The Relationship Between Sexual Abuse and Disordered Eating and the Mediating Effects of Physical Abuse, Emotional Abuse, and Trauma Symptomatology in Female Youth

Background and purpose: Interest in the link between sexual abuse and disordered eating (DE) in women began decades ago. Although previous research has established a link between these variables, the nature of this relationship is still not well understood. Few studies have focused on the relationship between sexual abuse and disordered eating in female youths. In a recent literature review no studies were found that investigated the relationship between sexual abuse, physical abuse, and psychological abuse simultaneously and trauma and DE.  This study addressed this gap by investigating the relationship between all three of these forms of abuse and trauma and DE in female youth. The purpose was to better understand the relationship between disordered eating and sexual abuse taking into account both physical and psychological abuse and trauma-related variables that may influence the development of DE.

Method: Data from the LONGSCAN database of the National Data Archive on Child Abuse and Neglect were used to examine the relationship between disordered eating and sexual abuse, physical abuse, emotional abuse, and trauma symptomatology. Data on sexual abuse were from the Age 18 Self-Report of Sexual Abuse Scale; on physical abuse from the Age 18 Self-Report of Physical Abuse Scale; on psychological abuse from the Age 18 Self-Report of Psychological Abuse Scale; on trauma from the Trauma Symptom Inventory; and on disordered eating from the eating disorder module of the Diagnostic Interview for Children.  The Participants included 450 female youth ages 22 and younger who participated in the eating disorder module of the Diagnostic Interview Schedule for Children given during the last data collection wave.  Path analysis methods were used to test the relationships between sexual abuse, physical abuse, psychological abuse, trauma, and disordered eating using SPSS AMOS.  Bootstrapped standard errors and confidence intervals were used in analyses.

Results: The fit indices suggested the final path model fit the data well, χ²(12) = 8.83, p = .72; CFI = 1.0; TLI = 1.0; RMSEA < .001, 90% CI, < .001 - .08, pclose = .86.  The standardized total effect of psychological abuse on disordered eating was, .61, and on trauma was, .68; the standardized total effect of trauma on disordered eating was, .57.  The 95% CI for the R² for trauma was, .19 - .53, and for disordered eating was, .11 - .56.  The results suggested trauma fully mediated the relationship between psychological abuse and disordered eating.  The findings further suggested that only psychological abuse scores were linked to trauma scores when considering sexual, physical, and psychological abuse. Furthermore, when considering sexual, physical, and psychological abuse along with trauma symptomatology, only trauma scores were related to disordered eating scores.

Conclusions and implications: These results are in contrast to prior research, which has found a relationship between sexual abuse and DE.  Future research should seek to replicate these findings. Subsequent studies should include multiple victimizations within and across abuse types in their analyses. The current findings underscore the importance of assessing for and treating psychological abuse within the context of treatment of DE.