Relationship between Trauma History and Eating Disorders in Adolescents

  • Taylor GrothEmail author
  • Mark Hilsenroth
  • Dana Boccio
  • Jerold Gold
Original Article


Reasons for developing an eating disorder (ED) are complex, yet one plausible risk factor gaining more relevance in adolescents with EDs is childhood trauma. The current study is the first to examine the presence of childhood trauma in relation to ED symptomatology in adolescents using DSM-5 criteria. It was hypothesized that patients with more traumatic experiences also have more severe ED symptoms. 112 therapists currently treating adolescent patients diagnosed with an ED completed an online survey consisting of a DSM-5 ED symptom checklist and a childhood trauma questionnaire on a current adolescent patient whom they have seen for at least eight sessions. Children with multiple traumatic experiences and the severity of those experiences demonstrated a relationship to overall ED (r = .179, p = .059) and bulimia symptoms (r = .183, p = .054), specifically binging (r = .188, p = .047). and purging (r = .217, p = .021). In addition, logistic regression analyses indicated that adolescents high on bulimia nervosa (B = 4.694, p = .044) were more likely to have been traumatized victims of violence. Exploratory analyses support prior literature that suggest similarities between adolescents’ lack of control of the experienced trauma(s) with lack of control of ED symptoms. These findings highlight the importance of exploring trauma history when treating an adolescent with an ED, especially bulimia.


Trauma Adolescents Eating disorders Bulimia 


Compliance with Ethical Standards

Disclosure of Interest

All authors declare that they have no conflicts to report.

Ethical Standards and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation [institutional and national] and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.


  1. Allen, K. L., Byrne, S. M., Crosby, R. D., & Stice, E. (2016). Testing for interactive and non-linear effects of risk factors for binge eating and purging eating disorders. Behaviour Research and Therapy, 87, 40–47.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.Google Scholar
  3. Andrews, B. (1997). Bodily shame in relation to abuse in childhood and bulimia: A preliminary investigation. British Journal of Clinical Psychology, 36(1), 41–49.Google Scholar
  4. Balantekin, K. N., Birch, L. L., & Savage, J. S. (2017). Eating in the absence of hunger during childhood predicts self-reported binge eating in adolescence. Eating Behaviors, 24, 7–10.Google Scholar
  5. Bernstein, D., Ahluvala, T., Pogge, D., & Handelsman, L. (1997). Validity of the childhood trauma questionnaire in an adolescent psychiatric population. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 340–348.Google Scholar
  6. Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 27(2), 169–190.Google Scholar
  7. Betan, E., Heim, A. K., Zittel Conklin, C., & Westen, D. (2005). Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. The American Journal of Psychiatry, 162, 890–898.Google Scholar
  8. Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15(4), 285–304.Google Scholar
  9. Bruch, H. (1981). Developmental considerations of anorexia nervosa and obesity. The Canadian Journal of Psychiatry, 26(4), 212–217.Google Scholar
  10. Carretero-Garcia, A., Planell, L. S., Doval, E., Estragués, J. R., Escursell, R. R., & Vanderlinden, J. (2012). Repeated traumatic experiences in eating disorders and their association with eating symptoms. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 17(4), e267–e273.Google Scholar
  11. Carter, J. C., Bewell, C., Blackmore, E., & Woodside, D. B. (2006). The impact of childhood sexual abuse in anorexia nervosa. Child Abuse & Neglect, 30, 257–269.Google Scholar
  12. Clinton, D., Björck, C., Sohlberg, S., & Norring, C. (2004). Patient satisfaction with treatment in eating disorders: Cause for complacency or concern? European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 12(4), 240–246.Google Scholar
  13. Cohen, J. (1988). Statistical power analysis for the social sciences.Google Scholar
  14. Dalle Grave, R. (2011). Eating disorders: Progress and challenges. European Journal of Internal Medicine, 22(2), 153–160.Google Scholar
  15. Dalle Grave, R., Rigamonti, R., Todisco, P., & Oliosi, E. (1996). Dissociation and traumatic experiences in eating disorders. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 4(4), 232–240.Google Scholar
  16. Fischer, S., Stojek, M., & Hartzell, E. (2010). Effects of multiple forms of childhood abuse and adult sexual assault on current eating disorder symptoms. Eating Behaviors, 11(3), 190–192.Google Scholar
  17. Goossens, L., Braet, C., Van Durme, K., Decaluwé, V., & Bosmans, G. (2012). The parent–child relationship as predictor of eating pathology and weight gain in preadolescents. Journal of Clinical Child & Adolescent Psychology, 41(4), 445–457.Google Scholar
  18. Grilo, C. M., & Masheb, R. M. (2001). Childhood psychological, physical, and sexual maltreatment in outpatients with binge eating disorder: Frequency and associations with gender, obesity, and eating-related psychopathology. Obesity, 9(5), 320–325.Google Scholar
  19. Jaite, C., Schneider, N., Hilbert, A., Pfeiffer, E., Lehmkuhl, U., & Salbach-Andrae, H. (2012). Etiological role of childhood emotional trauma and neglect in adolescent anorexia nervosa: A cross-sectional questionnaire analysis. Psychopathology, 45(1), 61–66.Google Scholar
  20. Johnson, J. G., Cohen, P., Kasen, S., & Brook, J. S. (2002). Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood. American Journal of Psychiatry, 159(3), 394–400.Google Scholar
  21. Kearney-Cooke, A., & Striegel-Moore, R. H. (1994). Treatment of childhood sexual abuse in anorexia nervosa and bulimia nervosa: A feminist psychodynamic approach. International Journal of Eating Disorders, 15(4), 305–319.Google Scholar
  22. Keel, P. K., & Brown, T. A. (2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43(3), 195–204.Google Scholar
  23. Kong, S., & Bernstein, K. (2009). Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders. Journal of Clinical Nursing, 18(13), 1897–1907.Google Scholar
  24. Lewinsohn, P. M., Striegel-Moore, R. H., & Seeley, J. R. (2000). Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. Journal of the American Academy of Child & Adolescent Psychiatry, 39(10), 1284–1292.Google Scholar
  25. Madowitz, J., Matheson, B. E., & Liang, J. (2015). The relationship between eating disorders and sexual trauma. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 20(3), 281–293.Google Scholar
  26. National Institute of Mental Health (November, 2017). “Eating Disorders”. Web. Retrieved from:
  27. Paivio, S. C., & Cramer, K. M. (2004). Factor structure and reliability of the childhood trauma questionnaire in a Canadian undergraduate student sample. Child Abuse & Neglect, 28(8), 889–904.Google Scholar
  28. Pennebaker, J. W., & Susman, J. R. (2013). Childhood trauma questionnaire.Google Scholar
  29. Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L., & Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: How “states” become “traits”. Infant Mental Health Journal, 16(4), 271–291.Google Scholar
  30. Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology, 53(1), 187–213.Google Scholar
  31. Poulsen, S., Lunn, S., Daniel, S. I., Folke, S., Mathiesen, B. B., Katznelson, H., & Fairburn, C. G. (2014). A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. American Journal of Psychiatry, 171(1), 109–116.Google Scholar
  32. Rayworth, B., Wise, L., & Harlow, B. (2004). Childhood abuse and risk of eating disorders in women. Epidemiology, 15, 271–278.Google Scholar
  33. Richards, L. K., Shingleton, R. M., Goldman, R., Siegel, D., & Thompson-Brenner, H. (2016). Integrative dynamic therapy for bulimia nervosa: An evidence-based case study. Psychotherapy, 53(2), 195–205.Google Scholar
  34. Rodriguez, M., Perez, V., & Garcia, Y. (2005). Impact of traumatic experiences and violent acts upon response to treatment of a sample of Colombian women with eating disorders. International Journal of Eating Disorders, 37, 299–306.Google Scholar
  35. Rome, E. S., Ammerman, S., Rosen, D. S., Keller, R. J., Lock, J., Mammel, K. A., O’Toole, J., Rees, J.M., Sanders, M.J., Sawyer, S.M., Schneider, M., Sigel, E., & Silber, T.J. (2003). Children and adolescents with eating disorders: The state of the art. Pediatrics, 111(1), e98–e108.Google Scholar
  36. Root, M. P., & Fallon, P. (1988). The incidence of victimization experiences in a bulimic sample. Journal of Interpersonal Violence, 3(2), 161–173.Google Scholar
  37. Rorty, M., Yager, J., & Rossotto, E. (1995). Aspects of childhood physical punishment and family environment correlates in bulimia nervosa. Child Abuse & Neglect, 19(6), 659–667.Google Scholar
  38. Schneider, J. A., & Agras, W. S. (1985). A cognitive behavioural group treatment of bulimia. The British Journal of Psychiatry, 146(1), 66–69.Google Scholar
  39. Schoemaker, C., Smit, F., Bijl, R. V., & Vollebergh, W. A. (2002). Bulimia nervosa following psychological and multiple child abuse: Support for the self-medication hypothesis in a population-based cohort study. International Journal of Eating Disorders, 32(4), 381–388.Google Scholar
  40. Schwartz, M. F., & Cohn, L. (Eds.). (1996). Sexual abuse and eating disorders. Psychology Press.Google Scholar
  41. Smolak, L., & Murnen, S. K. (2001). Gender and eating problems, Gender and eating problems.Google Scholar
  42. Smolak, L., & Murnen, S. K. (2002). A meta-analytic examination of the relationship between child sexual abuse and eating disorders. International Journal of Eating Disorders, 31(2), 136–150.Google Scholar
  43. Smyth, J. M., Heron, K. E., Wonderlich, S. A., Crosby, R. D., & Thompson, K. M. (2008). The influence of reported trauma and adverse events on eating disturbance in young adults. International Journal of Eating Disorders, 41(3), 195–202.Google Scholar
  44. Stefini, A., Salzer, S., Reich, G., Horn, H., Winkelmann, K., Bents, H., Rutz, U., Frost, U., von Boetticher, A., Ruhl, U., Kronmüller, K., & Specht, N. (2017). Cognitive-behavioral and psychodynamic therapy in female adolescents with bulimia nervosa: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(4), 329–335Google Scholar
  45. Suliman, S., Mkabile, S. G., Fincham, D. S., Ahmed, R., Stein, D. J., & Seedat, S. (2009). Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry, 50(2), 121–127.Google Scholar
  46. Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714–723.Google Scholar
  47. Sweetingham, R., & Waller, G. (2008). Childhood experiences of being bullied and teased in the eating disorders. European Eating Disorders Review, 16(5), 401–407.Google Scholar
  48. Sysko, R., Roberto, C. A., Barnes, R. D., Grilo, C. M., Attia, E., & Walsh, B. T. (2012). Test–retest reliability of the proposed DSM-5 eating disorder diagnostic criteria. Psychiatry Research, 196(2–3), 302–308.Google Scholar
  49. Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating Disorders, 22(1), 33–49.Google Scholar
  50. Tanzilli, A., Lingiardi, V., & Hilsenroth, M. (2017). Patient SWAP-200 personality dimensions and FFM traits: Do they predict therapist responses?.Google Scholar
  51. Tasca, G. A., Szadkowski, L., Illing, V., Trinneer, A., Grenon, R., Demidenko, N., Krysanski, V., Balfour, L., & Bissada, H. (2009). Adult attachment, depression, and eating disorder symptoms: The mediating role of affect regulation strategies. Personality and Individual Differences, 47(6), 662–667.Google Scholar
  52. Waller, G. (1998). Perceived control in eating disorders: Relationship with reported sexual abuse. International Journal of Eating Disorders, 23(2), 213–216.Google Scholar
  53. Welch, S. L., & Fairburn, C. G. (1996). Childhood sexual and physical abuse as risk factors for the development of bulimia nervosa: A community-based case control study. Child Abuse & Neglect, 20(7), 633–642.Google Scholar
  54. Wonderlich, S. A., Brewerton, T. D., Jocic, Z., Dansky, B. S., & Abbott, D. W. (1997). Relationship of childhood sexual abuse and eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 36(8), 1107–1115.Google Scholar
  55. Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Thompson, K. M., Redlin, J., Demuth, G., Smyth, J., & Haseltine, B. (2001). Eating disturbance and sexual trauma in childhood and adulthood. International Journal of Eating Disorders, 30(4), 401–412.Google Scholar
  56. Zaider, T. I., Johnson, J. G., & Cockell, S. J. (2000). Psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. International Journal of Eating Disorders, 28(1), 58–67.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Derner School of PsychologyAdelphi UniversityGarden CityUSA

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