A recent study has shown that the incidence of bulimic symptoms in adolescence is higher in girls who report childhood sexual abuse before age 16 years, even after adjustment for age, background factors, previous psychiatric morbidity, and dieting behavior. The incidence is 2.5 times higher for 1 episode of abuse vs 4.9 times higher for 2 or more episodes of abuse vs no abuse. The study suggests that sexual abuse may initiate a pattern of dealing with emotional distress that brings a high likelihood of bulimia. Before meaningful treatment of an eating disorder can begin the possibility of childhood sexual abuse should be examined.

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