The Impact of Retrospective Childhood Maltreatment on Eating Disorders as Mediated by Food Addiction: A Cross-Sectional Study

Abstract

Background: The current study aimed to test whether food addiction (FA) might mediate the relationship between the presence of a history of childhood maltreatment and eating disorder (ED) symptom severity. Methods: Participants were 231 patients with ED presenting between May 2017 and January 2020 to a daycare treatment facility for assessment and management with mainly the Eating Disorder Inventory-2 (EDI-2), the Child Trauma Questionnaire (CTQ), and the Yale Food Addiction Scale (YFAS 2.0). Results: Participants had a median age of 24 (interquartile range (IQR) 20–33) years and manifested anorexia nervosa (61.47%), bulimia nervosa (16.88%), binge-eating disorders (9.09%), and other types of ED (12.55%). They were grouped into those likely presenting FA (N = 154) and those without FA (N = 77). The group with FA reported higher scores on all five CTQ subscales, as well as the total score of the EDI-2 (p < 0.001). Using mediation analysis; significant indirect pathways between all CTQ subscales and the EDI-2 total score emerged via FA, with the largest indirect effect emerging for physical neglect (standardized effect = 0.208; 95% confidence interval (CI) 0.127–0.29) followed by emotional abuse (standardized effect = 0.183; 95% CI 0.109–0.262). Conclusion: These results are compatible with a model in which certain types of childhood maltreatment, especially physical neglect, may induce, maintain, and/or exacerbate ED symptoms via FA which may guide future treatments.

Mediating Factors between Childhood Traumatic Experiences and Eating Disorders Development: A Systematic Review

“…Finally, to measure inefficiency and interoceptive awareness as possible mediating factors, the Eating Disorder Inventory (EDI-2) was used in the study by Monteleone et al (2019) [36], and food addiction as a mediating factor was measured using the Yale Food Addiction Scale 2. 0 (YFAS 2.0) in the study by Khalil et al (2020) [37].…”

“…To measure general eating pathology the instruments most used were the Eating Disorders Inventory (EDI-2) and Eating Attitudes Test (EAT-26) [15,24,[27][28][29]31,[35][36][37]. The EDI-2 evaluates eating disorder symptomatology and psychopathology.…”

“…Again, all studies were of a cross-sectional design in nature [9,11,25,26,29,30,36,37], with one exception of one review study [17].…”

“…The studies carried out on clinical populations make up 44.4% of the total sample. The subjects were receiving various psychiatric diagnoses: binge eating disorder [11,25,26,37], anorexia nervosa [9,25,26,30,36,37], adolescents with multiple pathologies that include EDs [36], bulimia [25,26,29,37], and other specified feeding or EDs [29]. Overall, 42.8% were adolescents [9,29,30], while 57.1% were adults [9,25,26,29,36,37].…”

“…In individuals with anorexia nervosa, the mediating factors studied included emotion regulation [9], depression [29], obsession-compulsion [29], interoceptive awareness [36], inefficiency [36], food addiction [37], and dissociation [25]. With respect to emotion regulation as a possible mediator, emotional abuse was the type of abuse that was most related to difficulties with emotion regulation and with the severity of symptoms of anorexia nervosa.…”