A new study published in the Journal of Eating Disorders revealed high rates of adverse childhood experiences among patients with eating disorders. Different diagnoses were linked to specific patterns of trauma. For example, patients with binge eating disorder were especially likely to report a history of physical and emotional abuse.
An adverse childhood experience (ACE) is a negative experience occurring during childhood that can result in lasting physical and emotional trauma. These stressors include emotional, physical, and sexual abuse and negative family experiences like parental alcoholism or intimate partner violence. A history of ACEs has been linked to psychiatric diagnoses in adulthood, including eating disorders.
Eating disorders are a range of psychological conditions that involve disordered eating, including anorexia nervosa and bulimia nervosa. These disorders can have serious medical consequences, are deeply detrimental to quality of life, and are associated with high rates of mortality. Since eating disorders have been linked to a history of trauma, a growing number of clinicians are recommending trauma-informed care as part of treatment.
“ACEs are associated with many mental and physical disorders later in life, and are highly prevalent among those with an eating disorder,” said study author Renee D. Rienecke, an adjunct associate professor at Northwestern University and director of research at the Eating Recovery Center/Pathlight Mood & Anxiety Centers.
“We were interested in seeing how the overall prevalence and types of ACEs among those with an eating disorder compare to ACEs among those in the general population, which, to our knowledge, had not been examined before,” she explained. “We also wanted to compare differences in ACEs among different eating disorder diagnoses. A history of trauma can negatively impact treatment outcome for eating disorders, so it is important to have a good understanding of the prevalence and extent of trauma in this population.”
Rienecke and her team conducted a study with the potential to help guide the implementation of trauma-informed care among patients with eating disorders. Specifically, they investigated the prevalence of ACEs among patients with eating disorders and analyzed whether certain eating disorder diagnoses are associated with distinct patterns of trauma.
A total of 1,061 adult patients with eating disorders were recruited from two private treatment facilities in the United States. The patients answered a survey where they self-reported their history of childhood trauma, indicating whether they had experienced various adverse events during childhood. The researchers then compared this survey data to a nationally representative sample of over 200,000 U.S. adults.
It was found that patients with eating disorders had higher overall ACE scores compared to the national sample. This was true across the whole sample and within each specific eating disorder diagnosis. Patients with eating disorders also reported higher rates of sexual abuse, parental divorce, and having a household member with mental illness. Although the patient sample was disproportionately female and white compared to the national sample, the higher levels of ACEs among patients remained after controlling for gender and race.
“The number of ACEs experienced by those with an eating disorder was higher than among those in the general population, patients with binge eating disorder had the highest rates of ACEs, and certain eating disorder diagnoses were associated with certain patterns of ACEs (not just an overall number of ACEs),” Rienecke told PsyPost.
Notably, patients with a binge eating disorder endorsed more ACEs than patients with anorexia nervosa—restricting subtype (AN-R) and were more likely to report a history of physical abuse. Patients with other specified feeding or eating disorder (OSFED) were more likely to report emotional abuse or parental substance abuse compared to patients with AN-R. Patients with bulimia nervosa were more likely to report household substance abuse compared to patients with AN-R.
Next, the researchers applied a statistical technique called latent class analysis to group the patients according to their patterns of childhood trauma. They found that certain diagnoses were associated with specific patterns of childhood trauma. Patients with OSFED were more likely than patients with AN-R to fall into the group labeled “Household ACEs”, which was characterized by divorce, substance use, and mental illness in the home. Patients with binge eating disorder were more likely than patients with AN-R to fall into the group “Abuse ACEs”, which was characterized by a history of physical abuse, emotional abuse, and household mental illness.
Rienecke and her colleagues say it is unclear why childhood trauma is linked to the development of eating disorders. They note that longitudinal research is needed to investigate contextual factors that might lead a person who experiences trauma to develop an eating disorder versus another condition like depression. Such research might also illuminate why patients with AN-R tend to show lower rates of ACEs compared to patients with other eating disorders.
“The biggest caveat here is that these results are just associations – we were not examining any causal explanations for why certain ACEs might be associated with certain eating disorders. In addition, this was a treatment-seeking sample and might not be representative of all individuals with an eating disorder,” Rienecke said.
“Many questions still remain to be addressed: why do patients with binge eating disorder have higher rates of ACEs than patients with restrictive eating disorders? Why are certain eating disorder diagnoses associated with certain types of ACEs? Why do some people who experience ACEs go on to develop an eating disorder as opposed to, for example, a depressive disorder? Would public health efforts at reducing ACEs lead to a corresponding decrease in the development of mental health disorders later in life?”
“The purpose of this paper was more hypothesis-generating than hypothesis-testing,” Rienecke added. “In other words, we wanted to look for patterns in the data that might provide insight into future specific questions that other researchers may wish to examine.”
The study, “Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma profiles”, was authored by Renee D. Rienecke, Craig Johnson, Daniel Le Grange, Jamie Manwaring, Philip S. Mehler, Alan Duffy, Susan McClanahan, and Dan V. Blalock.