Childhood Sexual Abuse Review

Publications in top-tier peer-reviewed journals are difficult to produce. If it is original data, it should be done with high levels of statistical rigor and make a novel contribution. If it is a review article, it should offer something that has not been previously offered. This review article by David Wiss, Timothy Brewerton, and Janet Tomiyama offers a new perspective on the link between childhood sexual abuse and obesity! It has recently been published in the prestigious Eating and Weight Disorders journal.

This review employs a biopsychosocial perspective to better understand pathways from childhood sexual abuse to eating disorders, food and drug addictions, and obesity across the life course. Guided by an updated conceptual model, this review delineates how the biological embedding of childhood sexual abuse triggers a cascade of interrelated conditions that often result in failed attempts at weight suppression and eventually obesity.

This model calls into question the longstanding “protective measure” theory that purports individuals exposed to sexual abuse will deliberately or subconsciously gain weight in attempt to prevent future victimization. A more comprehensive understanding of the mechanisms by which childhood sexual abuse becomes biologically embedded may help clinicians and survivors normalize and/or address disordered eating and weight-related outcomes, as well as identify intervention strategies.

Abstract 

In addition to its immediate negative consequences, childhood sexual abuse is associated with lifelong deleterious mental and physical health outcomes. This review employs a biopsychosocial perspective to better understand pathways from childhood sexual abuse to eating disorders, food and drug addictions, and obesity across the life course. Guided by an updated conceptual model, this review delineates how the biological embedding of childhood sexual abuse triggers a cascade of interrelated conditions that often result in failed attempts at weight suppression and eventually obesity. Such biological embedding involves pathways such as inflammation, allostatic load, reward sensitivity, activation of the hypothalamic-pituitary-adrenal axis, epigenetics, and structural and functional changes in the brain. These pathways are in turn theorized to lead to food addiction, substance use disorder, and eating disorders—each with potential pathways toward obesity over time. Predisposing factors to childhood sexual abuse including gender, culture, and age are discussed. This model calls into question the longstanding “protective measure” theory that purports individuals exposed to sexual abuse will deliberately or subconsciously gain weight in attempt to prevent future victimization. A more comprehensive understanding of the mechanisms by which childhood sexual abuse becomes biologically embedded may help clinicians and survivors normalize and/or address disordered eating and weight-related outcomes, as well as identify intervention strategies.

 

David became a Registered Dietitian Nutritionist (RDN) in 2013 and founded Nutrition in Recovery, a group practice of RDNs specializing in the treatment of eating and substance use disorders. In 2017, David received the “Excellence in Practice” award at the national Food and Nutrition Conference and Expo. The California Academy of Nutrition and Dietetics awarded him the “Emerging Dietetic Leader Award” in 2020. He earned his PhD from UCLA’s Fielding School of Public Health in the Community Health Sciences department (with a minor in Health Psychology) by investigating the links between adverse childhood experiences and various mental health outcomes among socially disadvantaged men. His treatment philosophy is based on a biopsychosocial model which incorporates an understanding of biological mechanisms, psychological underpinnings, and contextual factors that integrate the social determinants of health. His website Wise Mind Nutrition offers a fully online interactive treatment program that will be available in the Summer of 2022.

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