Trauma’s Effect on Body Image

Sexual trauma can lead to a more negative
body image, especially among women.

A person’s body image reflects many factors in each individual’s unique history of development. It is assumed that development of a coherent body image can be severely impaired by violations of body self-boundaries, leading to symptoms of body dissatisfaction and reduced body vitality. Sexual trauma is particularly serious because it affects extremely personal aspects of life and often occurs within the structure of the family. Results of a recent study showed that victims of sexual trauma have a more complex symptom pattern, including a more negative perception of their body, compared with persons who have undergone non-sexual trauma or no trauma.

Does body image differ by type of abuse?

Martin Sack, MD and co-workers in Munich, Germany, recently reported the results of their study examining the effects of sexual and nonsexual trauma upon a group of outpatients at the Hanover Medical School in Munich. The goal of the study was to see if there were differences in body image disorders depending on the type of abuse. Several questionnaires were mailed to all participants, to be completed prior to the first appointment. Diagnoses were confirmed by clinical interviews according to ICD-10 criteria, and all interviews were performed by board-certified specialists in psychosomatic medicine or by psychiatrists.

Patients completed the Posttraumatic Diagnostic Scale, a self-report of symptoms related to posttraumatic stress disorder. The Body Image Questionnaire was developed for the participants’ cognitive and affective self-assessment of their bodies. This questionnaire is commonly used to evaluate body image in German-speaking countries and consists of 20 items, assessed on a four-point Likert scale regarding body perception and one’s attitudes toward his or her body. The Somatoform Disorders Screening Instrument-7 Days asks about the presence of all physical complaints on the DSM-IV somatization disorder symptom list, symptoms of the ICD-10 somatization disorder, and the ICD-10 somatoform autonomic dysfunction symptom list during the prior 7 days. Patients rate the severity on a scale of 0 (not present) to 4 (very severe). The Brief Symptom Inventory is a short form of the Symptom checklist SCL-90-R, a self-rating instrument for detection of subjective impairment due to somatic and psychological complaints. The Dissociative Experience Scale used in this study was a German adaptation and extension of the Dissociative Experience Scale, which was developed for screening for dissociative symptoms. This form contains 16 additional questions.

Results: Women had more severe symptoms

Among the 167 females and 73 males who participated in the study, the average age was 37 years, and the males were significantly older, with an average age of 42 years. Approximately 147 (63%) of the subjects were living in a partnership. One hundred (42%) were employed full time, 44 (18%) were employed part time, 42 (17%) were unemployed and 54 (23%) were pensioners or homemakers.

Twenty percent of the patients had PTSD. Further diagnoses included depressive disorders in 41, somatoform disorders in 36 and eating disorders in 33 (14%). Sexual trauma was reported significantly more often by women than by men (63 women vs. 7 men, or 26.3% vs. 9.6%, respectively).Among the female participants, the researchers also found a significant association of trauma history with body image disorders, which was not the case among the men. Sexually traumatized women also showed significantly more complaints in the Brief Symptom index Global Severity Scale, compared with nontraumatized or nonsexually traumatized women, whereas no group differences were found among the men.

The authors concluded that victims of sexual trauma suffer from a more complex pattern of symptoms than do those with nonsexual trauma. Those who have undergone sexual trauma have a more negative perception of their own body. To deal with those who have experienced sexual trauma, the authors suggest that trauma-oriented psychotherapy that aims not only to relieve trauma-related post-traumatic stress disorder (PTSD) symptoms but also to aid psychosomatic reintegration can be helpful. For example, women who are victims of sexual abuse often seek body-oriented forms of psychotherapy in their quest for sexual abuse recovery, to increase their acceptance of their body and to foster the integration of self and bodily experience.