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Bulimia Not Anorexia

Again and again, it has been both suggested and established by recent studies that victims of Childhood Sexual Abuse have an overall pattern of symptoms associated with eating disorders. Patients with histories of Childhood Sexual Abuse had scores greater than or equal to mean scores for eating-disordered groups (obtained from Garner et al., 1985) on the EDI subscales on Ineffectiveness, Interpersonal Distrust, Interoceptive Awareness, and Body Dissatisfaction. Furthermore, subjects who had histories of Childhood Sexual Abuse without having a diagnosis of an eating disorder still reported core features of both anorexia nervosa and bulimia nervosa. The authors contend that their results support an association between eating pathology and sexual abuse, with patients with histories of Childhood Sexual Abuse being more likely to present with a greater degree of eating pathology than non-abused patients.

The hypothesis of one study was that patients with histories of sexual abuse would show increased severity of pathological eating behaviors compared to a control group that did not report such history.   They were especially interested in bulimics as other studies had already proven that, interestingly enough, childhood sexual abuse more frequently led to bulimia rather than anorexia nervosa when an eating disorder arose in a female, especially in a developing adolescent or young adult.  They found that, the more brutal and frequent the childhood sexual abuse, the more severe was the later pathology of the eating behavior.

Elevated sexual abuse rates among bulimic women may explain why bulimics tend to report negative feelings regarding their bodies. Bulimics who reported sexual abuse dissociate significantly more than non-abused bulimic women; thus, it might be possible that binge-purge cycles serve to provide a form of psychological dissociation and/or emotional numbness for the victim.

Not all bulimics reported histories of sexual abuse and some non-bulimics reported sexual abuse; thus, it must be that there are other many operating factors and forces outside the experience of sexual abuse that ultimately lead to the development of an eating disorder. We cannot then surmise that only Childhood Sexual Abuse creates or brings on Bulimia.  There are other factors at work.  We cannot however, rule out the relationship.  It certainly appears that bulimia may be more likely to develop in women who have experienced a combined pattern of sexual abuse and food-related stress and control.
In examining the relationship between sexual abuse and the development of eating disorders, the data seems to suggest that there is a potential relationship between sexual abuse and bulimia nervosa. The data that has been presented here and in many, many recent studies does not seem to indicate that sexual abuse has any relationship to anorexia nervosa.  Furthermore, despite the fact that an association between sexual abuse and bulimia exists in some form, we cannot draw a causal connection, which has yet to be determined.  It appears that any traumatic event has the potential to lead to the development of bulimia given that the abuse occurs in an environment which can perpetuate this development. There are individuals with histories of childhood sexual abuse that never develop bulimia while, there are bulimics who have no history of sexual abuse. Clearly, we need to look further to be 100% certain. There is more to this relationship than just the two factors of abuse and bulimia.

Rika B.

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