Eating Disorders 251Childhood sexual abuse
Many patients with eating disorders disclose sexual abuse during the
treatment process. The publication of case studies on individual patients
reporting sexual abuse led to the study of the possible role of childhood
sexual abuse in triggering eating disorders (Crisp, 1984; Goldfarb, 1987).
This literature for sexual abuse in women was reviewed by Connors and
Morse (1993). They examined clinic-based studies, and reported rates of
sexual abuse in eating disordered patients of 29.5 percent (Oppenheimer
et al., 1985), 28.5 percent (Root and Fallon, 1988), 34.4 percent (Bulik,
Sullivan, and Rorty, 1989), 50 percent (Hall et al., 1989), and 30 percent
(Steiger and Zanko, 1990). They also reviewed community-based studies
and reported rates of 58 percent (Calan and Slade, 1989), 13 percent
(Bailey and Gibbons, 1989), and 23 percent (Smolak, Levine, and Sullins, 1990).
These studies used a range of definitions of sexual abuse and defined eat-
ing disorders using different assessment tools. Following their analysis of
the data, Connors and Morse (1993) concluded that about 30 percent of
individuals with an eating disorder have been sexually abused in childhood.
They suggested that this prevalence is similar to that found in non-
eating-disordered women, but lower than that reported by other psychi-
atric patients. Connors and Morse (1993) concluded that “child sexual abuse
is neither necessary nor sufficient for the development of an eating disorder”
(p. 9), but suggested that childhood sexual abuse is “best considered a risk
factor in a biopsychosocial etiological model of eating disorders” (p. 1).
The picture for men, however, may be different. For example, Feldman and
Meyer (2007a) explored the history of childhood sexual abuse in 193 gay
and bisexual men who were white, black, or Latino and also assessed the
presence or absence of an eating disorder. The results showed that the rate
of childhood sexual abuse was far higher in those with subclinical bulimia,
current AN or BN, or subclinical eating disorder and that this relationship
persisted even when depression and/or substance use disorders were con-
trolled for. Accordingly, they argue that eating disorders may be a potential
mechanism used by gay or bisexual men to cope with abuse in their
childhood.
Parental loss
Research has also addressed the extent to which parental loss through either
separation or death can trigger an eating disorder. Most research, however,
indicates that although such a theory of etiology has face validity, it is not
supported by the evidence. For example, Rastam and Gillberg (1991)