Sexual abuse and bulimia: Response to inpatient treatment and preliminary outcome

The purpose of this study was to explore the clinical impact of child sex abuse on bulimic patients. Specifically, differences in treatment response and preliminary treatment outcome between hospitalized bulimic patients with and without a reported history of sexual abuse were examined. The patients were evaluated for past history of alleged sexual abuse by investigator-based interview and ratings of severity of sexual abuse were made. Assessments of mood, eating disordered-related attitudes, and eating behaviors were conducted at the start of treatment, weekly during treatment, and three months post discharge. Sixty-one per cent (45) of the 74 patients enrolled in the study reported a history of child sexual abuse. The majority of such events constituted serious and very serious abuse by this study's criteria. The abused subjects exhibited higher levels of depression, anxiety, and eating disordered attitudes at each assessment point relative to nonabused subjects. In addition, abused subjects were more likely to be re-hospitalized in the 3 month post-discharge period. Significant differences in the extent of actual bulimic behaviors were not detected. Both the abused and nonabused bulimic patients demonstrated significant reductions in psychiatric symptomatology from pretreatment to posttreatment, and from posttreatment to follow-up. Contrary to prediction, differences in symptomatology between the very serious, serious, and least serious abused groups were not detected. Results suggest that bulimic patients with reported histories of sexual abuse can be effectively engaged in a conventional eating disorder treatment program, but that such abuse may place patients at a disadvantage owing to higher levels of pretreatment symptom severity. Findings suggest that extended and/or more specific intervention may be warranted for the abused bulimic patient.     

Relationship of childhood sexual abuse and eating disturbance in children

OBJECTIVE: To test the hypothesis that childhood sexual abuse increases the risk of eating disturbance in children. METHOD: Data obtained from 20 sexually abused children were compared with data obtained from 20 nonabused control children. All subjects were female and between the ages of 10 and 15 years. Subjects completed a battery of tests assessing eating disorder behaviors, body image concern, and childhood trauma history. RESULTS: Comparison of the 2 groups revealed that the abused children had higher levels of weight dissatisfaction and purging and dieting behavior. Furthermore, abused children reported eating less than control children when they felt emotionally upset. Abused children were less likely than control children to exhibit perfectionistic tendencies, but more likely to desire thinner body types. CONCLUSIONS: This is the first controlled study to examine the relationship between childhood sexual abuse and eating disturbance which relied on children as subjects. The results support previous findings with adult subjects which indicate that a history of childhood sexual abuse is associated with weight and body dissatisfaction, along with purging and dietary restriction.     

Depressive characteristics of sexually abused children

Allen and Tarnowski (1988) identified a pattern of depressive characteristics that distinguished physically abused from nonabused children. The present study attempted to extend the generality of these findings to sexually abused children Sexually abused and nonabused children were compared on measures of depression, hopelessness, and self-esteem. Results indicated that while sexually abused children self-reported more depressive symptoms in comparison to nonabused controls, that these differences were not statistically significant and failed to replicate the findings noted for physically abused children.     

Psychopathological characteristics of recovered bulimics who have a history of physical or sexual abuse.

We sought to clarify the influence of a history of sexual or physical abuse on a variety of psychopathologies in subjects with bulimia nervosa (BN). To avoid confounding effects, the presence of a history of sexual or physical abuse, lifetime axis I disorders, and personality disorders were assessed through direct structured interviews in 44 subjects recovered from BN for at least 1 year. Twenty abused subjects (45%) were significantly more likely than 24 subjects without abuse to have severe general psychopathology and eating disturbance. Compared with nonabused subjects, abused subjects showed a trend toward more frequent lifetime diagnoses of posttraumatic stress disorder and substance dependence. These results suggest that abusive experiences may be associated with some psychopathology of BN, particularly related to anxiety, substance abuse, and more severe core eating disorder pathology.     

Gender identification and sex role attribution in sexually abused adolescent females

An exploratory study of the association between child sexual abuse and subsequent gender identification and sex role attribution was conducted with 93 adolescent females. Victims of intrafamilial sexual abuse with a history of psychotherapeutic treatment were compared with nonabused subjects with a history of treatment and nonabused control subjects with no treatment history. Measures of gender identity found that sexually abused and nonabused treatment groups differed significantly from the no-treatment controls. Distinct patterns of gender identification emerged for the sexually abused victims. Hypothesized differences in sex role attribution were not found. Potential directions for future research are proposed and implications and recommendations for treatment are discussed.     

Specificity and sensitivity of sexually anatomically correct dolls in substantiating abuse: a pilot study

Sexually anatomically correct dolls are often used to verify or refute allegations of sexual abuse in young children. As a test of their effectiveness in facilitating decisions about the abuse status of young children, the authors conducted blind interviews with six abused subjects, five nonclinic controls and four psychiatric controls. The child psychiatrist interviewer followed a standardized protocol and was able to correctly categorize 33% of the abused and 67% of the nonabused children. Proper classification was 53% for the sample using this protocol. The authors' preliminary conclusion is that, without other information available to the interviewer, sexually anatomically correct dolls are a poor source of information to decide the abuse status of a young child. The authors recommend that professionals should be cautious when basing decisions on a single instrument, such as sexually anatomically correct dolls. Mental health professionals are encouraged to maintain quality standards in evaluation of children by conducting a comprehensive examination in child sexual abuse cases.     

The significance of emotions in the affective presentation of sexually abused girls

This study examined emotions and internalizing symptoms in sexually abused females. Children seen for outpatient evaluation for sexual abuse were compared to a normative sample on measures of emotional expression, anxiety and depression. The outpatient sample reported higher levels of emotions, lower levels of depression and statistically lower levels of anxiety as compared to non-abused peers. The outpatients also were compared to two inpatient samples: inpatient with no history of abuse, and inpatient with a history of abuse. Results are discussed in terms of the need to find different ways to assess emotional adjustment of sexually abused children.     

Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse

OBJECTIVE: To extend the knowledge on long-term effects of childhood abuse in psychiatric patients to a large sample, the authors explored childhood sexual and physical abuse in adult inpatients over 1,040 consecutive admissions. METHOD: The 947 patients were admitted to a tertiary-care military medical center. Each patient was interviewed, and abuse history, DSM-III-R diagnosis, and other characteristics were recorded. RESULTS: The prevalence of reported childhood abuse was 18% overall: 9% for sexual abuse (with or without physical abuse), 10% for physical abuse (with or without sexual abuse), and 3% for combined abuse. More female than male patients reported abuse. Alcohol use disorders were more common in victims of physical or combined abuse than in sexually abused or nonabused patients. Axis II diagnoses, particularly borderline personality disorder, were more frequent in abuse victims than in nonabused patients. Histories of drug and alcohol abuse were more common in patients reporting physical or combined abuse than in nonabused patients. Suicidality was also more frequent in abused than nonabused inpatients and was noted in 79% of the patients with histories of combined abuse. Combined abuse in women and physical abuse in men were associated with a family history of psychiatric illness, most commonly alcoholism in male relatives. CONCLUSIONS: These findings emphasize the need for greater attention to family dynamics, aggressive diagnosis and treatment of alcoholism within the family, and, especially, determination of patients' abuse histories, even if repeated questioning is necessary.     

Aspects of mental health among older lesbian, gay, and bisexual adults

This study examined aspects of mental health among 416 lesbian, gay, and bisexual adults aged 60 to 91 years old, attending social and recreational programs. Mental health indicators were perceived mental health status; self-esteem; internalized homophobia; loneliness; alcohol and drug abuse; and suicidality. Better mental health was correlated with higher self-esteem, less loneliness, and lower internalized homophobia. Compared to women, men reported significantly more internalized homophobia, alcohol abuse, and suicidality related to their sexual orientation. Less lifetime suicidal ideation was associated with lower internalized homophobia, less loneliness, and more people knowing about participants' sexual orientation.     

Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa.

BACKGROUND: Bulimia nervosa (BN) is reported to co-occur with childhood abuse and alterations in central serotonin (5-hydroxytryptamine [5-HT]) and cortisol mechanisms. However, findings also link childhood abuse to anomalous 5-HT and cortisol function, and this motivated us to explore relationships between childhood abuse and neurobiological variations in BN. METHODS: Thirty-five bulimic and 25 nonbulimic women were assessed for childhood physical and sexual abuse, eating symptoms, and comorbid psychopathological tendencies. These women provided blood samples for measurement of platelet hydrogen-3-paroxetine binding and serial prolactin and cortisol responses following oral administration of the partial 5-HT agonist meta-chlorophenylpiperazine (m-CPP). RESULTS: Bulimic women showed markedly lower mean +/- SD density (B(max)) of paroxetine-binding sites (631.12 +/- 341.58) than did normal eaters (1213.00 +/- 628.74) (t(54) = -4.47; P =.001). Paroxetine binding did not vary with childhood abuse. In contrast, measures of peak change on prolactin levels after m-CPP administration (Delta-peak prolactin) indicated blunted response in abused bulimic women (7.26 +/- 7.06), nonabused bulimic women (5.62 +/- 3.95), and abused women who were normal eaters (5.73 +/- 5.19) compared with nonabused women who were normal eaters (13.57 +/- 9.94) (F(3,51) = 3.04, P =.04). Furthermore, individuals reporting childhood abuse showed decreased plasma cortisol levels relative to nonabused women who were normal eaters. CONCLUSION: Findings imply that BN and childhood abuse are both generally associated with reduced 5-HT tone but that childhood abuse may be somewhat more specifically linked to reduced cortisol levels (ie, hypothalamic-pituitary-adrenal axis) activity.