Psychodynamics of eating disorder behavior in sexual abuse survivors.

The author reviews the psychodynamics of eating disorder behaviors in women with childhood sexual abuse histories, with a focus on anorexia, bingeing, purging, and overeating. The various defenses and behaviors interact with each other through numerous different feedback loops. The same behavior can have multiple defensive functions and the same defensive function can be served by different behaviors. None of the behaviors is specific to childhood sexual abuse, but the abuse history modifies the content, heightens the intensity of the feelings being defended against, and should be taken into account in the therapy. Several examples of therapeutic strategies are also provided.