Childhood sexual and physical abuse as risk factors for the development of bulimia nervosa: a community-based case control study.
Welch SL., Fairburn CG.
OBJECTIVE: There were two aims: First, to determine whether sexual or physical abuse in childhood or adolescence increases the risk of developing bulimia nervosa, and second, to see whether any increase in risk is specific to bulimia nervosa rather than being common to psychiatric disorders in general. METHOD: A case control design with individual matching was used. There were two related case control comparisons based on community samples. One hundred and two young adult women with bulimia nervosa were compared with 204 control subjects without an eating disorder, and with 102 control subjects with other psychiatric disorders, all recruited from the same community source. An investigator-based interview was used to assess sexual and physical abuse. RESULTS: Sexual abuse involving physical contact was reported by 35% of the cases of bulimia nervosa. It was more common among this group than among the normal controls. Physical abuse was also reported by a minority of the cases of bulimia nervosa, and was more common among this group than among the normal controls. However, there were no significant differences between the cases of bulimia nervosa and the controls with general psychiatric disorder, except in the category of repeated severe sexual abuse: this was more common among the cases of bulimia nervosa although present only in small numbers within these two groups. CONCLUSIONS: The findings indicate that sexual and physical abuse are both risk factors for the development of bulimia nervosa. However, they are not present in the majority of cases. This indicates that other risk factors must operate in these cases. Sexual and physical abuse do not appear to be risk factors specific to bulimia nervosa; rather, they appear to be risk factors for psychiatric disorder in general in young adult women.