CHILDHOOD ABUSE, FAMILY ENVIRONMENT, AND OUTCOME IN BULIMIA-NERVOSA

Background: About one third of patients with bulimia nervosa continue to do poorly despite intensive treatment. In an effort to identify his torical factors that might differentiate patients who are persistently bulimic from patients who have fully recovered, we examined the relat ionship between long-term outcome and three factors: childhood trauma, family environment, and parental psychopathology. Method: Fifty-two w omen previously hospitalized for bulimia nervosa were interviewed 2 to 9 years later. In addition to structured diagnostic interviews, measu res included the Family Environment Scale, the Family History intervie w, and a semistructured interview of childhood abuse. Outcome comparis ons were made between the fully recovered and the women who still met DSM-III-R criteria for bulimia nervosa. Results: Reports of childhood physical abuse and of a family environment characterized by low cohesi on and high control were significantly associated with poor outcome. C haracteristics of the family environment seemed to have greater influe nce on outcome than physical abuse alone. Sexual abuse in general was not associated with outcome. Outcome was not associated with comorbidi ty of Axis I or Axis II disorders or parental psychopathology. Conclus ion: Aspects of the family environment of childhood may contribute to the course of bulimia nervosa. Definitive conclusions require a prospe ctive study.