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Carvalho Silva R, Oliva F, Barlati S, Perusi G, Meattini M, Dashi E, Colombi N, Vaona A, Carletto S, Minelli A. Childhood neglect, the neglected trauma. A systematic review and meta-analysis of its prevalence in psychiatric disorders. Psychiatry Res 2024; 335:115881. [PMID: 38579459 DOI: 10.1016/j.psychres.2024.115881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
Traumatic events increase risk of mental illnesses, but childhood neglect prevalence in psychiatric disorders is understudied. This systematic review and meta-analysis assessed neglect prevalence, including emotional neglect (EN) and physical neglect (PN), among adults with psychiatric disorders. We conducted a systematic search and meta-analysis in 122 studies assessing different psychiatric disorders. Prevalence was 46.6% (95%CI[34.5-59.0]) for unspecified neglect (Ne), 43.1% (95%CI[39.0-47.4]) for EN, and 34.8% (95%CI[30.6-39.2]) for PN. Although a moderating effect of the psychiatric diagnostic category was not confirmed, some clinical diagnoses had significantly lower prevalence rates than others. Patients with bipolar disorder and major depressive disorder showed lower prevalence rates of EN and PN, whereas lower prevalence was found in psychotic disorders and eating disorders for PN only. Neglect assessment was a significant moderator for Ne and PN. No moderating effect of age and sex on neglect prevalence was found. Heterogeneity levels within and between psychiatric diagnostic categories remained high. This is the first meta-analysis examining diverse types of neglect prevalence considering different psychiatric diagnoses. Our results explore the prevalence of childhood neglect and its subtypes among adults with psychiatric disorders, contributing to understanding the nuanced interplay between neglect and specific psychiatric conditions, and guiding interventions for affected individuals.
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Affiliation(s)
- Rosana Carvalho Silva
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Oliva
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy; Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Perusi
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mattia Meattini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Elona Dashi
- Department of Neuroscience, University Hospital Center "Mother Theresa", Tirane, Albania
| | - Nicoletta Colombi
- Federated Library of Medicine "F. Rossi", University of Torino, Torino, Italy
| | - Alberto Vaona
- Azienda Ulss9, Department Cure Primarie, Verona, Italy
| | - Sara Carletto
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy; Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Desrivières S, Zhang Z, Robinson L, Whelan R, Jollans L, Wang Z, Nees F, Chu C, Bobou M, Du D, Cristea I, Banaschewski T, Barker G, Bokde A, Grigis A, Garavan H, Heinz A, Bruhl R, Martinot JL, Martinot MLP, Artiges E, Orfanos DP, Poustka L, Hohmann S, Millenet S, Fröhner J, Smolka M, Vaidya N, Walter H, Winterer J, Broulidakis M, van Noort B, Stringaris A, Penttilä J, Grimmer Y, Insensee C, Becker A, Zhang Y, King S, Sinclair J, Schumann G, Schmidt U. Machine learning models for diagnosis and risk prediction in eating disorders, depression, and alcohol use disorder. RESEARCH SQUARE 2024:rs.3.rs-3777784. [PMID: 38352452 PMCID: PMC10862965 DOI: 10.21203/rs.3.rs-3777784/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
This study uses machine learning models to uncover diagnostic and risk prediction markers for eating disorders (EDs), major depressive disorder (MDD), and alcohol use disorder (AUD). Utilizing case-control samples (ages 18-25 years) and a longitudinal population-based sample (n=1,851), the models, incorporating diverse data domains, achieved high accuracy in classifying EDs, MDD, and AUD from healthy controls. The area under the receiver operating characteristic curves (AUC-ROC [95% CI]) reached 0.92 [0.86-0.97] for AN and 0.91 [0.85-0.96] for BN, without relying on body mass index as a predictor. The classification accuracies for MDD (0.91 [0.88-0.94]) and AUD (0.80 [0.74-0.85]) were also high. Each data domain emerged as accurate classifiers individually, with personality distinguishing AN, BN, and their controls with AUC-ROCs ranging from 0.77 to 0.89. The models demonstrated high transdiagnostic potential, as those trained for EDs were also accurate in classifying AUD and MDD from healthy controls, and vice versa (AUC-ROCs, 0.75-0.93). Shared predictors, such as neuroticism, hopelessness, and symptoms of attention-deficit/hyperactivity disorder, were identified as reliable classifiers. For risk prediction in the longitudinal population sample, the models exhibited moderate performance (AUC-ROCs, 0.64-0.71), highlighting the potential of combining multi-domain data for precise diagnostic and risk prediction applications in psychiatry.
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Mendoza RR, Convertino AD, Blashill AJ. A longitudinal study of potentially traumatic events and binge-purge eating disorder onset in children. Appetite 2024; 193:107132. [PMID: 37995848 DOI: 10.1016/j.appet.2023.107132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
Although the association between childhood trauma and subsequent binge-purge spectrum eating disorders (BP-EDs) is established in adult samples, little is known about the temporal association between potentially traumatic life events and BP-ED onset in children. Using longitudinal data from the U.S.-nationwide Adolescent Brain Cognitive Development (ABCD) study with children aged 9-10 at baseline, logistic regression with complex sampling assessed the longitudinal association of exposure to potentially traumatic events (PTEs) at baseline and meeting BP-ED criteria one year later. Children exposed to PTEs prior to baseline had 1.91 times greater odds of being diagnosed with a BP-ED one year later (95% CI: 1.26 - 2.90; p = .004), compared to those who had not experienced a PTE. The current study extends previous cross-sectional research to show a significant temporal association between childhood PTEs before ages 9-10 and the subsequent onset of BP-EDs one year later. Future research should consider specific timing of PTE exposure as well as examining children diagnosed with restrictive eating disorders.
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Affiliation(s)
- Rebecca R Mendoza
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Aaron J Blashill
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA.
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Budia JM, Alcover CM, Fernández-Muñoz JJ, Blanco-Fernández A, Félix-Alcántara MP. Attachment, motivational systems and anorexia nervosa: A systematic review and proposed framework for eating disorders. Clin Psychol Psychother 2023; 30:913-930. [PMID: 36861498 DOI: 10.1002/cpp.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION There is a direct association between patients with insecure attachment style (IAS), behavioural inhibition (BIS) and behavioural activation (BAS) motivational systems, and anorexia nervosa (AN). However, the possible direct relationships between these three variables have not been studied. OBJECTIVE The main objective of this study is to analyse the relationship between these variables and propose a framework for analysing and understanding these relationships. METHODOLOGY A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, searching the following terms: 'anorexia', 'attachment' and those related to motivational systems. The final search was limited to publications in English dated between 2014-2022 for 'anorexia and attachment' and 2010-2022 for 'anorexia and BIS/BAS'. RESULTS Of the 587 articles retrieved, 30 were included in this study for the textual data analysis of the relationship between anorexia and attachment (17), anorexia and motivational systems (10) and anorexia, attachment and motivational systems (3). An association between avoidant IAS, AN and hypersensitivity to punishment of the BIS was observed in the analysis. A relationship was also observed with hyperreinforcement sensitivity of the BAS. After reviewing the articles, a possible relationship between the three factors, along with other mediating factors, was found. DISCUSSION AN is directly related to the avoidant IAS and to BIS. Similarly, bulimia nervosa (BN) was directly related with anxious IAS and BAS. However, contradictions were found in the BN-BAS relationship. This study proposes a framework for analysing and understanding these relationships.
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Isaksson J, Isaksson M, Stickley A, Vermeiren R, Koposov R, Schwab-Stone M, Ruchkin V. Community Violence Exposure and Eating Disorder Symptoms among Belgian, Russian and US Adolescents: Cross-Country and Gender Perspectives. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01590-1. [PMID: 37606867 DOI: 10.1007/s10578-023-01590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Community violence exposure (CVE) is one of the most common adverse childhood experiences worldwide. Despite this, its potential effect on disordered eating in adolescents from different cultures is underexplored. In the present cross-sectional study, self-reported data were collected from 9751 students (Mean age = 14.27) from Belgium, Russia and the US on CVE (witnessing violence and violence victimization), eating disorder (ED) symptoms (ED thoughts with associated compensatory behaviors), and comorbid symptoms of posttraumatic stress, depression and anxiety. Increased CVE (from no exposure to witnessing to victimization) was associated with more ED symptoms, and the associations remained significant after adjusting for comorbid conditions. The associations were similar for adolescents across the three countries. No gender differences were observed in the association between CVE and ED symptoms, even though girls in general reported more ED symptoms than boys. We conclude that CVE appears to be associated with ED symptoms in three culturally different samples of adolescents.
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Affiliation(s)
- Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Martina Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Robert Vermeiren
- Department of Child and Adolescent Psychiatry Curium, Leiden University Medical Center, Leiden, Netherlands
| | - Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsö, Norway
- Department of Epidemiology and Modern Technologies of Vaccination, Institute of Professional Education, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mary Schwab-Stone
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
- Child Study Center, Yale University School of Medicine, New Haven, USA.
- Sala Forensic Psychiatric Clinic, Sala, Sweden.
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6
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Convertino AD, Mendoza RR. Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. Int J Eat Disord 2023; 56:1055-1074. [PMID: 36916450 PMCID: PMC10247514 DOI: 10.1002/eat.23933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs. METHOD A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review. RESULTS Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment. DISCUSSION Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma-exposed and nontrauma-exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma-informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes. PUBLIC SIGNIFICANCE Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co-occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.
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Affiliation(s)
- Alexandra D. Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Rebecca R. Mendoza
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
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Kovács-Tóth B, Oláh B, Kuritárné Szabó I, Túry F. Adverse childhood experiences increase the risk for eating disorders among adolescents. Front Psychol 2022; 13:1063693. [PMID: 36578685 PMCID: PMC9791097 DOI: 10.3389/fpsyg.2022.1063693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Traumatic events often feature prominently in eating disorders. A questionnaire survey to assess the relation of eating disorder risk to the frequency of adverse childhood experiences (ACEs) and the possible association of eating disorder risk with a particular type of ACE was conducted in a community sample of Hungarian adolescents. Methods Demographic and anthropometric data, risk for eating disorders (by SCOFF questionnaire), and ACEs (by ACE score calculator) were collected from 432 adolescents aged 12-17 years. Results Adolescents who had undergone four or more ACEs were 5.7 times more likely to be in the high eating disorder risk group than those who did not report any ACEs. Cumulative maltreatment showed a greater association with overall risk for eating disorders than cumulative family dysfunction. There is an increased risk of eating disorders from emotional maltreatment (OR = 3.475), physical maltreatment (OR = 3.440), sexual maltreatment (OR = 10.973), and emotional neglect (OR = 3.331). Dysfunctional family circumstances revealed an association with household mental illness (OR = 3.401). Conclusion Our study of the connection between eating disorder risk and ACE is the first of its kind in Central and Eastern Europe. Maltreatments had a greater role than family dysfunctions in increasing the risk of eating disorders. Our findings contribute to a more precise understanding of the role that ACEs play in eating disorders. It is important to bring to clinicians' attention the importance of ACEs in the diagnosis and therapy of eating disorders and their potentially fundamental significance for therapy.
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Affiliation(s)
- Beáta Kovács-Tóth
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,*Correspondence: Beáta Kovács-Tóth,
| | - Barnabás Oláh
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Ildikó Kuritárné Szabó
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Ferenc Túry
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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9
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The Effects of Childhood Emotional and Physical Maltreatment on Adolescents' Disordered Eating Behaviors: The Mediating Role of Borderline Personality Features. J Nerv Ment Dis 2022; 210:831-837. [PMID: 35703279 DOI: 10.1097/nmd.0000000000001556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over time, a complex crossroad between disordered eating behaviors (DEBs) and borderline personality features (BPFs) and their association with childhood emotional and physical maltreatment have been established. The present study aimed at evaluating the direct and indirect effect of physical and emotional abuse and neglect on DEB via BPF in a nonclinical adolescent sample. A total of 786 adolescents (48.3% male; mean age, 16.25 years; SD, 1.76) participated in the study. The mediation model suggested the pivotal predictive role of emotional maltreatment compared with the physical one. Indeed, both emotional abuse and neglect directly and indirectly predicted disordered eating via BPF ( β = 0.097; p < 0.001 and β = 0.042; p < 0.01, respectively). Likely, the emotional maltreatment represents the beginning of a developmental cascade that culminates in DEB as a maladaptive coping strategy in response to negative emotions, through BPF. On the contrary, physical maltreatment seems to be less involved in the developmental cascade.
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Mason SM, Emery RL, Friedman J, Hanson S, Johnson S, Neumark-Sztainer D. Associations of abuse and neglect with young adult health in a population-based longitudinal cohort: Findings from Project EAT. Prev Med 2022; 164:107234. [PMID: 36063877 PMCID: PMC9951821 DOI: 10.1016/j.ypmed.2022.107234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/20/2022] [Accepted: 08/28/2022] [Indexed: 02/01/2023]
Abstract
Childhood maltreatment (abuse and neglect) is associated with a range of negative outcomes, but a gap remains in understanding of how specific maltreatment types, particularly neglect and non-familial sexual abuse, relate to health and behavior. This study examined the association of neglect and sexual abuse (both familial and non-familial), as well as familial physical and emotional abuse, with: depressive mood and eating disorders; tobacco and marijuana use; and BMI ≥ 25 kg/m2 and BMI ≥ 30 kg/m2 in young adults. Data came from Project EAT (Eating and Activity in Teens and Young Adults), a population-based longitudinal study of weight-related health from adolescence into young adulthood. Maltreatment before age 18 was retrospectively reported at ages 26-33. Risk differences (RDs) and 95% confidence intervals (CIs) were estimated for those with a given maltreatment type to those without, and also for the cumulative number of maltreatment types experienced. One in 3 participants reported abuse or neglect. All maltreatment types were associated with at least one adverse health outcome, with physical abuse being least consistently related to the outcomes. Emotional abuse showed the strongest association with depressive mood. All maltreatment types were associated with eating disorder diagnosis, tobacco use, and marijuana use (except physical abuse for eating disorder). There was little evidence of a maltreatment association with BMI ≥ 25 kg/m2; emotional abuse and neglect were associated with BMI ≥ 30 kg/m2. Prevention of maltreatment needs to be a top public health priority.
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Affiliation(s)
- Susan M Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, United States of America.
| | - Rebecca L Emery
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth campus, United States of America
| | - Jessica Friedman
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, United States of America
| | - Stephanie Hanson
- School of Social Work, University of Minnesota, United States of America
| | - Sydney Johnson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, United States of America
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, United States of America
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Lyons ER, Nekkanti AK, Funderburk BW, Skowron EA. Parent-Child Interaction Therapy Supports Healthy Eating Behavior in Child Welfare-Involved Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10535. [PMID: 36078247 PMCID: PMC9518458 DOI: 10.3390/ijerph191710535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We tested the efficacy of standard Parent-Child Interaction Therapy (PCIT), a live-coached, behavioral parent-training program, for modifying problematic eating behaviors in a larger effectiveness trial of PCIT for children involved in the child welfare system. METHOD Children ages 3-7 years and their parents were randomly assigned to PCIT intervention (n = 120) or services as the usual control (SAU; n = 84) groups in a randomized clinical trial. Children's eating behaviors were assessed pre- and post-intervention via the Child Eating Behaviors Questionnaire (CEBQ). Intention-to-treat analyses were conducted, followed by per-protocol analyses, on treatment-engaging families only. RESULTS PCIT led to reductions in child welfare-involved children's food responsiveness, speed of food consumption, and tendency to engage in emotional overeating relative to children in the services-as-usual control condition. Standard PCIT may be an effective intervention to promote healthy child eating behaviors in families involved with child welfare, even when food-related behaviors are not directly targeted by the intervention. Public Health Significance: This clinical trial provides evidence that child welfare-involved children who received PCIT experienced significant reductions in maladaptive eating-related behaviors, namely food responsiveness, emotional overeating, and speed of eating. These findings were observed in relation to children in a comparison control group who had access to child welfare services-as-usual.
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Affiliation(s)
- Emma R. Lyons
- Pediatric Mental Health Institute, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Akhila K. Nekkanti
- Center for Innovation and Research on Choice-Filled Lives, Choice-Filled Lives, Inc., Atlanta, GA 30305, USA
| | - Beverly W. Funderburk
- Department of Developmental and Behavioral Pediatrics, Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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12
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Convertino AD, Morland LA, Blashill AJ. Trauma exposure and eating disorders: Results from a United States nationally representative sample. Int J Eat Disord 2022; 55:1079-1089. [PMID: 35719053 PMCID: PMC9545485 DOI: 10.1002/eat.23757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Sexual assault, child abuse, and combat have been linked to eating disorders (EDs). However, noninterpersonal trauma is relatively understudied, and therefore it is unknown whether noninterpersonal trauma is associated with EDs. Furthermore, most previous studies do not account for multiple trauma exposures, or the relative association of traumatic events with EDs in the same statistical model. METHOD Multinomial regression was used to examine the association of lifetime ED diagnosis (anorexia nervosa [AN], bulimia nervosa [BN], binge eating disorder [BED]) with trauma type (sexual interpersonal, other interpersonal, war/combat, and noninterpersonal) in a nationally representative dataset of US adults in bivariate and multivariable (i.e., with all trauma types) models. RESULTS Sexual interpersonal trauma was significantly positively associated with AN and BED in bivariate and multivariable models. In the multivariable model, only BED was found to be equally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma. DISCUSSION These results indicate a strong positive association between sexual trauma and EDs, even when controlling for experiences of other trauma events. Future research should examine longitudinal mediators between trauma and EDs, especially sexual trauma, to identify what factors may explain this relationship. PUBLIC SIGNIFICANCE STATEMENT Individuals with eating disorders often experience traumatic events but it is unclear whether specific trauma types are more or less common in this population. This study found that only events such as rape and sexual assault are associated with anorexia nervosa, but that most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders.
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Affiliation(s)
- Alexandra D. Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia
| | - Leslie A. Morland
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia,Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA,Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA,National Center for PTSD–Pacific Islands DivisionHonoluluHawaiiUSA
| | - Aaron J. Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia,Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
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Eating disorders and subsequent risk of substance use disorders involving illicit drugs: a Danish nationwide register-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:695-708. [PMID: 34985528 DOI: 10.1007/s00127-021-02201-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE No study has investigated the ongoing risk of substance use disorders involving illicit drugs (ISUD) after first eating disorder (ED) and whether the pattern of risk differs according to types of ED and ISUD. Therefore, we aimed to longitudinally assess the risk of a subsequent diagnosis of any ISUD (pooled category) and specific ISUD after a first-time diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or unspecified ED (USED). METHODS A retrospective cohort study using data from Danish nationwide registers identified 20,759 ED patients and 83,038 matched controls (1:4 ratio). Risk of any ISUD diagnosis after first ED diagnosis was estimated by generating hazard ratios (HR). Logistic regression was applied to assess associations between each ED and specific ISUD. RESULTS Patients with AN, BN, and USED (without a prior ISUD diagnosis) exhibited an increased relative risk of a subsequent diagnosis of any ISUD compared with respective controls, and the elevated risk persisted over 10 years (AN, adjusted HRs ranging from 1.60 [99% CI 1.15-2.24] to 5.16 [3.14-8.47]; BN, 2.35 [1.46-3.79] to 14.24 [6.88-29.47]; USED, 2.86 [1.35-3.79] to 8.56 [3.31-29.47]). The highest estimates were observed during the first year of follow-up. Each ED type was associated with an increased likelihood of all types of ISUD. AN and USED were most strongly associated with sedatives/hypnotics, BN with other illegal substances (e.g., ecstasy and hallucinogens). CONCLUSIONS ED patients have a considerable risk for subsequent ISUD. Prevention efforts and treatment targeting ISUD are likely required to improve ED treatment prognosis.
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Spiegel J, Arnold S, Salbach H, Gotti EG, Pfeiffer E, Lehmkuhl U, Correll CU, Jaite C. Emotional abuse interacts with borderline personality in adolescent inpatients with binge-purging eating disorders. Eat Weight Disord 2022; 27:131-138. [PMID: 33677816 PMCID: PMC8860808 DOI: 10.1007/s40519-021-01142-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/01/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still uncertain, particularly in adolescents. This study investigates the correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female adolescent inpatients with eating disorders (EDs). METHODS One hundred and twenty-eight inpatients (ages 14-18) were assessed, 54 were diagnosed with restricting-type anorexia nervosa (AN-R) and 33 with a binge-purging ED [BP-ED; comprising patients with binge-purging type anorexia nervosa (AN-BP), n = 15, and bulimia nervosa (BN), n = 18]. Fifty healthy participants made up the control group (CG). CEN and CEA were assessed with the Childhood Trauma Questionnaire, while the Personality Style and Disorder Inventory was implemented to determine personality styles. RESULTS A MANOVA revealed a significant main effect of CEA on spontaneous-borderline personality style [F(8,119) = 17.1, p < 0.001, η2 = 0.126], as well as a main effect of ED group on spontaneous-borderline [F(2,119) = 3.1, p = 0.048, η2 = 0.050]. A significant interaction between ED group, CEA, and spontaneous-borderline was found [F(2,119) = 3.5, p = 0.034, η2 = 0.055] with BP-ED showing significantly higher scores in CEA (9.3 ± 4.0) and in spontaneous-borderline (14.2 ± 6.2). CONCLUSIONS Considering CEA and borderline personality style in adolescent inpatients with BN or AN-BP may help improve the understanding of the etiology and maintenance of BP-ED and provide more effective treatment targets. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- J Spiegel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Urban, Berlin, Germany
| | - S Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - H Salbach
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - E G Gotti
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Pfeiffer
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - C Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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15
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Pellegrini RA, Finzi S, Veglia F, Di Fini G. Narrative and Bodily Identity in Eating Disorders: Toward an Integrated Theoretical-Clinical Approach. Front Psychol 2021; 12:785004. [PMID: 34975677 PMCID: PMC8714898 DOI: 10.3389/fpsyg.2021.785004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
Eating disorders (EDs) can be viewed as “embodied acts” that help to cope with internal and external demands that are perceived as overwhelming. The maintenance of EDs affects the entire identity of the person; the lack of a defined; or valid sense of self is expressed in terms of both physical body and personal identity. According to attachment theory, primary relationships characterized by insecurity, traumatic experiences, poor mirroring, and emotional attunement lead to the development of dysfunctional regulatory strategies. Although the literature shows an association between attachment style or states of mind, trauma, behavioral strategies, and various EDs, the debate is still ongoing and the results are still conflicting. Therefore, we believe it is important to examine and treat EDs by understanding which narrative trajectory intercepts distress in relation to narrative and embodied self-concept. Drawing on clinical observation and a narrative review of the literature, we focus on the construction and organization of bodily and narrative identity. Because bodily representations are the primary tools for generating meaning, organizing experience, and shaping social identity from the earliest stages of life, we focus on the role that bodily interactions and sensorimotor and proprioceptive patterns have played in the development of EDs. We consider the role that lack of attunement, insecure attachment, and relational trauma play in mentalizing, affecting self-representation and emotion regulation strategies. The paper also considers a semantic mode of trauma in EDs that involves a top-down pathway through beliefs and narratives about oneself based on lack of amiability, on devaluation, and on humiliation memories. Finally, we would like to highlight the proposal of an integrated model with multiple access model to psychotherapy that takes into account the complexity of ED patients in whom aspects related to dysregulation, body image disintegration, and post-traumatic symptoms are associated with a suffering sense of self and a retraumatizing narrative.
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Affiliation(s)
| | - Sarah Finzi
- Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
- *Correspondence: Sarah Finzi,
| | - Fabio Veglia
- Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Giulia Di Fini
- Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
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Sankaranarayanan A, Johnson K, Mammen SJ, Wilding HE, Vasani D, Murali V, Mitchison D, Castle DJ, Hay P. Disordered Eating among People with Schizophrenia Spectrum Disorders: A Systematic Review. Nutrients 2021; 13:nu13113820. [PMID: 34836076 PMCID: PMC8618287 DOI: 10.3390/nu13113820] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
Disordered eating, or abnormal eating behaviours that do not meet the criteria for an independent eating disorder, have been reported among people with schizophrenia. We aimed to systemati-cally review literature on disordered eating among people with schizophrenia spectrum disorder (SSD). Seven databases were systematically searched for studies that described the prevalence and correlates of disordered eating among patients with SSD from January 1984 to 15 February 2021. Qualitative analysis was performed using the National Institutes of Health scales. Of 5504 records identified, 31 studies involving 471,159 subjects were included in the systematic review. The ma-jority of studies (17) rated fair on qualitative analysis and included more men, and participants in their 30s and 40s, on antipsychotics. The commonest limitations include lack of sample size or power calculations, poor sample description, not using valid tools, or not adjusting for con-founders. The reported rates were 4.4% to 45% for binge eating, 16.1% to 64%, for food craving, 27% to 60.6% for food addiction, and 4% to 30% for night eating. Positive associations were re-ported for binge eating with antipsychotic use and female gender, between food craving and weight gain, between food addiction and increased dietary intake, and between disordered eating and female gender, mood and psychotic symptoms. Reported rates for disordered eating among people with SSD are higher than those in the general population. We will discuss the clinical, treatment and research implications of our findings.
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Affiliation(s)
- Anoop Sankaranarayanan
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (D.M.); (P.H.)
- Correspondence:
| | - Karthika Johnson
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | - Sanop J. Mammen
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | | | - Deepali Vasani
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | - Vijaya Murali
- Western Sydney LHD Mental Health Service, Blacktown, NSW 2148, Australia; (K.J.); (S.J.M.); (D.V.); (V.M.)
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (D.M.); (P.H.)
| | - David J. Castle
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M5S 2E8, Canada;
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (D.M.); (P.H.)
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17
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Yu HJ, Liu X, Zheng M, Zhang MZ, Liu MW, He QQ. Child neglect and eating habits in primary schoolchildren: A prospective study in Wuhan, China. Appetite 2021; 168:105756. [PMID: 34648908 DOI: 10.1016/j.appet.2021.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Child neglect (CN) has been associated with eating disorders, but little is known about its prospective association with the eating habits (EHs) of children. This study aimed to assess the cross-sectional and prospective associations of baseline CN with six common EHs in Chinese primary schoolchildren. We analyzed two-wave data of 1102 children (aged 9.1 ± 0.5 years) in Wuhan, China. Baseline CN was investigated by the Child Neglect Scale. Baseline and follow-up EHs, including fruit, vegetables, milk, sugar-sweetened beverages, and high-calorie snack and breakfast consumption frequency, were assessed by the Food Frequency Questionnaires. The association of baseline CN with baseline/follow-up EHs was analyzed by the generalized linear model (GLM). The association of baseline CN with the change of EHs from baseline to follow-up was examined by the Generalized estimating equation (GEE) model. After adjusting for demographic characteristics, pubertal stage, and body mass index, GLM indicated that higher baseline CN was associated with lower frequency of consuming fruit/vegetables/milk/breakfast and higher frequency of consuming sugar-sweetened beverages and high-calorie snacks at baseline, while it was only associated with lower frequency of vegetables/breakfast consumption and higher frequency of sugar-sweetened beverages consumption at follow-up. GEE results indicated that children with higher CN had a more rapid increase for the frequency of fruit/milk/breakfast consumption and a steeper decrease for the frequency of sugar-sweetened beverages consumption. In conclusion, higher CN was associated with unhealthy EHs. Yet simultaneously, children with higher CN have more scope to promote the health of their EHs. Targeting and reducing CN may be a promising approach for future interventions to improve subsequent EHs.
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Affiliation(s)
- Hong-Jie Yu
- School of Health Sciences, Wuhan University, Wuhan, China
| | | | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, 3125, Australia
| | - Min-Zhe Zhang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Ming-Wei Liu
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Qi-Qiang He
- School of Health Sciences, Wuhan University, Wuhan, China; Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, China.
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18
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Kimber M, McTavish JR, Vanstone M, Stewart DE, MacMillan HL. Child maltreatment online education for healthcare and social service providers: Implications for the COVID-19 context and beyond. CHILD ABUSE & NEGLECT 2021; 116:104743. [PMID: 32980151 PMCID: PMC7513691 DOI: 10.1016/j.chiabu.2020.104743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 05/12/2023]
Abstract
Evidence indicates that healthcare and social service providers (HSSPs) receive inadequate education related to recognizing and responding to child maltreatment. This is despite the fact HSSPs are identified as an important factor in the primary, secondary, and tertiary prevention of this childhood exposure. The need for online education for HSSPs' is highlighted during the COVID-19 pandemic restrictions and will continue to be relevant afterward. The objective of this commentary is to provide an overview of: (a) educational interventions for HSSPs' related to recognizing and responding to child maltreatment; (b) the development of VEGA (Violence, Evidence, Guidance, Action), which is an online platform of educational resources to support HSSPs to recognize and respond to child maltreatment; and (c) the RISE (Researching the Impact of Service provider Education) project, which is an ongoing multi-province evaluation of VEGA in Canada. It is important to consider ongoing ways that HSSPs can receive education related to recognizing and responding to child maltreatment. The virtual implementation of VEGA and the RISE Project provide a necessary opportunity to continue to increase the capacity of Canada's HSSPs to adequately and safely recognize and respond to child maltreatment, while simultaneously advancing education scholarship for the field of child maltreatment and which will have relevance for the COVID-19 context and beyond.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.
| | - Jill R McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 1280 Main Street West, DBHSC 5003E, Hamilton, ON, L8S 4K1, Canada
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto and University Health Network, 200 Elizabeth Street, EN-7-229, Toronto, ON, M5G 2C4, Canada
| | - Harriet L MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, and Department of Pediatrics, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
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19
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Zelkowitz RL, Zerubavel N, Zucker NL, Copeland WE. Longitudinal associations of trauma exposure with disordered eating: Lessons from the Great Smoky Mountains Study. Eat Disord 2021; 29:208-225. [PMID: 34010107 PMCID: PMC8373713 DOI: 10.1080/10640266.2021.1921326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Disordered eating is prevalent among trauma survivors, yet little is known about mechanisms underlying this relation. We explored cross-sectional and longitudinal associations of trauma exposure and posttraumatic stress disorder symptoms (PTSD) with disordered eating among 1,420 community-based youth participating in the Great Smoky Mountain Study. Participants were interviewed about trauma exposure, PTSD symptoms, and disordered eating at regular intervals throughout childhood, adolescence, and early adulthood. Our findings confirmed associations of all forms of trauma exposure (violent, sexual, and other) with disordered eating symptoms in childhood and adulthood, although the pattern of results varied by disordered eating symptom and trauma exposure type. Only non-sexual, non-violent trauma exposure in childhood had significant associations with any disordered eating symptoms in adulthood. Within childhood, trauma exposures but not PTSD symptoms showed significant longitudinal associations with bulimia nervosa symptoms and sustained appetite changes and preoccupation with eating. In adulthood, PTSD symptoms but not trauma exposures showed significant longitudinal associations only with bulimia nervosa symptoms. The association of specific PTSD clusters on bulimia nervosa symptoms was significant for reexperiencing, whereas hyperarousal symptoms trended toward significance. The impact of trauma exposures on disordered eating may vary by developmental period.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, United States
| | - Noga Zerubavel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States
| | - Nancy L Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States
| | - William E Copeland
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States
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20
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Mediating Factors between Childhood Traumatic Experiences and Eating Disorders Development: A Systematic Review. CHILDREN-BASEL 2021; 8:children8020114. [PMID: 33561984 PMCID: PMC7915652 DOI: 10.3390/children8020114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
Background: Many people with eating disorders often report having suffered some kind of childhood trauma. For this reason, many studies have attempted to explore the mediating factors between traumatic experiences and the development of eating disorders. The aim of our study is to conduct a systematic review of published works on the mediating factors between childhood trauma and the development of eating disorders. Method: This review was carried out up to 5 December, 2020, using the databases PsycInfo and PubMed, combining the keywords, and applying a set of inclusion and exclusion criteria. Results: A total of 18 articles were retrieved. After the articles were analyzed, a set of mediating factors between childhood trauma and the development of eating disorders was established, including pathological dissociation, difficulty with emotion self-regulation, body dissatisfaction, negative affect/depression, anxiety, general distress, self-criticism, and alexithymia, among others. Conclusions: In addition to evaluating trauma in eating disorders, these results highlight the importance of paying special attention to the presence of various possible mediating factors, which must be taken into account in the planning of therapeutic treatment. Identifying symptoms of trauma or eating disorders early on could prevent onset of more severe psychopathology during adulthood.
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21
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Child Trauma Experiences and Dissociative Symptoms in Women with Eating Disorders: Case-Control Study. CHILDREN-BASEL 2020; 7:children7120274. [PMID: 33291436 PMCID: PMC7762173 DOI: 10.3390/children7120274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
Background: many people with different diagnoses, including eating disorders, have suffered traumatic experiences in childhood. Method: a case-control study was performed. The objective of this study was to evaluate the presence of child trauma and dissociative symptoms in people with eating disorders and compare the results obtained with a control group. Participants were administered the Mini International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for Personality Disorders (SCID-II) to confirm diagnostic criteria and explore possible comorbidities. Traumatic experiences in childhood were evaluated with the Child Trauma Questionnaire in its abbreviated version (CTQ-SF), psychoform dissociation was measured with the Scale of Dissociative Experiences (DES-II) and somatoform dissociation with the Somatoform Dissociation Scale (SDQ-20). Results: women with eating disorders reported a greater severity and higher prevalence of child trauma than the control group. Significant differences were found by groups in dissociative symptoms. Conclusions: our results, in a Spanish sample, confirm the findings of previous studies.
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22
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Gordon AL, Patterson TK, Knowlton BJ. Early-life stress is associated with a preponderance of habitual responding in a novel instrumental avoidance learning paradigm. Neurobiol Learn Mem 2020; 175:107316. [PMID: 33011387 PMCID: PMC7683304 DOI: 10.1016/j.nlm.2020.107316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 11/26/2022]
Abstract
There is substantial evidence linking early-life stress (ELS) to negative health outcomes in adulthood, including addiction. However, the neurocognitive and behavioral mechanisms through which ELS increases these risks remain unclear. To address this gap in knowledge, we developed a novel instrumental learning paradigm to explore the effects of ELS on the balance of habitual versus goal-directed learning. Habits efficiently reproduce repetitive behaviors but are inflexible whenreward contingencies related to those behaviors change. Persisting in performing a response after its outcome has been devalued is the hallmark of habitual behavior in instrumental learning. Participants with a history of higher ELS were significantly more likely to make habitual responses in this instrumental avoidance learning paradigm than individuals with a history of lower ELS. Logistic regression analysis showed that ELS is significantly related to habitual responding over and above the effects of retrospective socioeconomic status, trait and state anxiety, depression and recent levels of stress. Analysis of the differential impacts of the type of ELS suggested that these effects are largely driven by experiences of physical neglect.
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Affiliation(s)
- Alexander L Gordon
- University of California, Los Angeles, Department of Psychology, United States
| | - Tara K Patterson
- University of California, Los Angeles, Department of Psychology, United States
| | - Barbara J Knowlton
- University of California, Los Angeles, Department of Psychology, United States.
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23
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Carr A, Duff H, Craddock F. A Systematic Review of Reviews of the Outcome of Noninstitutional Child Maltreatment. TRAUMA, VIOLENCE & ABUSE 2020; 21:828-843. [PMID: 30249161 DOI: 10.1177/1524838018801334] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of the systematic review described in this article was to synthesize available high-quality evidence on the outcomes of noninstitutional child maltreatment across the life span. A systematic review of previous systematic reviews and meta-analyses was conducted. Ten databases were searched. One hundred eleven papers which met stringent inclusion and exclusion criteria were selected for review. Papers were included if they reported systematic reviews and meta-analyses of longitudinal or cross-sectional controlled studies, or single-group cohort primary studies of the outcomes of child maltreatment in the domains of physical and mental health and psychosocial adjustment of individuals who were children lived mainly with their families. Using AMSTAR criteria, selected systematic reviews and meta-analyses were found to be of moderate or high quality. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. The 111 systematic reviews and meta-analyses reviewed in this article covered 2,534 independent primary studies involving 30,375,962 participants, of whom more than 518,022 had been maltreated. The magnitude and quality of this evidence base allow considerable confidence to be placed in obtained results. Significant associations were found between a history of child maltreatment and adjustment in the domains of physical health, mental health, and psychosocial adjustment in a very wide range of areas. The many adverse outcomes associated with child maltreatment documented in this review highlight the importance of implementing evidence-based child protection policies and practices to prevent maltreatment and treat child abuse survivors.
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Affiliation(s)
- Alan Carr
- University College Dublin, Dublin, Ireland
- Clanwilliam Institute, Dublin, Ireland
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24
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Coffino JA, Grilo CM, Udo T. Childhood food neglect and adverse experiences associated with DSM-5 eating disorders in U.S. National Sample. J Psychiatr Res 2020; 127:75-79. [PMID: 32502721 DOI: 10.1016/j.jpsychires.2020.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) and restricted food access have been associated with risk for eating disorders (EDs). This study examined the relationship between childhood food neglect, an ACE specifically involving restricted food access, and DSM-5-defined EDs in a nationally representative sample of U.S. adults, with a particular focus on whether the relationship persists after adjusting for other ACEs and family financial difficulties. METHODS Participants were 36,145 respondents from the National Epidemiological Survey on Alcohol and Related Conditions III (NESARC-III) who provided data regarding childhood food neglect. Prevalence rates of lifetime anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) were determined for those who reported versus denied childhood food neglect. Analyses compared the odds of each ED diagnosis after adjusting for sociodemographic characteristics (Model 1) and further adjusting for other ACEs and governmental-financial support during childhood (Model 2). RESULTS Prevalence estimates for AN, BN, and BED with a history of childhood food neglect were 2.80% (SE = 0.81), 0.60% (SE = 0.21), and 3.50% (SE = 0.82), respectively and 0.80% (SE = 0.07), 0.30% (SE = 0.03), and 0.80% (SE = 0.05) for those without a history (all significantly different, p < .05). In the fully-adjusted model, odds of having an ED diagnosis were significantly higher for AN (AOR = 2.98 [95% CI = 1.56-5.71]) and BED (AOR = 2.95 [95% CI = 1.73-5.03]) in respondents with a history of childhood food neglect compared with those without. CONCLUSION Individuals who experience childhood food neglect may be at increased risk for AN and BED and the elevated risk exists after adjusting for other adverse experiences and financial difficulties during childhood.
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Affiliation(s)
- J A Coffino
- Department of Psychiatry, Yale University, United States; Department of Psychology, University at Albany, State University of New York, United States.
| | - C M Grilo
- Department of Psychiatry, Yale University, United States
| | - T Udo
- Department of Health Policy, Management, and Behavior, University at Albany, State University of New York, United States
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Kimber M, Gonzalez A, MacMillan HL. Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders. Front Psychiatry 2020; 11:678. [PMID: 32754071 PMCID: PMC7366365 DOI: 10.3389/fpsyt.2020.00678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/29/2020] [Indexed: 11/29/2022] Open
Abstract
Child maltreatment encompasses a constellation of adverse parental behaviors that include physical, sexual, or emotional abuse, physical or emotional neglect, as well as exposure to violence between parents. A growing body of literature indicates that exposure to child maltreatment is a significant risk factor for the development and maintenance of eating disorders (EDs) and that practitioners experience challenges related to recognizing and responding to various forms of child maltreatment in their practice. Parent-child interactions signifying possible child maltreatment can be subtle; furthermore, the emotional and behavioral symptoms associated with an ED can overlap with those linked with child maltreatment, making it difficult for practitioners to distinguish whether children's symptoms are attributable to underlying psychopathology versus exposure to child maltreatment. This challenge can be further complicated in the context of delivering family-based treatment (FBT); FBT reaffirms that there is no single cause of EDs and asserts the leadership role of parents in their child's recovery process-both of which may lead practitioners to inadvertently miss indicators of child maltreatment. In this article, we provide an overview of the evidence linking child maltreatment to EDs among children and adolescents, as well as evidence-informed strategies for practitioners to safely recognize and respond to suspected child maltreatment when delivering FBT to children and adolescents in their practice.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Parreco J, Quiroz HJ, Willobee BA, Sussman M, Buicko JL, Rattan R, Namias N, Thorson CM, Sola JE, Perez EA. National Risk Factors for Child Maltreatment after Trauma: Failure to Prevent. Am Surg 2020. [DOI: 10.1177/000313481908500726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to identify the risk factors for hospital readmission for child maltreatment after trauma, including admissions across different hospitals nationwide. The Nationwide Readmissions Database for 2010–2014 was queried for all patients younger than 18 years admitted for trauma. The primary outcome was readmission for child maltreatment. The secondary outcome was readmission for maltreatment presenting to a hospital different than the index admission hospital. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome. There were 608,744 admissions identified and 44,569 (7.32%) involved maltreatment at the index admission. Readmission for maltreatment was found in 1,948 (0.32%) patients and 368 (18.89%) presented to a different hospital. The highest risk for readmission for maltreatment was found in patients with maltreatment identified at the index admission (odds ratios (OR) 9.48 [8.35–10.76]). The strongest risk factor for presentation to a different hospital was found with the lowest median household income quartile (OR 3.50 [2.63–4.67]). The subgroup analysis identified 647 (0.11%) children with readmission for maltreatment that was missed during the index admission. The strongest risk factor for this outcome was Injury Severity Score > 15 (OR 3.29 [2.68–4.03]). This study demonstrates that a significant portion of admissions for trauma in children and teenagers could be misrepresented as not involving maltreatment. These index admissions could be the only chance for intervention for child maltreatment. Identifying these at-risk individuals is critical to prevention efforts.
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Affiliation(s)
- Joshua Parreco
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Hallie J. Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Brent A. Willobee
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Mathew Sussman
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jessica L. Buicko
- Division of Endocrine Surgery, Weil Cornell Medical Center, New York, New York
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care; and
| | | | - Chad M. Thorson
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E. Sola
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A. Perez
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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27
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Olofsson ME, Oddli HW, Vrabel KAR, Hoffart A. «In solitude is safeness»: a patient perspective on eating disorders in the context of multiple childhood trauma. NORDIC PSYCHOLOGY 2020. [DOI: 10.1080/19012276.2020.1762714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | - Asle Hoffart
- Department of Psychology, Oslo University, Oslo, Norway
- Modum Bad Research Institute, Vikersund, Norway
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28
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Wolf NM, Elklit A. Child Maltreatment and Disordered Eating in Adulthood: a Mediating Role of PTSD and Self-Esteem? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:21-32. [PMID: 32318225 PMCID: PMC7163900 DOI: 10.1007/s40653-018-0224-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The current study investigated relationships between different experiences of child maltreatment (CM) and disordered eating (DE) in a large population-based sample of Danish young adults. Participants completed a structured interview comprising socio-demographic, psychological and physical domains. Questions regarding CM, DE, PTSD symptoms and self-esteem were analyzed using chi-square-tests, ANOVAs, hierarchical regression, and multiple mediation analyses. Participants with a history of CM experienced higher levels of DE than non-abused individuals. PTSD symptoms and self-esteem appeared to differentially mediate the relationship between three classes of CM and DE. Whereas the relation between emotional and sexual abuse with DE was partially mediated via participants' level of PTSD symptoms and self-esteem with emotional abuse having a stronger impact on self-esteem and sexual abuse more strongly influencing PTSD symptoms, the relation between polyvictimization and DE was fully mediated by PTSD and self-esteem, mainly due to the indirect effect via PTSD.
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Affiliation(s)
- Nele Marie Wolf
- National Center of Psychotraumatology, University of Southern Denmark, Odense, Denmark
- Present Address: Alexianer Center of Psychotraumatology, Michaelshovener Str. 11, 50999 Cologne, Germany
| | - Ask Elklit
- National Center of Psychotraumatology, University of Southern Denmark, Odense, Denmark
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29
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Quiroz HJ, Parreco J, Easwaran L, Willobee B, Ferrantella A, Rattan R, Thorson CM, Sola JE, Perez EA. Identifying Populations at Risk for Child Abuse: A Nationwide Analysis. J Pediatr Surg 2020; 55:135-139. [PMID: 31757508 PMCID: PMC7848807 DOI: 10.1016/j.jpedsurg.2019.09.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Child abuse is a national, often hidden, epidemic. The study objective was to determine at-risk populations that have been previously hospitalized prior to their admission for child abuse. METHODS The Nationwide Readmissions Database (NRD) was queried for all children hospitalized for abuse. Outcomes were previous admissions and diagnoses. χ2 analysis was used; significance equals p < 0.05. RESULTS 31,153 children were hospitalized for abuse (half owing to physical abuse) during the study period. 11% (n = 3487) of these children had previous admissions (one in three to a different hospital), while 3% (n = 1069) had multiple hospitalizations. 60% of prior admissions had chronic conditions, and 12% had traumatic injuries. Children with chronic conditions were more likely to have sexual abuse (89% vs. 57%, p < 0. 001) and emotional abuse (75% vs. 60%, p < 0. 01). 25% of chronic diagnoses were psychiatric, who were also more likely to have sexual and emotional abuse (47% vs. 5.5% and 10% vs. 1%, all p < 0. 001). CONCLUSION This study uncovers a hidden population of children with past admissions for chronic conditions, especially psychiatric diagnoses that are significantly associated with certain types of abuse. Improved measures to accurately identify at-risk children must be developed to prevent future childhood abuse and trauma. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Hallie J. Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, RMSB RM 1010, 1600 NW 10th Avenue, Miami, Florida 33136,Corresponding author. Tel.: +1 316 253-8950. (H.J. Quiroz)
| | - Joshua Parreco
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | | | - Brent Willobee
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Anthony Ferrantella
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Chad M. Thorson
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Juan E. Sola
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Eduardo A. Perez
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
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Farina B, Liotti M, Imperatori C. The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension. Front Psychol 2019; 10:933. [PMID: 31080430 PMCID: PMC6497769 DOI: 10.3389/fpsyg.2019.00933] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Epidemiological, clinical, and neurobiological studies of the last 30 years suggest that traumatic attachments during the early years of life are associated to specific psychopathological vulnerabilities based on dissociative pathogenic processes. It has been observed that the dissociative pathogenic processes caused by these traumatic attachments either may contribute to the genesis of well-defined mental disorders (e.g., dissociative disorders) or may variably occur in many other diagnostic categories, complicating their clinical pictures and worsening their prognosis. For this reason, we proposed to define the dimension of psychopathological outcomes linked to traumatic attachments and dissociative pathogenic processes as the “traumatic-dissociative” dimension (TDD). The clinical complexity of the TDD requires specific training to enable mental health professionals to recognize the signs of traumatic developments and to implement specific treatment strategies. The present article aims to review some crucial points about the clinical meaning and treatment strategies of the TDD, the dissociative pathogenic processes characterizing the TDD, as well as of the role of attachment trauma in the TDD. We also focused on the clinical and theoretical evidence suggesting that dissociation and dis-integration may be considered two different processes but highly correlated. The usefulness of clinical reasoning in terms of psychopathological dimensions, instead of distinct diagnostic categories, as well as several therapeutic implications of these issues was finally discussed.
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Affiliation(s)
- Benedetto Farina
- Department of Human Sciences, European University of Rome, Rome, Italy.,Traumatic Treatment Unit, Centro Clinico De Sanctis, Rome, Italy
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31
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Amianto F, Spalatro AV, Rainis M, Andriulli C, Lavagnino L, Abbate-Daga G, Fassino S. Childhood emotional abuse and neglect in obese patients with and without binge eating disorder: Personality and psychopathology correlates in adulthood. Psychiatry Res 2018; 269:692-699. [PMID: 30273894 DOI: 10.1016/j.psychres.2018.08.089] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 06/25/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
The link between childhood traumatic experiences such as sexual and physical abuse and EDs in adulthood has been widely demonstrated. To date, however, little research focused on the association between emotional abuse and neglect in childhood and Binge Eating Disorder (BED) and obesity in adulthood. We enrolled 127 patients [84 with BED and 43 obese] and 45 healthy controls (HCs). All participants were administered the same battery of psychometric tests. Between-group differences were explored and the relationship between emotional abuse and neglect in childhood and personality and psychopathology in adulthood was tested. Obese patients showed higher scores in emotional abuse and neglect and sexual abuse when compared to HCs. Within obese participants, those with BED reported higher emotional abuse and emotional neglect than obese without BED and HCs; the BED group differed in physical and sexual abuse from obese participants. The association between traumatic experiences in childhood and obesity in adulthood has been confirmed independently of the type of trauma. Therapists should take into account the traumatic etiology of BED, in particular psychological abuse, even in those patients who do not recall physical or sexual abuses. Specific techniques to approach traumatic experiences could be applied to BED or non-BED patients.
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Affiliation(s)
- Federico Amianto
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin 10135, Italy.
| | - Angela Valentina Spalatro
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin 10135, Italy
| | - Miriam Rainis
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin 10135, Italy
| | - Carla Andriulli
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin 10135, Italy
| | - Luca Lavagnino
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas, United States
| | - Giovanni Abbate-Daga
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin 10135, Italy
| | - Secondo Fassino
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin 10135, Italy
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Connors KJ. Dissociative and complex trauma disorders in health and mental health contexts: Or why is the elephant not in the room? J Trauma Dissociation 2018; 19:1-8. [PMID: 28929908 DOI: 10.1080/15299732.2018.1379855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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33
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Afifi TO, Sareen J, Fortier J, Taillieu T, Turner S, Cheung K, Henriksen CA. Child maltreatment and eating disorders among men and women in adulthood: Results from a nationally representative United States sample. Int J Eat Disord 2017; 50:1281-1296. [PMID: 28990206 PMCID: PMC5698735 DOI: 10.1002/eat.22783] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Child maltreatment is associated with an increased likelihood of having mood disorders, anxiety disorders, post-traumatic stress disorder, substance use disorders, and personality disorders, but far less is known about eating disorders. The objective of the current study was to examine the associations between child maltreatment, including harsh physical punishment, physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence, and eating disorders in adulthood among men and women. METHOD Data were from the National Epidemiologic Survey on Alcohol and Related Conditions wave 3 (NESARC-III) collected in 2012-2013. The sample was nationally representative of the United States adult population (N = 36,309). Lifetime eating disorders (anorexia nervosa [AN], bulimia nervosa [BN], and binge-eating disorder [BED]) were assessed using diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria and the alcohol use disorder and associated disabilities interview schedule-5 (AUDADIS-5). RESULTS The prevalence of any lifetime eating disorder was 1.7% (0.8% among men and 2.7% among women). All child maltreatment types were associated with AN, BN, and BED with notable differences among men and women. Overall, the types of child maltreatment with the strongest relationships with any eating disorder were sexual abuse and physical neglect among men and sexual abuse and emotional abuse among women. DISCUSSION Clinicians should be mindful that child maltreatment experiences are associated with increased odds of eating disorders including AN, BED, and BN. Such relationships are significant among men and women although notable gender differences in these relationships exist. Abstract word count = 248.
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Affiliation(s)
- Tracie O. Afifi
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada,Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Jitender Sareen
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada
| | - Janique Fortier
- Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Tamara Taillieu
- Applied Health Sciences Program, University of ManitobaManitobaR3E 0W5Canada
| | - Sarah Turner
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada,Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Kristene Cheung
- Department of PsychologyUniversity of ManitobaManitobaR3E 0W5Canada
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