Coping, sexual abuse, and compensatory behavior

We explored rates of sexual abuse in different diagnostic subgroups of eating disorder patients, and the extent to which sexually abused patients presented with a higher incidence of disturbed behavior, affective distress, and personality disturbance. Further, we explored Waller's hypothesis that self-criticism may be an important mediator between sexual abuse, compensatory behavior, and personality disturbance.

We assessed sexual abuse in 103 eating disorder patients, and compared abused and nonabused patients on measures of coping, eating disorder symptoms, affective distress, personality disorders, and behavioral dysregulation.

Although the overall rate of abuse was equivalent to previous reports, about 40%, frequency of abuse was strikingly different across diagnostic subgroups, ranging from 12% to 75%. Abuse was lowest in compulsive overeaters (12%) and highest in patients who engaged in compensatory behaviors but did not binge or meet criteria for anorexia (75%). Abused patients were not only more disturbed on comorbid psychiatric symptoms, but were more likely to have engaged in self-injurious behavior (80%) and attempted suicide (75%). Consistent with Waller's model, self-criticism was the only primary coping strategy to differentiate abused from nonabused patients.

The findings indicate the possible need for a reprioritization of purging and compensatory behaviors in the diagnostic schedule for eating disorders, and the importance of assessing sexual abuse as a comorbid factor.