CHILDHOOD SEXUAL, PHYSICAL, AND PSYCHOLOGICAL ABUSE AND THEIR RELATIONSHIP TO COMORBID PSYCHOPATHOLOGY IN BULIMIA-NERVOSA

We examined the relationship between childhood sexual, physical, psych ological, and ''multiple'' abuse (i.e., abuse in more than one form) a nd comorbid Axis I and personality psychopathology among women with a lifetime history of bulimia nervosa (BN group; n = 80) and a control g roup of noneating-disordered women (n = 40). Subjects were recruited p rimarily by newspaper advertisement. They participated in structured c linical interviews for diagnosis of Axis I and personality pathology, and they completed child abuse questionnaires in the interview setting . At odds with prediction, child abuse in various forms was not associ ated with the presence of lifetime comorbid Axis I disorders in genera l (i.e., 1 or more) or disorder classes in particular (mood, alcohol/s ubstance use, anxiety) among BN subjects, although sexual, psychologic al, and multiple abuse were associated with the diagnosis of a higher total number of Axis I conditions. A history of psychological and mult iple abuse (but not physical or sexual abuse alone) among BN subjects was strongly associated with the presence of personality disorder diag noses, especially those in the ''anxious-fearful'' cluster (Cluster C) . Finally, we found that when a personality disorder was present in ad dition to the Axis I conditions in question, significant relationships emerged between abuse and Axis I pathology, particularly for psycholo gical and multiple abuse. In general, control group findings were in a ccord with BN group findings, indicating that our findings were not sp ecific to eating-disordered women. Our results suggest that childhood abuse, particularly psychological abuse and abuse in multiple forms, i ncrease the likelihood of lifetime comorbid Axis I disorders and perso nality pathology among bulimic patients. Eating-disordered women with a history of child abuse may thus represent a subgroup of patients req uiring especially intensive intervention. (C) 1994 by John Wiley & Son s, Inc.