Childhood abuse, family environment, and outcome in bulimia nervosa

About one third of patients with bulimia nervosa continue to do poorly despite intensive treatment. In an effort to identify historical factors that might differentiate patients who are persistently bulimic from patients who have fully recovered, we examined the relationship between long-term outcome and three factors: childhood trauma, family environment, and parental psychopathology.

Fifty-two women previously hospitalized for bulimia nervosa were interviewed 2 to 9 years later. In addition to structured diagnostic interviews, measures included the Family Environment Scale, the Family History interview, and a semistructured interview of childhood abuse. Outcome comparisons were made between the fully recovered and the women who still met DSM-III-R criteria for bulimia nervosa.

Reports of childhood physical abuse and of a family environment characterized by low cohesion and high control were significantly associated with poor outcome. Characteristics of the family environment seemed to have greater influence on outcome than physical abuse alone. Sexual abuse in general was not associated with outcome. Outcome was not associated with comorbidity of Axis I or Axis II disorders or parental psychopathology.

Aspects of the family environment of childhood may contribute to the course of bulimia nervosa. Definitive conclusions require a prospective study.