Childhood Sexual Abuse Increases Risks for Eating Disorder Symptoms and Eating Disorder-Related Health Problems in Females

  • Jacinda C. LiEmail author
  • Jennie G. Noll
  • Heather E. Bensman
  • Frank W. Putnam
Part of the SpringerBriefs in Psychology book series (BRIEFSPSYCHOL)


Childhood sexual abuse (CSA) is implicated in the etiology of eating disorders (ED) and health problems in females, but prospective evidence is limited. ED symptoms are widespread but often undertreated, potentially contributing to subsequent ED-related health problems. Using data from Trickett and colleagues’ Female Growth and Development Study, the present report investigated the prospective associations among CSA, ED symptomatology in adolescence, and ED-related health problems in adulthood. Females with substantiated CSA and demographically-matched comparisons (N = 135) were followed at mean ages 11 through 24. Symptom counts and diagnoses of anorexia nervosa (AN) and bulimia nervosa (BN) over the lifetime were assessed in adolescence. Self-reported physical health problems were assessed in adulthood. Controlling for depression, anxiety, and age, CSA participants reported more symptoms and related health problems of BN, but not AN, relative to comparisons. CSA was not associated with the likelihood of receiving a diagnosis for either ED. BN symptom count accounted for a portion of the association between CSA and increased BN-related health problems. This report provided prospective evidence for the associations between CSA and BN symptoms and BN-related health problems. These findings support the recommendations to bolster resources and expertise for trauma-informed ED screening and treatment, ED treatments for patients with subthreshold symptoms, and enhanced treatments addressing ED and health problems for sexual abuse survivors.


Sexual abuse Child maltreatment Child abuse Eating disorder Bulimia nervosa Anorexia nervosa Health problem 



This research was partially supported by grants from the National Institute of Mental Health (MH48330, MH01284); National Institute of Child Health and Human Development (HD41402, HD045346, HD060604); National Institute Of Diabetes And Digestive And Kidney Diseases (F31DK109578); National Center on Child Abuse and Neglect (90-CA-1549, 90-CA-1686); United States Department of Agriculture Childhood Obesity Prevention Transdisciplinary Training Program (Agriculture and Food Research Initiative Grant no. 2011-67001-30117 Program area A2121 from the USDA National Institute of Food and Agriculture Childhood Obesity Prevention Challenge Area); and private foundations including the W. T. Grant Foundation, Smith Richardson Foundation, and John Templeton Foundation (ID5119). This paper is published in dedication to Penelope K. Trickett (1943 - 2016) who devoted life and career to the betterment of abused and neglected children.

Financial Disclosure Statement

None of authors have financial relationships relevant to this article.

Conflict of Interest Statement



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Copyright information

© The Editor(s) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Jacinda C. Li
    • 1
    Email author
  • Jennie G. Noll
    • 1
  • Heather E. Bensman
    • 2
  • Frank W. Putnam
    • 3
  1. 1.College of Health and Human Development, Department of Human Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkUSA
  2. 2.Behavioral Medicine and Clinical Psychology, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of PsychiatryUniversity of North Carolina School of MedicineChapel HillUSA

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