of participants reported experiencing moderate to severe sexual violence, with 48% (n=12) reporting severe sexual violence. Childhood sexual violence onset was reported by 65% (n=11) and adult sexual violence onset by 35% (n=6). Of those severely sexually abused, 58% were also physically abused as children. The presence of severe sexual abuse was higher in females than in males (p<.01).

Of those severely sexually abused, 50% were re-victimized by at least one other perpetrator with an average of five perpetrators, ten being the highest number of perpetrators and two being the lowest number of perpetrators. Severe sexual violence was experienced repetitively throughout the childhood of 20% (n=3) of the participants, while 25% (n=4) experienced severe sexual violence repetitively for a period of two to three years, and 29% (n=5) experienced severe sexual violence as an isolated event.

None of the perpetrators paid legal consequences for their acts of sexual violence against the participants. Of the participants severely sexually abused, 60% (n=6) had never told anyone about the abuse prior to this study, 20% (n=3) told someone years after the abuse occurred, and 20% (n=3) told someone what had happened to them soon after the abuse occurred.

DISCUSSION

In the current study, 48% of participants reported experiencing severe sexual violence. These abusive experiences were found to be significantly associated with obesity, the use of weight manipulation to avoid unwanted sexual experiences, and overeating, The cumulative effect of both severe sexual violence and childhood physical abuse resulted in a stronger association with overeating than severe sexual abuse alone.

Findings in this study have significant implications for programming in health care, education, and sexual violence prevention. There is a high prevalence rate of sexual violence, childhood physical abuse, and frequent re-victimization. Health care professionals play a vital role in identifying those who have experienced sexual violence and offering assistance. Medical and mental health professionals should routinely screen for sexual abuse and be aware of appropriate referrals. In addition, our findings indicate that individuals who experience severe sexual violence are at greater risk for health concerns due to obesity. Therefore, practitioners working to combat obesity should address sexual violence as a potential factor in treating obese patients.

Findings also indicate that more than half of the severely sexually abused individuals do not report the abuse after it occurs. In addition, few perpetrators pay legal consequences for their acts of sexual violence against their victims, including those that are exposed for their acts of violence. Identification of social contexts and experiences that make perpetration of sexual violence more likely and knowledge of developmental factors that make this behavior less likely is needed to prevent sexual abuse from occurring.

In addition, findings indicate that individuals who experience severe sexual abuse are more likely to have experienced childhood physical abuse. This may be due to increased vulnerability due the effects of physical abuse on self-esteem and unclear boundaries developed in childhood, among other possible effects on increased vulnerability due to childhood physical abuse. These relationships should be studied further in future research.

The present study is not without limitations. For example, the findings indicate that severe sexual abuse in females is far greater than in the males. A larger sample of males may indicate otherwise. However, past research indicates that the lack of research attention to male sexual abuse seems to be partially due to underreporting of sexual violence in males (Morrell, Mendel, & Fischer, 2001). Therefor, it is of interest that one in four of the males in this study reported being severely sexually abused and had a BMI indicating obesity. He also indicated that he manipulated his weight to avoid unwanted sexual experiences, struggled with overeating, and experienced physical abuse as a child. This is consistent with the data provided by the female participants in the study.

REFERENCES

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AUTHOR’S NOTE