Sexual abuse in eating disorder subtypes and control women: The role of comorbid substance dependence in bulimia nervosa

Objective: The relationship between sexual abuse and eating disorders remai ns uncertain. Recent data have raised the possibility of differential rates of sexual abuse among subtypes of eating disorders. Methods: We studied wo men with three subtypes of eating disorders: (1) 26 anorexia nervosa subjec ts (AN); (2) 20 bulimia nervosa subjects with comorbid substance dependence (BN+SDD); and (3) 27 bulimia nervosa subjects without substance dependence (BN-SDD). We compared women with these-eating disorder subtypes to 44 cont rol women (CW). Sexual abuse rates and diagnoses were assessed through dire ct structured interviews. Results: We found an order effect for sexual abus e which was most common (65%) in BN+SDD subjects, followed by a rare of 37% in BN-SDD subjects and 23% in AN subjects. Subjects of all eating disorder subtypes had significantly higher rates of sexual abuse compared to a rate of 7% in CW subjects. Discussion: Women with BN+SDD had the highest freque ncy and the most severe history of sexual abuse. However, the causal relati onship between eating disorders and sexual abuse remains to be elucidated. (C) 1999 by John Wiley & Sons, Inc.