Pope H G, Hudson J I
Biological Psychiatry Laboratory, McLean Hospital, Boston, MA.
Am J Psychiatry. 1992 Apr;149(4):455-63. doi: 10.1176/ajp.149.4.455.
It is of considerable theoretical and clinical importance to assess whether childhood sexual abuse is a risk factor for the development of bulimia nervosa. The authors reviewed the scientific literature bearing on this issue.
Since prospective studies on this question have not been done, they assessed 1) controlled retrospective studies comparing the prevalence of childhood sexual abuse among bulimic and control groups, 2) uncontrolled retrospective studies of the prevalence of childhood sexual abuse in samples of 10 or more bulimic subjects, and 3) studies of the prevalence of childhood sexual abuse in the general population, which were chosen to match as closely as possible in methodology the available studies of bulimia nervosa (i.e., in geographic location, age and ethnicity of subjects, interview method, and criteria for defining childhood sexual abuse).
Controlled studies generally did not find that bulimic patients show a significantly higher prevalence of childhood sexual abuse than control groups, especially when allowance is made for possible methodologic effects. Furthermore, neither controlled nor uncontrolled studies of bulimia nervosa found higher rates of childhood sexual abuse than were found in studies of the general population that used comparable methods. When it is taken into consideration that several methodologic factors might have exaggerated the rates of childhood sexual abuse among subjects with bulimia nervosa relative to rates in the general population, the absence of actual observed differences becomes particularly striking.
Current evidence does support the hypothesis that childhood sexual abuse is a risk factor for bulimia nervosa.
评估儿童期性虐待是否为神经性贪食症发病的危险因素具有重要的理论和临床意义。作者回顾了与此问题相关的科学文献。
由于尚未开展关于此问题的前瞻性研究，他们评估了：1）对照回顾性研究，比较神经性贪食症患者组和对照组中儿童期性虐待的患病率；2）对10名或更多神经性贪食症患者样本中儿童期性虐待患病率的非对照回顾性研究；3）一般人群中儿童期性虐待患病率的研究，这些研究在方法上尽可能与现有的神经性贪食症研究相匹配（即地理位置、研究对象的年龄和种族、访谈方法以及定义儿童期性虐待的标准）。
对照研究通常未发现神经性贪食症患者儿童期性虐待的患病率显著高于对照组，尤其是考虑到可能的方法学效应时。此外，无论是对神经性贪食症的对照研究还是非对照研究，均未发现其儿童期性虐待的发生率高于采用类似方法的一般人群研究。考虑到一些方法学因素可能夸大了神经性贪食症患者中儿童期性虐待的发生率相对于一般人群的发生率，实际观察到的差异不存在就显得尤为突出。
目前的证据并不支持儿童期性虐待是神经性贪食症危险因素这一假说。
