Childhood sex abuse can have long lasting unpredictable effects. Now add bulimia to the list of surprises.
A new study headed by Lena Sanci, a senior lecturer in general practice at the University of Melbourne in Australia, suggests that bulimia is just as likely to result from abuse as any other mental illness. Results were published in the March Archives of Pediatrics and Adolescent Medicine.
Sanci and her coworkers randomly selected some 1,000 female students from 44 public, Catholic or private schools to participate in their study, according to Arehart-Treichel. They followed their subjects until they were young adults to see whether they developed bulimia nervosa or anorexia nervosa.
Thirty-five were found to have acquired bulimia and 32 anorexia during that age span, said Arehart-Treichel.
At age 24, the subjects were asked certain questions to determine whether they had experienced sexual abuse before age 16, she said.
"We measured childhood sexual abuse in adulthood because our state has a statutory requirement to report all abuse in children younger than 17 years to government services," Sanci and her coworkers explained in their study report.
Ninety-six of the subjects reported one episode of sexual abuse, and 70 reported two or more episodes, according to Arehart-Treichel. The researchers then looked to see whether there were any links between subjects' retrospective reports of having been abused sexually as a child and their later developing bulimia or anorexia.
During this analysis, subjects' background differences — such as their parents' educational levels and whether their parents were divorced — were considered, said Arehart-Treichel.
Sanci and her colleagues found no link between reports of having been sexually abused in childhood and developing anorexia, but they did find a link with bulimia, said Arehart-Treichel. Compared with subjects who had experienced no childhood sexual abuse, the incidence of bulimia was three times higher among those who reported one episode and five times higher among those who reported two or more episodes.
Thus, "childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting," Sanci and her group concluded in their report.
Their findings largely jive with those obtained by other investigators, they pointed out. In four different studies, investigators were able to link childhood sexual abuse with both bulimia and anorexia, but the links they found were much stronger for bulimia, said Arehart-Treichel.
"I was surprised that we found such a clear association between childhood sexual abuse and bulimia symptoms, as there has been so much controversy in the past [about whether such a connection exists]," Sanci told Psychiatric News. "This paper takes us a step further in confirming suspicions that clinicians have long had that childhood sexual abuse is common in young women with bulimia," George Patton, a professor of psychiatry at the University of Melbourne and senior investigator of the study, added.
"The paper [also] takes us a step further by suggesting that sexual abuse may initiate a pattern of dealing with emotional distress that brings a high likelihood of bulimia. Young bulimics share both emotional secrecy and profound guilt with many victims of sexual abuse. It is possible that for some patients, this emotional style begins with the abusive experience. This psychological style may be an important focus for psychotherapy."