Child Abuse and Development of EDs

Courtesy of Eating Disorders Review

The type of abuse had later effects on individual disorders.

A history of trauma during childhood is more common among patients with eating disorders than among the general population, and this relationship has been extensively studied. Results from a recent study at the University of Montpellier in southern France, add new information about early abuse and its effect on EDs (Scientific Reports; published online before print, doi: 10:1038/srep35761).

Dr. S. Guillaume and his colleagues report that while many studies of child abuse have focused upon sexual or physical abuse, far fewer have examined the effects of emotional abuse and neglect during childhood. The authors’ results indicate that more severe eating disorder symptoms may be related to specific types of childhood trauma. In their study, emotional abuse during childhood independently predicted higher Eating Disorders Examination Questionnaire (EDE-Q) scores for eating, weight, and shape concerns, along with poorer daily functioning. In contrast, sexual and physical abuse predicted greater EDE-Q eating concerns.

In their study, the researchers examined 192 consecutive young adult female patients admitted to an outpatient treatment unit (102 with anorexia nervosa, 64 with bulimia nervosa, and 26 with binge-eating disorder). For the clinical assessment, the psychiatrists administered the EDE-Q, and the Functioning Assessment Short Test (FAST). The FAST’s 24-item questionnaire assesses impairment or disability in 6 specific areas of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships and leisure time (Clin Pract Epidemiol Ment Health. 2007; 3:5). Childhood trauma was evaluated with the French version of the Childhood Trauma Questionnaire, which retrospectively examines 5 types of trauma through self-reports: sexual abuse, physical abuse, physical neglect, emotional abuse, and emotional neglect (J Am Acad Child Adolesc Psychiatry. 1997; 36:340).

Depression was the most common comorbidity

The most common lifetime comorbidities were major depressive disorders (77%) and anxiety disorders (42%). More than three-fourths of patients were college educated, and the mean age was 25 years. When evaluated for childhood trauma, 42% reported none, while 21% of the subjects had experienced at least 3 types of trauma. Emotional neglect was most common, reported by 36% of the women. Moderate-to-severe trauma was more common among patients with BN than among those with AN. The proportion of patients with physical and sexual trauma did not differ among the three groups. However, those found to have high scores for EDE-Q restraint had more psychiatric disorders, such as major depressive illness, bipolar disorder or substance abuse disorder, and were more likely to have had a lifetime history of suicide attempts than were patients with lower restraint scores.

One goal of the study was to scrutinize the impact of psychiatric comorbidities on the relationship between trauma during childhood and the subsequent severity of ED symptoms. The authors concluded that not all subtypes of abuse have the same impact upon patients. Instead, different types of abuse act additively to exacerbate “the severity of a wide range of ED features, including clinical and neuropsychological dimensions and daily functions.”