Dissociation, Comorbidity of Dissociative Disorders, and Childhood Abuse in a Community Sample of Women with Current and Past Bulimia

Article excerpt

Dissociation and childhood sexual abuse were examined in a community sample of current bulimics (N=47), past bulimics (N-9), and non-bulimic controls (N=37). All respondents completed questionnaires requesting information relating to bulimia, dissociation, and incidence and severity of childhood sexual abuse. Participants scoring high on the measure of dissociation (N=21) were further assessed with a structured clinical interview to determine the proportion who would fulfill the formal criteria for a DSM-IV dissociative disorder Results indicated that dissociation was highest among current bulimics, and that past bulimics had lower levels of dissociation than current bulimics (although higher than non-bulimic controls). However, there was no association between level of dissociation and incidence of reported childhood sexual abuse. In addition, the incidence of childhood sexual abuse was no higher among bulimics than among the general population - although the severity of the abuse was reported to have been higher. The severity of self reported childhood sexual abuse was also found to be higher among current bulimics than among past bulimics. Comorbidity of DSM-IV dissociative disorders among current bulimics was found to be 10%.

In the last two decades there has been an increased interest in the level of dissociation in various populations. Much of this research has focused on etiological aspects, particularly the incidence of childhood trauma that appears to have typically been present among those with severe dissociative disorders. More recently, research has suggested that dissociative experiences and childhood abuse occur quite frequently among women with bulimia nervosa. However, little is known about either the course of the dissociative experiences among bulimics or how (or whether) they become resolved as bulimia improves.

There are a number of sources linking bulimia with dissociative experiences. Clinical observations have often noted dissociative experiences among bulimics which is consistent with the phenomenological descriptions of bulimics themselves (Beaumont & Abrams, 1983; Johnson & Larson, 1982). These include a sense of loss of control, narrowing of cognitive focus, occasional amnesia, depersonalization, and derealization. In addition, greater hypnotizability has been noted among both persons with extreme concerns with eating (Groth-Marnat,1991; troth-Marnat & Schumaker, 1990; Schumaker & troth-Marnat, 1988) as well as among actual bulimics (Barabasz, 1991; Pettinati, Horne, & Staats, 1985). Dissociation itself has been amply demonstrated to occur at higher levels among bulimics (Covino, Jimerson, Wolfe, & Franko, 1994; Demitrack, Putnam, Brewerton, Brandt, 8c Gold, 1990; Everill, Waller, & McDonald, 1995; Goldner, Cockhill, Bakan, 8c Birmingham, 1991; Havenaar, Boon, & Tordoir, 1991; Katz & Cleaves, 1996; McCallum, Lock, Kulla, Rorty, & Wetzel, 1992; Reto, Dalenberg, & Coe, 1993; Schumaker, Warren, Carr, & Schreiber, 1995; Schumaker, Warren, Schreiber, & Jackson,1994; Vanderlinden, Vandereycken, van Dyck, R. & Vertommen, H., 1993). In addition, a subgroup of patients with dissociative disorders have been known to present initially with eating disorders (Ross, 1989; Ross, Norton, & Wozney, 1989; Torem, 1986, 1990). These authors suggest that, for this subgroup, the eating disordered behavior itself is an expression of the underlying dissociative disorder.

While greater dissociation has been clearly associated with bulimia, the reasons for this association are less clear. One possibility is that the occurrence of childhood sexual abuse (CSA) might lead to dissociative defenses which then predispose the person to developing bulimia. The literature on this has remained controversial. Many studies do seem to support such a link (Beckman & Burns, 1990; Palmer, Oppenheimer, Dignon, Chaloner, & Howells,1990; Steiger & Zanko,1990; Stuart, Laria, Ballanger, & Lydiard, 1990; Vanderlinden et al. …