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Am J Psychiatry 1992; 149:455-463
Copyright © 1992 by American Psychiatric Association
Is childhood sexual abuse a risk factor for bulimia nervosa?
HG Pope Jr and JI Hudson
Biological Psychiatry Laboratory, McLean Hospital, Boston, MA.
OBJECTIVE: It is of considerable theoretical and clinical importance to
assess whether childhood sexual abuse is a risk factor for the development
of bulimia nervosa. The authors reviewed the scientific literature bearing
on this issue. METHOD: Since prospective studies on this question have not
been done, they assessed 1) controlled retrospective studies comparing the
prevalence of childhood sexual abuse among bulimic and control groups, 2)
uncontrolled retrospective studies of the prevalence of childhood sexual
abuse in samples of 10 or more bulimic subjects, and 3) studies of the
prevalence of childhood sexual abuse in the general population, which were
chosen to match as closely as possible in methodology the available studies
of bulimia nervosa (i.e., in geographic location, age and ethnicity of
subjects, interview method, and criteria for defining childhood sexual
abuse). RESULTS: Controlled studies generally did not find that bulimic
patients show a significantly higher prevalence of childhood sexual abuse
than control groups, especially when allowance is made for possible
methodologic effects. Furthermore, neither controlled nor uncontrolled
studies of bulimia nervosa found higher rates of childhood sexual abuse
than were found in studies of the general population that used comparable
methods. When it is taken into consideration that several methodologic
factors might have exaggerated the rates of childhood sexual abuse among
subjects with bulimia nervosa relative to rates in the general population,
the absence of actual observed differences becomes particularly striking.
CONCLUSIONS: Current evidence does support the hypothesis that childhood
sexual abuse is a risk factor for bulimia nervosa.
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