Skip to main content

Relationship between Trauma History and Eating Disorders in Adolescents

Journal of Child & Adolescent Trauma volume 13, pages 443–453 (2020)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  • 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.

    PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15(4), 285–304.

    PubMed  Google Scholar 

  • Bruch, H. (1981). Developmental considerations of anorexia nervosa and obesity. The Canadian Journal of Psychiatry, 26(4), 212–217.

    PubMed  Google Scholar 

  • 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 

  • 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 

  • 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 

  • Cohen, J. (1988). Statistical power analysis for the social sciences.

    Google Scholar 

  • Dalle Grave, R. (2011). Eating disorders: Progress and challenges. European Journal of Internal Medicine, 22(2), 153–160.

    PubMed  Google Scholar 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Keel, P. K., & Brown, T. A. (2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43(3), 195–204.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • 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 

  • National Institute of Mental Health (November, 2017). “Eating Disorders”. Web. Retrieved from:https://www.nimh.nih.gov/health/statistics/eatingdisorders.shtml#part_155061

  • 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 

  • Pennebaker, J. W., & Susman, J. R. (2013). Childhood trauma questionnaire.

  • 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 

  • Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology, 53(1), 187–213.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Rayworth, B., Wise, L., & Harlow, B. (2004). Childhood abuse and risk of eating disorders in women. Epidemiology, 15, 271–278.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

  • 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 

  • 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 

  • Schneider, J. A., & Agras, W. S. (1985). A cognitive behavioural group treatment of bulimia. The British Journal of Psychiatry, 146(1), 66–69.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Schwartz, M. F., & Cohn, L. (Eds.). (1996). Sexual abuse and eating disorders. Psychology Press.

  • Smolak, L., & Murnen, S. K. (2001). Gender and eating problems, Gender and eating problems.

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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), 329–335

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • Sweetingham, R., & Waller, G. (2008). Childhood experiences of being bullied and teased in the eating disorders. European Eating Disorders Review, 16(5), 401–407.

    PubMed  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    PubMed  PubMed Central  Google Scholar 

  • Tanzilli, A., Lingiardi, V., & Hilsenroth, M. (2017). Patient SWAP-200 personality dimensions and FFM traits: Do they predict therapist responses?.

  • 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 

  • Waller, G. (1998). Perceived control in eating disorders: Relationship with reported sexual abuse. International Journal of Eating Disorders, 23(2), 213–216.

    PubMed  Google Scholar 

  • 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 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY, 11530, USA

    Taylor Groth, Mark Hilsenroth, Dana Boccio & Jerold Gold

Authors
  1. Taylor Groth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Hilsenroth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dana Boccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jerold Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taylor Groth.

Ethics declarations

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.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Groth, T., Hilsenroth, M., Boccio, D. et al. Relationship between Trauma History and Eating Disorders in Adolescents. Journ Child Adol Trauma 13, 443–453 (2020). https://doi.org/10.1007/s40653-019-00275-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40653-019-00275-z

Keywords

  • Trauma
  • Adolescents
  • Eating disorders
  • Bulimia