Extreme Obesity and its Associations with Victimization, PTSD, Major Depression and Eating Disorders in a National Sample of Women

Abstract

Background: Crime victimization experiences, such as rape, molestation, and aggravated assault are significantly associated with bulimia nervosa (BN) and associated psychiatric comorbidity such as posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and substance abuse. Obesity also appears to be a major risk factor for the development of BN, but few studies have examined the relationship of crime victimization experiences to obesity and related psychopathology. Methods: During the 3rd wave of the National Women’s Study, a representative sample of 3,012 adult women (≥ 18 y/o) randomly selected from 4 geographic areas of the US completed a telephone interview including screenings for rape, attempted sexual assault, molestation, aggravated assault, surviving homicide, as well as PTSD, MDD, and BN. Self-reported height and weight were obtained, and current BMI and maximum/minimum BMI’s during adulthood were calculated. Subjects were categorized into 5 groups based on maximum BMI for comparisons: 1) <25; 2) 25-<30; 3) 30-<35; 4) 35-<40; and 5) ≥ 40 (extreme obesity (EO)). Findings: Lifetime diagnosis of EO (BMI ≥ 40) was strongly associated with history of rape (ANOVA, p<0.001), childhood sexual abuse (p<0.001), childhood abuse (p<0.001), and current (p<0.001) and lifetime PTSD (p<0.001) in comparison to all other BMI groups. EO subjects were also most likely to engage in binge eating (p<0.001) and purging behaviors (p<0.001) and to meet DSM-IV criteria for BN, any ED (BN or BED), and MDD. Alcohol and drug abuse were not associated with obesity. Conclusion: These data suggest that crime-related victimization experiences (especially rape) and associated PTSD are important risk factors for EO, which is often also associated with bingeing, purging and bulimic EDs. Careful screening for victimization histories, PTSD, MDD, and EDs is warranted, especially in EO.