Objective: We explored rates of sexual abuse in different diagnostic subgroups of eating disorder patients, and the extent to which sexually abused patients presented with a higher incidence of disturbed behavior, affective distress, and personality disturbance. Further, we explored Waller's hypothesis that self-criticism may be an important mediator between sexual abuse, compensatory behavior, and personality disturbance. Method: We assessed sexual abuse in 703 eating disorder patients, and compared abused and nonabused patients on measures of coping, eating disorder symptoms, affective distress, personality disorders, and behavioral dysregulation. Results: Although the overall rate of abuse was equivalent to previous reports, about 40%, frequency of abuse was strikingly different across diagnostic subgroups, ranging from 12% to 75%. Abuse was lowest in compulsive overeaters (72%) and highest in patients who engaged in compensatory behaviors but did not binge or meet criteria for anorexia (75%). Abused patients were not only more disturbed on comorbid psychiatric symptoms, but were more likely to have engaged in self-injurious behavior (80%) and attempted suicide (75%). Consistent with Waller's model, self-criticism was the only primary coping strategy to differentiate abused from nonabused patients. Discussion: The findings indicate the possible need for a reprioritization of purging and compensatory behaviors in the diagnostic schedule for eating disorders, and the importance of assessing sexual abuse as a comorbid factor. 0 7996 by John Wiley & Sons, Inc.
Waller has proposed a linkage between sexual and psychological trauma, and a selfdenigrating cognitive style that promotes affective disturbance, personality difficulties, and bulimic behaviors (Pitts & Waller, 1993). Although a number of studies have found a relationship between sexual abuse, affective distress, and personality disorders in eating disorders (Fullerton, Wonderlich,