Links have been proposed between childhood sexual abuse and the development of eating disorders (e.g., Fallon & Wonderlich, 1997; Root & Fallon, 1989). However, the reported prevalence of such trauma in the eating-disordered population varies widely across studies, due to differences in definitions, methodologies and tools used (Lacey, 1990, Waller, 1991 and Welch and Fairburn, 1994). Given the similar prevalences of reported sexual abuse in eating-disordered patients, female psychiatric controls, and non-psychiatric controls, some researchers have concluded that there is no specific relationship between sexual abuse and the eating disorders (Pope & Hudson, 1992; Welch & Fairburn, 1994). However, while there appears to be no straightforward causal link between childhood sexual abuse and the simple presence of an eating disorder, there does appear to be evidence for more complex relationships between abuse and specific bulimic behaviors and eating attitudes. For example, when one compares diagnostic subgroups of eating-disordered patients, the prevalence of childhood sexual abuse is unusually low among restrictive anorexics, but high among women with disorders involving bulimic behaviors (e.g., Steiger & Zanko, 1990; Waller, 1991 and Waller et al., 1993a). Bingeing and purging behaviors appear to regulate disturbing cognitions and emotions, which can arise from an abuse history (e.g., Root and Fallon, 1989). Similar links appear to be found with other behaviors that can be characterized as assisting in the blocking of intolerable emotional states, such as self-harm (Romans, Martin, Anderson, Herbison, & Mullen, 1995). In addition to the abuse-eating behavior link, there is also a link to negative body image (Andrews, 1997 and Byram et al., 1995; Waller, Hamilton, Rose, Sumra, & Baldwin, 1993), possibly due to the development of body shame and deprecation following the abuse.
To summarize, there is evidence of a link between childhood sexual abuse and specific aspects of the eating disorders (bingeing, vomiting, and body image disturbance). However, it is not clear whether there is a link between childhood sexual abuse and other behaviors or more specific eating-related cognitions. The first aim of this study of a large clinical sample was to replicate and extend the link between reported sexual abuse and different eating disorder diagnoses. In keeping with previous findings, it was hypothesized that sexual abuse would be less commonly reported among groups with no purging behaviors (restrictive anorexics and binge eating disorder). However, there are moves towards considering the core elements of the eating disorders rather than focusing on diagnostic differences (Fairburn, Cooper, & Shafran, 2003; Waller, 1993). Therefore, it is important that such an investigation should use a measure of eating-related pathology that is relevant to the broad spectrum of the eating disorders. Thus, the second aim was to determine the dimensional association of reported sexual abuse with a broad range of eating characteristics (both cognitions and behaviors). Again, in keeping with research to date, it was hypothesized that such a trauma history would be associated with bulimic behaviors and with negative attitudes relating to body shape and size.
