Adverse Childhood Experiences and Disordered Eating Behaviors Among US Children: Untangling the Developmental Sex Differences.

Abstract

Objective: This study examined associations between adverse childhood experiences (ACEs) and heterogeneous disordered eating behaviors (DEBs) in a nationally representative sample of US children, investigating how sex and developmental stage jointly moderate these relationships.

Method: Data from the 2022-2023 National Survey of Children's Health included 67,607 children aged 6-17 years (weighted N = 50,023,339), with information collected from caregivers. Latent class analysis identified DEB patterns. Multinomial logistic regression analyzed associations between both cumulative ACE scores and specific ACE types with DEB classes. Average marginal effects assessed how sex and developmental stage modified these associations.

Results: Among participants, 44% had experienced at least one ACE. Four distinct DEB classes emerged: Minimal Disordered Eating (81.7%), Binge/Fasting Eating (7.3%), Picky/Restrictive Eating (8.9%), and Severe Mixed Dysregulation (2.1%). Cumulative ACE exposure showed significant relationships with all DEB subtypes. Each additional ACE increased the likelihood of Severe Mixed Dysregulation by 70% (RRR = 1.70, 95% CI [1.62, 1.75]). Economic hardship, household mental illness, and health discrimination showed significant positive associations across all DEB subtypes. Sex and developmental stage significantly moderated these associations: boys exhibited increasing ACE effects with developmental stage in the Binge/Fasting Eating group, while girls showed intensified ACE effects with increasing developmental stage in the Severe Mixed Dysregulation group, particularly for health discrimination.

Discussion: Findings support the adoption of trauma-informed and developmentally sensitive approaches. Sex-specific patterns highlight the need for interventions that consider both sex and developmental stage, with particular attention to girls entering middle-late adolescence who demonstrate elevated vulnerability to developing eating dysregulation following ACE exposure.