Child Maltreatment and Disordered Eating in Adulthood: a Mediating Role of PTSD and Self-Esteem?

The impact of intuitive eating on the association between posttraumatic stress disorder (PTSD) symptoms and disordered eating among women who have experienced intimate partner violence (IPV)

OBJECTIVE

Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating.

METHODS

Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors.

RESULTS

Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors.

DISCUSSION

Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.

Disclosure of sexual abuse by adolescents treated in a psychiatry department

OBJECTIVES

The aim of the study is to describe the population of adolescents who have disclosed sexual abuse to a health professional during their care in a psychiatric department. We also want to discuss the circumstances that enable adolescents to make this disclosure.

METHODS

This single-center retrospective observational study is based on the mandatory reports (n=139) sent by a Paris adolescent psychiatry department between 2005 and 2021 after patients disclosed previous sexual abuse. R® (3.6.1) and RStudio® (1.2.5001) software were used for statistical analysis.

RESULTS

Girls accounted for almost all the adolescents who disclosed (95.7%). First abuse occurred around the age of 12 years and was first disclosed to a health professional a mean of 3.5 years later; 66 (47.5%) patients were admitted for inpatient care during their follow-up. The most common diagnoses were depression, eating disorders, posttraumatic stress disorders, and other anxiety disorders. Before disclosing to a health professional, most of these adolescents had already talked about it, mainly to a family member (69.8%) or peers (24.7%).

CONCLUSION

This is the first study in France on the reporting of sexual abuse after its disclosure by adolescents being treated in a psychiatry unit. Our results show that child sexual abuse is rarely reported and that health care professionals are far from being the first recipients of these disclosures. We recommend routine screening for sexual abuse in adolescent psychiatry units, improved training for staff receiving these disclosures, and consideration of how best to coordinate medical, social, and legal services for these adolescents.

Longitudinal associations between community violence exposure, posttraumatic stress symptoms, and eating disorder symptoms

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.

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

BACKGROUND

Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality.

METHODS

In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable.

RESULTS

At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide.

CONCLUSIONS

The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

Resilience and Self-Esteem Mediated Associations between Childhood Emotional Maltreatment and Aggression in Chinese College Students

Although associations between physical or sexual abuse and aggression have been mainly explored, relationships and pathways between childhood emotional maltreatment and aggression need further exploration, particularly in the Chinese cultural context. This study aimed to explore the associations between childhood emotional maltreatment and aggression and to examine the mediating effects of resilience and self-esteem on those associations. Data were obtained from a convenience sampling of 809 (aged 17−23) college students from three Chinese universities in December 2021, which was approved by the ethics committee of Beijing Normal University, China. All participants completed measures of childhood emotional maltreatment, aggression, resilience, and self-esteem. The results showed that childhood emotional maltreatment was positively associated with aggression (r = 0.41, p < 0.01), and it was negatively associated with resilience (r = −0.56, p < 0.01) and self-esteem (r = −0.10, p < 0.01). Regarding the mediation processes, resilience and self-esteem partially mediated the relationships between childhood emotional maltreatment and aggression. These findings underscore the importance of enhancing levels of resilience and self-esteem in interventions designed to reduce aggression of college students who were emotionally maltreated in childhood.

The nature and extent of child maltreatment in Denmark: Using self-report and administrative data from the 1984 birth cohort

BACKGROUND

Research on child maltreatment (CM) has few longitudinal studies that combine self-report data with objective administrative data that has been collected continuously for decades.

OBJECTIVE

To give an overview of 20 studies investigating the impact of CM in a Danish representative sample.

PARTICIPANTS AND SETTING

From the full 1984 Danish birth cohort, 2980 24-years old were randomly selected. There was an oversampling of child protection cases.

METHODS

The participants were interviewed by trained interviewers and Computer Assisting Methods were used for sensitive topics. The survey data were linked to several national registers using the Civil Registry Number for a series of studies on risk factors and outcomes. Linkage with parental data enabled parental risk factors before the birth to be analysed as well as several physical, psychological, and social events during their lifetime. These factors were studied in relation to the CM classes that were identified via the survey.

RESULTS

The maltreatment classes had both several specific and shared effects pertaining to risk factors before birth, during childhood through to early adulthood. Their problems included many arenas within health, mental and social life.

CONCLUSIONS

Data linkage studies provide an opportunity to conduct research using accurate sources of information which can be used to explore risk and protective factors. The prospective nature of this combined data facilitates temporal ordering which strengthen the conclusions based on longer-term follow-up.

Childhood Environmental Instability and Social-Emotional Outcomes in Emerging Adults

Adverse childhood experiences (ACEs) can negatively affect social-emotional functioning. The association between individual and cumulative ACEs and social-emotional domains of self-esteem, loneliness, and negotiation in intimate partner relationships has not been explored in low-risk emerging adults, a gap this study aims to fill. An online survey was administered to undergraduate emerging adults, ages 18 to 25 years (M_age = 19.73, SD = 1.83; N = 436; 20.60% Hispanic; 63.80% female). The ACEs Survey, Child Abuse Potential Inventory, and Conflict Tactics Scale-2nd Edition were used. Three multivariate ordinary least squares regressions were run, each including predictors significant in bivariate analyses and outcomes of self-esteem, loneliness, and negotiation for each regression. Emotional abuse, B = -.20, p < .01; emotional neglect, B = -.21, p < .001; and substance using family member, B = -.12, p < .05, were negatively associated with self-esteem; emotional neglect, B = .11, p < .01, and cumulative ACEs, B = .16, p < .01, were positively associated with loneliness; and incarcerated family member was positively associated with negotiation, B = .12, p < .05. Overall, these findings suggest that individual ACEs associated with environmental instability (e.g., emotional abuse) are strong predictors of social-emotional outcomes, relative to ACEs associated with more direct physical harm (e.g., sexual abuse).

How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders?

The negative impact of COVID-19 pandemic on people with Eating Disorders (EDs) has been documented. The aim of this study was to evaluate whether a history of traumatic experiences during childhood or adolescence was associated with a higher degree of psychopathological worsening during COVID-19 related lockdown and in the following re-opening period in this group of people. People with EDs undergoing a specialist ED treatment in different Italian services before the spreading of COVID-19 pandemic (n = 312) filled in an online survey to retrospectively evaluate ED specific and general psychopathology changes after COVID-19 quarantine. Based on the presence of self-reported traumatic experiences, the participants were split into three groups: patients with EDs and no traumatic experiences, patients with EDs and childhood traumatic experiences, patients with EDs and adolescent traumatic experiences. Both people with or without early traumatic experiences reported retrospectively a worsening of general and ED-specific psychopathology during the COVID 19-induced lockdown and in the following re-opening period. Compared to ED participants without early traumatic experiences, those with a self-reported history of early traumatic experiences reported heightened anxious and post-traumatic stress symptoms, ineffectiveness, body dissatisfaction, and purging behaviors. These differences were seen before COVID-19 related restrictions as well as during the lockdown period and after the easing of COVID-19 related restrictions. In line with the "maltreated ecophenotype" theory, these results may suggest a clinical vulnerability of maltreated people with EDs leading to a greater severity in both general and ED-specific symptomatology experienced during the exposure to the COVID-19 pandemic.

Stressful life events among individuals with a history of eating disorders: a case-control comparison

BACKGROUND

Experiencing stressful life events (SLEs) can negatively impact mental health and increase risk for psychiatric disorders including eating disorders (EDs). Previous research has shown that childhood sexual abuse is associated with some EDs, but less is known about the association between other non-sexual SLEs and EDs.

METHOD

A case-control study of individuals with (n = 495, age mean ± SD = 29.1 ± 9.8 years) and without (n = 395, age = 30.2 ± 11.7) self-reported lifetime history of EDs was conducted to compare history of self-reported SLEs. Participants reported history of sexual (e.g., rape, other sexual assault) and non-sexual (e.g., emotional abuse, assault, bereavement) life events using an adaptation of the Stressful Life Events Screening Questionnaire. Individuals with EDs were divided into ED subtypes along the restricting - binge eating/purging spectrum to examine subtype differences. Logistic regressions were conducted for each SLE and ED subtype to obtain odds ratios (ORs). We report p-values corrected for multiple comparisons.

RESULTS

Exposure to any SLE was significantly more common in individuals with EDs than in controls (OR = 2.47, p < .001). Specifically, rape, other sexual assault, and emotional abuse were significantly more common among individuals with a history of binge-eating/purging ED subtypes (ORs = 2.15-3.58, p's < .01) compared with controls. Furthermore, history of life-threatening disease and loss of a close relative/partner/friend were associated with some ED subtypes. The association between SLEs and EDs was stronger for individuals who had experienced multiple SLEs.

CONCLUSION

By investigating a range of different SLEs, we showed that both sexual and non-sexual SLEs were more common in individuals with a history of EDs (binge-eating/purging subtypes) than controls. Results highlight the importance of assessing a variety of past SLEs in risk assessment for different EDs.

A Multiplicative Approach to Polyvictimization: A Study of Intimate Partner Violence Types as Risk Factors for Child Polyvictimization in South Korea

Drawing on a new typology of intimate partner violence (IPV), this paper tests the relationship between indicators of totalitarian and anarchic IPV and child polyvictimization incidence and severity. The paper argues for and utilizes a quantitative approach to study polyvictimization severity. Polyvictimization is operationalized as a multiplicative relationship between physical abuse and neglect in a random sample of 204 children from Kyunggi province, South Korea. The indicator of totalitarian IPV significantly predicted polyvictimization severity and incidence even when a traditional measure of intimate terrorism was held constant. The indicator of anarchic IPV significantly predicted polyvictimization severity but not incidence when a traditional measure of intimate terrorism was held constant. Implications are discussed.