Sexual harassment – an experience of non-consensual sexual behaviour from another individual – is highly prevalent across the lifespan. Recent figures suggest that approximately 72% of individuals living in the United Kingdom have experienced at least one form of sexual harassment (Adams et al., 2020).
This form of assault is appearance-based; thus, individuals who suffer this often experience an increased preoccupation with their physicality. Preoccupation with one’s appearance can lead to body dissatisfaction and low self-esteem, both of which are well-documented antecedents of eating disorder psychopathology (Tylka et al. 2004).
Considering this, research has been focussed on understanding the relationship between sexual harassment and eating disorder psychopathology. A recent study by Samantha Hayes and colleagues (2021) aimed to combine results from various articles to assess whether sexual harassment plays a role in developing eating disorder symptoms.
Sexual harassment has various negative impacts on one’s mental wellbeing, such as heightened body dissatisfaction, which is a well-known risk factor for eating disorder pathology.
Methods
The following databases were searched: CINAHL, PsycInfo, PubMed/Medline, Scopus, Web of Science and OpenGrey.
Inclusion criteria for studies were:
- Involved human participants
- Written in English
- Included measurements of sexual harassment and eating disorder psychopathology
Exclusion criteria for studies were:
- Only focus on sexual abuse/assault
- Book chapters, reviews, and qualitative papers.
Articles were reviewed qualitatively, and their quality was examined using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP, 2010). Findings were also meta-analytically examined to assess the cross-sectional association between sexual harassment and eating disorder psychopathology.
Results
252 studies were screened for eligibility, and 15 met the inclusion criteria for the systematic review. Of the 15 studies, 12 were included in the meta-analysis.
Most studies were cross-sectional, with one using a longitudinal design. Further, the samples mainly comprised females, with one study having a male sample. The samples were mainly made up of young adults from university (n=8), whereas three studies had adolescent populations and the remaining studies had adults. Most studies were based in the USA (n=12), with the others conducted in Italy (n=1), Norway (n=1) and West Africa (n=1). The study sample sizes ranged from 108 to 639,925.
Out of the 15 studies, 14 found that sexual harassment and eating disorder psychopathology were positively related. It is also important to note that of these 14 studies, many reported high levels of sexual harassment amongst the participants. For example, one study found that 89% of the mixed male and female sample experienced sexual harassment in their early teenage years (Harned, 2000). The meta-analysis revealed a small, but significant effect size between sexual harassment and eating disorder psychopathology (r=0.177).
Eight studies further assessed factors that could explain why there is a relationship between sexual harassment and eating disorder psychopathology. The evidence suggested that psychological distress, self-objectivication and self-surveillance, body shame, self-esteem and emotional eating can partially explain the relationship between sexual harassment and eating disorder psychopathology.
Two papers also investigated factors that may change the strength of the relationship between sexual harassment and eating disorder psychopathology. It was found that posttraumatic stress, anxiety, and gender impacted this relationship. Individuals who reported higher levels of these psychological stressors had the highest levels of eating disorder psychopathology. Further, women who had greater experiences of sexual harassment where more likely to exhibit eating disorder symptoms.
The systematic review and meta-analysis f0und a small, but significant relationship between sexual harrassment and eating disorder psychopathology.
Conclusions
In summary, Samantha Hayes and colleagues (2021) found that sexual harassment is associated with eating disorder psychopathology. Interestingly, this relationship can be explained by various factors, including psychological distress and body shame. Further, individuals identifying with the female gender and those who suffered from posttraumatic stress and anxiety, reported higher levels of eating disorder psychopathology following an experience of sexual harassment.
Those who identify as female and/or have experienced posttraumatic stress and anxiety may be more likely to develop eating disorder psychopathology following an experience of sexual harassment.
Strengths and limitations
This is the first review to examine whether a specific form of sexual abuse – sexual harassment – is associated with eating disorder symptomology. This is important considering the high prevalence rates of sexual harassment and eating disorder psychopathology within the population. All the studies included in the review used valid and reliable measurements of sexual harassment, enhancing the accuracy of the findings obtained. Further, all the studies included in the review used considerable-sized samples, with the smallest number of participants in one given study being 108 and the largest sample size being 639,925. Therefore, enhancing the generalisability of the results obtained.
However, there are some limitations regarding the specific studies included in the review which should be highlighted. Most of the studies had young samples from the USA; therefore, the findings may not generalise to older populations and those from different countries. Also, most studies had female-only samples, meaning these results may not apply to men. Further, not addressing the impact of sexual harassment on men’s mental health could further contribute to the high levels of stigma and shame experienced by male victims of sexual harassment (National Sexual Violence Resource Center, n.d.). Therefore, future research should consider male-only samples whilst investigating this topic.
There are also some more downfalls. Although a strength of the study was the use of valid and reliable measurements, the questionnaires used are somewhat limited since they are self-report and retrospective. Research has demonstrated that following a stressful or traumatic experience, people can experience dissociative amnesia, when the brain blocks out certain information about the event (Mangiulli et al., 2021). Therefore, it is possible that participants did not accurately recall the sexual harassment they experienced. Other limitations of the study include only including studies written in English; it is likely that important information was missed from non-English written articles. Also, all the data was obtained from participants at one-time point, making it difficult to understand the directionality of the relationship between sexual harassment and eating disorder symptomology. The causality of the relationship is further questioned since only one study adjusted for other psychiatric outcomes such as depression.
The main limitations of this review relate to the studies included in the review which suffer from a lack of generalisability, measurements that are not valid or reliable, and assessing participants at only one time-point.
Implications for practice
These findings suggest that victims of sexual harassment experience higher levels of eating disorder psychopathology. Sexual harassment has been described as a “widespread workplace phenomenon” (McDonald et al., 2015, p.41); therefore, policies should be implemented to reduce this. An article details key features that should be emphasised in such policies, such as accurately depicting what wrong-doing is in the organisation and ensuring commitment to gender equality when addressing sexual harassment allegations (McDonald et al., 2015). It is also essential to provide training that educates employees about sexual harassment (McDonald et al., 2015). Strategies could also be implemented in schools. A randomised experimental study demonstrated that students in secondary school who were educated on the laws, definitions and repercussions of sexual harassment reported lower rates of sexual harassment and increased awareness of abusive behaviours (Taylor et al., 2010). Therefore, such procedures should be considered.
Beyond prevention, it is crucial that victims of sexual harassment are provided with effective and accessible mental health care. Particularly evidence-based interventions that can treat eating disorder psychopathology, such as body dissatisfaction and restrictive eating patterns. For example, a recent meta-analysis demonstrated that mindfulness was an effective intervention to reduce eating disorder psychopathology (Sala et al., 2020). Therefore, these types of interventions should be implemented in settings that support victims of sexual harassment.
This evidence suggests that victims of sexual harassment should be provided with adequate mental health care to prevent the onset of eating disorder psychopathology.
Statement of interests
None.
Links
Primary paper
Hayes, S., Linardon, J., Kim, C., & Mitchison, D. (2021). Understanding the relationship between sexual harassment and eating disorder psychopathology: A systematic review and meta‐analysis. International Journal of Eating Disorders, 54(5), 673-689.
Other references
Adams, L., Hilger, L., Moselen, E., Basi, Tanya., Gooding, O., & Hull, J. (2020). 2020 Sexual Harassment Survey. Government Equalities Office.
Ephpp, P. (2010). Quality assessment tool for quantitative studies. Hamilton: The Effective Public Health Practice Project. http://www.ephpp.ca/PDF/Quality%20Assessment
Harned, M. S. (2000). Harassed bodies: An examination of the relationships among women’s experiences of sexual harassment, body image, and eating disturbances. Psychology of Women Quarterly, 24(4), 336-348.
Mangiulli, I., Jelicic, M., Patihis, L., & Otgaar, H. (2021). Believing in dissociative amnesia relates to claiming it: a survey of people’s experiences and beliefs about dissociative amnesia. Memory, 1-13.
McDonald, P., Charlesworth, S., & Graham, T. (2015). Developing a framework of effective prevention and response strategies in workplace sexual harassment. Asia Pacific Journal of Human Resources, 53(1), 41-58.
National Sexual Violence Resource Center (n.d.). Understanding Male Socialisation, Stigma, and Reactions to Sexual Violence. The National Sexual Violence Resource Center. Retrieved December 19 2021, from https://www.nsvrc.org/working-male-survivors-sexual-violence/Understanding
Sala, M., Shankar Ram, S., Vanzhula, I. A., & Levinson, C. A. (2020). Mindfulness and eating disorder psychopathology: A meta‐analysis. International Journal of Eating Disorders, 53(6), 834-851.
Taylor, B., Stein, N., & Burden, F. (2010). The effects of gender violence/harassment prevention programming in middle schools: A randomized experimental evaluation. Violence and victims, 25(2), 202-223.
Tylka, T. L. (2004). The Relation Between Body Dissatisfaction and Eating Disorder Symptomatology: An Analysis of Moderating Variables. Journal of Counselling Psychology, 51(2), 178.
Photo credits
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I’m increasingly drawn to the use of mindfulness exercises, particularly because they go hand in hand with my counselling approach. The emphasis is on increasing awareness, and perhaps in the scope of your article, Andie, when clients learn to trust their “gut feeling”, they learn to differentiate between angst-driven and healthy eating patterns.