The Relationship Between Childhood Trauma History and Severity of Eating Disorder Symptoms in Adolescents

Abstract

Childhood trauma has been identified as one of the well-known correlates of eating pathology, but there is still a lack of understanding regarding its association with the severity of eating problems and the mechanisms that connect the two in adolescents. The aim of this cross-sectional study was to investigate whether the severity and nature of childhood trauma is related to the severity of eating disorder symptoms in a clinical adolescent sample and whether this relationship is mediated by emotion dysregulation. A total of 340 adolescents (aged 12 to 18 years; 84% female) who were undergoing treatment for a DSM-5 eating disorder completed the Childhood Trauma Questionnaire (CTQ), the Eating Disorder Examination Questionnaire (EDE-Q), and the Difficulties in Emotion Regulation Scale (DERS). Eating disorder severity rose with each category of trauma (F(3,336)=19.8, p<.001) and was correlated with CTQ total score (r=0.44, p<.001). Each of the trauma subtypes was positively correlated with the severity of symptoms, and emotional abuse had the highest correlation. The partial mediation of the relationship between trauma and symptoms was accounted for by emotion dysregulation, accounting for ~34% of the total effect (indirect effect=0.15, 95% CI 0.09–0.22). Adolescents who experienced more than one type of trauma were over three times more likely to have clinically severe eating pathology (OR=3.12, 95% CI 1.94–5.02). These results suggest that a history of trauma, especially emotional abuse and cumulative exposure, is related to higher eating disorder severity among adolescents, in part due to problems with emotion regulation, impacting trauma-informed assessment and treatment.