Childhood maltreatment and longitudinal trajectories of disordered eating behaviors: sociodemographic moderators and behavior-specific sensitivity analyses.

Abstract

Objective: Disordered eating behaviors (DEBs) represent a significant public health issue, with childhood maltreatment emerging as a potential contributing factor. However, the longitudinal impact of maltreatment on the progression of disordered eating behaviors from adolescence to adulthood remains inadequately understood. This study aims to explore how childhood maltreatment influences the trajectory of disordered eating behaviors, focusing on potential moderating factors such as sociodemographic variables, race, and sex.

Methods: Data from Waves I-III of Add Health (ages 11-26) were used to assess DEB trajectories, with retrospective childhood maltreatment data collected in Wave IV. Repeated measures mixed-effects models accounted for intra-individual variability, adjusting for relevant covariates. Interaction effects between maltreatment subtypes and sociodemographic covariates (sex, race/ethnicity, income) were analyzed to examine how these intersections influenced DEB trajectories.

Results: Among the 15,363,384 participants, 49.2% experienced childhood maltreatment. Adjusted models indicated significant increases in DEBs over time, particularly between Waves II and III (β = 19.9, p < 0.001). Although physical abuse (β = 1.88, p = 0.1330), verbal abuse (β = -0.67, p = 0.4529), and sexual abuse by a parent (β = 1.59, p = 0.4204) were not significant predictors of worsening behaviors, stratified analyses revealed that low-income individuals exposed to non-familial sexual abuse demonstrated the steepest worsening of DEBs (β = 26.5, p = 0.0048). Interaction effects revealed that Asian or Pacific Islander participants experiencing verbal abuse, and low-income individuals exposed to non-familial sexual abuse demonstrated pronounced worsening of DEBs. We observed significant sex differences: males exhibited higher levels of worsening behaviors over time (β = -10.8, p < 0.0001).

Conclusion: Our findings suggest that sociodemographic characteristics (sex, race, income) may moderate the persistence of DEBs, underscoring the need for trauma-informed and tailored interventions. Addressing childhood adversity through public health, policy, and clinical efforts can help support those at highest risk. Future research should examine these trajectories beyond early adulthood and explore protective factors that may buffer against long-term DEB risk.