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Ferreira P, Fraga S, Oliveira A. Association of adverse childhood experiences with dietary patterns of school-age children: evidence from the birth cohort Generation XXI. Am J Clin Nutr 2024; 120:328-335. [PMID: 38857694 DOI: 10.1016/j.ajcnut.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) have been associated with health-risk behaviors and several chronic diseases in adulthood. However, the relationship between exposure to ACEs and dietary patterns at school age is unknown. OBJECTIVES To investigate the association between ACEs and dietary patterns of 10-year-olds. METHODS The study included 5034 children from the Generation XXI cohort, recruited in 2005/2006 in Porto, Portugal. ACEs were assessed through a self-administered questionnaire covering the first 10 years (y) of life, quantified and grouped into 5 dimensions: "abuse," "school problems," "death/severe disease," "life changes," and "household dysfunction." Dietary patterns were identified by latent class analysis using data collected with a validated food frequency questionnaire. Five dietary patterns were studied: "low consumption," "energy-dense foods," "snacking," "intermediate consumption," and "healthier" (used as reference). Multinomial regression analyses were conducted, adjusted for the child's sex, household income, family structure, and mother's age [odds ratio (OR) and 99% confidence intervals (CIs)]. RESULTS Most children were exposed to ≥1 ACE (96%), and ∼27% had reported 6 or more ACEs throughout life. Those reporting 4-5 and ≥6 ACEs were more likely to follow the "Energy-dense foods" dietary pattern compared with those with no ACEs (OR: 2.41; 99% CI: 1.00, 5.77 and OR: 2.65; 99% CI: 1.10, 6.39, respectively). Children exposed to "abuse" in the first 10 y showed 28% higher odds of following the "low consumption" dietary pattern when compared to children with no reported ACEs and using the "healthier" dietary pattern as a reference (OR: 1.28; 99% CI: 1.00, 1.63). CONCLUSIONS Exposure to ACEs was associated with less healthy dietary patterns in school-aged children. Results suggest a cumulative effect of the adverse experiences resulting in a dietary pattern higher in energy-dense foods. Children with ACEs reported under the dimension of "abuse" seemed to have reduced food consumption.
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Affiliation(s)
- Pedro Ferreira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto (Epidemiology Research Unit, Institute of Public Health, University of Porto), Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Sílvia Fraga
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto (Epidemiology Research Unit, Institute of Public Health, University of Porto), Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreia Oliveira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto (Epidemiology Research Unit, Institute of Public Health, University of Porto), Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.
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Aloi M, Carcione A, Lo Coco G, Rania M, Carbone EA, de Filippis R, Segura-Garcia C, Liuzza MT. Metacognition as a transdiagnostic factor across eating disorders: a latent profile analysis study. Front Psychol 2024; 15:1391715. [PMID: 38988401 PMCID: PMC11234852 DOI: 10.3389/fpsyg.2024.1391715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Background Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA). Method A total of 395 patients with a DSM-5 diagnosis of ED (116 AN-R, 30 AN/BP, 100 BN, 149 BED) participated in this study. They completed self-report measures assessing metacognition, eating psychopathology, depression, emotional dysregulation, personality traits, and childhood adversities. LPA and Welch ANOVAs were conducted to identify profiles based on metacognition scores and examine psychological differences between them. Logistic regression models were employed to explore associations between personal characteristics and different profiles. Results A 3-class solution had a good fit to the data, revealing profiles of high functioning (HF), intermediate functioning (IF), and low functioning (LF) based on levels of metacognitive impairments. Participants in the IF group were older and had a higher BMI than those in the HF and LF groups. Individuals with BN were largely categorized into HF and LF profiles, whereas participants with BED were mainly included in the IF profile. Participants in the LF group reported an impaired psychological profile, with high levels of depression, emotional dysregulation, childhood adversity, and personality dysfunction. Multinomial logistic regression analyses showed significant associations between metacognitive profiles and emotional and neglect abuse, emotion dysregulation, and detachment. Conclusion This exploratory study unveils distinct metacognitive profiles in EDs, providing a foundation for future research and targeted interventions. In this light, metacognitive interpersonal therapy could be a valid and effective treatment for EDs, as suggested by the initial promising results for these patients.
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Affiliation(s)
- Matteo Aloi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy, Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
- Department of Human Science, University “Guglielmo Marconi”, Rome, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Elvira Anna Carbone
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Renato de Filippis
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Marco Tullio Liuzza
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
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Isaksson M, Isaksson J, Schwab-Stone M, Ruchkin V. Longitudinal associations between community violence exposure, posttraumatic stress symptoms, and eating disorder symptoms. J Eat Disord 2024; 12:6. [PMID: 38212849 PMCID: PMC10785541 DOI: 10.1186/s40337-024-00965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Eating disorder (ED) symptoms have been associated with different types of traumatic events, such as exposure to sexual and physical violence, and emotional abuse. However, the relation between ED symptoms and community violence exposure (CVE) is underexplored, despite the latter's adverse effects on many aspects of adolescent functioning. The primary aim of this study was to evaluate the relation between CVE and ED symptoms in adolescents, while also investigating the potential mediating and moderating roles of posttraumatic stress (PTS) symptoms, gender, and ethnicity. METHODS Data were collected longitudinally over two consecutive years in the city of New Haven, CT, in the United States. Participants were 2612 adolescent students from the public school system (1397 girls and 1215 boys) with an average age of 12.8 years (SD = 1.29). The students were comprised of several different ethnic groups, including Caucasians, African Americans and Hispanic Americans. Associations between CVE (no exposure, witnessing, and victimization) and PTS symptoms at year one, and ED symptoms (thoughts and compensatory behaviors) at year two, were assessed with self-rating instruments. Moderation and mediation analyses were conducted using a variant of linear regression (Hayes PROCESS macro). RESULTS ED symptoms at year two were significantly associated with both witnessing and being a victim of community violence at year one, with most or all of the relations being explained by PTS symptoms. Overall, neither gender nor ethnicity had a meaningful moderating effect in the observed relations. CONCLUSIONS The findings support the notion that assessing and addressing PTS symptoms might be beneficial when treating individuals with ED symptoms who have experienced community violence, irrespective of gender or ethnicity.
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Affiliation(s)
- Martina Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden
| | - Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Mary Schwab-Stone
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden.
- Child Study Center, Yale University School of Medicine, New Haven, USA.
- Sala Forensic Psychiatric Clinic, Sala, Sweden.
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Eielsen HP, Ulvenes P, Hoffart A, Rø Ø, Rosenvinge JH, Vrabel K. Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years. Int J Eat Disord 2024; 57:81-92. [PMID: 37897047 DOI: 10.1002/eat.24067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood. METHOD A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested. RESULTS We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome DISCUSSION: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential. PUBLIC SIGNIFICANCE Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care.
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Affiliation(s)
- Hanna Punsvik Eielsen
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Pål Ulvenes
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Jan H Rosenvinge
- Institute of Psychology, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway
| | - KariAnne Vrabel
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
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Fowler N, Mikhail ME, Neale M, Keel PK, Katzman DK, Sisk CL, Burt SA, Klump KL. Between- and within-person effects of stress on emotional eating in women: a longitudinal study over 49 days. Psychol Med 2023; 53:5167-5176. [PMID: 37650340 PMCID: PMC10471857 DOI: 10.1017/s0033291722002185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/24/2022] [Accepted: 06/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Stress is associated with binge eating and emotional eating (EE) cross-sectionally. However, few studies have examined stress longitudinally, limiting understanding of how within-person fluctuations in stress influence EE over time and whether stress is a risk factor or consequence of EE. Additionally, little is known regarding how the biological stress response relates to EE. METHODS We used an intensive, longitudinal design to examine between-person and within-person effects of major life stress, daily stress, and cortisol on EE in a population-based sample of women (N = 477; ages 15-30; M = 21.8; s.d. = 3.0) from the Michigan State University Twin Registry. Participants reported past year major life stress, then provided daily ratings of EE and stress for 49 consecutive days. Hair cortisol concentration (HCC) was collected as a longitudinal biological stress measure. RESULTS Women reported greater EE when they experienced greater mean stress across days (between-person effects) or greater stress relative to their own average on a given day (within-person effects). Daily stress was more strongly associated with EE than major life stress. However, the impact of daily stress on EE was amplified in women with greater past year major life stress. Finally, participants with lower HCC had increased EE. CONCLUSIONS Findings confirm longitudinal associations between stress and EE in women, and highlight the importance of within-person shifts in stress in EE risk. Results also highlight HCC as a novel biological stress measure that is significantly associated with EE and may overcome limitations of prior physiological stress response indicators.
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Affiliation(s)
- Natasha Fowler
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Megan E. Mikhail
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Michael Neale
- Department of Psychiatry, Human Genetics, and Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Debra K. Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl L. Sisk
- Neuroscience Program, Michigan State University, East Lansing, Michigan, USA
| | - S. Alexandra Burt
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Kelly L. Klump
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
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O'Loghlen E, Galligan R, Grant S. Childhood maltreatment, shame, psychological distress, and binge eating: testing a serial mediational model. J Eat Disord 2023; 11:96. [PMID: 37312168 PMCID: PMC10265894 DOI: 10.1186/s40337-023-00819-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE Despite evidence of causal relationships between childhood maltreatment and the development of binge eating disorder (BED), research on mediating mechanisms is lacking. The present study sought to understand the childhood maltreatment-binge eating relationship more fully by examining three types of shame (internal, external, body) and psychological distress as mediators in this relationship. There is evidence that shame and psychological distress are associated with both childhood maltreatment and binge eating pathology. It was hypothesised that shame stemming from childhood maltreatment would contribute to psychological distress, and to binge eating as a dysfunctional emotion regulation strategy, in a serial mediational model. METHOD Five hundred and thirty adults with self-reported binge eating symptoms completed an online survey, which included measures of childhood maltreatment, internal shame, external shame, body shame, psychological distress, and binge eating and other eating disorder symptoms. RESULTS Path analyses showed three specific relationships: (1) a relationship between childhood emotional maltreatment and binge eating, which was serially mediated by internal shame and psychological distress; (2) a relationship between childhood sexual abuse and binge eating, which was mediated by body shame; and (3) a relationship between childhood physical maltreatment and binge eating, which was mediated by psychological distress. We also found a feedback loop, whereby binge eating might lead to increased overvaluation of body shape and weight (possibly due to increased weight) and then to an increase in internal shame and body shame. The final model showed excellent fit for the data. DISCUSSION Findings extend our understanding of the link between childhood maltreatment and BED. Future intervention research should focus on examining the efficacy of interventions for different forms of childhood maltreatment, based on the key mediating factors.
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Affiliation(s)
- Elyse O'Loghlen
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Sharon Grant
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
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Martin GM, Tremblay J, Gagnon-Girouard MP. Sexual self-concept, functioning, and practices of women with binge eating episodes. Eat Weight Disord 2023; 28:37. [PMID: 37069446 PMCID: PMC10108796 DOI: 10.1007/s40519-023-01565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/21/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE Positive sexuality has received little empirical attention in relation to eating disorders. Two tendencies related to sexuality have been identified among women with anorexia nervosa (avoidance) and bulimia nervosa (disinhibition), but it is unclear if they also apply to women with binge eating episodes without compensatory behaviors. This study aimed at (1) exploring the sexual self-concept, functioning, and practices of women with binge eating episodes with or without comorbid restrictive and/or compensatory behaviors, considering past experiences of violence, and (2) verifying the presence of distinct profiles of sexual dispositions among this population. METHODS In total, 253 women reporting recurrent episodes of loss of control related to food intake in the past 5 years, completed a web-based questionnaire. Descriptive and correlational analyses were conducted to outline participants' sexual self-concept, functioning, and practices and to examine the relationship between these factors. A two-step cluster analysis was also performed to determine whether participants presented distinct profiles of sexual dispositions. RESULTS Participants were generally characterized by a negative sexual self-concept and poor sexual functioning. While a first subgroup of participants displayed a pattern of sexual difficulties and avoidance, a second subgroup had a positive sexual self-concept, better sexual functioning and a wider range of sexual practices. Subgroups did not differ relative to binge eating. CONCLUSIONS Sexuality offers a platform for positive embodiment, which can lead to the improvement of body image and mind-body connection and may thus constitute an essential clinical target to improve treatment related to binge eating episodes. LEVEL OF EVIDENCE Level II: The experimental study is a non-randomized controlled trial.
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Affiliation(s)
- Geneviève Manuela Martin
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, G1V 0A6, Québec, Canada.
| | - Jérôme Tremblay
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
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O'Loghlen E, Galligan R, Grant S. The functions of binge eating scale (FBES): Development and preliminary psychometric validation. Appetite 2023; 183:106479. [PMID: 36736905 DOI: 10.1016/j.appet.2023.106479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs). METHOD The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity. RESULTS Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs. DISCUSSION Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.
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Affiliation(s)
- Elyse O'Loghlen
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Sharon Grant
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
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Rosenberg T, Lahav Y, Ginzburg K. Child abuse and eating disorder symptoms: Shedding light on the contribution of identification with the aggressor. CHILD ABUSE & NEGLECT 2023; 135:105988. [PMID: 36493509 DOI: 10.1016/j.chiabu.2022.105988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Childhood abuse has been increasingly recognized as a risk factor for eating disorder symptoms. Additionally, it has been demonstrated that childhood abuse may lead to identification with the aggressor, an automatic defensive process, to survive the abuse. Although it has been clinically implied, the role of identification with the aggressor as a potential mechanism underlying the relation between childhood abuse and eating disorder symptoms has not yet been empirically explored. OBJECTIVE This study examines the role of identification with the aggressor as mediator in the association between history of childhood abuse and eating disorder symptoms among adults. PARTICIPANTS AND METHODS A convenience sample of 198 participants completed self-report questionnaires assessing history of childhood abuse, eating disorder symptoms, and the various facets of identification with the aggressor. RESULTS Severity of childhood abuse was significantly associated with shape and weight overevaluation, body dissatisfaction, and binge eating, as well as with all components of identification with the aggressor. In addition, almost all components of identification with the aggressor were significantly associated with eating disorder symptoms. Finally, identifying with the perpetrator's aggression mediated the association between childhood abuse and eating disorder symptoms. CONCLUSIONS The findings may contribute to future clinical interventions by illuminating identification with the aggressor as an important aspect in treating eating disorders. Understanding the pervasive effects of identification with the aggressor on survivors' self and their interactions with others may point to the significance of the therapeutic relationship, through which survivors can reprocess and weaken its detrimental effects.
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Affiliation(s)
- Tamar Rosenberg
- Tel Aviv University, Bob Shapell School of Social Work, Gershon H. Gordon Faculty of Social Sciences, Israel
| | - Yael Lahav
- Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Karni Ginzburg
- Tel Aviv University, Bob Shapell School of Social Work, Gershon H. Gordon Faculty of Social Sciences, Israel.
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The Effects of Childhood Emotional and Physical Maltreatment on Adolescents' Disordered Eating Behaviors: The Mediating Role of Borderline Personality Features. J Nerv Ment Dis 2022; 210:831-837. [PMID: 35703279 DOI: 10.1097/nmd.0000000000001556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over time, a complex crossroad between disordered eating behaviors (DEBs) and borderline personality features (BPFs) and their association with childhood emotional and physical maltreatment have been established. The present study aimed at evaluating the direct and indirect effect of physical and emotional abuse and neglect on DEB via BPF in a nonclinical adolescent sample. A total of 786 adolescents (48.3% male; mean age, 16.25 years; SD, 1.76) participated in the study. The mediation model suggested the pivotal predictive role of emotional maltreatment compared with the physical one. Indeed, both emotional abuse and neglect directly and indirectly predicted disordered eating via BPF ( β = 0.097; p < 0.001 and β = 0.042; p < 0.01, respectively). Likely, the emotional maltreatment represents the beginning of a developmental cascade that culminates in DEB as a maladaptive coping strategy in response to negative emotions, through BPF. On the contrary, physical maltreatment seems to be less involved in the developmental cascade.
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Eating disorders among middle school students in a Chinese population: Prevalence and associated clinical correlates. J Psychiatr Res 2022; 154:278-285. [PMID: 35964346 DOI: 10.1016/j.jpsychires.2022.07.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Eating disorders are regarded to be associated with many psychological and behavioral problems. Moreover, adolescence has been reported to be the key period for developing eating habits, and eating disorders typically emerge in adolescence and early adulthood. This study aimed to investigate the prevalence of eating disorders and explore the associated factors among adolescents in Hunan province, China METHODS: A total of 1610 middle school students from Hunan province, China, were enrolled in this study. The participants were aged from 11 to 16 years old. The following data were collected: demographic variables, Body Mass Index (BMI), suicidal behaviors, non-suicidal self-injury, depression, anxiety, stress (depression - anxiety - stress scale, DASS-21), childhood trauma (Childhood Trauma Questionnaire, CTQ), symptoms of social anxiety (Social Anxiety Scale-Adolescents, SAS-A), and eating problems (Eating Attitudes Test, EAT-26). RESULTS The estimated prevalence of eating disorders was 8.9%. Compared with participants without eating disorders, participants with eating disorders were more likely to be at a younger age, obese and overweight, and have a history of non-suicidal self-injury, suicidal ideation, suicidal plans, suicide attempts, emotional abuse, physical abuse, emotional neglect, and physical neglect; more likely to experience stress, anxiety or depression as well as have high scores of social avoidance and distress related to general social contexts. Anxiety, emotional neglect, physical neglect, obesity, and overweight were still significant in the binary logistic regression model after controlling for confounding factors. Additionally, younger age, emotional abuse, physical abuse, stress, anxiety, depression, social avoidance, and distress related to general social contexts were significantly correlated with the EAT-26 scores in correlation analysis CONCLUSIONS: Eating disorders are quite common among middle school students. Moreover, eating disorders are associated with younger age, non-suicidal self-injury, suicidal ideation, suicide attempts, stress, anxiety, depression, emotional abuse, physical abuse, emotional neglect, physical neglect, social avoidance, and distress related to general social contents and BMI. This study provides a reference for school counselors and clinicians in the prevention and treatment of eating disorders.
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Borg SL, Schaefer LM, Hazzard VM, Herting N, Peterson CB, Crosby RD, Crow SJ, Engel SG, Wonderlich SA. Relationships Between Childhood Abuse and Eating Pathology Among Individuals with Binge-Eating Disorder: examining the Moderating Roles of Self-Discrepancy and Self-Directed Style. Eat Disord 2022; 30:355-369. [PMID: 33734931 PMCID: PMC8448781 DOI: 10.1080/10640266.2020.1864588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Childhood maltreatment appears to increase the risk for eating disorders (EDs). The current study examined potential moderating factors (i.e., self-discrepancy and negative self-directed style), which may increase or decrease the impact of maltreatment (i.e., emotional abuse, physical abuse, sexual abuse) on later ED symptoms. One hundred seven men and women with binge-eating disorder (BED) completed semi-structured interviews and questionnaires assessing childhood maltreatment, self-discrepancy, negative self-directed style, and ED pathology. Linear regression was used to examine the moderating role of self-discrepancy and negative self-directed style in the associations between each type of abuse and level of ED severity. Actual:ought self-discrepancy (i.e., the difference between one's self and who one believes they ought to be) moderated the relationships between ED pathology and emotional abuse (β =.26 p =.007), as well as physical abuse (β =.23, p =.02). Results suggest that the relationship between childhood abuse (i.e., emotional abuse, physical abuse) and ED pathology may be stronger for those with higher levels of actual:ought self-discrepancy. Further clarification of the relationships between actual:ought self-discrepancy and distinct forms of childhood abuse is needed, as well as intervention studies examining whether targeting actual:ought self-discrepancy provides an additional benefit for trauma-exposed individuals with BED.
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Affiliation(s)
- Skylar L. Borg
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
| | - Lauren M. Schaefer
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
| | - Vivienne M. Hazzard
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
| | - Nicola Herting
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- Red River Children’s Advocacy Center, Fargo, North Dakota, USA
| | - Carol B. Peterson
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, Minnesota, USA
| | - Ross D. Crosby
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, North Dakota, USA
| | - Scott J. Crow
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, Minnesota, USA
- The Emily Program, St. Paul, Minnesota, USA
| | - Scott G. Engel
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, North Dakota, USA
| | - Stephen A. Wonderlich
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, North Dakota, USA
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Talmon A, Widom CS. Childhood Maltreatment and Eating Disorders: A Prospective Investigation. CHILD MALTREATMENT 2022; 27:88-99. [PMID: 33525891 DOI: 10.1177/1077559520988786] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine whether childhood maltreatment is a risk factor for two eating disorders (anorexia nervosa and bulimia nervosa) using objective and subjective case definitions. METHODS Using a prospective cohorts design, children with documented cases of physical abuse, sexual abuse, and neglect (ages 0-11) from 1967 to 1971 in a Midwestern metropolitan county area were matched on age, race, sex, and approximate family socioeconomic status with non-maltreated children. Both groups were followed up. Retrospective self-reports about childhood maltreatment were collected at age 29. DSM-IV anorexia nervosa (AN) and bulimia nervosa (BN) disorders were assessed at age 41 (N = 807). Logistic and linear regression results are reported. RESULTS Using documented cases, childhood maltreatment was not a significant risk factor for AN or BN diagnoses or symptoms in adulthood. However, adults who retrospectively reported any maltreatment and physical and sexual abuse reported significantly more symptoms of AN than those who did not. CONCLUSIONS The prediction that childhood maltreatment is a risk factor for anorexia nervosa and bulimia nervosa was partially supported in this longitudinal study. While misattribution of cases might have occurred, these results suggest that researchers and clinicians should use caution in drawing inferences about these relationships and designing interventions.
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Affiliation(s)
- Anat Talmon
- Psychology Department, 6429Stanford University, Stanford, CA, USA
| | - Cathy Spatz Widom
- Psychology Department, 14775John Jay College, and Graduate Center, City University of New York, NY, USA
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Childhood trauma and disordered eating: Exploring the role of alexithymia and beliefs about emotions. Appetite 2020; 154:104802. [PMID: 32717292 DOI: 10.1016/j.appet.2020.104802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/04/2020] [Accepted: 07/11/2020] [Indexed: 11/21/2022]
Abstract
Although often perceived as non-threatening, disordered eating poses a significant risk to physical and psychological wellbeing. Given the modest effectiveness of current interventions, there is a need to identify specific psychological targets for treatment. One risk factor that has long been liked to eating issues is childhood trauma. The present study aimed to clarify the associations between five distinct forms of trauma and three disordered eating behaviours (Cognitive Restraint, Uncontrolled Eating, and Emotional Eating). In addition, it aimed to determine the role of alexithymia and beliefs about emotions in this association. Three hundred and thirty-two participants from the Australian community completed an online questionnaire measuring alexithymia, beliefs about emotions, disordered eating, and childhood trauma. Hierarchical multiple regression analyses were conducted to examine total effects between independent forms of childhood trauma and eating behaviours, followed by bootstrapped confidence intervals to delineate indirect effects. A significant direct association was evidenced between Childhood Emotional Abuse and Cognitive Restraint, in addition to Childhood Sexual Abuse and Emotional Eating. Numerous indirect effects were detected involving the beliefs that emotions are 'Overwhelming and Uncontrollable' and 'Damaging'. Findings indicated that experiences of childhood trauma were associated with disordered eating behaviours through the detection of significant total and/or indirect effects. However, effect sizes of indirect effects (involving beliefs about emotions) were small, suggesting that there are additional factors involved. Further longitudinal research is necessary to determine the causal direction of these findings.
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15
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Li ET, Carracher E, Bird T. Linking childhood emotional abuse and adult depressive symptoms: The role of mentalizing incapacity. CHILD ABUSE & NEGLECT 2020; 99:104253. [PMID: 31812024 DOI: 10.1016/j.chiabu.2019.104253] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Accumulated evidence suggests that childhood emotional abuse is particularly related to adulthood depression. However, this connection demands further explanation regarding potential intermediate factors. OBJECTIVE This study aims to disentangle the independent effects of emotional abuse on adulthood depressive symptoms by statistically controlling for other forms of childhood maltreatment, and to examine mentalizing incapacity (i.e., hypermentalizing, hypomentalizing) as a potential mediator in this relationship. PARTICIPANTS A general sample of 205 adults were assessed online. METHOD Participants completed a set of self-report measures assessing childhood maltreatment history, mentalizing and depression symptoms. Hierarchical multiple regression was employed to assess the independent effect of emotional abuse on depression. Bootstrap analysis was used to test mediation models. RESULTS Emotional abuse continued to exert a significant effect on adulthood depression after controlling for other forms of childhood maltreatment and mentalizing incapacity. A mediation effect between childhood emotional abuse and adulthood depression symptoms via mentalizing incapacity, both hypermentalizing (b = 2.02, 95 % CI [0.96, 3.25]) and hypomentalizing, (b = 1.26, 95 % CI [0.59, 1.99]), was established. CONCLUSIONS This study provided preliminary evidence for hypermentalizing and hypomentalizing as mechanisms whereby early emotional abuse can lead to later depression. A normal to high level of mentalizing capacity might serve as a protective factor to suspend the pathway from childhood maltreatment to subsequent depression and become a promising target in psychological treatments. As cross-sectional data does not allow conclusions to be drawn on causal relationships, longitudinal data in a more representative sample is needed to capture relevant context and further examine our findings.
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Affiliation(s)
- Elizabeth Tianyu Li
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ellen Carracher
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom.
| | - Timothy Bird
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
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16
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Belli H, Ural C, Akbudak M, Sagaltıcı E. Levels of childhood traumatic experiences and dissociative symptoms in extremely obese patients with and without binge eating disorder. Nord J Psychiatry 2019; 73:527-531. [PMID: 31502911 DOI: 10.1080/08039488.2019.1662085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: It has been suggested that obese patients with binge eating disorder (BED) show higher levels of dissociation and childhood trauma. Aim: This study assesses childhood trauma history and dissociative symptoms in obese patients with BED compared to obese patients without BED. Methods: The 241 patients participating in the study had to meet obesity criteria. These patients were applicants for bariatric surgery and were consulted by a psychiatry service. Patients were separated into two groups that were accompanied by BED diagnoses according to structured clinical interviews administered according to the DSM-IV (SCID-I). Patients were assessed using the Dissociation Questionnaire (DIS-Q) and the Childhood Trauma Questionnaire (CTQ). The two groups of patients were compared. Results: A total of 75 (31.1%) of the 241 obese patients were diagnosed with BED. The study showed that obese patients with BED had higher dissociative scores than those without BED (p < .05). The results showed higher total scores and two different types of childhood trauma (physical abuse and emotional abuse) in BED patients compared to non-BED patients (p < .05). Conclusions: Clinicians should be fully aware of BED, dissociative symptoms and childhood traumatic experiences. These results show that, for at least a sub-group of obese patients, BED is associated with obesity and may be connected with dissociative symptoms and childhood physical abuse and emotional abuse.
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Affiliation(s)
- Hasan Belli
- Department of Psychiatry, Bagcilar Education and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Cenk Ural
- Department of Psychiatry, Bagcilar Education and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Mahir Akbudak
- Department of Psychiatry, Mardin State Hospital , Mardin , Turkey
| | - Eser Sagaltıcı
- Department of Psychiatry, Bagcilar Education and Research Hospital, University of Health Sciences , Istanbul , Turkey
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17
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Fowler N, Vo PT, Sisk CL, Klump KL. Stress as a potential moderator of ovarian hormone influences on binge eating in women. F1000Res 2019; 8. [PMID: 30854192 PMCID: PMC6396839 DOI: 10.12688/f1000research.16895.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/30/2022] Open
Abstract
Previous research has demonstrated significant associations between increased levels of ovarian hormones and increased rates of binge eating (BE) in women. However, whereas all women experience fluctuations in ovarian hormones across the menstrual cycle, not all women binge eat in response to these fluctuations, suggesting that other factors must contribute. Stress is one potential contributing factor. Specifically, it may be that hormone-BE associations are stronger in women who experience high levels of stress, particularly as stress has been shown to be a precipitant to BE episodes in women. To date, no studies have directly examined stress as a moderator of hormone-BE associations, but indirect data (that is, associations between BE and stress and between ovarian hormones and stress) could provide initial clues about moderating effects. Given the above, the purpose of this narrative review was to evaluate these indirect data and their promise for understanding the role of stress in hormone-BE associations. Studies examining associations between all three phenotypes (that is, ovarian hormones, stress, and BE) in animals and humans were reviewed to provide the most thorough and up-to-date review of the literature on the potential moderating effects of stress on ovarian hormone-BE associations. Overall, current evidence suggests that associations between hormones and BE may be stronger in women with high stress levels, possibly via altered hypothalamic-pituitary-adrenal axis response to stress and increased sensitivity to and altered effects of ovarian hormones during stress. Additional studies are necessary to directly examine stress as a moderator of ovarian hormone-BE associations and identify the mechanisms underlying these effects.
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Affiliation(s)
- Natasha Fowler
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
| | - Phuong T Vo
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
| | - Cheryl L Sisk
- Neuroscience Program, Michigan State University, 293 Farm Lane, East Lansing, MI, 48824-1116, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
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18
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Palmisano GL, Innamorati M, Sarracino D, Bosco A, Pergola F, Scaltrito D, Giorgio B, Vanderlinden J. Trauma and dissociation in obese patients with and without binge eating disorder: A case – control study. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1470483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Giovanni Luca Palmisano
- Department of Psychology of the University of Bari “Aldo Moro”, Piazza Umberto I, 70121 Bari, BA, Italy
| | - Marco Innamorati
- Department of History, Cultural Heritage, Education and Society of the University of Rome “Tor Vergata”, Via Columbia 1, 00133 Roma, Italy
| | - Diego Sarracino
- Department of Psychology, University of Milan “Bicocca”, Piazza dell’Ateneo Nuovo 1, CP 20126 Milan, MI, Italy
| | - Andrea Bosco
- Department of Psychology of the University of Bari “Aldo Moro”, Piazza Umberto I, 70121 Bari, BA, Italy
| | - Filippo Pergola
- Department of History, Cultural Heritage, Education and Society of the University of Rome “Tor Vergata”, Via Columbia 1, 00133 Roma, Italy
| | - Daniela Scaltrito
- Department of Psychiatry of "Santa Maria Del Piede" Hospital, Eating Disorder Center “Salvatore Cotugno”, Gravina in Puglia, Via S Maria Del Piede 5, Bari, CP 70024, Italy
| | - Bartolomeo Giorgio
- Department of Psychiatry of "Santa Maria Del Piede" Hospital, Eating Disorder Center “Salvatore Cotugno”, Gravina in Puglia, Via S Maria Del Piede 5, Bari, CP 70024, Italy
| | - Johan Vanderlinden
- Eating Disorder Unit, University Psychiatric Center K.U. Leuven, Campus Kortenberg, Leuvense Steenweg 517, B-3070 Kortenberg, Belgium
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19
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Castellini G, Lelli L, Cassioli E, Ciampi E, Zamponi F, Campone B, Monteleone AM, Ricca V. Different outcomes, psychopathological features, and comorbidities in patients with eating disorders reporting childhood abuse: A 3-year follow-up study. EUROPEAN EATING DISORDERS REVIEW 2018. [PMID: 29542195 DOI: 10.1002/erv.2586] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to evaluate the role of childhood adversities in long-term outcomes in eating disorders (EDs). One hundred thirty-three eating disorder patients were studied by means of the Structured Clinical Interview for DSM-IV and psychometric tests, at baseline, at the end of individual cognitive behavioural therapy, and at 3-year follow-up. As compared with the other patients, those reporting childhood abuse (overall: 24.8%; physical abuse: 20.3%; sexual abuse: 13.6%) showed higher impulsivity, psychiatric comorbidity, lower full recovery at follow-up (12.1% vs. 31%), and higher diagnostic crossover (39.4% vs. 13.0%). The different rates of recovery were mostly due to a higher persistence of depression in abused patients (77.8% vs. 26.7%). Patients with both abuse and neglect had a higher probability of dropout. Eating disorder patients with childhood abuse represent a group of persons with more complex psychopathological features and a worse long-term outcome, thus requiring specific treatment strategies.
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Affiliation(s)
| | - Lorenzo Lelli
- Psychiatry Unit, Department Health Science, University of Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department Health Science, University of Florence, Italy
| | - Eleonora Ciampi
- Psychiatry Unit, Department Health Science, University of Florence, Italy
| | - Francesco Zamponi
- Psychiatry Unit, Department Health Science, University of Florence, Italy
| | - Beatrice Campone
- Psychiatry Unit, Department Health Science, University of Florence, Italy
| | | | - Valdo Ricca
- Psychiatry Unit, Department Health Science, University of Florence, Italy
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20
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Palmisano GL, Innamorati M, Susca G, Traetta D, Sarracino D, Vanderlinden J. Childhood Traumatic Experiences and Dissociative Phenomena in Eating Disorders: Level and Association with the Severity of Binge Eating Symptoms. J Trauma Dissociation 2018; 19:88-107. [PMID: 28281939 DOI: 10.1080/15299732.2017.1304490] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the current study is to evaluate the presence of childhood trauma, psychoform, and somatoform dissociation in eating disorders (ED). Eighty-six ED outpatients participated in this study, 20 of them were diagnosed with restrictive anorexia (AN-R), 10 of them with anorexia nervosa binge-purging subtypes (AN-B), 25 with bulimia nervosa (BN), and 31 with binge eating disorder (BED). They were matched by sex and age with a control group consisting of 86 healthy subjects (HC). Traumatic experiences were assessed by means of the Childhood Trauma Questionnaire (CTQ), psychological, and somatoform dissociation, respectively, by means of the Dissociative Experience Scale (DES-II) and Somatoform Dissociation Questionnaire (SDQ-20), and binge eating symptoms by means of Binge Eating Scale (BES). ED subjects showed higher levels of childhood trauma, and both psychoform and somatoform dissociation compared to HC subjects. ED patients showed higher levels of childhood trauma compared to the HC group. No significant differences were shown between ED subgroups with respect to all forms of childhood trauma. BN and AN-B subgroups showed higher levels of both psychological and somatoform dissociation. Dissociation and childhood trauma predicted the severity of binge eating symptoms. Our results confirm previous studies in the same field.
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Affiliation(s)
| | - Marco Innamorati
- b Department of Science and Technology of Education , University of Rome "Tor Vergata" , Roma , Italy
| | - Giovanna Susca
- a Department of Psychology , University of Bari "Aldo Moro" , Bari , Italy
| | - Denise Traetta
- c Eating Disorder Center "Salvatore Cotugno" , Department of Psychiatry, "Azienda Unità Sanitaria Locale-4" , Bari , Italy
| | - Diego Sarracino
- d Department of Psychology , University of Milan "Bicocca" , Milano , Italy
| | - Johan Vanderlinden
- e Eating Disorder Unit of the University Psychiatric Center K.U. Leuven , Kortenberg , Belgium
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21
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Afifi TO, Sareen J, Fortier J, Taillieu T, Turner S, Cheung K, Henriksen CA. Child maltreatment and eating disorders among men and women in adulthood: Results from a nationally representative United States sample. Int J Eat Disord 2017; 50:1281-1296. [PMID: 28990206 PMCID: PMC5698735 DOI: 10.1002/eat.22783] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Child maltreatment is associated with an increased likelihood of having mood disorders, anxiety disorders, post-traumatic stress disorder, substance use disorders, and personality disorders, but far less is known about eating disorders. The objective of the current study was to examine the associations between child maltreatment, including harsh physical punishment, physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence, and eating disorders in adulthood among men and women. METHOD Data were from the National Epidemiologic Survey on Alcohol and Related Conditions wave 3 (NESARC-III) collected in 2012-2013. The sample was nationally representative of the United States adult population (N = 36,309). Lifetime eating disorders (anorexia nervosa [AN], bulimia nervosa [BN], and binge-eating disorder [BED]) were assessed using diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria and the alcohol use disorder and associated disabilities interview schedule-5 (AUDADIS-5). RESULTS The prevalence of any lifetime eating disorder was 1.7% (0.8% among men and 2.7% among women). All child maltreatment types were associated with AN, BN, and BED with notable differences among men and women. Overall, the types of child maltreatment with the strongest relationships with any eating disorder were sexual abuse and physical neglect among men and sexual abuse and emotional abuse among women. DISCUSSION Clinicians should be mindful that child maltreatment experiences are associated with increased odds of eating disorders including AN, BED, and BN. Such relationships are significant among men and women although notable gender differences in these relationships exist. Abstract word count = 248.
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Affiliation(s)
- Tracie O. Afifi
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada,Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Jitender Sareen
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada
| | - Janique Fortier
- Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Tamara Taillieu
- Applied Health Sciences Program, University of ManitobaManitobaR3E 0W5Canada
| | - Sarah Turner
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada,Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Kristene Cheung
- Department of PsychologyUniversity of ManitobaManitobaR3E 0W5Canada
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22
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Kimber M, McTavish JR, Couturier J, Boven A, Gill S, Dimitropoulos G, MacMillan HL. Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review. BMC Psychol 2017; 5:33. [PMID: 28938897 PMCID: PMC5610419 DOI: 10.1186/s40359-017-0202-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/04/2017] [Indexed: 12/18/2022] Open
Abstract
Background Child maltreatment and eating disorders are significant public health problems. Yet, to date, research has focused on the role of child physical and sexual abuse in eating-related pathology. This is despite the fact that globally, exposure to emotional abuse, emotional neglect and intimate partner violence are the three of the most common forms of child maltreatment. The objective of the present study is to systematically identify and critically review the literature examining the association between child emotional abuse (EA), emotional neglect (EN), and exposure to intimate partner violence (IPV) and adult eating-disordered behavior and eating disorders. Methods A systematic search was conducted of five electronic databases: Medline, Embase, PsycINFO, CINAHL, and ERIC up to October 2015 to identify original research studies that investigated the association between EA, EN and children’s exposure to IPV, with adult eating disorders or eating-disordered behavior using a quantitative research design. Database searches were complemented with forward and backward citation chaining. Studies were critically appraised using the Quality in Prognosis Studies (QUIPS) tool. Results A total of 5556 publications were screened for this review resulting in twenty-three articles included in the present synthesis. These studies focused predominantly on EA and EN, with a minority examining the role of child exposure to IPV in adult eating-related pathology. Prevalence of EA and EN ranged from 21.0% to 66.0%, respectively. No prevalence information was provided in relation to child exposure to IPV. Samples included predominantly White women. The methodological quality of the available literature is generally low. Currently, the available literature precludes the possibility of determining the extent to which EA, EN or child exposure to IPV have independent explanatory influence in adult eating-related pathology above what has been identified for physical and sexual abuse. Conclusions While a large proportion of adults with eating disorders or eating-disordered behavior report EA, EN, or child exposure to IPV , there is a paucity of high-quality evidence about these relationships. Electronic supplementary material The online version of this article (10.1186/s40359-017-0202-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Offord Centre for Child Studies, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.
| | - Jill R McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Offord Centre for Child Studies, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Alison Boven
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sana Gill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Offord Centre for Child Studies, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.,Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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23
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Molendijk ML, Hoek HW, Brewerton TD, Elzinga BM. Childhood maltreatment and eating disorder pathology: a systematic review and dose-response meta-analysis. Psychol Med 2017; 47:1402-1416. [PMID: 28100288 DOI: 10.1017/s0033291716003561] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Meta-analyses have established a high prevalence of childhood maltreatment (CM) in patients with eating disorders (EDs) relative to the general population. Whether the prevalence of CM in EDs is also high relative to that in other mental disorders has not yet been established through meta-analyses nor to what extent CM affects defining features of EDs, such as number of binge/purge episodes or age at onset. Our aim is to provide meta-analyses on the associations between exposure to CM (i.e. emotional, physical and sexual abuse) on the occurrence of all types of EDs and its defining features. METHOD Systematic review and meta-analyses. Databases were searched until 4 June 2016. RESULTS CM prevalence was high in each type of ED (total N = 13 059, prevalence rates 21-59%) relative to healthy (N = 15 092, prevalence rates 1-35%) and psychiatric (N = 7736, prevalence rates 5-46%) control groups. ED patients reporting CM were more likely to be diagnosed with a co-morbid psychiatric disorder [odds ratios (ORs) range 1.41-2.46, p < 0.05] and to be suicidal (OR 2.07, p < 0.001) relative to ED subjects who were not exposed to CM. ED subjects exposed to CM also reported an earlier age at ED onset [effect size (Hedges' g) = -0.32, p < 0.05], to suffer a more severe form of the illness (g = 0.29, p < 0.05), and to binge-purge (g = 0.31, p < 0.001) more often compared to ED patients who did not report any CM. CONCLUSION CM, regardless of type, is associated with the presence of all types of ED and with severity parameters that characterize these illnesses in a dose dependent manner.
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Affiliation(s)
- M L Molendijk
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| | - H W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, Columbia University, New York, USA
| | - T D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - B M Elzinga
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
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Pignatelli AM, Wampers M, Loriedo C, Biondi M, Vanderlinden J. Childhood neglect in eating disorders: A systematic review and meta-analysis. J Trauma Dissociation 2017; 18:100-115. [PMID: 27282982 DOI: 10.1080/15299732.2016.1198951] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Individuals with eating disorders (EDs) often report a history of early traumatization. Although great attention has been paid to certain types of trauma, such as sexual and emotional abuse, less is known about the occurrence of childhood neglect in individuals with EDs. The aim of the present meta-analysis was to provide an estimate of the prevalence of childhood emotional neglect (EN) and physical neglect (PN) in individuals with EDs. A systematic literature search, a critical appraisal of the collected studies, and a meta-analysis were conducted. An electronic search of EMBASE, PsycINFO, PubMed, and the Cochrane Library from the inception of these databases up to July 2015 was performed. The final meta-analyzed data set included 7 studies focusing on EN in EDs (N = 963) and 6 on PN in EDs (N = 665). Our meta-analytic data showed that among individuals with EDs, the prevalence of childhood EN is 53.3%, whereas 45.4% reported experience of childhood PN. These preliminary findings confirm the high prevalence of childhood EN and PN in ED samples compared to the general population and underline the importance of systematically screening for the presence of neglect as a possible traumatic experience in individuals with EDs, as its presence may have important consequences for the therapeutic approach.
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Affiliation(s)
- Annalisa M Pignatelli
- a Department of Neurology and Psychiatry , "Sapienza" University of Rome , Rome , Italy
| | - Martien Wampers
- b University Psychiatric Center KU Leuven, Eating Disorder Unit , Leuven , Belgium
| | - Camillo Loriedo
- a Department of Neurology and Psychiatry , "Sapienza" University of Rome , Rome , Italy
| | - Massimo Biondi
- a Department of Neurology and Psychiatry , "Sapienza" University of Rome , Rome , Italy
| | - Johan Vanderlinden
- b University Psychiatric Center KU Leuven, Eating Disorder Unit , Leuven , Belgium
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25
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Associations between adverse childhood experiences and clinical characteristics of eating disorders. Sci Rep 2016; 6:35761. [PMID: 27804994 PMCID: PMC5090200 DOI: 10.1038/srep35761] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/03/2016] [Indexed: 11/10/2022] Open
Abstract
Patients with eating disorders (EDs) frequently report a history of childhood trauma (CT). We investigated whether certain subtypes of CT are associated with more severe features of EDs, independently of psychiatric comorbidity, and whether they act additively. One hundred and ninety-two patients with DSM-V-defined EDs were consecutively recruited. Five clinical characteristics were assessed: restraint, eating, shape and weight concerns on the EDE-Q, and daily functioning. CT was assessed by the childhood traumatism questionnaire. The clinical features were associated with at least one CT subtype (emotional, sexual or physical abuse, emotional neglect). Multivariate analyses adjusted for lifetime comorbid psychiatric disorders revealed that emotional abuse independently predicted higher eating, shape and weight concerns and lower daily functioning, whereas sexual and physical abuse independently predicted higher eating concern. A dose-effect relationship characterised the number of CT subtypes and the severity of the clinical features, suggesting a consistent and partly independent association between CT and more severe clinical and functional characteristics in EDs. Emotional abuse seems to have the most specific impact on ED symptoms. Last, not all CT subtypes have the same impact but they do act additively.
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26
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Castellini G, Lelli L, Tedde A, Piaceri I, Bagnoli S, Lucenteforte E, Sorbi S, Monteleone AM, Hudziak JJ, Nacmias B, Ricca V. Analyses of the role of the glucocorticoid receptor gene polymorphism (rs41423247) as a potential moderator in the association between childhood overweight, psychopathology, and clinical outcomes in Eating Disorders patients: A 6 years follow up study. Psychiatry Res 2016; 243:156-60. [PMID: 27400218 DOI: 10.1016/j.psychres.2016.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/13/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
Abstract
Childhood overweight and the SNP rs41423247 of the glucocorticoid receptor gene (GR) were reported to represent predisposing factors for Eating Disorders (EDs). The distribution of the polymorphism was evaluated in 202 EDs patients, and in 116 healthy subjects. The Structured Clinical Interview for the DSM-IV and self-reported questionnaires were administered at the admission to the clinic and at 3 time points (end of a cognitive behavioral therapy, 3 and 6 years follow up). G-allele was associated with childhood overweight, depressive disorder comorbidity, and diagnostic instability. G-allele carriers reporting childhood overweight showed greater frequency of subjective binge eating and emotional eating.
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Affiliation(s)
- Giovanni Castellini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy; Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Italy
| | - Lorenzo Lelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Andrea Tedde
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Irene Piaceri
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Ersilia Lucenteforte
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | | | - James J Hudziak
- Vermont Center for Children, Youth, and Families, University of Vermont, Burlington, VT, United States; Erasmus University, Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Child Psychiatry, Washington University, St. Louis, MO, United States
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Valdo Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy.
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27
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Chiesa M, Larsen-Paya M, Martino M, Trinchieri M. The relationship between childhood adversity, psychiatric disorder and clinical severity: results from a multi-centre study. PSYCHOANALYTIC PSYCHOTHERAPY 2016. [DOI: 10.1080/02668734.2016.1145131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Palmisano GL, Innamorati M, Vanderlinden J. Life adverse experiences in relation with obesity and binge eating disorder: A systematic review. J Behav Addict 2016; 5:11-31. [PMID: 28092189 PMCID: PMC5322988 DOI: 10.1556/2006.5.2016.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/14/2016] [Accepted: 01/17/2016] [Indexed: 01/11/2023] Open
Abstract
Background and aims Several studies report a positive association between adverse life experiences and adult obesity. Despite the high comorbidity between binge eating disorder (BED) and obesity, few authors have studied the link between trauma and BED. In this review the association between exposure to adverse life experiences and a risk for the development of obesity and BED in adulthood is explored. Methods Based on a scientific literature review in Medline, PubMed and PsycInfo databases, the results of 70 studies (N = 306,583 participants) were evaluated including 53 studies on relationship between adverse life experiences and obesity, 7 studies on post-traumatic stress disorder (PTSD) symptoms in relation to obesity, and 10 studies on the association between adverse life experiences and BED. In addition, mediating factors between the association of adverse life experiences, obesity and BED were examined. Results The majority of studies (87%) report that adverse life experiences are a risk factor for developing obesity and BED. More precisely a positive association between traumatic experiences and obesity and PTSD and obesity were found, respectively, in 85% and 86% of studies. Finally, the great majority of studies (90%) between trauma and the development of BED in adulthood strongly support this association. Meanwhile, different factors mediating between the trauma and obesity link were identified. Discussion and conclusions Although research data show a strong association between life adverse experiences and the development of obesity and BED, more research is needed to explain this association.
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Affiliation(s)
| | - Marco Innamorati
- Department of Science and Technology of Education, University of Rome “Tor Vergata”, Rome, Italy
| | - Johan Vanderlinden
- Eating Disorder Unit, University Psychiatric Center K.U. Leuven, Leuven, Belgium
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29
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Klatzkin RR, Gaffney S, Cyrus K, Bigus E, Brownley KA. Binge eating disorder and obesity: Preliminary evidence for distinct cardiovascular and psychological phenotypes. Physiol Behav 2015; 142:20-7. [DOI: 10.1016/j.physbeh.2015.01.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 01/12/2023]
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30
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Brewerton TD, Rance SJ, Dansky BS, O'Neil PM, Kilpatrick DG. A comparison of women with child-adolescent versus adult onset binge eating: results from the National Women's Study. Int J Eat Disord 2014; 47:836-43. [PMID: 24904009 DOI: 10.1002/eat.22309] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Studies of age of first binge have been conducted in clinical samples of patients with bulimia nervosa (BN) and binge eating disorder (BED), but few studies have examined age of first binge using nationally representative samples. METHOD We examined age of first binge and its clinical correlates using data generated from the National Women's Study (n = 3,006). Participants who endorsed ever binge eating (n = 707) were divided into two groups: (1) child-adolescent onset (CO)--age of first binge <18 years, and (2) adult onset (AO)--age of first binge ≥18 years. We hypothesized that CO binge eating would be associated with greater (1) likelihood of developing BN/BED, (2) severity of BN/BED, (3) history of trauma and PTSD, and (4) history of psychiatric comorbidity, such as major depression and substance use. RESULTS Of those who ever endorsed binge eating, 212 reported CO (30%) and 495 (70%) reported AO. Although AO binge eating was more common, CO binge eating was associated with higher rates of lifetime BN, greater severity of bulimic symptoms, earlier age of first dieting; earlier age at highest weight, greater likelihood of ED treatment, and higher rates of molestation, physical assault, any direct victimization, lifetime PTSD, and substance abuse. CONCLUSIONS AO binge eating is more than twice as common as CO binge eating in women, but CO binge eating is associated with higher rates of lifetime BN, greater severity of BN, and higher rates of victimization, PTSD, and substance abuse.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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31
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Carr CP, Martins CMS, Stingel AM, Lemgruber VB, Juruena MF. The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes. J Nerv Ment Dis 2013; 201:1007-20. [PMID: 24284634 DOI: 10.1097/nmd.0000000000000049] [Citation(s) in RCA: 506] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Early life stress (ELS; sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect) has been the focus of numerous studies. It has been associated with the onset and the severity of psychiatric disorders in adults. The objective of this study was to review the literature on ELS associated with psychiatric disorders in adulthood, seeking to identify whether there are independent effects between subtypes of early stress in triggering psychopathology in adults. We reviewed articles from 2001 to 2011 in four databases (PubMed, SciELO, LILACS, and PsycINFO), with the following key words: child abuse, maltreatment, early life stress, psychiatric disorders, mental disease, and psychopathology. Forty-four articles were selected, and most of these articles demonstrate that the subtypes of ELS are associated with several psychiatric disorders, more specifically: physical abuse, sexual abuse, and unspecified neglect with mood disorders and anxiety disorders; emotional abuse with personality disorders and schizophrenia; and physical neglect with personality disorders. Physical neglect had the weakest association between the subtypes. ELS subtypes in childhood and adolescence can predict the development of psychopathology in adults. Scientific evidence shows that ELS triggers, aggravates, maintains, and increases the recurrence of psychiatric disorders. These results demonstrate the importance of a deeper understanding about the unique effects of ELS subtypes, especially for mental health professionals.
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Affiliation(s)
- Clara Passmann Carr
- *Faculty of Medicine of Ribeirão Preto (FMRP), University of São Paulo (USP), São Paulo, Brazil; †Psychiatric Service of Santa Casa de Misericordia of Rio de Janeiro (SCMRJ), Rio de Janeiro, Brazil; and ‡Catholic University of Rio de Janeiro (PUC-RIO), Rio de Janeiro, Brazil
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32
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Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr 2012; 59:409-16. [PMID: 22107822 DOI: 10.1097/qai.0b013e31824150bb] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Traumatic life histories are highly prevalent in people living with HIV/AIDS and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We sought to quantify the association of trauma with negative behavioral and health outcomes and to assess whether those associations were explained by mediation through psychosocial characteristics. METHODS In 611 outpatient people living with HIV/AIDS, we tested whether trauma's influence on later health and behaviors was mediated by coping styles, self-efficacy, social support, trust in the medical system, recent stressful life events, mental health, and substance abuse. RESULTS In models adjusting only for sociodemographic and transmission category confounders (estimating total effects), pasttrauma exposure was associated with 7 behavioral and health outcomes including increased odds or hazard of recent unprotected sex [odds ratio (OR) = 1.17 per each additional type of trauma, 95% confidence interval = 1.07 to 1.29], medication nonadherence (OR = 1.13, 1.02 to 1.25), hospitalizations (hazard ratio = 1.12, 1.04 to 1.22), and HIV disease progression (hazard ratio = 1.10, 0.98 to 1.23). When all hypothesized mediators were included, the associations of trauma with health care utilization outcomes were reduced by about 50%, suggesting partial mediation (eg, OR for hospitalization changed from 1.12 to 1.07), whereas point estimates for behavioral and incident health outcomes remained largely unchanged, suggesting no mediation (eg, OR for unprotected sex changed from 1.17 to 1.18). Trauma remained associated with most outcomes even after adjusting for all hypothesized psychosocial mediators. CONCLUSIONS These data suggest that past trauma influences adult health and behaviors through pathways other than the psychosocial mediators considered in this model.
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