Background: Individuals with eating disorders often report histories of childhood
sexual abuse, but no direct relationship has been elucidated. Studies have examined sexual,
physical and emotional abuse as factors contributing to the pathogenesis of eating disorders.
Objective: Clinical studies and vignettes of eating disorder patients with histories of abuse or
neglect are discussed, as are personality and family traits, genetics, and neurobiological
changes that mediate this relationship.
Methods: MedlinePlus, PsycINFO, PsychiatryOnline, and PubMed were searched, using
filters for full-text clinical studies in English between 1996-2016. Studies were only included
if they were published in peer-reviewed journals, scholarly books, or clinical manuals; used
reliable validated scales or structured interviews; and involved subjects who experienced
abuse before age eighteen. Methodological issues and efforts aimed to overcome them are
Results: Within an eating disorder population, patients with histories of childhood abuse are
more likely to purge, self-harm, and have psychiatric comorbidity. Childhood abuse is more
often reported by bulimics than anorexics. Purging anorexics report childhood abuse more
often than restricting anorexics. Rates of childhood abuse are comparable in ED populations
and general psychiatric populations.
Conclusion: Childhood abuse is a non-specific risk factor for eating disorders. Eating
disorder patients who report childhood abuse are more likely to purge, self-harm, or have
psychiatric comorbidities, thus treatment of these patients must address trauma. Many
biopsychosocial factors contribute to outcomes of childhood abuse victims, and further
research is needed in order to understand the link between adversity in childhood and
subsequent eating pathology.