Bulimia nervosa following psychological and multiple child abuse: support for the self-medication hypothesis in a population-based cohort study.
OBJECTIVE
To unravel the complex role of child abuse as a risk factor for bulima nervosa (BN), from the perspective of the self-medication hypothesis which asserts that in abused BN cases binge eating is primarily a way of coping with the anxiety or mood disorders that stem from the abuse.


METHODS
In a population-based study (N = 1,987) DSM-III-R diagnoses were assessed with the CIDI. Differences in exposure rates to child abuse between BN cases versus healthy, psychiatric, substance use, and dual diagnosis controls were employed to test the self-medication hypothesis.


RESULTS
A history of psychological or multiple abuse was found to be a specific risk factor for dual diagnosis disorder (cases with psychiatric and substance use disorders) and for BN. Nearly all BN cases that experienced multiple or psychological child abuse, showed such comorbid anxiety or mood disorders.


CONCLUSIONS
We found tentative support for the self-medication hypothesis.
Schoemaker
Casper
C
Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. cschoemaker@trimbos.nl
Smit
Filip
F
Bijl
Rob V
RV
Vollebergh
Wilma A M
WA
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D002032:Bulimia / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires