Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T07:39:05.469Z Has data issue: false hasContentIssue false

Sexual Abuse and Eating Disorders

Borderline Personality Disorder as a Mediating Factor?

Published online by Cambridge University Press:  02 January 2018

Glenn Waller*
Affiliation:
University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT

Abstract

Sexual abuse appears to be causally linked to eating disorders, particularly those involving bulimic features. However, the psychological factors that mediate between these two phenomena are not understood. Recent findings suggest that borderline personality disorder may explain some of the association. The present research investigates the potential links between reported sexual abuse, borderline personality disorder, and eating psychopathology in a case series of 100 women with eating disorders. The results suggest that borderline personality disorder is a psychological factor that explains a small part of the causal link between sexual abuse and bulimic behaviour - especially frequency of bingeing. However, other factors are likely to be involved, and further research is suggested to investigate these.

Type
Research Article
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Briere, J. & Zaidi, L. Y. (1989) Sexual abuse histories and sequelae in female psychiatric emergency room patients. American Journal of Psychiatry, 146, 16021606.Google ScholarPubMed
Brown, G. R. & Anderson, B. (1991) Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 5561.Google Scholar
Bryer, J. B., Nelson, B. A., Miller, J. B., et al (1987) Childhood sexual and physical abuse as factors in adult psychiatric illness. American Journal of Psychiatry, 144, 14261430.Google Scholar
Calam, R. & Slade, P. (1989) Sexual experience and eating problems in female undergraduates. International Journal of Eating Disorders, 8, 391397.Google Scholar
Calam, R. & Slade, P. (1991) Eating patterns and unwanted sexual experiences. In Why Women: Gender Issues and Eating Disorders (eds Dolan, B. & Gitzinger, I.). London: European Council on Eating Disorders.Google Scholar
Fahy, T., Eisler, I. & Russell, G. F. M. (1993) Personality disorder and treatment response in bulimia nervosa. British Journal of Psychiatry, 162, 765770.Google Scholar
Finn, S., Hartman, M., Leon, G., et al (1986) Eating disorders and sexual abuse: lack of confirmation for a clinical hypothesis. International Journal of Eating Disorders, 5, 10511060.Google Scholar
Gartner, A. F., Marcus, R. N., Halmi, K., et al (1989) DSM-III-R personality disorders in patients with eating disorders. American Journal of Psychiatry, 146, 15851591.Google Scholar
Goldfarb, L. A. (1987) Sexual abuse antecedent to anorexia nervosa, bulimia, and compulsive overeating: three case reports. International Journal of Eating Disorders, 6, 675680.Google Scholar
Hall, R. C. W., Tice, L., Beresford, T. P., et al (1989) Sexual abuse in patients with anorexia nervosa and bulimia. Psychosomatics, 30, 7379.CrossRefGoogle ScholarPubMed
Herman, J. L., Perry, J. C. & van der Kolk, B. A. (1989) Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146, 490495.Google Scholar
Hurt, S. W., Hyler, S. E., Frances, A., et al (1984) Assessing borderline personality disorder with self-report, clinical interview or semistructured interview. American Journal of Psychiatry, 141, 12281231.Google Scholar
Jacobson, A. (1989) Physical and sexual assault histories among psychiatric outpatients. American Journal of Psychiatry, 146, 755758.Google ScholarPubMed
Jacobson, A. & Richardson, B. (1987) Assault experience of 100 psychiatric inpatients: evidence of the need for routine inquiry. American Journal of Psychiatry, 144, 908913.Google ScholarPubMed
Jehu, D. (1988) Beyond Sexual Abuse: Therapy with Women who were Childhood Victims. Chichester: Wiley.Google Scholar
Johnson, C., Tobin, D. & Dennis, A. (1990) Difference in treatment outcome between borderline and non-borderline bulimics at one year follow-up. International Journal of Eating Disorders, 9, 617627.Google Scholar
Lacey, J. H. (1990) Incest, incestuous fantasy and indecency: a clinical catchment area study of normal-weight bulimic women. British Journal of Psychiatry, 157, 399403.Google Scholar
Lacey, J. H. & Evans, C. D. H. (1986) The impulsivist: a multiimpulsive personality disorder. British Journal of Addiction, 81, 641649.Google Scholar
McClelland, L., Mynors-Wallis, L., Fahy, T., et al (1991) Sexual abuse, disordered personality and eating disorders. British Journal of Psychiatry, 158 (suppl. 10), 6368.Google Scholar
Mullen, P. E., Romans-Clarkson, S. E., Walton, V. A., et al (1988) Impact of sexual and physical abuse on women's mental health. Lancet, i, 841845.Google Scholar
Nurnberg, H. G., Raskin, M., Levine, P. E., et al (1991) The comorbidity of borderline personality disorder and other DSM-III-R Axis II personality disorders. American Journal of Psychiatry, 148, 13711377.Google Scholar
Ogata, S. N., Silk, K. R., Goodrich, S., et al (1990) Childhood sexual and physical abuse in adult patients with borderline personality disorder. American Journal of Psychiatry, 147, 10081013.Google Scholar
Oppenheimer, R., Howells, K., Palmer, R. L., et al (1985) Adverse sexual experience in childhood and clinical eating disorders: a preliminary description. Journal of Psychiatric Research, 19, 357361.Google Scholar
Palmer, R. L., Chaloner, D. A. & Oppenheimer, R. (1992) Childhood sexual experiences with adults reported by female psychiatric patients. British Journal of Psychiatry, 160, 261265.CrossRefGoogle ScholarPubMed
Palmer, R. L., Oppenheimer, R., Dignon, A., et al (1990) Childhood sexual experiences with adults reported by women with eating disorders: an extended series. British Journal of Psychiatry, 156, 699703.CrossRefGoogle ScholarPubMed
Pope, H. G., Frankenberg, F., Hudson, J. I., et al (1987) Is bulimia associated with borderline personality disorders? A controlled study. Journal of Clinical Psychiatry, 48, 181184.Google Scholar
Pope, H. G., & Hudson, J. I. (1989) Are eating disorders associated with borderline personality disorder? A critical review. International Journal of Eating Disorders, 8, 19.Google Scholar
Rosenfeld, A. A. (1979) Incidence of a history of incest among 18 female psychiatric patients. American Journal of Psychiatry, 136, 791795.Google ScholarPubMed
Russell, D. (1983) Incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children. Child Abuse and Neglect, 7, 133146.Google Scholar
Schechter, J. O., Schechter, H. P. & Greenfeld, D. G. (1987) Sexual assault and anorexia nervosa. International Journal of Eating Disorders, 6, 313316.Google Scholar
Shearer, S. L., Peters, C. P., Quaytman, M. S., et al (1990) Frequency and correlates of childhood sexual and physical abuse histories in adult female borderline inpatients. American Journal of Psychiatry, 147, 214216.Google Scholar
Sloan, G. & Leichner, P. (1986) Is there any relationship between sexual abuse or incest and eating disorders? Canadian Journal of Psychiatry, 31, 656660.Google Scholar
Smolak, L., Levine, M. P. & Sullins, E. (1990) Are child sexual experiences related to eating disordered attitudes and behaviours in a college sample? International Journal of Eating Disorders, 9, 167178.Google Scholar
Tyrer, P., Casey, P. & Ferguson, B. (1991) Personality disorder in perspective. British Journal of Psychiatry, 159, 463471.Google Scholar
Waller, G. (1991) Sexual abuse as a factor in eating disorders. British Journal of Psychiatry, 159, 664671.Google Scholar
Waller, G. (1992a) Sexual abuse and the severity of bulimic symptoms. British Journal of Psychiatry, 161, 9093.Google Scholar
Waller, G. (1992b) Sexual abuse and bulimic symptoms in eating disorders: do family interaction and self-esteem explain the links? International Journal of Eating Disorders, 12, 235240.Google Scholar
Williams, H. J., Wagner, H. L. & Calam, R. C. (1992) Eating attitudes in survivors of unwanted sexual experiences. British Journal of Clinical Psychology, 31, 203206.Google Scholar
Winfield, I., George, L. K., Swartz, M., et al (1990) Sexual assault and psychiatric disorders among a community sample of women. American Journal of Psychiatry, 147, 335341.Google Scholar
Wonderlich, S. A., Swift, W. J., Slotnick, H. B., et al (1990) DSM-III-R personality disorders in the eating disorder subtypes. International Journal of Eating Disorders, 9, 607616.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.