Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis

Abstract

Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology.Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators.Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology.Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed.

The Cyberball task in people after obesity surgery: preliminary evaluation of cognitive effects of social inclusion and exclusion with a laboratory task

“…Recent studies have identified EMSs as possible obesity maintaining factors. For instance, research has shown that dysfunctional emotion-avoidant strategies could have been embodied during childhood and could drive someone to use eating behaviors to manage their emotions [ 5 , 24 ]. Psychological treatments of EMS and structured schema therapy treatments have been proven to be clinically relevant interventions in patients with obesity [ 11 , 29 ]; however, less is known about patients who have already undergone bariatric surgery intervention.…”

Cognitive Behavioral Therapy of Patients with Somatic Symptoms—Diagnostic and Therapeutic Difficulties

“…A recent meta-analysis of the available literature showed that the frequency of experiencing violence in the group of people with eating disorders is significantly higher than in the general population and in the group of patients with other mental disorders [ 20 ]. Theoretical approaches explaining the causes of these disorders indicate that eating disorders are a form of autoaggression that helps the victim to work through the experienced trauma and return to balance [ 21 ].…”

A Multi-Faceted Evaluation of Impulsivity Traits and Early Maladaptive Schemas in Patients with Anorexia Nervosa

“…Early maladaptive schemas are linked to several psychopathologies and have been widely evaluated in the literature [34]. In eating disorders, EMSs have been linked to a more severe clinical presentation [35] as well as to dysfunctional responses to interpersonal scenarios [36]. Moreover, EMSs have been shown to play a mediation role between early maltreatment and impulsive behaviors, from binge eating to self-harm [37,38], which highlights the role that cognitive functioning may play in impulsivity [29].…”