Bulimia Nervosa and Child Abuse

The connection between sexual abuse during childhood and subsequent development of bulimia nervosa (BN) has been widely studied. However, other types of abuse during childhood—emotional, psychological, or physical, for example—also frequently play a role in the complex picture of bulimia nervosa. For example, with the self-medication hypothesis, binge eating may be an effort to regulate anxiety and depression that stem from the abuse. Alcohol or drug use may also have a self-medicating effect.

A team of researchers from the Netherlands found that a history of psychological or multiple types of abuse was a specific risk factor for dual-diagnosis disorder (cases with psychiatric and substance abuse disorders) and for BN (Int J Eat Disord 2002; 32:381).

The study group included 1987 women ranging in age from 18 to 45 years. Of these, 11 (29%) were regarded as “pure” BN cases. Seventy-one percent of this group had an anxiety or a mood disorder, or both.

The other groups included: (1) a psychiatric control group of 476 women with a history of at least one DSM-III-R disorder but no substance use disorder and no eating disorder; (2) a substance use disorder control group of 62 women who met at least one criterion for substance use disorder, and (3) a dual-diagnosis control group consisting of 61 women who had at least one mental disorder and who also met the criteria for at least one substance use disorder.

High levels of abuse among BN patients

Reports of exposure to psychological and multiple abuse were about twice as high in the BN group as in the psychiatric control group (women who had a history of at least one DSM-III-R disorder but no substance abuse and no eating disorder), and similar to that in the dual-diagnosis group. Moreover, 94% of the BN cases who experienced psychological or multiple abuse developed BN with comorbid psychiatric Axis I disorders.

According to the authors, future research should concentrate on the sequence of the onset of depression, anxiety disorder, eating disorders and substance use disorder. According to the self-medication hypothesis, the expected sequence of the disorders is abuse, followed by anxiety or mood disorders, and then by BN or substance use disorders, in an attempt to cope with the abuse.