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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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2
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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3
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Bozkurt O, Kocaadam-Bozkurt B, Köksal E, Özalp Ateş FS. Children's eating attitudes test (ChEAT): validation and reliability in Turkish children. J Eat Disord 2023; 11:93. [PMID: 37649120 PMCID: PMC10469453 DOI: 10.1186/s40337-023-00811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/16/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES This study aims to examine the validity and reliability of the children's eating attitudes test (ChEAT) in Turkish children. METHODS The participants were 331 children (137 boys and 194 girls, ages 8-15). Data was collected through face-to-face interviews using a questionnaire containing socio-demographic characteristics, the ChEAT, and the children's eating behaviour questionnaire (CEBQ). Exploratory factor analysis (EFA) was performed to determine the factor structure of the Turkish version of the ChEAT. Additionally, the reliability was examined in terms of internal consistency and test-retest reliability. All statistical analyses were performed using Mplus Trial Version and SPSS 11.5 (SPSS, Chicago, IL, USA). RESULTS According to the goodness-of-fit statistic, a three-factor solution was appropriate and compatible with clinical considerations. The three factors explained 50.1% of the variance. Cronbach's alpha coefficient was 0.75 for ChEAT-26, 0.67 for "Preoccupation with thinness and food", 0.63 for "Social pressure to eat", and 0.71 for "Dieting". Furthermore, the test-retest reliability was 0.72, 0.62, 0.59, and 0.59 respectively. Statistically significant correlations between the ChEAT and CEBQ were found (p < 0.05). "Preoccupation with thinness and food" was significantly higher in obese children (p < 0.05), while "Social pressure to eat" was lower (p < 0.001). Sex, grade, BMI, parental education in addition to working status affected the ChEAT-26 scores. CONCLUSIONS The present study has provided preliminary evidence for the validity and reliability of a Turkish version of the ChEAT.
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Affiliation(s)
- Osman Bozkurt
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erzurum Technical University, Erzurum, Turkey
| | - Betul Kocaadam-Bozkurt
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erzurum Technical University, Erzurum, Turkey
| | - Eda Köksal
- Department of Nutrition and Dietetics, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Funda Seher Özalp Ateş
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Manisa Celal Bayar University, 45030 Manisa, Turkey
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Pruccoli J, Guardi G, La Tempa A, Valeriani B, Chiavarino F, Parmeggiani A. Food and Development: Children and Adolescents with Neurodevelopmental and Comorbid Eating Disorders-A Case Series. Behav Sci (Basel) 2023; 13:499. [PMID: 37366751 DOI: 10.3390/bs13060499] [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: 03/06/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
The impact of psychiatric comorbidities in the diagnosis and treatment of feeding and eating disorders (FEDs) represents an emerging research topic. The current literature, nonetheless, lacks studies investigating the developmental paths of individuals with FEDs and comorbid neurodevelopmental disorders (NDDs). Here, we report 11 cases of children and adolescents with comorbid FEDs and NDDs, as assessed along the neuropsychological, psychopathological, and nutritional developmental pathways. The onset of FED-related psychopathology was preceded, sometimes undiagnosed, by altered neurodevelopmental features leading to specific NDD diagnoses (autism spectrum disorder-ASD; attention-deficit/hyperactivity disorder-ADHD; specific learning disorder-SLD). NDDs appeared to influence the diagnoses and treatments of FEDs, frequently with an impact on socio-relational and emotional premorbid features, and on the possibility to receive and attend FED-targeted treatments. Further studies should longitudinally contribute to assessing the experiences of care and neurodevelopmental pathways of children with FEDs and specific NDD comorbidities.
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Affiliation(s)
- Jacopo Pruccoli
- Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età Evolutiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, U.O. Neuropsichiatria dell'età Pediatrica, 40138 Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
| | - Giulia Guardi
- Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età Evolutiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, U.O. Neuropsichiatria dell'età Pediatrica, 40138 Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
| | - Angela La Tempa
- Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età Evolutiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, U.O. Neuropsichiatria dell'età Pediatrica, 40138 Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
| | - Beatrice Valeriani
- Centre for Chronic Intestinal Failure-Clinical Nutrition and Metabolism Unit, Universitaria di Bologna, IRCCS Azienda Ospedaliero, 40138 Bologna, Italy
| | - Francesca Chiavarino
- Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età Evolutiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, U.O. Neuropsichiatria dell'età Pediatrica, 40138 Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
| | - Antonia Parmeggiani
- Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età Evolutiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, U.O. Neuropsichiatria dell'età Pediatrica, 40138 Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40126 Bologna, Italy
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Abstract
BACKGROUND Although the prevalence rates of preadolescent eating disorders (EDs) are on the rise, considerably less is known about the correlates and treatment of EDs in this age group. Clarifying the epidemiology of EDs in preadolescent children is a necessary first step to understand the nature and scope of this problem in this age group. METHODS Analysis of data collected in the ABCD Study release 2.0.1. The ABCD cohort was a population-based sample that consisted of 11 721 children ages 9-10 years. Measures included reports of a lifetime and current mental disorders determined using a diagnostic interview for DSM-5 disorders, sociodemographic factors, and psychiatric treatment utilization. RESULTS The lifetime prevalence of EDs was 0.95%. Being Black, multiracial, having unmarried parents, and family economic insecurity were significant predictors for developing an ED. Among psychiatric conditions, the major depressive disorder was most robustly associated with EDs in both cross-sectional and temporal analyses. Only 47.40% of children who had a lifetime ED received some type of psychiatric treatment. EDs were not a significant predictor of psychiatric treatment utilization after accounting for sex, sexual orientation, parent marital status, economic insecurity, and all other psychiatric diagnoses. CONCLUSIONS Despite increasing prevalence rates of preadolescent EDs, the current findings suggest that the majority of children with these disorders remain untreated. Devoting increased attention and resources to reaching families of children with EDs with the least means for receiving care, and screening for EDs in children with depression, may be important steps for reducing this unmet need.
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Affiliation(s)
| | - Rachel Y. Levin
- Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Richard T. Liu
- Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
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Sohn MN, Dimitropoulos G, Ramirez A, McPherson C, Anderson A, Munir A, Patten SB, McGirr A, Devoe DJ. Non-suicidal self-injury, suicidal thoughts and behaviors in individuals with an eating disorder relative to healthy and psychiatric controls: A systematic review and meta-analysis. Int J Eat Disord 2023; 56:501-515. [PMID: 36647184 DOI: 10.1002/eat.23880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Eating disorders (ED) may be associated with an increased prevalence of non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs) relative to healthy (HC) and psychiatric (PC) controls. However, precise estimates of differences in prevalence between individuals with EDs and controls are unclear. We compared the prevalence of NSSI, suicidal ideation (SI), suicide attempts (SA), and deaths by suicide in controls and individuals with EDs. METHOD We searched MEDLINE, PsycINFO, EMBASE, and CINAHL for peer-reviewed publications reporting the prevalence of NSSI and/or STBs in EDs and HC or PC group (PROSPERO: CRD42021286754). A series of random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) for NSSI, SI, SA, and death by suicide in EDs. RESULTS Across 32 studies, individuals with an ED had a significantly increased prevalence of NSSI (HC: OR = 6.85 [95% CI: 3.60, 13.04]; PC: OR = 2.74 [95% CI: 1.49, 5.06]), SI (HC: OR = 3.63 [95% CI: 2.43, 5.41]; PC: OR = 3.10 [95% CI: 2.01, 4.78]), and SA (HC: OR = 5.16 [95% CI: 4.27, 6.24]; PC: OR = 1.37 [95% CI: 0.37, 4.99]) relative to HC and PC groups. A 2.93-times increased odd of death by suicide did not achieve statistical significance. There was a high-level of heterogeneity between studies. DISCUSSION Our findings indicate that ED populations have an increased prevalence of NSSI, SI, and SA but not death by suicide compared to controls and emphasize the need for effective clinical strategies to address these behaviors in ED populations. PUBLIC SIGNIFICANCE This review provides evidence for an increased prevalence of non-suicidal self-injury, suicidal ideation, and suicide attempts in populations with eating disorders compared to controls. Our findings emphasize the need for effective clinical strategies to address these behaviors in patients with eating disorders.
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Affiliation(s)
- Maya N Sohn
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Ana Ramirez
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Claire McPherson
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alida Anderson
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Amlish Munir
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Daniel J Devoe
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Department of Psychology, Mount Royal University, Calgary, Alberta, Canada
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7
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Chu J, Raney JH, Ganson KT, Wu K, Rupanagunta A, Testa A, Jackson DB, Murray SB, Nagata JM. Adverse childhood experiences and binge-eating disorder in early adolescents. J Eat Disord 2022; 10:168. [PMID: 36384578 PMCID: PMC9670461 DOI: 10.1186/s40337-022-00682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are common and linked to negative health outcomes. Previous studies have found associations between ACEs and binge-eating disorder (BED), though they have mainly focused on adults and use cross-sectional data. The objective of this study was to examine the associations between ACEs and BED in a large, national cohort of 9-14-year-old early adolescents in the US. METHODS We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,145, 2016-2020). Logistic regression analyses were used to determine the associations between self-reported ACEs and BED based on the Kiddie Schedule for Affective Disorders and Schizophrenia at two-year follow-up, adjusting for sex, race/ethnicity, baseline household income, parental education, site, and baseline binge-eating disorder. RESULTS In the sample, (49% female, 46% racial/ethnic minority), 82.8% of adolescents reported at least one ACE and 1.2% had a diagnosis of BED at two-year follow-up. The mean number of ACEs was higher in those with a diagnosis of BED compared to those without (2.6 ± 0.14 vs 1.7 ± 0.02). The association between number of ACEs and BED in general had a dose-response relationship. One ACE (adjusted odds ratio [aOR] 3.48, 95% confidence interval [CI] 1.11-10.89), two ACEs (aOR 3.88, 95% CI 1.28-11.74), and three or more ACEs (aOR 8.94, 95% CI 3.01-26.54) were all associated with higher odds of BED at two-year follow-up. When stratified by types of ACEs, history of household mental illness (aOR 2.18, 95% 1.31-3.63), household violence (aOR 2.43, 95% CI 1.42-4.15), and criminal household member (aOR 2.14, 95% CI 1.23-3.73) were most associated with BED at two-year follow-up. CONCLUSIONS Children and adolescents who have experienced ACEs, particularly household challenges, have higher odds of developing BED. Clinicians may consider screening for ACEs and providing trauma-focused care when evaluating patients for BED.
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Affiliation(s)
- Jonathan Chu
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Julia H Raney
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | - Kelsey Wu
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Ananya Rupanagunta
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
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8
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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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Novack K, Dufour R, Picard L, Booij L, Chadi N. An Intensive Ambulatory Care Program for Adolescents with Eating Disorders Combining In-Person and Virtual Care: Protocol for a Single-Site Naturalistic Trial (Preprint). JMIR Res Protoc 2022; 11:e37420. [DOI: 10.2196/37420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
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