P2.A004: Eating Disorders in Adolescents: The Link Between Purging and Intimate Partner Violence in Both Sexes

Background: Intimate partner violence (IPV) in romantic relationships is a significant public health issue among adolescents, with lifetime victimization estimated at 69%. Past studies show a strong relationship between IPV and eating disorders (ED), namely purging behaviors. Purging is a common and dangerous manifestation of several eating disorders. Because identifying EDs early is critical for effective management and treatment, pediatric providers screening for EDs should account for the specific risk factors that predict disordered eating behaviors. Past work analyzing the relationship between IPV and eating disorders is limited by small samples, regional specificity, a focus on adults, and gender bias. To date, no studies have used a large, nationally representative dataset of adolescents to explore the associations between purging and IPV in both sexes. We sought to examine the relationship between IPV and purging behaviors among adolescents.

Methods: Data from the 2013 Youth Behavioral Risk Survey (N=10,988) were analyzed. The 2013 iteration is the most recent to include a question about purging behaviors. Multivariable logistic regression models were performed separately by sex and adjusted for racial identity/ethnicity and age to obtain adjusted odds ratios (aOR) and 95% confidence intervals (CI) for associations between IPV and purging.

Results: 6% of girls reported purging behaviors, compared to 2.15% of boys (p < 0.01). Being the victim of a single instance of sexual violence increased purging risk by 4.89 times for boys (95% CI 2.37-10.09, p < 0.01) and 2.33 times for girls (95% CI 1.54-3.51, p < 0.01). Similarly, four or more instances of physical IPV increased purging risk by 11.85 times for boys (95% CI 7.27-19.32, p < 0.01) and 4.28 times for girls (95% CI 2.73-6.71, p < 0.01). All instances of violence showed a statistically significant increase in purging risk for both sexes (p < 0.01), except for one-time physical violence in boys only (p = 0.06).

Conclusion: This study is the first to affirm the relationship between IPV and purging in a nationally representative sample of both sexes, providing guidance for pediatric providers who screen adolescents for both IPV and ED behaviors. These findings highlight the significantly elevated purging risk in boys who have experienced IPV and underscore the importance of tailored screening and management of eating disorders in boys, a historically underrepresented group in ED research.