OBJECTIVE: It is of considerable theoretical and clinical
importance to assess whether childhood sexual abuse is a risk factor
for the development of bulimia nervosa. The authors reviewed the
scientific literature bearing on this issue. METHOD: Since prospective
studies on this question have not been done, they assessed 1)
controlled retrospective studies comparing the prevalence of childhood
sexual abuse among bulimic and control groups, 2) uncontrolled
retrospective studies of the prevalence of childhood sexual abuse in
samples of 10 or more bulimic subjects, and 3) studies of the
prevalence of childhood sexual abuse in the general population, which
were chosen to match as closely as possible in methodology the
available studies of bulimia nervosa (i.e., in geographic location,
age and ethnicity of subjects, interview method, and criteria for
defining childhood sexual abuse). RESULTS: Controlled studies
generally did not find that bulimic patients show a significantly
higher prevalence of childhood sexual abuse than control groups,
especially when allowance is made for possible methodologic
effects. Furthermore, neither controlled nor uncontrolled studies of
bulimia nervosa found higher rates of childhood sexual abuse than were
found in studies of the general population that used comparable
methods. When it is taken into consideration that several methodologic
factors might have exaggerated the rates of childhood sexual abuse
among subjects with bulimia nervosa relative to rates in the general
population, the absence of actual observed differences becomes
particularly striking. CONCLUSIONS: Current evidence does support the
hypothesis that childhood sexual abuse is a risk factor for bulimia
nervosa.