Childhood Adverse Experiences in Anorexia Nervosa: Impact on Comorbid Psychopathological Features and Cumulative Effect on Clinical Severity

Eur Eat Disord Rev. 2025 Nov 6. doi: 10.1002/erv.70052. Online ahead of print.

ABSTRACT

OBJECTIVE: Adverse childhood experiences (ACEs) are risk factors for anorexia nervosa (AN). We compared patients with AN and Healthy Control subjects (HCs) on the frequency and type of ACEs, assessed the association between each ACE and the likelihood of having specific psychopathological features in AN, and explored the relationship between the number of ACEs and clinical severity.

METHOD: One-hundred and twenty-nine patients with AN and 111 HCs completed several self-report questionnaires assessing ACEs, post-traumatic symptoms, eating-related, and general psychopathology.

RESULTS: Patients with AN reported a higher number of and more mixed (i.e., both emotional and physical abuse) ACEs than HCs. Each ACE, except for physical abuse and neglect, was associated with an increasing likelihood of comorbid features, including self-harm, lifetime probable PTSD, and substance/alcohol abuse, independently of AN subtype. An increased number of ACEs was linked to a doubled likelihood of being in the AN versus HC group, and to emotion dysregulation, somatoform dissociation, and depression, both in patients and HCs.

CONCLUSION: ACEs contributed to a more complex picture in AN, with the specific influence of each ACEs type. The study revealed a cumulative effect of ACEs on dissociation and emotional symptoms, suggesting an important role of traumatic history in individuals with AN.

PMID:41199424 | DOI:10.1002/erv.70052