Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma profiles 

The following summary includes reference to childhood sexual, physical, and emotional abuse. 

If you or someone you know has been impacted by childhood trauma you can call: Blue Knot Helpline and Redress Support Service on 1300 657 380 between 9-5 Monday-Sunday AEST.  

If you or someone you know is experiencing family violence, phone 000 or 1800 RESPECT. 

For support contact lifeline.org.au 24/7 on 13 11 14.

For counselling, advice and support for men who have anger, relationship or parenting issues, call the Men’s Referral Service on 1300 766 491. 

Why is this research important? 

Adverse childhood experiences (ACEs), such as abuse, are considered a significant public health crisis and are associated with mental and physical health problems later in life. The strong link between traumatic and unsafe experiences in childhood, and physical and mental health in adulthood, has led to a policy statement being released by the American Academy of Paediatrics stating that reducing toxic stress in childhood should be a leading priority for the field of medicine [6]. In addition to being highly prevalent among people with mental health conditions such as anxiety or depression [7], childhood maltreatment is associated with eating disorders (ED) and ED behaviours in adulthood [8,9,10,11]. Among clinical samples, a meta-analysis found that EDs are associated with childhood sexual, physical, and emotional abuse [16]. Individuals with EDs also report higher rates of childhood maltreatment than healthy controls or psychiatric control groups [17]. People with bulimia nervosa (BN) report more moderate to severe trauma histories than those with anorexia nervosa (AN) [18]. 

Given the prevalence of adverse childhood experiences, their association with EDs, and the impairment with which they are associated, trauma-informed care (TIC) has been increasingly recommended as part of the treatment approach for people with both EDs and a history of trauma or comorbid post-traumatic stress disorder [20]. To properly design and implement TIC for the broader ED population, as well as specific symptomatology within people experiencing EDs, it is important to know the prevalence and severity of their adverse childhood experiences, and to know whether some individuals may have a more significant childhood history of trauma than others. This research sought to examine and compare ACEs between two samples: treatment-seeking adults, and a nationally representative sample of adults; to characterize ACEs items and total scores across demographic and diagnostic information in adults seeking treatment for an ED; to statistically classify ACEs profiles into groups; and to examine associations between ACEs profiles and eating disorder diagnoses. 

Findings highlight the likely importance of screening for adverse childhood experiences among people with eating disorders as part of standard care, and more broadly, providing children with safe environments to lessen the long-term development of several serious illnesses, including eating disorders. 

If you would like to access the Adverse Childhood Experience (ACE) survey or other resources about ACEs, see links below: 

• CDC Vital signs website: ACEs  
• Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence

• CDC Vital Signs: Information about ACEs pdf 
• Harvard University – ACE Quiz

Authors: Renee D. Rienecke, Craig Johnson, Daniel Le Grange, Jamie Manwaring, Philip S. Mehler, Alan Duffy, Susan McClanahan & Dan V. Blalock 

Abstract/Summary: 

Background: Adverse childhood experiences (ACEs) are prevalent, impact long-term physical and mental health, and are associated with eating disorders (EDs) in adulthood. The primary objectives of the current study were: (1) to examine and compare ACEs between two samples: treatment-seeking adults, and a nationally representative sample of adults, (2) to characterize ACEs items and total scores across demographic and diagnostic information in adults seeking treatment for an ED, (3) to statistically classify ACEs profiles using latent class analysis, and (4) to examine associations between ACEs profiles and diagnosis. 

Methods: This cross-sectional study assessed patients with a DSM-5 ED receiving treatment between October 2018 and April 2020 at the inpatient, residential, or partial hospitalization levels of care at one of two private ED treatment facilities. ACEs were assessed with the Adverse Childhood Experiences Survey at admission. Generalized linear models and Welch’s t-tests were used to compare ACEs in the current sample with national estimates. A latent class analysis was conducted to examine subgroups of ACEs responses, and differences in these classes by ED diagnoses were examined with multinomial logistic regression. 

Results: Patients with EDs had significantly higher ACEs scores (M = 1.95, SD = 1.90) than the nationally representative sample (M = 1.57, SD = 4.72; t = 6.42, p < .001). Within patients with EDs, four latent classes of ACEs item endorsement were identified. Patients with other specified feeding or eating disorder (OSFED) and binge eating disorder (BED) were more likely to fall into the “Household ACEs” and “Abuse ACEs” groups, respectively, compared to anorexia nervosa-restricting subtype (AN-R). 

Conclusion: Patients with EDs reported more ACEs than the nationally representative sample, and differences in total ACEs and latent class membership were found across ED diagnoses. The current study can inform the development of trauma-informed care for patients with EDs. 

Access: Open 

Link:  https://rdcu.be/cVbb6 

Citation: Rienecke, R.D., Johnson, C., Le Grange, D. et al. Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma profiles. J Eat Disord 10, 72 (2022). https://doi.org/10.1186/s40337-022-00594-x