Relationship between Trauma History and Eating Disorders in Adolescents

Trauma-Informed Practice in Physical Activity Programs for Young People: A Systematic Review

Physical activity, sport, and physical education share many similar qualities with trauma-informed practice, including promoting relationships, inclusion, and physical and mental well-being. There is growing research and programs that incorporate trauma-informed practices into physical activity programs for young people. The aim of this systematic review was to explore current evidence-based, Trauma-Informed Physical Activity programs for young people. Four databases were searched using the Preferred Reporting Items of Systematic Review and Meta-Analyses guidelines for systematic reviews. The search identified 19 studies that highlighted most Trauma-Informed Physical Activity programs reviewed resulted in positive social, emotional, behavioral, and academic outcomes for children and adolescents. However, further research and randomized control trials are required to understand the longitudinal outcomes of Trauma-Informed Physical Activity programs for children and adolescents. Program facilitators reported on the benefits of support and professional development opportunities for trauma awareness to administer Trauma-Informed Physical Activity programs with children and young people. Implications from this study emphasize the importance of the continued design, delivery, and research of Trauma-Informed Physical Activity programs for young people exposed to trauma.

Early maladaptive schemas mediate the relationship between severe childhood trauma and eating disorder symptoms: evidence from an exploratory study

BACKGROUND

Childhood trauma history has frequently been linked to eating disorders (EDs); nevertheless, the scientific literature calls for extending knowledge regarding mediators between EDs and childhood trauma. This study explored whether ED symptoms and early maladaptive schemas were more severe in ED patients with severe childhood trauma than in ED patients with no/mild childhood trauma and whether early maladaptive schemas mediated the relationship between childhood trauma and ED symptom severity.

METHODS

Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona. The extracted data included self-reported data, including the Eating Disorder Inventory-3 score, Young Schema Questionnaire score, Childhood Experience and Experience of Care and Abuse Questionnaire score, and sociodemographic and clinical information on the ED outpatients seeking care. A mediation analysis using the structural equation modeling procedure was conducted.

RESULTS

Forty-two outpatients, 31% of whom exhibited severe childhood trauma, satisfied the criteria for registry data extraction. The severity of ED symptoms, as well as the early maladaptive schemas' scores for emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity, were greater in ED outpatients with severe childhood trauma. Furthermore, early maladaptive schemas related to defectiveness, failure, and negativity had a mediating role in the relationship between severe childhood trauma and ED symptom severity.

CONCLUSIONS

This exploratory study provides preliminary evidence about the importance of early maladaptive schemas in the relationship between trauma history and ED psychopathology. In addition, ED symptoms may represent a dysfunctional attempt to avoid unpleasant emotions associated with schema activation. The results support the need to consider early maladaptive schemas in the treatment of traumatized patients with ED symptoms. Study limitations, research and clinical implications are discussed.

Trauma exposure proximity associated with eating disorder diagnosis in women with food insecurity

Trauma exposure is a risk factor for both food insecurity (FI) and increased eating disorder (ED) pathology. The purpose of this study was to explore the relation between trauma and ED diagnosis in a sample of women experiencing FI. A cross-sectional analysis of surveys from 99 women with self-reported FI (54% White; mean [SD] age = 40.26 [14.33] years) in the United States was employed. Participants completed online surveys including the Life Events Checklist (LEC) questionnaire, General Anxiety Disorder-7, Patient Health Questionnaire-9, and an interview comprised of the Household Food Security Survey Module (HFSSM) and Eating Disorder Diagnostic Interview (EDDI). LEC traumatic events were weighted by proximity: events experienced directly were weighted by a factor of 3, witnessed by 2, learned about by 1, and summed to a total weighted score. ED diagnosis in the past 12 months was assessed via the EDDI using DSM-5 diagnostic criteria. A binary logistic regression model tested associations between weighted trauma score, FI, and ED diagnosis. Weighted trauma score significantly predicted any ED diagnosis (OR = 1.039, p = .016), but FI severity did not (OR = .746, p = .101). These results suggest trauma proximity predicts ED diagnosis beyond that of FI severity and may be an important component of the association between FI and ED pathology. Future work may consider evaluating longitudinal symptoms of trauma and trauma severity in relation to FI.

Non-interpersonal traumatic events in patients with eating disorders: a systematic review

Objectives

The purpose of the systematic review was to synthesize literature on eating disorders (ED) and non-interpersonal traumatic events (NTE) and consolidate the reported prevalence of NTE in patients with an ED.

Methods

The literature search was performed in Embase, PsycInfo, and PubMed. The keywords in the search were "eating disorder," "trauma" and "non-interpersonal," using index-terms and free-search keywords related to NTE and ED. The PRISMA guidelines were followed. Relevant studies were screened using Rayyan.

Results

Of the 16 studies included in the quantitative synthesis, five overall types of NTE were identified: accidents, illness, injury, natural disaster and war. Findings provided tentative evidence for illness and injury being more prevalent in patients suffering from an ED compared to controls. The remaining subtypes of NTE did not show a higher prevalence in patients with an ED when compared to controls. Findings also suggest that those with binge/purge subtype of anorexia nervosa (AN) had a higher prevalence of non-interpersonal traumatic events compared to the restrictive subtype of AN.

Discussion

This systematic review provided a clear synthesis of previous findings related to NTE among patients with an ED. Noteworthy, is that many studies do not take into account if the trauma happened prior or after to ED onset, which may affect the association. Furthermore, the body of research on NTE in patients with ED is exceedingly limited, and more research is needed.

Eating behaviors as pathways from early childhood adversity to adolescent cardiometabolic risk

OBJECTIVE

To identify specific eating behavior pathways that mediate associations between financial difficulties, negative life events, and maternal depressive symptoms from 0 to 5 years and cardiometabolic risk in adolescence.

METHOD

Hypotheses were tested with data from birth to age 15 years using the Avon Longitudinal Study of Parents and Children, a birth cohort in the United Kingdom (n = 3,887 for current analyses). Mothers reported on financial difficulties, negative life events, and maternal depressive symptoms at multiple points from 0 to 5 years and reported on worry about child overeating at 8 years. Youth self-reported restrained, emotional, and external eating at age 14. Youth completed a cardiometabolic health assessment at age 15 where waist circumference, triglycerides, high-density lipoprotein, and insulin resistance were measured. Longitudinal structural equation modeling with bootstrapping was used to test mediation models.

RESULTS

Greater negative life events and maternal depressive symptoms predicted greater parental worry about child overeating at age 8, which directly predicted greater restrained and emotional eating at 14 and cardiometabolic risk at 15. Restrained and emotional eating at 14 directly predicted greater cardiometabolic risk at age 15.

CONCLUSIONS

Negative life events and maternal depressive symptoms in infancy/early childhood are associated with cardiometabolic risk in adolescence through pathways of parental worry about child overeating in middle childhood and youth-reported restrained and emotional eating in adolescence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description

This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.

The Association Between Childhood Maltreatment and Body (dis)satisfaction in Adolescents and Young Adults from the General Population

Adolescents with a history of childhood maltreatment are vulnerable to body dissatisfaction and associated psychopathology such as eating disorders. The aim of this study was to expand the understanding of the association between childhood maltreatment and body dissatisfaction in adolescents and young adults. In an epidemiological cohort study, N = 1,001 participants aged 14-21 years from Dresden, Germany, completed self-report measures on childhood maltreatment, body image, and self-esteem. Lifetime mental disorders were assessed in standardized clinical interviews. Data analyses included multiple regression and mediation analyses. More than one-third of the participants reported experiences of childhood maltreatment (37.4%), in which emotional neglect and abuse were the most frequent subtypes. Individuals with a history of childhood maltreatment showed significantly less satisfaction with their physical appearance than participants without such adverse experiences. In a single mediator model, self-esteem emerged as potential mediator in the association between child maltreatment and body (dis)satisfaction. Experiences of childhood maltreatment may be considered as risk factor for the development of body dissatisfaction in adolescents, and the role of potential mediator variables such as self-esteem warrants further prospective research.

Oxidative stress and inflammatory pathways in female eating disorders and borderline personality disorders with emotional dysregulation as linking factors with impulsivity and trauma

BACKGROUND

Borderline personality disorder (BPD) and eating disorders (ED) are both disorders with emotional dysregulation that may share some similar biological underpinnings, leading to oxidative/inflammatory alterations. Unfortunately, to date, no studies have assessed the relationship between clinical features, inflammatory alterations and childhood trauma across these disorders. Our aim was to identify the potential common and disorder-specific inflammatory pathways and examine possible associations between these dysregulated pathways and the clinical features.

METHODS

We studied a sample of 108 women (m = 27.17 years; sd = 7.64), divided into four groups: 23 patients with a restrictive ED (ED-R), 23 patients with a bingeeating/ purging ED (ED-P) and 26 patients with BPD; whereas the control group included 23 healthy subjects. Several inflammatory/oxidative parameters: tumor necrosis factor alpha (TNFα), Thiobarbituric Acid Reactive Substances (TBARS), inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX2), p38 mitogenactivated protein kinases, ERK mitogen-activated protein kinases and c-Jun NH2- terminal kinase (JNK), and some antiinflammatory antioxidant elements: glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), Kelch-like ECHassociated protein (Keap1) were determined in plasma or peripheral blood mononuclear cells. Furthermore, clinical, impulsivity, trauma and eating behavior questionnaires were administered.

RESULTS

Three main inflammatory/oxidative components were extracted using principal component analysis (59.19 % of biomarker variance explained). Disorder-specific dysfunction in the inflammatory and oxidative pathways in patients with BPD and ED were revealed by means of relationships with specific principal components (p < .01). BPD patients showed higher levels of a component featured by elevated levels of JNK and lower of GPx and SOD. ED-R and impulsivity were associated with a component featured by the activation of ERK and negative influence of Keap1. The component featured by the suppression of catalase and COX2 was associated with both ED subtypes and trauma exposure.

CONCLUSION

Several risk factors such as trauma, impulsivity and eating disorder symptoms were transdiagnostically associated with some inflammatory alterations regardless of diagnosis. These findings suggest that the clinical profile comprising trauma exposure and an emotional dysregulation disorder might constitute a specific endophenotype highly linked with inflammatory alterations.

Childhood trauma and food addiction: The role of emotion regulation difficulties and gender differences

OBJECTIVE

Childhood trauma has been associated with substance use disorders (SUDs), but less research has investigated its association with food addiction (i.e., compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). Existing research on childhood trauma and food addiction has focused primarily on women from restricted samples. Further, emotion dysregulation difficulties are implicated in both childhood trauma and food addiction, but research has not explored whether it may play a mediating role.

METHOD

Thus, the current study utilizes a sample of 310 participants recruited from Amazon Mechanical Turk (mean age = 41.3 years old, 47.4% men, 78.7% white) to investigate the mediating role of emotion dysregulation in the association between childhood trauma and food addiction. We also conducted exploratory analyses to investigate for gender differences in these associations. Gender-stratified correlational matrixes were conducted to investigate association between childhood trauma, food addiction, and emotional dysregulation. Moderated mediation models and multilevel regressions were also conducted to identify the role of gender in the association between childhood trauma, food addiction, and emotion dysregulation.

RESULTS

Emotion dysregulation was found to partially mediate the associations between food addiction and childhood trauma and gender was found to moderate associations between childhood trauma and emotion dysregulation, as well as childhood trauma and food addiction. Both moderating pathways were significantly stronger for men compared to women.

DISCUSSION

Results suggests that emotion dysregulation may be one important mediator in the association between childhood trauma and food addiction, particularly for men. The identification of other potential mechanisms contributing to the association between childhood trauma and food addiction and the use of longitudinal measurement strategies will be important in future research.

Failures in Reflective Functioning, Dissociative Experiences, and Eating Disorder: a Study On a Sample of Italian Adolescents

Although impairments in mentalizing and dissociation have been linked to the onset of eating disorders, there is still a paucity of studies investigating their relationships among adolescents. This study aimed at investigating the role of failures in reflective functioning and dissociation in predicting the risk of eating disorders during adolescence. The Eating Disorder Inventory-3 (EDI-3), the Reflective Functioning Questionnaire (RFQ), and the Adolescent Dissociative Experiences Scale (A-DES) were administered to a sample of 427 adolescents between 13 and 20 years old. Results of correlational analysis showed that the risk of eating disorders was positively correlated with uncertainty about mental states. Eating disorder risk was also inversely correlated with certainty about mental states. Dissociation scores and its domain scores were all positively related to the risk of eating disorders. Results of regression analysis displayed that uncertainty about mental states and dissociation were statistically significant predictors of an increased risk of eating disorders. Gender and BMI were also significant predictors in the final model, which explained 24% of the variance. Regarding the specific dissociative domains, findings indicate that the depersonalization/derealization factor was the only significant predictor for the risk of eating disorder. The present study points out that uncertainty about mental states and dissociation could play a relevant role in increasing the risk of eating disorders during adolescence.

Mediating Role of Intimate Partner Violence Between Emotional Dependence and Addictive Behaviours in Adolescents

Objective

Intimate partner violence (IPV) has been related to emotional dependence and addictive disorders. This study aims to provide a global approach to analyse the relationship between these variables and to determine the factors underlying permanence in violent relationships.

Methods

It is a non-experimental, cross-sectional correlational design study. Participants had to have at least one dating relationship for at least 1 month to complete the questionnaire, which included the following instruments: emotional dependence scale (DEN), scale of violence in dating relationships (VREP) and impulse control disorders scale (MULTICAGE CAD 4).

Results

The sample consisted of 1.533 adolescents, 53.9% were male (n = 826) and 46.1% female (n = 707), between 14 and 18 years. Emotional dependence correlated significantly with received violence (r = 0.37, p &lt; 0.001). Compulsive spending is strongly associated with emotional dependence (r = 0.21, p &lt; 0.001), whereas sex addiction is associated with received violence to a greater extent (r = 0.18, p &lt; 0.001). Received violence mediates on emotional dependence and addictions.

Conclusion

IPV is a risk factor for the perpetuation of addictive behaviours. It is advisable to promote affective education for developing resilience and adequate coping.

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.

Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care

OBJECTIVE

Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents.

METHODS

Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self-report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM-5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM-5.

RESULTS

PTSD+ occurred in 35.4% of participants, and those with ED-PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type.

CONCLUSIONS

Results confirm that adolescent patients in residential treatment with ED-PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed in ED programs that treat adolescents.

Patient crying during psychotherapy intake sessions: Relationship to patient characteristics and early treatment process

The aim of the present study is to further the understanding of who cries at the beginning of psychotherapy and patients' experience of crying in that process. Intake sessions for 53 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics were also collected at intake. Results indicate that crying during intake sessions was related to lower global functioning and higher severity of childhood sexual abuse. Furthermore, patients who cried at intake were over four times more likely to also cry at feedback, and those who cried at feedback were almost 12 times more likely to have cried at intake. Finally, crying in the intake session did not appear to be related to patient- or therapist-rated working alliance. Overall, the present study provides valuable information about characteristics of patients who cry at the outset of the therapy process and patients' experience of crying over time in therapy. Findings suggest the need for further research on patient characteristics and aspects of the therapy process that may predict patient crying over the course of treatment, as well as how these early crying experiences may be related to eventual patient outcomes.

The Relationship between Childhood Trauma, Eating Disorders, and Sleep Quality among Registered Hospital Nurses in South Korea

This cross-sectional study examined the relationship between childhood trauma, eating disorders, and sleep quality among registered hospital nurses in South Korea. Self-report questionnaires were answered by 279 nurses from six general hospitals. Factors affecting sleep quality were analyzed with a linear regression analysis. The factors that influenced sleep quality included age, alcohol consumption, chronic disease, BMI, and emotional abuse in childhood trauma. Hospital nurses need to increase their sleep health knowledge to maintain a healthy lifestyle while working as a nurse. Therefore, hospital and nursing managers should consider strategies to prevent and intervene in the sleep quality threats attributed to the adverse childhood experiences of hospital nurses.

Coping with childhood maltreatment: Avoidance and eating disorder symptoms

Childhood maltreatment is associated with eating disorder symptoms; however, the nature of this association is unclear. We found those who experienced childhood maltreatment had higher avoidant coping and eating disorder symptoms. We also found an additive effect for maltreatment, such that with more types of maltreatment experienced, avoidant coping and eating disorder symptoms were greater. We also found evidence of an indirect effect such that childhood maltreatment was related to eating disorder symptoms through avoidant coping. Future research is needed to better understand factors that may promote development of adaptive coping patterns and prevention of eating disorder symptoms.

Clinician Reactions When Working with Adolescent Patients: The Therapist Response Questionnaire for Adolescents

This study examined the factor structure and psychometric properties of the Therapist Response Questionnaire for Adolescents (TRQ-A), an 86-item clinician-report instrument measuring a wide range of thoughts, feelings, and behaviors expressed by therapists toward their adolescent patients. A sample of psychodynamic and cognitive-behavioral clinicians (N = 192) filled in the TRQ-A and the latest version of the Shedler-Westen Assessment Procedure for Adolescents (SWAP-II-A) in order to assess the personality styles/disorders of a randomly selected adolescent patient in their care. Factor analysis identified six conceptually coherent and internally consistent countertransference patterns: warm/attuned, angry/criticized, disorganized/frightened, overinvolved/worried, disengaged/hopeless, and sexualized. These patterns were significantly related to patients' personality styles/disorders in a clinically meaningful and systematically predictable manner. The results support the TRQ-A's validity and internal reliability in evaluating the complex portrait of multifaceted reactions that clinicians typically experience toward adolescent patients, and its potential to improve diagnostic accuracy and guide clinicians in planning effective therapeutic interventions. The TRQ-A promises to significantly contribute to this less explored research area and encourage systematic studies of youth treatment, promoting best practice for successful therapeutic outcomes.