De nombreux auteurs se sont intéressés à l’impact d’une précédente expérience d’abus sexuel au cours de l’enfance dans le développement des troubles du comportement alimentaire (TCA). Étonnamment, peu de travaux ont eu pour but de documenter l’histoire traumatique plus étendue de ces patientes ou d’évaluer la comorbidité entre TCA et état de stress post-traumatique (ESPT). Soixante-neuf patientes anorexiques, âgées en moyenne de 23,4ans (± 6,9), toutes hospitalisées pour la gravité de leurs symptômes, ont complété une fiche anamnestique ainsi que trois questionnaires permettant d’évaluer l’intensité de l’exposition traumatique au cours de la vie (LEC), la symptomatologie spécifique des ESPT (PCLS) et la gravité des tendances anorexiques (EAT-16). La majorité des femmes rapportaient avoir été confrontées dans leur histoire de vie à au moins une situation traumatique (82,6 %). La comorbidité entre TCA et ESPT a été évaluée à 37,7 % (n=26). L’intensité des symptômes d’anorexie était corrélée à l’intensité des symptômes d’ESPT, mais aucune différence n’a pu être relevée sur les scores de ces deux variables en fonction du type de trauma rapporté (sexuel ou non). Dans une analyse de régression multiple, un seul prédicteur s’est avéré significatif de la gravité des symptômes d’anorexie : la présence d’un trouble obsessionnel compulsif comorbide. Les résultats de cette étude viennent développer la littérature concernant la comorbidité entre TCA et ESPT et infirmer l’hypothèse selon laquelle le vécu d’un trauma sexuel est prédicteur de l’intensité des symptômes d’anorexie mentale.

The literature on comorbidity between eating disorders (ED) and anxiety disorders is well documented. The most frequently observed anxiety disorders are obsessive/compulsive disorder (OCD) and social phobia (SP). During the 1980s and 1990s, many studies examined the link between traumatic events and the development of eating disorders and have studied the impact of childhood sexual abuse (CSA). For some researchers, CSA was a non-specific risk factor for eating disorders. For others researchers, data were insufficient to consider CSA as a risk factor. Despite this body of research, there is a lack of (1) data about traumatic history during life in women with ED and (2) data about real comorbidity between post-traumatic stress disorder (PTSD) and ED.

This exploratory study explored lifetime traumatic history and investigated the comorbidity between PTSD and ED symptoms in a clinical sample with eating disorders (anorexia nervosa).

The sample included 69 women with anorexia nervosa, who were hospitalized in a specific clinic for significant and vital symptomology in Lyon, France. The women participating in this study were 23 years old on average (X=23.4; SD = 6.9) and they had an average body mass index (BMI) of 17 (X = 17.25; ET = 3.39). Thirty-seven women were excluded from the study because of non-specified eating disorder diagnosis (n=19); bulimia disorder diagnostic (n=10) and because of incomplete questionnaires (n=8).

Each woman completed a personal information form and three questionnaires in order to assess previous exposure to potentially traumatic events (Life Events Checklist [LEC]); post-traumatic stress disorder symptoms (Posttraumatic Stress Disorder Checklist Scale [PCLS]) and anorexia nervosa symptoms (Eating Attitudes Test [EAT-16]). ED diagnosis was provided at admission by a psychiatrist.

Means, standard deviations, and frequency distributions were calculated to describe the population. Spearman correlations were performed between variables and a multiple regression analysis was carried out on data from the EAT-16 (anorexia nervosa symptoms). The choice of predictive factors to test was made after examination of group comparison analyses (Mann-Whitney; Kruskall Wallis) as well as correlations (Spearman coefficient). Only factors that had a significant influence on EAT-16 scores were included in the regression analysis.

The majority of the women had experienced at least one trauma in their life (n=57; 82.6%) and one-third had experienced at least five traumas (n=22; 32%), as evaluated with the LEC. The most frequently traumatic events were “severe human suffering”, “unwanted or uncomfortable sexual experience”, “sexual assault”, “physical assault” and “sudden, violent death”. Twenty-six women (37.7%) fulfilled the criteria for a current PTSD (PCLS Score>44+valid criterion A). A significant correlation was observed between anorexia nervosa symptoms and post-traumatic disorder symptoms (Rho=0.25). Regarding group comparisons analyses, there was no significant differences on anorexia nervosa symptoms between the type of traumatic events mentioned as criterion A (sexual assault, death of significant people, illness or physical assault) (H(4, N=69)=8.7; P=0.07). Only one variable was predictive of global EAT-16 scores: comorbidity between OCD (beta=0.27; P=0.03). The tested model explained only 13% of the variance (adjusted R2=0.13).

The objective of this research was (1) to study overall exposure to traumatic events during life (not only CSA events) and (2) to evaluate comorbidity between PTSD and anorexia nervosa. As seen in previous research, results suggest that women with anorexia nervosa have a history of high exposure to diverse traumatic events during life, and not only sexual traumatic events. Indeed, increasing exposure to trauma appears to increase manifestation of anorexia nervosa symptoms. Women with current traumatic symptoms linked to sexual assault do not manifest more anorexia symptoms than women with a history of other types of traumatic events. Current posttraumatic stress symptoms do not appear to predict the intensity of anorexia nervosa symptoms. Only one variable predicted ED symptoms: OCD comorbidity. Results provide an interesting insight for further studies on PTSD and ED.