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Gardner MJ, Thomas HJ, Erskine HE. The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2019; 96:104082. [PMID: 31374447 DOI: 10.1016/j.chiabu.2019.104082] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Child maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders. METHODS Published cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment. RESULTS All forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14-2.87]; sexual abuse [OR = 2.11, 1.83-2.44]; physical abuse [OR = 1.78, 1.57-2.01]; emotional abuse [OR = 2.35, 1.74-3.18]; neglect [OR = 1.65, 1.35-2.02]; and exposure to IPV [OR = 1.68, 1.34-2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders ('any child maltreatment' [OR = 1.68, 1.33-2.4]; sexual abuse [OR = 1.90, 1.6-2.25]; physical abuse [OR = 1.56, 1.39-1.76]; and neglect [OR = 1.34, 1.09-1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD). CONCLUSIONS There is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.
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Affiliation(s)
- M J Gardner
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
| | - H J Thomas
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - H E Erskine
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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2
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Larsen JT, Munk-Olsen T, Bulik CM, Thornton LM, Koch SV, Mortensen PB, Petersen L. Early childhood adversities and risk of eating disorders in women: A Danish register-based cohort study. Int J Eat Disord 2017; 50:1404-1412. [PMID: 29105808 DOI: 10.1002/eat.22798] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Previous studies evaluating the association between early childhood adversities and eating disorders have yielded conflicting results. The aim of this study is to examine the association between a range of adversities and risk of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) in 495,244 women. METHOD In this nationwide, register-based cohort study, nine types of early childhood adversity (family disruption, residential instability, placement in out-of-home care, familial death, parental somatic illness, parental psychiatric illness, parental disability, severe parental criminality, and parental substance use disorder) were defined and exposure during the first 6 years of life was determined. Hazard ratios for eating disorders were calculated using Cox regression. RESULTS Few adversities were significantly associated with AN, and for each, the presence of the adversity was associated with lower risk for AN. BN, and EDNOS were positively associated with several types of adversities. AN rates were unchanged or reduced by up to 54% by adversities, whereas rates of BN and EDNOS were unchanged or increased by adversities by up to 49 and 89%, respectively. DISCUSSION Our findings indicate that childhood adversities appear to be associated with an increased risk of BN and in particular EDNOS, whereas they seem to be either unassociated or associated with a decreased risk of AN.
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Affiliation(s)
- Janne Tidselbak Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susanne Vinkel Koch
- Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
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3
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Abstract
Despite early theories suggesting that family dysfunction (FD) may cause disordered eating, FD has been linked with other disorders and is a non-specific risk factor for disordered eating. We examined one potential model of the way FD relates to disordered eating, drawing on research that identified depression as a risk factor for bulimia. We examined whether depression symptoms (DEPs) partially mediated the relationship between family cohesion (as a measure of FD) and bulimic symptoms (BNs) using a sample of 215 never-married college women under age 20. Perceptions that one's family was less cohesive (or more disengaged) was associated with increased DEPs and BNs. Moreover, DEPs partially mediated the influence of cohesion on BNs through a significant indirect effect. Both family systems in general and treatment of mood difficulties may be important considerations in the prevention of disordered eating, and prevention efforts that include family relationships should be experimentally explored.
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4
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Rozenblat V, Ryan J, Wertheim E, King R, Olsson CA, Letcher P, Krug I. Relationships Between Self-Reported and Observed Parenting Behaviour, Adolescent Disordered Eating Attitudes and Behaviours, and the 5-HTTLPR Polymorphism: Data From the Australian Temperament Project. EUROPEAN EATING DISORDERS REVIEW 2017; 25:381-388. [PMID: 28695573 DOI: 10.1002/erv.2530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 12/15/2022]
Abstract
This study examined whether self-reported and observationally measured parental behaviours were associated with disordered eating, and investigated possible moderation by a serotonin-transporter polymorphism (5-HTTLPR). Study 1 included 650 adolescents from the Australian Temperament Project who completed the Eating Disorder Inventory-2 Drive for Thinness and Bulimia scales at 15/16 years and were genotyped for 5-HTTLPR. Parents completed an Australian Temperament Project-devised measure of parental warmth and harsh punishment. Study 2 included a subgroup of 304 participants who also engaged in a video-recorded family interaction, with observed parental warmth and hostility coded by the Iowa Family Interaction Rating Scale. Greater self-reported parental warmth was associated with lower bulimia scores. Conversely, observationally measured parental warmth was associated with lower drive for thinness, but not bulimia. Self-reported parental harsh punishment was associated with bulimia only, with observed parental hostility associated with neither outcome. 5-HTTLPR genotype did not moderate the relationship between parent behaviours and adolescent disordered eating. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Vanja Rozenblat
- Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Joanne Ryan
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Eleanor Wertheim
- School of Psychology and Public Health, Faculty of Health, La Trobe University, Bundoora, VIC, Australia
| | - Ross King
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Craig A Olsson
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Paediatrics, The Royal Children's Hospital Melbourne, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Primrose Letcher
- Department of Paediatrics, The Royal Children's Hospital Melbourne, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Isabel Krug
- Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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5
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Molendijk ML, Hoek HW, Brewerton TD, Elzinga BM. Childhood maltreatment and eating disorder pathology: a systematic review and dose-response meta-analysis. Psychol Med 2017; 47:1402-1416. [PMID: 28100288 DOI: 10.1017/s0033291716003561] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Meta-analyses have established a high prevalence of childhood maltreatment (CM) in patients with eating disorders (EDs) relative to the general population. Whether the prevalence of CM in EDs is also high relative to that in other mental disorders has not yet been established through meta-analyses nor to what extent CM affects defining features of EDs, such as number of binge/purge episodes or age at onset. Our aim is to provide meta-analyses on the associations between exposure to CM (i.e. emotional, physical and sexual abuse) on the occurrence of all types of EDs and its defining features. METHOD Systematic review and meta-analyses. Databases were searched until 4 June 2016. RESULTS CM prevalence was high in each type of ED (total N = 13 059, prevalence rates 21-59%) relative to healthy (N = 15 092, prevalence rates 1-35%) and psychiatric (N = 7736, prevalence rates 5-46%) control groups. ED patients reporting CM were more likely to be diagnosed with a co-morbid psychiatric disorder [odds ratios (ORs) range 1.41-2.46, p < 0.05] and to be suicidal (OR 2.07, p < 0.001) relative to ED subjects who were not exposed to CM. ED subjects exposed to CM also reported an earlier age at ED onset [effect size (Hedges' g) = -0.32, p < 0.05], to suffer a more severe form of the illness (g = 0.29, p < 0.05), and to binge-purge (g = 0.31, p < 0.001) more often compared to ED patients who did not report any CM. CONCLUSION CM, regardless of type, is associated with the presence of all types of ED and with severity parameters that characterize these illnesses in a dose dependent manner.
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Affiliation(s)
- M L Molendijk
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| | - H W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, Columbia University, New York, USA
| | - T D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - B M Elzinga
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
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6
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Krug I, King RM, Youssef GJ, Sorabji A, Wertheim EH, Le Grange D, Hughes EK, Letcher P, Olsson CA. The effect of low parental warmth and low monitoring on disordered eating in mid-adolescence: Findings from the Australian Temperament Project. Appetite 2016; 105:232-41. [PMID: 27212673 DOI: 10.1016/j.appet.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 05/13/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the interactions between low parental warmth and monitoring at age 13-14 years and disordered eating attitudes and behaviours at age 15-16 years. METHOD Data on 1300 (667 females) adolescents and their parents were drawn from The Australian Temperament Project (ATP), a 30 year (15 wave) population based longitudinal study of social-emotional development. Parent participants completed surveys on parenting practices in late childhood, and adolescent participants reported disordered eating using the drive for thinness and bulimia subscales of the Eating Disorder Inventory (EDI) and an additional body dissatisfaction scale. Interaction was examined on the additive scale by estimating super-additive risk; i.e., risk in excess of the sum of individual risks. RESULTS For boys, neither parental warmth or monitoring, nor their interaction, was related to disordered eating. For girls, low parental warmth (alone) was associated with bulimic behaviours. In contrast, exposure to both low monitoring and warmth was associated with ∼3½-fold, ∼4-fold and ∼5-fold increases in the odds of reporting body dissatisfaction, drive for thinness and bulimia, respectively. For body dissatisfaction and drive for thinness, risk associated with joint exposure exceeded the sum of individual risks, suggesting an additive interaction between parenting styles. CONCLUSION Further investment in family-level interventions that focus on promoting parental monitoring behaviour and a warm parent-child relationship remain important strategies for preventing a range of disordered eating behaviours in adolescents.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Victorian Australia, 14-20 Blackwood Street, VIC, 3010, Melbourne, Australia.
| | - Ross M King
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Anisha Sorabji
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Eleanor H Wertheim
- School of Psychology and Public Health, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, Bundoora, VIC, 3086, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, LH Suite 245, San Francisco, CA, 94143-0503, USA
| | - Elizabeth K Hughes
- Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Primrose Letcher
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Craig A Olsson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victorian Australia, 14-20 Blackwood Street, VIC, 3010, Melbourne, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
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7
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Bergner RM. Status Dynamic Treatment of a Case of Bulimia. Clin Case Stud 2016. [DOI: 10.1177/1534650103259711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
According to Marshall (1993), bulimic individuals often emerge from families where the methods of parental governance are characterized by excessive coerciveness, disregard for who the child actually is, and insistence on conformity to an a priori template of how the child should be. Later, these methods are adopted by the child in her attempts to control her own behavior. Bulimic binge eating represents a rebellious reaction against these coercive and self-disregarding methods of familial and self governance. Bulimic purging represents a reinstatement of the coercive regime and sets the stage for further rebellion in the future. A critical practical implication of this formulation is that therapeutic emphasis should be placed on changing the self-governance strategies of bulimic individuals. A clinical case is presented in which such a focus resulted in a highly favorable outcome.
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8
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Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis. Psychosom Med 2016; 78:79-90. [PMID: 26461853 DOI: 10.1097/psy.0000000000000233] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to estimate the association between distinct types of child abuse--sexual (CSA), physical (CPA), and emotional (CEA)--and different eating disorders (EDs). METHODS Electronic databases were searched through January 2014. Studies reporting rates of CSA, CPA, and CEA in people with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), as compared with individuals without EDs, were included. Pooled analyses were based on odds ratios (ORs), with relevant 95% confidence intervals (CIs), weighting each study with inverse variance models with random effects. Risk of publication bias was estimated. RESULTS Thirty-two of 1714 studies assessed for eligibility met the inclusion criteria, involving more than 14,000 individuals. The association between EDs and any child abuse showed a random-effects pooled OR of 3.21 (95% CI = 2.29-4.51, p < .001) with moderate heterogeneity (I2 = 57.2%, p = .005), whereas for CSA, this was 1.92 (95% CI = 1.13-3.28, p = .017), 2.73 (95% CI = 1.96-3.79, p < .001), and 2.31 (95% CI = 1.66-3.20, p < .001), for AN, BN, and BED, respectively. However, adjusting for publication bias, the estimate for CSA and AN was not significant (OR = 1.06, 95% CI = 0.59-1.88, p = .85). Although CPA was associated with AN, BN, and BED, CEA was associated just with BN and BED. CONCLUSIONS BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs. TRIAL REGISTRATION The protocol was registered in PROSPERO (an international prospective register of systematic reviews) with the reference number CRD42014007360.
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9
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Horesh N, Sommerfeld E, Wolf M, Zubery E, Zalsman G. Father-daughter relationship and the severity of eating disorders. Eur Psychiatry 2014; 30:114-20. [PMID: 24908149 DOI: 10.1016/j.eurpsy.2014.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/20/2014] [Accepted: 04/21/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mother-daughter relationship was the focus of studies on the development of eating disorders (ED) for many years. This study aimed to examine the association between the father-daughter relationship and ED and depressive symptoms. METHODS Fifty-three women diagnosed with ED were compared to a psychiatric control group (n=26) and to healthy participants (n=60) regarding their perception of their fathers and the relationship with them. Assessments were done using the Parental Bonding Instrument, the Eating Disorders Questionnaire, the Body Shape Questionnaire, the Eating Attitude Test, and the Beck Depression Inventory as well as narrative-based methods. RESULTS Fathers' negative attributes were significantly associated with ED and depressive symptom. Two profiles of father-daughter relationship were found, the "caring and benevolent" relationship and the "overprotective and avoidant" one. In the latter, patients displayed significantly higher levels of food-restraint, more concerns about eating and about their body shape and appearance, and higher levels of depression. DISCUSSION Negative perception of the father's parenting style as well as the quality of the relationship with him are crucial for the understanding of the development and persistence of ED. Therapeutic programs for ED should focus not only on the relationship with the mother but must also address the relationship with the father.
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Affiliation(s)
- N Horesh
- Bar Ilan University, Ramat Gan, Israel
| | - E Sommerfeld
- Ariel University, Ariel, Israel; Child and Adolescents Division, Geha Mental Health Center, Tel Aviv University, P.O. Box 102, 49100 Petah Tikva, Israel
| | - M Wolf
- Bar Ilan University, Ramat Gan, Israel
| | - E Zubery
- Shalvata Mental Health Center, Hod HaSharon, Israel
| | - G Zalsman
- Child and Adolescents Division, Geha Mental Health Center, Tel Aviv University, P.O. Box 102, 49100 Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Psychiatry Department, Columbia University, NY, USA.
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10
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Vajda A, Láng A. Emotional Abuse, Neglect in Eating Disorders and their Relationship with Emotion Regulation. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.sbspro.2014.04.135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc 2010; 85:618-29. [PMID: 20458101 PMCID: PMC2894717 DOI: 10.4065/mcp.2009.0583] [Citation(s) in RCA: 537] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. PATIENTS AND METHODS We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity. RESULTS The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape. CONCLUSION A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.
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Affiliation(s)
- Laura P Chen
- Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA
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12
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Kluck AS. Family factors in the development of disordered eating: integrating dynamic and behavioral explanations. Eat Behav 2008; 9:471-83. [PMID: 18928911 DOI: 10.1016/j.eatbeh.2008.07.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 07/11/2008] [Accepted: 07/29/2008] [Indexed: 01/28/2023]
Abstract
Previous studies exploring the dynamic (e.g., enmeshment, disengagement, rigidity, communication difficulties, overprotectiveness) and behavioral (e.g., parental modeling of eating behavior and attitudes toward weight, parental criticism and teasing, parental encouragement to diet) influences of the family on disordered eating behaviors have yielded mixed results. However, past research explored these different aspects of the family environment in isolation. The present study extended previous research by testing a prediction model in which the effects of family dynamics on the development of eating disorders operate through family food-related experiences. A total of 268 single college women completed the Eating Attitudes Test - Revised, Bulimia Test - Revised, Parental Bonding Instrument - II, Family Adaptability and Cohesion Scales - II, Parent Adolescent Communication Scale - Adolescent Form, Family Influence Scale, and Family Experiences Related to Food Questionnaire. Structural Equation Modeling revealed that both family dysfunction and negative family food-related experiences were associated with increased disordered eating. Results indicated that negative family food-related experiences mediated the relationship between family dysfunction and disordered eating. Discussion focuses on implications for the assessment and treatment of eating disorders.
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Affiliation(s)
- Annette S Kluck
- Psychology MS 2051, Texas Tech University, Lubbock, Texas 79409, United States.
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13
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Sanftner JL, Tantillo M, Seidlitz CSL. A Pilot Investigation of the Relation of Perceived Mutuality to Eating Disorders in Women. Women Health 2008; 39:85-100. [PMID: 15002884 DOI: 10.1300/j013v39n01_05] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Relational theory predicts that lack of mutuality in important relationships leads to the development of psychological problems, including eating disorders. We sought to explore the association between perceived mutuality in relationships with partners and friends and eating disorders. Participants were 74 women, 35 with an eating disorder diagnosis and 39 non-psychiatric controls. The eating disorder group reported lower perceived mutuality than controls for both partners and friends. The negative aspects of perceived mutuality were particularly important in differentiating between groups. These findings held when depression was included as a covariate for friends only. Results suggest that the disconnecting aspects of relationships may play a powerful role in the phenomenology of eating disorders.
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Affiliation(s)
- Jennifer L Sanftner
- Department of Psychology, Slippery Rock University, Slippery Rock, PA 16057, USA.
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14
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Jones CJ, Leung N, Harris G. Father-daughter relationship and eating psychopathology: the mediating role of core beliefs. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2007; 45:319-30. [PMID: 17147099 DOI: 10.1348/014466505x53489] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The study aimed to establish the relationships between recalled paternal rearing behaviours, core beliefs and eating symptomatology and to test whether core beliefs play a mediating role between the father-daughter relationship and eating psychopathology. DESIGN Associations between eating psychopathology, core beliefs and recalled parental rearing behaviours were examined in women with and without eating disorders. Regression analyses were used to test whether core beliefs played a mediating role in the relationship between paternal rearing behaviours and eating psychopathology. METHOD Sixty-six eating-disordered women and fifty female controls completed three self-report questionnaires measuring parental rearing behaviours, core beliefs and eating psychopathology. RESULTS In eating-disordered women, paternal rejection and overprotection were found to predict aspects of eating psychopathology via the mediating role of abandonment, defectiveness/shame and vulnerability to harm core beliefs. DISCUSSION Core beliefs relating to feelings of abandonment and inherent defectiveness appear to be important in the relationship between unhealthy father-daughter relationships and eating disorder symptoms.
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Affiliation(s)
- Ceri J Jones
- School of Psychology, University of Birmingham, UK.
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Mutuality as an Aspect of Family Functioning in Predicting Eating Disorder Symptoms in College Women. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2006. [DOI: 10.1300/j035v21n02_06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Jones C, Harris G, Leung N. Parental rearing behaviours and eating disorders: the moderating role of core beliefs. Eat Behav 2005; 6:355-64. [PMID: 16257809 DOI: 10.1016/j.eatbeh.2005.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Revised: 04/12/2005] [Accepted: 05/26/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Core beliefs have been shown to mediate between eating psychopathology and dysfunctional parent-daughter interactions. However, the possible moderating role of core beliefs has been neglected. This study aimed to explore the hypothesis that core beliefs serve as moderator variables in the relationship between recalled parental rearing behaviours and eating psychopathology. METHOD Sixty-six women with a current eating disorder completed self-report measures of parental rearing behaviours, core beliefs, and eating psychopathology. RESULTS Three core beliefs were found to moderate the relationship between paternal rejection and aspects of eating psychopathology. The predictive validity of paternal rejection on aspects of eating symptomatology was found to decrease as dysfunctional core beliefs increased. DISCUSSION When levels of social isolation, vulnerability to harm, and self-sacrifice core beliefs were high, recalled parental relationships were no longer relevant to current eating psychopathology. The findings provide further evidence that core beliefs are important factors in eating disorder psychopathology and may be clinically useful in identifying targets for treatment.
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Affiliation(s)
- C Jones
- School of Psychology, University of Birmingham, UK.
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Perkins S, Schmidt U, Eisler I, Treasure J, Yi I, Winn S, Robinson P, Murphy R, Keville S, Johnson-Sabine E, Jenkins M, Frost S, Dodge L, Berelowitz M. Why do adolescents with bulimia nervosa choose not to involve their parents in treatment? Eur Child Adolesc Psychiatry 2005; 14:376-85. [PMID: 16254767 DOI: 10.1007/s00787-005-0485-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although the use of family therapy for adolescents with anorexia nervosa is well established, there has been limited research into the efficacy of family therapy in adolescents with bulimia nervosa (BN). No previous research has investigated why individuals with BN do or do not involve their parents in treatment. This is an exploratory study aimed at determining whether there are any differences between these individuals in terms of eating disorder symptomatology, psychopathology, familial risk factors, patients' perception of parental expressed emotion (EE) and family functioning. METHODS Participants were 85 adolescents with BN or Eating Disorder Not Otherwise Specified, recruited to a randomised controlled evaluation of the cost-effectiveness of cognitive-behavioural guided self-care vs. family therapy. Participants were interviewed regarding the history of their eating disorder and completed self-report measures. RESULTS Patients who did not involve their parents in treatment were significantly older, had more chronic eating disorder symptoms, exhibited more co-morbid and impulsive behaviours and rated their mothers higher in EE. However, they did not have more severe eating disorder symptomatology. CONCLUSIONS These preliminary findings, although in need of replication with a larger sample and limited by the attrition rate in some of the self-report measures, indicate that patients who did not involve their parents in treatment may perceive their mothers as having a more blaming and negative attitude towards the patient's illness. Public awareness about BN needs to be raised, focusing on reducing the stigma and negative views attached to this illness.
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Affiliation(s)
- Sarah Perkins
- Eating Disorders Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK
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Wentz E, Gillberg IC, Gillberg C, Råstam M. Fertility and history of sexual abuse at 10-year follow-up of adolescent-onset anorexia nervosa. Int J Eat Disord 2005; 37:294-8. [PMID: 15856506 DOI: 10.1002/eat.20093] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We studied fertility and history of child sexual abuse (CSA) in a representative group of anorexia nervosa (AN) cases. METHOD Fifty-one adolescent-onset AN cases recruited after community screening and 51 matched comparison cases were interviewed 10 years after reported AN onset, at mean age 24 years, regarding children, miscarriages, and fertility problems. They completed anonymously the Finkelhor self-report questionnaire regarding history of CSA. RESULTS There were few fertility problems in our AN population. There was a tendency towards more subjects in the AN group to give birth to a child (10 AN and 4 comparison mothers). The prevalence of CSA was equal between groups. For example, 6% in each group had experienced CSA before the age of 10 years, and 14% of the AN and 12% of the comparison cases reported CSA. DISCUSSION Infertility and history of CSA may not be overrepresented in a population-based AN sample at long-term follow-up.
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Affiliation(s)
- Elisabet Wentz
- Department of Child and Adolescent Psychiatry, Göteborg University, Göteborg, Sweden.
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Smolak L, Murnen SK. A meta-analytic examination of the relationship between child sexual abuse and eating disorders. Int J Eat Disord 2002; 31:136-50. [PMID: 11920975 DOI: 10.1002/eat.10008] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study had two goals. The first was to assess the magnitude and consistency of the relationship between child sexual abuse (CSA) and eating disorders (ED). The second was to examine methodological factors contributing to the heterogeneity of this relationship. METHOD Meta-analysis was used to examine both questions. Fifty-three studies were included in the analysis. RESULTS A small, significant positive relationship between CSA and ED emerged. The relationship was marked by heterogeneity. Effect sizes were largest when CSA was the grouping variable, the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT) was used as the measure of eating disorders, and nonclinical groups were compared with clinical samples. DISCUSSION Models of CSA and ED need to more clearly specify what aspects of ED (e.g., body image or binge eating) are most influenced by which types of CSA. These specific relationships then need to be examined empirically.
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Affiliation(s)
- Linda Smolak
- Department of Psychology, Kenyon College, Gambier, Ohio 43022, USA.
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20
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Perceptions of Parental Messages Regarding Eating and Weight and Their Impact on Disordered Eating. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2000. [DOI: 10.1300/j035v15n02_07] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Abstract
The potential role of childhood emotional abuse (CEA) in the etiology and maintenance of eating psychopathology is reviewed. While childhood sexual and physical abuse have been hypothesized as risk factors in multifactorial models of eating disorders, a role for CEA has only recently been considered. Initial findings demonstrate a phenomenological link between CEA and eating psychopathology, and suggest that this association might be different to the links for other forms of trauma (i.e., CEA may have a relationship with a broader range of eating symptoms than sexual and physical abuse). However, the psychological processes that might account for such a link are not yet well understood. Potential cognitive and affective mediators are considered, with a particular emphasis upon low self-esteem and anxiety. A model is proposed, to act as a framework for further research into this field. The clinical implications of the research to date and of the proposed model are discussed.
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Affiliation(s)
- A Kent
- Riversley Park Resource Centre, North Warwickshire, United Kingdom
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22
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Wolfe WL, Maisto SA. The relationship between eating disorders and substance use: moving beyond co-prevalence research. Clin Psychol Rev 2000; 20:617-31. [PMID: 10860169 DOI: 10.1016/s0272-7358(99)00009-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The frequent comorbidity of eating disorders and substance use has been demonstrated consistently by research. Less is known about the basis of this relationship. A review of the literature indicates that the hypotheses proposed to clarify the etiological relationship between eating disorders and substance use have not been supported sufficiently or consistently by empirical evidence. General criticisms include: a lack of well developed models, a reliance on co-prevalence data, and a lack of integration of knowledge from eating disorder and substance use research. It is suggested that an understanding of the etiological relationship between eating disorders and substance use will be arrived at only after fundamental inquiries into the functional relationship between eating disorders symptomatology and substance use patterns have been conducted. A behavioral assessment approach is offered as a means of evaluating the functional relationship between eating disorder symptomatology and substance use.
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Affiliation(s)
- W L Wolfe
- Department of Psychology, Syracuse University, NY 13244-2340, USA.
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23
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Rapmund V, Moore C. Women's Stories of Depression: A Constructivist Approach. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2000. [DOI: 10.1177/008124630003000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to allow depressed women to tell their stories about depression. The epistemological framework was that of constructivism. The study involved a series of in-depth interviews with three depressed women with young children. Their stories provide an alternative reality to the traditional way of viewing depression. The major themes that emerged from the participants' stories seemed to be linked to the way in which they found themselves being pulled in opposite directions, ending up in a ‘no-win situation’, with the ‘stuckness’ maintaining the depression. The recurring themes centre around: Divided loyalties; failure to meet expectations; control; competence versus incompetence; love and rejection experienced by the ‘special child’; rootedness versus alienation; confrontation versus avoidance of issues and problems and; the role of support. The themes identified in this study may be helpful to those who work with depressed women in both a Western and African context.
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Affiliation(s)
- Val Rapmund
- Department of Psychology, University of South Africa, Box 392, Pretoria, 0003, South Africa
| | - Cora Moore
- Department of Psychology, University of South Africa, Box 392, Pretoria, 0003, South Africa
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Groth-Marnat G, Michel N. DISSOCIATION, COMORBIDITY OF DISSOCIATIVE DISORDERS, AND CHILDHOOD ABUSE IN A COMMUNITY SAMPLE OF WOMEN WITH CURRENT AND PAST BULIMIA. SOCIAL BEHAVIOR AND PERSONALITY 2000. [DOI: 10.2224/sbp.2000.28.3.279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dissociation and childhood sexual abuse were examined in a community sample of current bulimics (N=47), past bulimics (N=29), and non-bulimic controls (N=37). All respondents completed questionnaires requesting information relating to bulimia, dissociation, and
incidence and severity of childhood sexual abuse. Participants scoring high on the measure of dissociation (N=21) were further assessed with a structured clinical interview to determine the proportion who would fulfill the formal criteria for a DSM-IV dissociative disorder. Results
indicated that dissociation was highest among current bulimics, and that past bulimics had lower levels of dissociation than current bulimics (although higher than non-bulimic controls). However, there was no association between level of dissociation and incidence of reported childhood sexual
abuse. In addition, the incidence of childhood sexual abuse was no higher among bulimics than among the general population – although the severity of the abuse was reported to have been higher. The severity of self-reported childhood sexual abuse was also found to be higher among current
bulimics than among past bulimics. Comorbidity of DSM-IV dissociative disorders among current bulimics was found to be 10%.
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25
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Abstract
More than a decade of research has characterized the families of individuals with bulimia and bulimia anorexia (Anorexia Nervosa, Binge/Purging Type) as less expressive, less cohesive, and experiencing more conflicts than normal control families. This two-part study investigated variables believed more directly related to disturbed eating and bulimia as contributing to a "family climate for eating disorders." In Study 1. a nonclinical sample of 324 women who had just left home for college and a sample of 121 mothers evaluated their families. Principal-components analyses revealed the same factor structure for both students and mothers, with Family Body Satisfaction, Family Social Appearance Orientation, and Family Achievement Emphasis loading together, representing the hypothesized family climate for eating disorders: the remaining variables loaded with the more traditional family process variables (conflict, cohesion, expressiveness), representing a more general family dysfunction. As predicted, the family climate for eating disorders factor score was a more powerful predictor of disturbed eating. Study 2 extended these findings into a clin ical population, examining whether the family climate for eating disorders variables would distinguish individuals with bulimia from both depressed and healthy controls. Groups of eating-disordered patients (n = 40) and depressed (n = 17) and healthy (n = 27) controls completed family measures. The eating-disordered group scored significantly higher on family climate variables than control groups. Family process variables distinguished clinical groups (depressed and eating disordered) from healthy controls, but not from one another. Controlling for depression removed group differences on family process variables, but family climate variables continued to distinguish the eating-disordered group from both control groups. Indications for further research are discussed.
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Affiliation(s)
- M Laliberté
- Eating Disorders & Weight Preoccupation Program and McMaster University, Dundas, Ontario, Canada
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26
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27
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Deep AL, Lilenfeld LR, Plotnicov KH, Pollice C, Kaye WH. Sexual abuse in eating disorder subtypes and control women: the role of comorbid substance dependence in bulimia nervosa. Int J Eat Disord 1999; 25:1-10. [PMID: 9924647 DOI: 10.1002/(sici)1098-108x(199901)25:1<1::aid-eat1>3.0.co;2-r] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The relationship between sexual abuse and eating disorders remains uncertain. Recent data have raised the possibility of differential rates of sexual abuse among subtypes of eating disorders. METHODS We studied women with three subtypes of eating disorders: (1) 26 anorexia nervosa subjects (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 control women (CW). Sexual abuse rates and diagnoses were assessed through direct structured interviews. RESULTS We found an order effect for sexual abuse which was most common (65%) in BN + SDD subjects, followed by a rate 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 frequency and the most severe history of sexual abuse. However, the causal relationship between eating disorders and sexual abuse remains to be elucidated.
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Affiliation(s)
- A L Deep
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Medical Center, Pennsylvania 15213, USA
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28
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Abstract
This theoretical paper argues that a range of social factors are relevant to the genesis of depression in women. These include stressors which particularly pertain to gender, and include poverty, limited practical and social supports and resources, violence against women and childhood sexual assault. After explicating an interpersonal model for the etiology of depression, the paper outlines approaches that nurses can draw on to take sex-based factors into account when assessing and working with women experiencing depression. Nursing strategies which emphasise hope, use group approaches and deal with emotions and unconscious issues are deemed to be especially important.
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Affiliation(s)
- J Horsfall
- Faculty of Nursing, University of Sydney
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29
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Schmidt U, Humfress H, Treasure J. The role of general family environment and sexual and physical abuse in the origins of eating disorders. EUROPEAN EATING DISORDERS REVIEW 1997. [DOI: 10.1002/(sici)1099-0968(199709)5:3<184::aid-erv203>3.0.co;2-b] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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30
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Wonderlich SA, Brewerton TD, Jocic Z, Dansky BS, Abbott DW. Relationship of childhood sexual abuse and eating disorders. J Am Acad Child Adolesc Psychiatry 1997; 36:1107-15. [PMID: 9256590 DOI: 10.1097/00004583-199708000-00018] [Citation(s) in RCA: 177] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To review the literature that has examined the relationship between childhood sexual abuse and the eating disorders. METHOD Each of the five authors reviewed all identified empirical studies to be certain that inclusion/exclusion criteria were met. Two teams of raters then independently reviewed each study to determine whether it supported any of a series of six hypotheses that had been tested in this literature. RESULTS This review indicates that childhood sexual abuse is a nonspecific risk factor for bulimia nervosa, particularly when there is psychiatric comorbidity. There is some indication that childhood sexual abuse is more strongly associated with bulimic disorders than restricting anorexia, but it does not appear to be associated with severity of the disturbance. CONCLUSION Childhood sexual abuse is a risk factor for bulimia nervosa with significant comorbidity. Further study of the nature of this relationship is warranted.
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Affiliation(s)
- S A Wonderlich
- Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo 58102, USA.
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31
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Rorty M, Yager J. Histories of childhood trauma and complex post-traumatic sequelae in women with eating disorders. Psychiatr Clin North Am 1996; 19:773-91. [PMID: 8933608 DOI: 10.1016/s0193-953x(05)70381-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The profound self-destructiveness and tenacity of eating disorders found among women abused and neglected in childhood become comprehensible when understood within a complex posttraumatic conceptualization as desperate attempts to regulate overwhelming affective states and construct a coherent sense of self and system of meaning. Trauma leads to the predictable consequences of dysregulation of the arousal system, avoidance, and constriction of affect; coherence of self and world are shattered. Abused patients' childhood experiences teach them that to need is to expose oneself to the pain of abandonment and betrayal at the hands of individuals responsible for their care. Consequently, needs-psychological, physical, and spiritual-come to be perceived as dangerous, and human relationships are simultaneously yearned for and feared. Robbed of the opportunity to develop a cohesive self and a coherent system of meaning and faith to sustain from within, the traumatized eating-disorder patient turns to the culture to tell her who to be and how to live; she learns that to conquer rather than satisfy needs and to be "in control" (an internal state of equanimity manifested externally in a thin body) will bring meaning and purpose. Binge eating, purging, and starving become apt metaphors for the boundless hunger, the wish to fulfill needs together with the wish to rid oneself forever of need, the desire to "purify" the damaged psychic and physical self, and the hope of restoring meaning. The treatment of the traumatized eating disorder patient is complex. Individual therapy provides the opportunity for intensive relational work that begins to restore faith in human connection and that provides a "safe base" from which to examine the trauma and separate past from present. Therapy groups for eating-disordered women and trauma survivors provide relief from isolation, valuable perspectives from others who have "been there," and the opportunity to contribute to others' healing as one heals. Ultimately, these patients must be willing to leave the world of obsession with food and weight, which guarantees safety from interpersonal hurt while it simultaneously guarantees that hope will not be restored. Though reconnecting with humanity carries the risk of further pain, it opens up the opportunity for connection, healing, and growth.
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Affiliation(s)
- M Rorty
- Department of Psychology, Claremont McKenna College, California, USA
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32
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Laws A, Golding JM. Sexual assault history and eating disorder symptoms among White, Hispanic, and African-American women and men. Am J Public Health 1996; 86:579-82. [PMID: 8604796 PMCID: PMC1380566 DOI: 10.2105/ajph.86.4.579] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Data from two Epidemiologic Catchment Area Program sites (Los Angeles and North carolina) were analyzed to examine relations of sexual assault history to eating disorder symptoms. In regression analyses controlling for age, gender, ethnicity, income, socioeconomic status, and study site, persons with sexualy assault history (n = 514) were more likely than those not assaulted (n = 5511) to report thinking they were too fat (odds ratio [OR] = 1.6); losing > or = 15 lb (OR = 1.86); weight loss to 85% of normal (OR = 2.08); one or more anorexia symptoms (OR = 1.81); and sudden weight change (OR = 2.32). Ethnicity and income modified the relations. The data support an association of sexual assault history with eating disorder symptoms.
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Affiliation(s)
- A Laws
- Stanford Medical Group, Stanford University School of Medicine, Stanford, CA 94305-2205, USA
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Rorty M, Yager J, Rossotto E. Aspects of childhood physical punishment and family environment correlates in bulimia nervosa. CHILD ABUSE & NEGLECT 1995; 19:659-667. [PMID: 7552835 DOI: 10.1016/0145-2134(95)00024-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Although histories of child sexual abuse among eating disorder patients have attracted considerable attention in the past decade, relatively little is known about parental physical abuse among these patients. We examined aspects of childhood parental physical punishment and its family environmental correlates among women with a lifetime history of bulimia nervosa (BN group; n = 80) and women with no history of eating disorder (Control group; n = 40), recruited primarily by newspaper advertisement. Women in the BN group reported significantly more physical punishment and perceived their discipline to have been more harsh and capricious than women in the Control group. Nonetheless, the groups did not differ significantly in the extent to which they believed they deserved their punishment or in their belief that they were "physically abused." Further, subjects often failed to assert that they had been physically abused despite meeting conservative criteria, while the reverse tendency was uncommon. Finally, increased levels of physical punishment were associated with greater global family pathology in the BN group, but not in the Control group. Our findings underscore the necessity of explicitly inquiring about physically punitive events in the histories of bulimic women, as well as beliefs regarding these events.
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Affiliation(s)
- M Rorty
- UCLA Neuropsychiatric Institute 90024-1759, USA
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Abstract
At initial contact in an eating disorders clinic, 712 female eating disorder patients were asked if they had been physically or sexually abused as children. They also completed a Beck Depression Inventory (BDI) and an Eating Disorders Inventory (EDI). Their eating disorder symptom frequency and severity was determined. They were asked if they had alcohol problems, had attempted suicide, or had shoplifting problems. Twenty-nine percent reported sexual abuse. Twenty-five percent reported physical abuse. There was no correlation between reports of abuse and symptom frequency or severity. The abused subjects were more depressed on the BDI and showed more psychological disturbance on the EDI. Abused subjects were much more likely than nonabused subjects to report alcohol problems, suicide attempts, or shoplifting.
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Affiliation(s)
- D T Fullerton
- University of Wisconsin Medical School, Madison 53792-2475, USA
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35
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Abstract
The comorbidity of eating disorders and substance use and abuse has frequently been reported in the past 15 years. To date, however, no synthesis of this literature exists. Here, 51 studies reporting on these associations are reviewed. Studies of substance use and abuse in eating disordered women are considered, as are studies of eating disorders among women classified as substance abusers. The rates of substance abuse among eating disordered women are also examined. This review indicates that associations are stronger with bulimia, and "bulimic" behaviors, than with anorexia nervosa. Analogously, bulimic anorectics report more substance use and abuse than restricters. The prevalence of drug abuse was not found to differ between the relatives of bulimics and anorectics. Several mechanisms explaining the eating disorder-substance use/abuse link are considered, and suggestions for future research made.
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Abstract
Psychiatric nurses are confronted daily with individuals who are suffering from the consequences of trauma. Physical and sexual abuse is associated with acute psychiatric symptomatology in children and may progress to a spectrum of psychiatric and medical disorders in adults, ranging from the extreme adaptive reactions seen in multiple personality disorder and refractory psychosis to intermediate adaptive reactions present in borderline personality disorder to more delimited reactions manifest in chronic headaches and unremitting pelvic pain. Subjects sampled in inpatient, outpatient, psychiatric, medical, criminal, and community settings describe the link between histories of widespread abuse and various intractable and common disorders. This article presents the state-of-the-art knowledge of the long-term sequelae of childhood physical and sexual abuse by critically reviewing the initial uncontrolled investigations and mounting evidence from controlled studies.
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Affiliation(s)
- C A Glod
- McLean Hospital, Belmont, MA 02178
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38
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Folsom V, Krahn D, Nairn K, Gold L, Demitrack MA, Silk KR. The impact of sexual and physical abuse on eating disordered and psychiatric symptoms: a comparison of eating disordered and psychiatric inpatients. Int J Eat Disord 1993; 13:249-57. [PMID: 8477296 DOI: 10.1002/1098-108x(199304)13:3<249::aid-eat2260130302>3.0.co;2-n] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors compared rates of physical and sexual abuse in women with eating disorders (N = 102) and general psychiatric disorders (N = 49). Relationships between sexual abuse and severity of eating disordered and psychiatric symptoms were also examined. While high rates of sexual abuse were found in the eating disordered sample, these rates were not significantly higher than those found in the general psychiatric population. No relationship between a history of sexual abuse and severity of eating disordered symptoms was found. However, within the eating disordered group, sexually abuse subjects reported more severe psychiatric disturbances of an obsessive and phobic nature than nonabused subjects. These findings suggest that while sexually abusive experiences may be related to increased psychological distress, they do not serve to increase eating disordered symptomatology.
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Affiliation(s)
- V Folsom
- Mental Health Services, Group Health Cooperative of Puget Sound, Olympia, Washington
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39
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LAWS AMI. Does a History of Sexual Abuse in Childhood Play a Role in Women's Medical Problems? A Review. J Womens Health (Larchmt) 1993. [DOI: 10.1089/jwh.1993.2.165] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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40
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Codependency and the Eating-disorder Client. Nurs Clin North Am 1991. [DOI: 10.1016/s0029-6465(22)00287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Laraia MT, Stuart GW. Bulimia. A review of nutritional and health behaviors. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC AND MENTAL HEALTH NURSING 1990; 3:91-7. [PMID: 2195155 DOI: 10.1111/j.1744-6171.1990.tb00469.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nurses working with adolescents need an understanding of the clinical syndrome of bulimia in order to identify individuals at risk for this disorder and implement preventive and therapeutic interventions. The epidemiology, early precipitants, physiology, and biochemistry of bulimia nervosa are reviewed. From this integrated framework, implications for treatment are explored with an emphasis on holistic nursing care including health education.
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