Psychological and clinical associations of adverse childhood experiences in Chinese patients with eating disorders.

Abstract

Background: Eating disorders (EDs) are severe mental illnesses with significant morbidity and mortality. Adverse childhood experiences (ACEs) are recognized risk factors, but their specific impact across ED subtypes and the mediating psychological mechanisms require further elucidation.

Methods: In this cross-sectional study (2008-2015), 970 outpatients with eating disorders (919 female) were assessed for adverse childhood experiences and clinical behaviors with the Eating Disorder Questionnaire, and for psychological traits with the Eating Disorder Inventory-1. This study used factorial ANOVA, Lasso regression, and mediation analysis to clarify the effects of ACEs and diagnostic subtypes, identify specific influencing factors, and explore the mediating role of psychological traits.

Results: ACEs were nominally associated with most clinical behaviors except dieting; after correction, the most robust associations were observed for binge eating, laxative use, and several onset-age variables. Childhood emotional abuse most profoundly impacted psychological traits. The cumulative number of ACEs was associated with increased severity of psychological traits and a higher likelihood of clinical behaviors. Mediation analyses revealed that psychological traits significantly mediated the relationship between ACEs and clinical behaviors. For instance, ineffectiveness mediated the link from cumulative ACE count (mediation proportion = 0.481), "criticism and blame" (mediation proportion = 0.629), and "abandonment threats" (mediation proportion = 0.601) to binge eating.

Conclusions: Childhood emotional abuse and cumulative ACEs significantly correlated with worsened psychological traits and clinical ED behaviors, with notable implications for binge-eating/purging symptoms. Several psychological traits showed substantial indirect associations between ACE exposure and clinical ED behaviors. These findings highlight the necessity of routine ACE assessment and trauma-informed interventions targeting these psychological vulnerabilities in ED treatment.