Eating Disorders and Abuse

Background: Individuals with eating disorders often report histories of childhood sexual abuse, but no direct relationship has been elucidated. Studies have examined sexual, physical and emotional abuse as factors contributing to the pathogenesis of eating disorders. Objective: Clinical studies and vignettes of eating disorder patients with histories of abuse or neglect are discussed, as are personality and family traits, genetics, and neurobiological changes that mediate this relationship. Methods: MedlinePlus, PsycINFO, PsychiatryOnline, and PubMed were searched, using filters for full-text clinical studies in English between 1996-2016. Studies were only included if they were published in peer-reviewed journals, scholarly books, or clinical manuals; used reliable validated scales or structured interviews; and involved subjects who experienced abuse before age eighteen. Methodological issues and efforts aimed to overcome them are discussed. Results: Within an eating disorder population, patients with histories of childhood abuse are more likely to purge, self-harm, and have psychiatric comorbidity. Childhood abuse is more often reported by bulimics than anorexics. Purging anorexics report childhood abuse more often than restricting anorexics. Rates of childhood abuse are comparable in ED populations and general psychiatric populations. Conclusion: Childhood abuse is a non-specific risk factor for eating disorders. Eating disorder patients who report childhood abuse are more likely to purge, self-harm, or have psychiatric comorbidities, thus treatment of these patients must address trauma. Many biopsychosocial factors contribute to outcomes of childhood abuse victims, and further research is needed in order to understand the link between adversity in childhood and subsequent eating pathology.