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Findings From the Victorian Adolescent Health Cohort Study

Lena Sanci, MBBS, PhD, FRACGP; Carolyn Coffey, BSc, Grad Dip Epi; Craig Olsson, PhD; Sophie Reid, PhD; John B. Carlin, PhD; George Patton, MBBS, MD, FRANZCP

Arch Pediatr Adolesc Med. 2008;162(3):261-267.

Objective  To examine the relationship between childhood sexual abuse (CSA) before the age of 16 years and later onset of bulimia and anorexia nervosa symptoms in females.

Design  A longitudinal cohort study of adolescents observed from August 1992 to March 2003. The cohort was defined in a 2-stage cluster sample using 44 Australian schools in Victoria.

Setting  Population based.

Participants  A total of 1936 persons participated at least once and survived to the age of 24 years, including 999 females. The mean (SD) age of females at the start of follow-up was 14.91 (0.39) years; and at completion, 24.03 (0.55) years.

Main Exposure  Self-reported CSA before the age of 16 years was ascertained retrospectively at the age of 24 years.

Outcome Measures  Incident Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)–defined partial syndromes of anorexia and bulimia nervosa were identified between waves 4 (mean age, 16.3 years) and 6 (mean age, 17.4 years) using the Branched Eating Disorder Test.

Results  The incidence of bulimic syndrome during adolescence was 2.5 (95% confidence interval, 0.80-8.0) times higher among those who reported 1 episode of CSA and 4.9 (95% confidence interval, 1.9-12.7) times higher among those who reported 2 or more episodes of CSA, compared with females reporting no episodes, adjusted for age and background factors. The association persisted after adjusting for possible confounders or mediators measured 6 months earlier, including psychiatric morbidity and dieting behavior. There was little evidence of an association between CSA and partial syndromes of incident anorexia nervosa.

Conclusion  Childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting.

Author Affiliations: Department of General Practice, University of Melbourne, Carlton (Dr Sanci); Centre for Adolescent Health (Ms Coffey and Drs Olsson, Reid, and Patton) and Clinical Epidemiology and Biostatistics Unit (Dr Carlin), Murdoch Childrens Research Institute, Parkville; and Department of Paediatrics, University of Melbourne, Melbourne (Dr Carlin), Victoria, Australia.