Psychological Medicine

Research Article

Is there a specific trauma precipitating anorexia nervosa?

a1 Pace Team, Institute of Psychiatry and Royal Holloway, University of London


Background. The aims of this study were to explore the role of life events and difficulties in the onset of anorexia nervosa and bulimia nervosa and to find out whether events and difficulties with a specific meaning, i.e. those of a certain sexual nature, are important in the onset of anorexia nervosa.

Methods. Seventy-two patients with anorexia nervosa (AN) and 29 with bulimia nervosa (BN) were assessed with the life events and difficulties schedule (Brown & Harris, 1978), the year before onset was studied. A new dimension to measure specific meaning of life events and difficulties called ‘pudicity’ was developed. Subjects from two community cohorts were used as comparison groups (Brown & Harris, 1978; Andrews et al. 1990).

Results. Anorexic patients, bulimic patients and community controls did not differ in the proportion of patients with at least one severe event; however, significantly more AN and BN patients than community controls had experienced a major difficulty. Sixty-seven per cent of anorexics and 76% of bulimia nervosa patients had either a severe event or a marked difficulty during the year before onset. In AN and BN the most common serious life stresses before onset concerned close relationships with family and friends with BN patients being significantly more often than AN patients directly involved in the problem (interpersonal events). Patients with anorexia nervosa had significantly more pudicity events before onset than BN patients or community controls.

Conclusion. While serious life stresses commonly precede the onset of anorexia nervosa and bulimia nervosa, problems with sexuality seem to be specific in triggering the onset of anorexia nervosa.


Address for correspondence: Dr Ulrike Schmidt, Pace Team, 300 Ivydale Road, London SE15 3DG.