Effects of Childhood Emotional Abuse on Treatment Outcome in Adolescent Inpatients With Anorexia Nervosa

Objective

Although childhood maltreatment, especially emotional abuse, is strongly linked to the psychopathology of anorexia nervosa (AN), the impact of such a traumatic experience on treatment outcome is not clear. This study aimed to explore how emotional abuse affects change in psychopathology during treatment.

Method

Adolescents with AN (n = 331) completed the Childhood Trauma Questionnaire at admission to inpatient treatment and the Eating Disorder Inventory-2, Patient Health Questionnaire-9, Patient Health Questionnaire-15, and Generalized Anxiety Disorder-7 both at admission and at discharge. Relationships of emotional abuse with body mass index (BMI) and questionnaire scores at admission and at discharge were examined with percentage bend correlation coefficients. Changes in BMI and questionnaire scores from admission to discharge and whether these changes were moderated by emotional abuse were tested with robust mixed models.

Results

Higher emotional abuse scores related to higher eating disorder, depressive, anxiety, and somatic symptoms but not to BMI at admission and at discharge. BMI increased and eating disorder, depressive, anxiety, and somatic symptoms decreased from admission to discharge but these changes were not moderated by emotional abuse scores.

Discussion

Emotional abuse did not affect treatment response during hospitalization for AN, but it was associated with heightened eating and general psychological symptom severity at both hospital admission and discharge. Clinicians are advised to investigate a history of emotional abuse in adolescents with AN and to consider emotional abuse not as a predictor of treatment resistance, but as a psychological scar that persists regardless of symptom severity.