Childhood Sexual Abuse and Its Association with Clinical and Psychological Features in Patients with Eating Disorders in China

Background: To investigate the incidence of childhood sexual abuse (CSA) and its association on the clinical and psychological characteristics of patients with eating disorders (EDs). Methods: In total, 970 patients, including 51males and 919 females, were included in this study during 2008– 2015. A cross-sectional survey was conducted using the Eating Disorder Questionnaire (CSA was assessed with two brief yes/no questions) and Eating Disorder Inventory. The patients were divided into two groups based on their CSA experience and into four groups based on the Diagnostic and Statistical Manual of Mental Disorders IV. Demographic, clinical, and psychological characteristics were compared between the two groups. A general linear model was used to explore interactions between ED subtypes and CSA and moderator effect models were used to assess how CSA influenced the relationship between psychological features and binge eating in bulimia nervosa (BN) and EDs not otherwise specified. Results: The prevalence of CSA among patients with eating disorders was 8.4%, aligning with the general population in China. Those with a history of CSA exhibited significantly higher scores on psychological measures, with the exception of fear of maturity. Anorexia nervosa of the restricting type, had a lower rate of 4.9%, showing minimal association on this subtype. BN had the highest incidence of abuse of 12.6%. CSA history was significantly associated with higher ineffectiveness scores in both BN and EDNOS groups. CSA significantly moderated the associations between psychological traits (drive for thinness, bulimia, and interoceptive awareness) and binge eating frequency, with stronger associations observed in individuals without a history of CSA. Conclusion: This study showed a nuanced interaction between CSA history and ED psychopathology. This emphasizes the need for clinicians to consider a history of CSA when assessing and treating individuals with EDs, especially BN and EDs not otherwise specified, as it may influence the severity and presentation of the disorder. Keywords: eating disorders, childhood sexual abuse, China, diagnosis subtypes, psychological features