Sexual abuse histories among treatment-resistant bulimia nervosa patients.

Although cognitive behavior therapy has been found to be an effective treatment for bulimia nervosa, it has been noted that a subset of patients fail to engage in treatment. We examined the connection between a history of sexual abuse and symptoms suggestive of poor prognosis including a history of multiple therapists or hospitalizations, self-injury or suicide attempts, and alcohol or drug problems. Subjects were 464 bulimic women in treatment at a residential facility for women with eating disorders. Of the women with all of the indicators of poor prognosis, approximately 71% reported a history of sexual abuse. Of the women who reported none of the symptoms indicative of poor prognosis, only 15% reported a history of abuse, and none of these women reported recurrent abuse (greater than five times). We discuss the possible connections between previous treatment failures and histories of abuse and discuss the implications for successful case formulation and treatment.