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Rorty M., Yager J., Rossotto M.A.

Childhood Sexual, Physical and Psychological Abuse in Bulima Nervosa

American Journal of Psychiatry 151,8: 1122-1126 (1994)

Abstract

Objective:

This study sought to determine if rates of childhood sexual, physical, psychological, and multiple abuse (i.e. abuse in more than one form) differed between women with a lifetime history of bulima nervosa and women with no history of eating disorders.

Method:

Subjects were 80 women, aged 18-35, with a lifetime history of bulima nervosa (40 women who had recovered for a year or more and 40 women curently suffering from bulima nervosa) and 40 women who had never had an eating disorder or related difficulties. The cohort was obtained primarily by newspaper advertisement. Subjects participated in structured diagnostic interviews and completed paper-and-pencil questionaires related to abusive experiences in childhood.

Results:

Women in the bulima nervosa group reported higher levels of childhood physical, psychological, and multiple abuse. Contrary to expectation, rates of sexual abuse did not distinguish the groups, except in combination with other forms of abuse.

Conclusions:

The higher rates of psychological, physical, and multiple abuse found among women with a lifetime history of bulima nervosa than among comparison subjects underscore the importance of examining the full range of possible abusive experiences in women with eating disorders, rather than focusing simply on sexual abuse.

Some Quotes

[...] Moreover, it is not even clear that women with bulima nervosa report higher rates of sexual abuse than those found in the general population (Pope 1992). However, methodological differences and weaknesses, including varying definitions of sexual abuse, different age cutoffs for victims to be considered children, failure ot adequately screen nonabused comparison groups, and disparate methods of identifying abuse (e.g. self-repot questionaire, interview, therapy disclosure), have made discrepant findings in the existing literature difficult to interpret.

A handful of studies have investigated childhood physical abuse or family violence in addition to sexual abuse in eating disorders. To our knowledge, no study has yet examined other potentially importand forms of abuse in patients with eating disorders, particularly psychological abuse, in spite of its importance as part of the spectrum of childhood abuse. Finally, although studies of female psychiatric inpatients and outpatients have demonstrated that the endurance of multiple forms of abuse in childhood (i.e., both sexual and physical abuse) has more deleterious effects than one form alone, as far as we know no investigation in the child abuse/eating disorder literature has yet examined the possible compounding effects of endurin several forms of child abuse on eating pathology.

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Measures

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Results

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We hypothesized that the bulima nervosa group would have experienced significantly more sexual, physical and psychological abuse than their peers who did not have eating disorder. The proportion of sexually abused subjects in the bulima nervosa group (28.8%, N=23) and comparison group (20.0%, N=8) did not differ significantly (p=0.38, Fisher's exact test). However, a significantly greater proportion of bulima nervosa subjects (17.5%, N=14) met criteria for physical abuse than comparison subjects (2.5%, N=1) (p < 0.02, Fisher's exact test). Moreover, the bulima nervosa group reported significantly more maternal psychological maltreatment (t=3.31, df=118, p<0.002) and paternal psychological maltreatment than comparison subjects (t=4.26, df=108, p<0.0001). When we used this study's definition of psychological abuse, a significantly greater proportion of bulima nervosa subjects (76.3%, N=61) reported psychological abuse by at least one of the parent than did the comparison subjects (37.5%, N=15) (p<0.0001, Fisher's exact test)

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Discussion

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Our study has several strenghts. [...] Finally, our use of strict criteria for child abuse mitigates against the problem encountered in some studies in which abuse is defined so liberally as to be almost meaningless. [...]

Childhood Sexual, Physical, and Psychological Abuse Reported by
Bulima Nervosa Subjects (40 Recovered and 40 Nonrecovered) and a
Comparison group


Form of abuse         Bulima Nervosa (N=80)    Comparison Subjects (N=40)
                        N          %   	       	     N        %
---------------------------------------------------------------------------
None             	15	   18.8	       	    19 	    47.5

Sexual                   3          3.8              6 	    15.0

Sexual and physical	 0	    0.0		     0 	     0.0

Sexual and psychol.	13 	   16.3    	     2 	     5.0

Physical    		 1 	    1.3   	     0 	     0.0

Physical and psych.	 6	    7.5   	     1 	     2.5

Psychological	 	35 	   43.8    	    12      30.0

Sexual, physical 	 7     	    8.8   	     0 	     0.0
and psychological