The
role of sexual abuse as a risk
factor for the development
of eating disorders has been a
source of considerable controversy,
largely because of
inconsistent findings
(1). Conflicting results
have been attributed to
methodological limitations and
differences across
studies. Reviewing early studies on
the relationship between
sexual abuse and bulimia nervosa,
Pope and Hudson
(2) identified five
methodological shortcomings: 1)
inadequate comparison
groups, 2) problematic sexual abuse
definitions, 3) inadequate
sexual abuse assessment, 4)
inattention to the timing of abuse
in relation to onset of
bulimia nervosa, and 5) no
psychiatric comparison
groups, thus making an examination
of specificity (i.e.,
whether the association is unique to
bulimia nervosa)
impossible. Also, Welch and Fairburn
(3) noted an overreliance
on patient samples, which
likely resulted in an oversampling
of individuals with a history
of abuse
(4).
A
comprehensive review of studies that
addressed these methodological
concerns
(5) concluded that childhood
sexual abuse is a nonspecific
risk factor for bulimia
nervosa (i.e., abuse also increases
risk for other mental
disorders) and that the relationship
of childhood sexual abuse
to bulimia nervosa appears to be
stronger than its
association with anorexia nervosa.
The authors hypothesized
that binge eating may be an
important strategy for coping with
the aversive states that
result from childhood abuse. This
report uses data
collected during a community-based
study of risk factors for
binge eating disorder in women to
advance understanding of
the relationship between childhood
sexual abuse and eating
disorders in three ways: by studying
binge eating disorder, by
including a sample of black women
with binge eating disorder,
and by integrating the study
of sexual abuse with physical abuse
and other abusive events.
Epidemiological studies suggest that
binge eating disorder is
more common than bulimia nervosa
(6,
7) and represents a clinically
significant syndrome
(8,
9). To our knowledge, no study
has examined the
relationship between childhood
sexual abuse and binge
eating disorder as defined in DSM-IV
with use of the methods
recommended by Pope and Hudson
(2). The present study
replicates and extends
the Oxford case-control studies of
risk factors for the
development of eating disorders
(3,
10,
11).
Although epidemiological studies
have found no differences in
the prevalence of binge eating
disorder across different ethnic
groups
(12,
13), most nonepidemiological
studies of eating disorders
have included only white
participants. Ethnic minority
populations are less
likely than white populations to use
mental health services
and, consequently, are
underrepresented in studies
that rely on patient samples
(9,
14,
15). Studies of mental
health among ethnic minority
groups are needed that focus on
variation by ethnicity in the
expression of disorders and on
risk factors associated with
these disorders
(16). This report
extends the investigation of binge
eating disorder by including
an ethnic minority group that
appears to be as vulnerable to
developing binge eating
disorder as the white population
(17).
Experts have urged researchers to
comprehensively assess abusive
experience in the study of
risk factors for mental disorders
(18). Research on the adverse
mental health effects of childhood
physical abuse has underscored
its public health importance
(18,
19). Physical bullying by peers
is another form of abuse
that is gaining attention, given
data documenting its relationship
to adverse mental health
outcomes
(20), including binge eating
(21). Finally, studies of health
and psychological problems
among black Americans have
identified discrimination based on
ethnicity as an important
ethnicity-specific risk factor
(22,
23). The present study examined
the contribution of four types
of abusive experiences to risk
for the development of binge
eating disorder: childhood
sexual abuse, physical abuse,
bullying by peers, and
discrimination.
A
critical methodological
consideration in the study of risk
factors for mental disorders
involves documenting the time
sequence of the potential
risk event and symptom onset.
Distinguishing between
risk factors versus correlates of
psychiatric disorder
requires that the risk variable
occur before the onset of
psychiatric symptoms
(24,
25). Thus, the present study
focused the assessment of
abusive experiences on the time
before onset of the eating
disorder.
The
present study examined in a
community-based sample of black
women and white women whether
abusive experiences in childhood
increase the risk of
developing binge eating disorder and
whether the increase in
risk is specific to binge eating
disorder or reflects a
greater general risk for psychiatric
disorder. Data about
childhood sexual and physical abuse,
bullying by peers, and
discrimination were collected as
part of a case-control
study, the New England Women’s
Health Project, designed
to investigate risk factors for
binge eating disorder in
non-Hispanic black
American and white American women.
As
previously described in detail
(8,
17), the New England Women’s
Health Project recruited women
aged 18 to 40 years from the
general community in distinct
geographic areas in Connecticut,
New York City, and the greater
Boston area. All women were told
that the purpose of the study
was to understand factors that
might influence the
development of an eating disorder;
childhood abuse was not
specifically referenced. A detailed
examination of ethnic
differences in the clinical
presentation of binge
eating disorder has been the subject
of a previous report
(9). Given
significant differences in ethnic
groups in the clinical
presentation of binge eating
disorder and in exposure to certain
types of victimization (e.g.,
discrimination), the relationship
between childhood abuse and
the risk for binge eating disorder
was examined separately for
black and white women.
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