Since it was reported that a high proportion of patients in a treatment programme for anorexia nervosa gave histories of sexual abuse in childhood, it has been supposed that this trauma would be a contributory causal factor.(43) It would be better if this history could be corroborated, but for obvious reasons it is often difficult to do so. Investigators often stress that their patients' accounts are convincing and that they should be believed. Hence this subject raises unusual difficulties in judging the reliability of the data. Child sexual abuse is also discussed in the chapter on bulimia nervosa ( Ch§ipteL4J.0 2.).
In a careful study of childhood sexual experiences reported by women with anorexia nervosa, the authors classified the events according to the seriousness of the sexual act in childhood and concentrated on sexual experiences with someone at least 5 years older. (44) They found surprisingly high rates (about one-third) of adverse sexual experiences in women with eating disorders, and, unlike other investigators, they did not find that the frequency of these reports was less in anorexia nervosa than bulimia nervosa. They concluded that it was plausible that childhood sexual contact with an adult may in some cases contribute to a later eating disorder.
The complexity of this subject has been increased by a study on the relationship between sexual abuse, disordered personality, and eating disorders. (45) The authors found that 30 per cent of patients referred to an eating disorders clinic (a majority with anorexia nervosa) gave a history of childhood sexual abuse. In addition, they found that 52 per cent of their patients had a personality disorder. A significantly higher proportion of women with a personality disorder had a history of childhood sexual abuse, compared with those without a personality disorder. Surprisingly they still concluded that in patients with eating disorders it was not possible to show a clear causal link between child sexual abuse and personality disorder.
In a review of the subject a number of hypotheses were examined on the relationship between childhood sexual abuse and eating disorders. (46) One hypothesis is that child sexual abuse is more common in bulimia nervosa than in anorexia nervosa. The authors had to concede that the findings remain inconclusive. They also examined the question of whether child sexual abuse is a specific risk factor for eating disorders. They concluded that this was not the case, as the rates of child sexual abuse in eating disorder patients were similar to or less than those in various other psychiatric comparison groups. Finally, they found strong evidence that patients with eating disorders reporting child sexual abuse were more likely to show general psychiatric symptoms including depression, alcohol problems, or suicidal gestures, in addition to the association with personality disorders already mentioned.
Was this article helpful?