Eating Disorders in Organised and Ritual Abuse Survivors

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Eating Disorders in Organised and Ritual Abuse Survivors

Difficulties with food including feeding and eating disorders are often found in people who have experienced child abuse, especially child sexual abuse, and are common in survivors of ritual abuse and organised abuse beginning in childhood.12 Problems with eating reported in ritual and organised abuse survivors include:

  • having flashbacks to the abuse when eating3
  • being repulsed by the look or texture of some foods4
  • fasting, purging, anorexia, and higher rates of obesity5
  • being vegetarian or having ritualized eating habits, such as eating only certain foods or in a certain order35

Eating difficulties in abuse survivors may be directly linked to the abuse. Some reasons for this include:

  • Foods or drinks may act as reminders of the body fluids a survivor was forced to ingest during abuse, resulting in certain types of food being avoided, e.g. milk as a reminder of swallowing semen,36 red foods may remind ritual abuse survivors of ingesting blood or the killing of animals, and brown foods of eating faeces78
  • Eating disorders may give an illusion of control when the person feels helpless or out of control9
  • Eating may provoke flashbacks to oral abuse (experiencing food as a “foreign object” in their mouth)610
  • A compulsion to repeat or reenact abuse, or to compensate for past it, e.g., being deliberated starved, being punished for eating, or vomiting during abuse94
  • Dissociation from bodily sensations is present: hunger and fullness are not experienced or not recognized11
  • As a coping mechanism e.g., using numbing to regulate emotions1211
  • Somitisation: a type of dissociation in which feelings are substituted for physical sensations, e.g. feeling angry becomes feeling fat11
  • Self-soothing e.g. seeking comfort in food11
  • Using overeating or eating behaviors to suppress memories of abuse10

Websites and online articles

Anna Paterson. Anna suffered extreme emotional abuse from her grandmother and developed life-thretening anorexia in an effort to become invisible. She shares her story of suffering and recovery. http://web.archive.org/web/20160308043813/http://www.annapaterson.com/

Beat. The UK’s Eating Disorder Charity. Information, resources and a helpline. https://www.beateatingdisorders.org.uk/

Coleman, J. (1994). Presenting features in adult victims of Satanist ritual abuse. Child Abuse Review, 3(2), 83-92.

Courage to Nourish. Run by eating disorder dietitian nutritionists supporting people in eating disorder recovery, including paid treatment from dietitians. Based around anti-diet, intuitive eating, and body liberation standpoint. including Health At Every Size©. Free resources include worksheets and a comprehensive set of quizzes including many less well-recognized Feeding and Eating Disorders like orthorexia, binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). https://couragetonourish.com/eating-disorder-quizzes/

Eating Disorders Resource Catalog. For men, women, families and professionals. A comprehensive site listing treatment centers, therapists, support groups, organizations, conferences and events, hundreds of books and articles, and archives of information on various eating disorder issues. Free catalog of resources. Note: the live website has been hacked (Nov 2024), the archived website is available http://web.archive.org/web/20220121063754/http://www.edcatalogue.com/

Hay, P. (2020). Current approach to eating disorders: a clinical update. Internal medicine journal, 50(1), 24–29. Note: A clinical summary with current diagnostic criteria, treatment approaches, and recovery rates including both binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). https://doi.org/10.1111/imj.14691

Lacter, E. (2013). Adult and Adolescent Indicators of Ritual Trauma Two different groups of eating difficulties are included in the long list of possible indicators of a past history of ritual abuse/trauma, the list is not intended to be diagnostic.

National Alliance for Eating Disorders – U.S. charity providing a free helpline staffed by therapists who specialise in eating disorders, help with referrals to care, free support groups, educational opportunities, and more. https://www.allianceforeatingdisorders.com/

National Eating Disorders Association (NEDA). Resources for clients, health care professionals, famililes. Hotline and referrals to therapists. Thirty-eight downloadable books. https://www.nationaleatingdisorders.org/

Nelson, S., & Hampson, S. (2008). Yes You Can!. Working with survivors of childhood sexual abuse.

Nobakht, H. N., & Yngvar Dale, K. (2018). The importance of religious/ritual abuse as a traumatic predictor of dissociation. Journal of interpersonal violence, 33(23), 3575-3588. Note: Academic journal article.

Sarson, J., & MacDonald, L. (2009). Behavioural harms: Enforced and survival tactics in ritual abuse-torture victimization. In annual conference of the Substance Abuse Librarians & Information Specialists, Halifax, Nova Scotia, Canada. Note: Academic journal article.

Schröder, J., Nick, S., Richter-Appelt, H., & Briken, P. (2018). Psychiatric impact of organized and ritual child sexual abuse: Cross-sectional findings from individuals who report being victimized. International Journal of Environmental Research and Public Health, 15(11), 2417. Note: Academic journal article.

Self-help and therapy books

Canter, Sheryl. (2009) Normal eating for normal weight: The path to freedom from weight obsession and food cravings. Permutations Software, NY, NY. NOTE: From the publisher: “Normal Eating is a uniquely effective step-by-step program to free people from compulsive urges and emotional eating. It draws from the Zen principle of mindfulness, 12-step wisdom on addiction, intuitive eating (the non-diet approach), cognitive psychology, and solid nutrition.” Previews in Amazon books and Google books

Cash, Thomas F. and Smolak, Linda. (2011) Body image, second edition: A handbook of science, practice, and prevention. Guilford Press, NY, NY. TABLE OF CONTENTS: PART I. CONCEPTUAL FOUNDATIONS: – Understanding Body Images: Historical and Contemporary Perspectives – Sociocultural Perspectives on Human Appearance and Body Image – Evolutionary Perspectives on Human Appearance – Genetic and Neuroscientific Perspectives on Body Image – Cognitive-Behavioral Perspectives on Body Image – Feminist Perspectives on Body Image – Positive Psychology Perspectives on Body Image – PART II. DEVELOPMENTAL PERSPECTIVES AND INFLUENCES: – Body Image Development in Childhood – Body Image Development in Adolescent Girls – Body Image Development in Adolescent Boys – Body Image Development in Adulthood – Media Influences on Body Image – Interpersonal and Familial Influences on the Development of Body Image – Sexual Abuse and Body Image – PART III. BODY IMAGE ASSESSMENT: – Crucial Consideration in the Assessment of Body Image – Body Image Assessment of Children – Perceptual Measures of Body Image for Adolescents and Adults– Attitudinal Assessment of Body Image efor Adolescents and Adults – PART IV. INDIVIDUAL AND CULTURAL DIFFERENCES: – Gender and Body Images – Obesity and Body Image in Youth – Obesity and Body Image in Adulthood – Body Image and Muscularity – Body Image and Athleticism – Gay and Lesbian Body Images – African American Body Images – Asian American Body Images – Hispanic/Latino Body Images – Body Images in Non-Western Cultures – Body Image and Congenital Conditions Resulting in Visible Difference – PART V. BODY IMAGE DYSFUNCTIONS AND DISORDERS: – Body Image and Social Functioning – Body Image and Sexual Functioning – Body Image and Anorexia Nervosa – Body Image and Bulimia Nervosa – Body Image and Binge-Eating Disorder – Body Image and Body Dysmorphic Disorder – Body Image and Appearance and Performance-Enhancing Drug Use – PART VI. BODY IMAGE ISSUES IN MEDICAL CONTEXTS: – Body Image Issues in Dermatology – Body Image Issues in Oncology – Body Image in Obstetrics and Gynecology – Body Image Issues in Rheumatology – Body Image Issues Associated with Burn Injuries – PART VII. CHANGING THE BODY: MEDICAL, SURGICAL, AND OTHER APPROACHES: – Weight Loss and Changes in Body Image– Exercise and Changes in Body Image – Body Art and Body Image – Cosmetic Surgery and Changes in Body Image – Body Image and Biomedical Interventions for Disfiguring Conditions – PART VIII. CHANGING BODY IMAGES: PSYCHOSOCIAL INTERVENTIONS FOR TREATMENT AND PREVENTION: – Cognitive-Behavioral Approaches to Body Image Change – Experiential Approaches to Body Image Change – School-Based Psychoeducational Approaches to Prevention – Computer-Based Approaches to Prevention – Ecological and Activism Approaches to Prevention – Public Policy Approaches to Prevention – Future Challenges for Body Image Science, Practice, and Prevention Preview in Amazon books and Google books

Golden, Jocelyn. (2012) 50 Strategies to Sustain Recovery From Bulimia. Living as You, Vienna, VA. NOTE: From the publisher: “Jocelyn Golden, who suffered from bulimia for over twenty three years shares the practical strategies she has employed to ensure she sustains her recovery. These simple to use tools have profound, life-changing impact and help those in recovery build positive, fulfilling relationships with themselves and the world around them. Jocelyn’s message of self-empowerment and the detailed action steps needed to achieve it will prove truly transformational to those with a willingness to embrace change.” Previews in Amazon books and Google books.

Gur, A. (2018). Foreign Bodies: Eating Disorders, Childhood Sexual Abuse, and Trauma-Informed Treatment. United Kingdom: Taylor & Francis.

Heiderscheit, Annie, Ed. (2016) Creative arts therapies and clients with eating disorders. Jessica Kingsley, London, England. NOTE: Different chapters focus on art, music, dance, poetry, DBT and art therapy, internal family systems and drama therapy and guided imagery. Residential, inpatient, intensive outpatient, and outpatient setting for adolescents and adults are included. There are case vignettes and illustrations for most of the chapters. Preview in Amazon books and Google books.

Hinz, Lisa D. (2006) Drawing from within: Using art to treat eating disorders. Jessica Kingsley, London, England. NOTE: From the publisher: “Lisa D. Hinz outlines the areas around which the therapist can design effective treatment programmes, covering familyinfluences, body image, self-acceptance, problem solving and spirituality. Each area is discussed in a separate chapter and is accompanied by suggestions for exercises, with advice on materials to use and how to implement them. Case examples show how a therapy programme can be tailored to the individual client and photographs of client artwork illustrate the text throughout.” The exercises are suitable for people suffering from an eating disorder. Preview in Amazon books and Google books

Jacobson-Levy, Mindy and Foy-Tornay, Maureen. (2011). Finding your voice through creativity: The art and journaling workbook for disordered eating. Gurze Books, Carlsbad, CA. TABLE OF CONTENTS: Let’s Be Selfish For A Minute – Opening Your Heart –Emotional Armor – Finding Your Voice – Are You Hungry? – Panning For Gold – Trying On A Different Hat – Barriers To Healing – Problem Solving – Permission To Love Yourself – Creating A New Path NOTE: From the publisher: “Readers are encouraged to draw, write, and create directly in the book. These images, symbols, and journal entries then become a ”personal signature” that can be accessed and explored to resolve any obstacles to emotional well-being. Included are fifty-eight expressive art projects and corresponding written exercises, which lead readers through specific stages of self-discovery related to disordered eating patterns, body image issues, relationships, life skills, emotions, self love, and personal transformation.” Preview in Amazon books and Google books

Koenig, Karen R. (2011) The food and feelings workbook: A full course meal on emotional health. Gurze Books, Carlsbad, CA. TABLE OF CONTENTS: The Function of Feelings – Fear of Feelings – Feelings, Not Food – The Seven Most Difficult Feelings for Disordered Eaters – Guilt – Shame – Helplessness – Anxiety – Disappointment – Confusion – Loneliness – Freeing Your Feelings – Triggers to Intense Feelings and Disordered Eating – Feeling Your Way to Happiness, Health, and a Natural Body Weight NOTE: From the publisher: “Each chapter has two sets of exercises: experiential exercises that relate to emotions and eating, and questionnaires that provoke thinking about and understanding feelings and their purpose. Supplemental pages help readers identify emotions and chart emotional development. The final part of the workbook focuses on strategies for disconnecting feeling from food, discovering emotional triggers, and using one’s feelings to get what one wants out of life.” Preview in Amazon books and Google books

Lacter, E., & Lehman, K. (2008). Guidelines to differential diagnosis between schizophrenia and ritual abuse/mind control traumatic stress. In Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social and Political Considerations, 85-154. Note: A book chapter aimed at therapists, full chapter available online.

Levitt, John L., Sansone, Randy A.. and Cohn, Leigh, Eds. (2004) Self-harm behavior and eating disorders: Dynamics, assessment, and treatment. Brunner-Routledge, NY, NY. TABLE OF CONTENTS: Introduction – Epidemiology – The Prevalence of Self-Harm Behavior Among Those with Eating Disorders – Dying to Live: Eating Disorders and Self-Harm Behavior in a Cultural Context – Psychodynamics – Impulsive and Compulsive Self-Injurious Behavior and Eating Disorders: an Epidemiological Study – Self-Harm and Suicide Attempts in Bulimia Nervosa – Feminist Perspectives on Self-Harm Behavior and Eating Disorders Assessment – Assessment Tools: Eating Disorder Symptoms and Self-Harm Behavior – An Assessment Tool for Self-Injury: the Self-Injury Self-Report Inventory (Sisri) Treatment – An Overview of Psychotherapy Strategies for the Management of Self-Harm Behavior – Therapy-Related Assessment of Self-Harming Behavior in Patients with Eating Disorders: a Case Illustration – 1 Dialectical Behavior Therapy Strategies in the Management of Self-Harm Behavior in Patients with Eating Disorders – :An Integrative Cognitive Therapy Approach to the Treatment of Multi-Impulsive Bulimia Nervosa – Eclectic Treatment of Eating Disorders and Self-Injury: a Case Illustration – Interventions and Strategies for Families and Friends of the Self-Harming Patient with an Eating Disorder – A Self-Regulatory Approach to the Treatment of Eating Disorders and Self-Injury – Group Therapy Approaches to the Treatment of Eating Disorders and Self-Injury NOTE: Self-harm behaviors such as burning, cutting or abrading oneself are common in individuals with eating disorders. This book examines the co-occurrence of self-harm behavior and eating disorders from a variety of perspectives –cross-cultural factors, the complications caused when a patient suffers from other disorders, and the efficacy of various treatment programs. Preview in Amazon books and Google books

Mitchell, James E. and Peterson, Carol B. (2012) Assessment of eating disorders. Guilford Press, NY, NY and London, England. TABLE OF CONTENTS: – 1: Diagnostic Issues – 2: The Classification of Eating Disorders – 3: Conducting the Diagnostic Interview – 4: A Standardized Database – 5: Structured Instruments – 6: Self-Report Measures – 7: Medical Assessment – 8: Nutritional Assessment – 9: Family Assessment – 10: Assessment of Body Image Disturbance – 11: Ecological Momentary Assessment – 12: Treatment Planning Preview in Amazon books and Google books

Nelson, S., & Hampson, S. (2008). Yes You Can!. Working with survivors of childhood sexual abuse. Scottish Government.ISBN 9780755956159. Note: This eBook is available free online. It is aimed at therapists and has a short section about ritual and organised abuse.

Samelson, Doreen A. (2009) Feeding the starving mind: A personalized, comprehensive approach to overcoming anorexia and other starvation eating disorders. New Harbinger Pub., Oakland, CA TABLE OF CONTENTS: Stage I Education: – What is a Starvation Eating Disorder? – The Starving Body – The Starving Brain – How Did I Get This Way? – Fear: Obsessive Thinking and Compulsive Behaviors – Stage II Getting ready: – Making a Commitment to Opposite Action – Who’s on Your Team: Health Care Providers and Nonprofessional Coaches – Treatment Components – Stage III Getting Well: – Eating Disorders and Self Harm: Minimizing Health Risks – Restoring Your Health with Food: the First four Phases – Restoring Your Heath with Food: Phases 5 and 6 – Cognitive Therapy: Changing Your Thinking – Challenging Core Anxiety – Stage IV Staying Healthy and Building a Life Beyond a Starvation Eating Disorder: – Relapse Prevention: Maintaining a Healthy Weight – Building a Life Without a Starvation Eating Disorder. Preview in Amazon books and Google books

Sandoz, Emily K., Wilson, Kelly G. and Dufrene, Troy. (2010) Acceptance and committment therapy for EDs: A process-focused guide to treating anorexia and bulimia. New Harbinger Pub., Oakland, CA. TABLE OF CONTENTS: Introduction: New Perspectives on the Treatment of Disordered Eating – Part 1 Foundations of ACT: – What is ACT? – What Are Eating Disorders? – Where Do Eating Disorders Come From and How Do They Work? – The Goals and Targets of ACT for Eating Disorders – Part 2 Delving into ACT: – Training Present-Moment Focus – Training Cognitive Defusion – Training Experiential Acceptance – Training Transcendent Self-Awareness – Training Valued Living – Training Committed Action – Measuring and Making Change – Part 3 Sample Protocol (What This Work Might Look Like): Phase 1: Choosing Direction – Phase 2: Building Flexibility in the Therapy Session – Phase 3: Bringing Flexibility to Bear in Your Life – Conclusion – What Now? Integration and Reconceptualization: Appendices: A – Body Image – Acceptance and Action Questionnaire – Process Notes – Template For Assessment Plan – Template for Self-Monitoring Food Diary – Blank Hexaflex – Example Narrative Conceptualization Preview in Amazon and Google books

Schwartz, M.F. & Cohn, L. (Eds.) (1996). Sexual abuse and eating disorders. Brunner/Mazel. Note: Republished in 2015. Aimed at therapists or researchers. Preview in google books.

Treasure, Janet, Smith, Gráinne, and Crane, Anna. (2007) Skills-based learning for caring for a loved one with an eating disorder: The new Maudsley method. Routledge, London, England and NY, NY. Note: From the publisher: “Through a coordinated approach, this book offers information alongside detailed techniques and strategies, which aim to improve professionals’ and home carers’ ability to build continuity and consistency of support for their loved ones. The authors use evidence-based research and personal experience, as well as practical support skills, to advise the reader on a number of difficult areas in caring for someone with an eating disorder. These include: working towards positive change through good communications skills, developing problem solving skills, building resilience, managing difficult behaviour.” Preview in Amazon books and Google books

Vanderlinden, Johan and Vandereycken, Walter. (1997) Trauma, dissociation, and impulse dyscontrol in eating disorders. Brunner/Mazel, Philadelphia, PA. TABLE OF CONTENTS: Trauma history and dissociative experiences – The link between trauma and dissociative experiences – Impulse Dyscontrol – Multidimensional assessment – Regaining self-control – Using hypnotherapeutic techniques – The place of the family – Risks, complications, and pitfalls – Appendices – References and readings NOTE: From the publisher: “…presents the latest in theory, assessment, and treatment of traumatic and dissociation experiences coupled with eating disorders. Many examples and practical guidelines are given throughout the book about assessment and treatment. Original research findings, extensive case vignettes, detailed therapeutic guidelines, a full copy of several new questionnaires, and a complete list of references on the subject are also included.”  Preview in Amazon books and Google books

Memoirs and survivor accounts

Bramhall, Carolyn (2005). Am I a Good Girl Yet?: Childhood Abuse Had Shattered Her. Could She Ever Be Whole? Monarch Books; New edition ISBN: 9781854247247 / 1854247247. Note: Carolyn Bramhall describes her recovery from severe childhood abuse including the ritual abuse that caused her to develop polyfragmented DID, anorexia, PTSD and severe depression.

Jamieson, Alice. (2009). Today I’m Alice: Nine Personalities, One Tortured Mind Sidgwick & Jackson Ltd. ISBN. 978-0283071010. Note: An account of healing after ritual abuse and incest which resulted in dissociative identity disorder, anorexic nervous and OCD. Alice’s book focuses on her nine main alter identities and her struggle for recognition and treatment in the British health care system.

References

Coleman, J. (1994). Presenting features in adult victims of Satanist ritual abuse. Child Abuse Review, 3(2), 83-92.

updated 11/2024

  1. Marvasti, J.A.; Dripchack, V.L. American series in behavioral science and law. Psychiatric treatment of victims and survivors of sexual trauma: A neuro-bio-psychological approach. In The Trauma of Incest and Child Sexual Abuse: Psychobiological Perspective; Marvasti, J.A., Ed.; Charles, C. Tomas Publisher: Springfield, IL, USA, 2004; pp. 3–17. [↩]
  2. Schröder, J., Nick, S., Richter-Appelt, H., & Briken, P. (2018). Psychiatric impact of organized and ritual child sexual abuse: Cross-sectional findings from individuals who report being victimized. International Journal of Environmental Research and Public Health, 15(11), 2417. [↩]
  3. Nelson, S., & Hampson, S. (2008). Yes You Can!. Working with survivors of childhood sexual abuse. [↩] [↩] [↩]
  4. Sarson, J., & MacDonald, L. (2009). Behavioural harms: Enforced and survival tactics in ritual abuse-torture victimization. In annual conference of the Substance Abuse Librarians & Information Specialists, Halifax, Nova Scotia, Canada. [↩] [↩]
  5. Lacter, E. (2013). Adult and Adolescent Indicators of Ritual Trauma [↩] [↩]
  6. Vanderlinden, J., & Palmisano, G. L. (2018). Trauma and Eating Disorders. Trauma-informed approaches to eating disorders (pp.68-105) [↩] [↩]
  7. Lacter, E. (2013). Adult and Adolescent Indicators of Ritual Trauma [↩]
  8. Lacter, E., & Lehman, K. (2008). Guidelines to differential diagnosis between schizophrenia and ritual abuse/mind control traumatic stress. In Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social and Political Considerations, 85-154 [↩]
  9. M. F. Schwartz & L. Cohn (Eds.) (1996). Sexual abuse and eating disorders (pp. 113-114). Brunner/Mazel. [↩] [↩]
  10. Gur, A. (2018). Foreign Bodies: Eating Disorders, Childhood Sexual Abuse, and Trauma-Informed Treatment. United Kingdom: Taylor & Francis. [↩] [↩]
  11. M. F. Schwartz & L. Cohn (Eds.) (1996). Sexual abuse and eating disorders (pp. 113-114). Brunner/Mazel. [↩] [↩] [↩] [↩]
  12. Vanderlinden, J., & Palmisano, G. L. (2018). Trauma and Eating Disorders. Trauma-informed approaches to eating disorders (pp.68-105) [↩]