Unraveling Some of the ‘Whys’ of BED

Emotional and sexual abuse in childhood may trigger a vicious cycle.

Despite many research advances and the fact that binge eating disorder (BED) has finally been recognized as an important public health problem, little is known about the risk factors that can lead to this disorder. Clinicians at McGill University, Montreal, and Yale University School of Medicine, New Haven, CT, have isolated a possible risk factor: self-criticism following mistreatment during childhood (Int J Eat Disord 2010; 43:274).

David M. Dunkley, PhD, Robin M. Masheb, PhD, and Carlos M. Grilo, PhD note that one possible route to self-criticism is that people who experience excessive criticism, repeated insults, and/or some type of physical/sexual abuse during childhood may develop a similarly critical view of themselves over time. This might result in a self-critical cognitive personality style that involves constant and harsh self-scrutiny and concerns about others’ criticisms. In the case of eating disorders, this can produce heightened concern about and increased dissatisfaction with one’s appearance.

The authors sought to examine the relations between various kinds of childhood mistreatment, including emotional, physical, and sexual abuse, and emotional and physical neglect. They hypothesized that maltreatment in childhood would first lead to self-criticism, then to depressive symptoms and body dissatisfaction, and then to depressive symptoms, culminating in body dissatisfaction. The authors selected a consecutive series of 170 overweight adults (body mass index, or BMI, greater than 25 kg/m2) who were seeking treatment for obesity and who met DSM-IV criteria for BED. The group was predominately female (78%) and had a mean age of 43 years. Eighty-five percent had either attended or completed college. The group’s mean BMI was 36.6 kg/m².

The study participants filled out a series of questionnaires, including the Childhood Trauma Questionnaire, a 28-item self-report instrument that assesses emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect during childhood. The participants also completed the Depressive Experiences Questionnaire, a 66-item instrument used to assess self-criticism, and the Rosenberg Self-Esteem Scale, the Beck Depression Inventory, and the Body Shape Questionnaire.

Two types of abuse had the greatest impact

Emotional abuse and sexual abuse were significantly associated with body dissatisfaction; in contrast, childhood physical abuse, physical neglect, and emotional neglect were not significantly associated with body dissatisfaction. (This does not mean there are no negative effects in these two areas, however.) Self-criticism, self-esteem, and body dissatisfaction were each significantly associated with emotional abuse and body dissatisfaction.

The authors suggest that within the considerations of the strengths of the study (large sample size) and limitations of the study (self-report format), their results may provide a preliminary step toward better understanding the relationships among a history of childhood maltreatment and depressive symptoms and body dissatisfaction in BED patients. Knowledge of proximal factors (such as self-criticism) and distal events (mistreatment in childhood) may help explain the processes by which body dissatisfaction develops in BED patients.