Reported Sexual Abuse and Bulimic Symptoms: the Mediating Role of Dissociation

There is only inconclusive evidence of a specific association between a history of sexual abuse and diagnosable eatingdisorders. However, there is stronger support for a link between sexual abuse and bulimic symptomatology. The mediating factors in this relationship are still unclear. Dissociation appears to be a strong candidate, given its links to both early trauma and bulimic psychopathology. This study examines the role of dissociation as a potential mediating factor in the relationship between a reported history of sexual abuse and specific bulimic behaviors in 60 women with eating disorders. A reported history of sexual abuse was associated with greater dissociation and with a greater frequency of bingeing. In an Analysis of Covariance, dissociation accounted for the association between a reported history of sexual abuse and frequency of bingeing. Further research is required to determine the other factors involved in this relationship. Studies have linked a reported history of abuse with a number of psychiatric disorders (Briere & Zaidi, 1989; Hall, Tice, Beresford, Wooley, & Hall, 1989; Mullen, RomansClarkson, Walton, & Herbison, 1988). In particular, there has been considerable interest in the association between a history of sexual abuse and the eating disorders (Bulik, Sullivan, & Rorty, 1989; Lacey, 1990; Oppenheimer, Howells, Palmer, & Chaloner, 1985; Palmer & Oppenheimer, 1992; Welch & Fairburn, 1994). The findings of these studies are mixed, with a range of prevalence rates reported, suggesting that any link between abuse and the eating disorders may not be a specific one (Pope & Hudson, 1992; Conners & Morse, 1993). There appears to be particular utility in considering a specific link to bulimic symptomatology (Bushnell, Wells & Oakley-Browne, 1992; Hastings & Kern, 1994; Pribor & Dinwiddie, 1992; Root & Fallon, 1988; Steiger & Zanko, 1990; Waller, 1991, 1992). The research suggests that a reported history of sexual abuse is not linked directly to a diagnosis of bulimia nervosa. Rather, there appears to be a specific link to the bulimic behaviors of bingeing and purging (Pitts & Waller, 1993; Waller, 1992). Functional models suggest that bingeing and purging behavior can serve a number of defensive purposes (Lacey, 1986), and that those defenses are especially valuable for the bulimic with a history of abuse (Root & Fallon, 1989). In particular, it is proposed that a temporary cognitive narrowing is experienced during a binge as the bulimic refocuses attention on to the immediate stimulus. This refocusing allows a reduction in negative affect or a general reduction in self-awareness (Heatherton & Baumeister, 1991). In the case of a woman who has a history of sexual abuse, there are likely to be a number of intolerable emotional states present, due to the unresolved nature of the experience (Briere, 1992) . Consequently, there will be a greater need for this reduction in awareness in women with such a history. This pattern of "escaping from awareness" appears to involve cognitive processes similar to those that underpin the concept of dissociation. Dissociation is a relatively primitive defense mechanism, which is characterized by poor integration of thought processes (Spiegel, 1986). It can involve feelings of absorption, derealization/depersonalization, and amnestic dissociation (memory loss). Although dissociation is a natural cognitive process, especially in response to trauma (e.g., Spiegel & Cardena, 1991) , with continued use over time it can become maladaptive. High levels of dissociation have been found in a number of psychiatric disorders, including multiple personality disorder, borderline personality disorder, post-traumatic stress disorder, and the eating disorders (e.g., Carlson & Putnam, 1993). A number of studies have reported dissociative tendencies in eating-disordered women (Abraham & Beumont, 1982; Demitrack, Putnam, Brewerton, Brandt, & Gold, 1990; Goldner, Cockhill, & Bakan,