Childhood maltreatment raises eating disorder risk differently for men and women

April 10, 2021
There's a complex relationship between childhood abuse and adult eating disorders. (AP Photo/Paul Sakuma)

There's a complex relationship between childhood abuse and adult eating disorders. (AP Photo/Paul Sakuma)

Analyzing data from a large, longitudinal study, researchers have found that childhood maltreatment raises the risk of disordered eating among adult men and women — but the kind of disordered eating that maltreatment elicits may differ based on gender.

"There's a fairly wide literature showing that individuals exposed to childhood maltreatment are more likely to be diagnosed with a clinical eating disorder, like anorexia or bulimia," Rebecca L. Emery, a researcher in the School of Public Health at the University of Minnesota and lead author of the study, published March 24 in Appetite, told The Academic Times. "Most of these studies have been done in women, largely because eating disorders are more common in women. But there's also been some research showing that childhood maltreatment relates to disordered eating in men."

"We wanted to look at how childhood maltreatment related to disordered eating in both men and women to try to get a sense of whether there are gender differences and what those gender differences might be — and also to move beyond a clinical diagnosis of an eating disorder and to look more broadly at disordered eating behaviors that might be expressed among community samples of individuals," Emery added. She and her colleagues focused on a range of disordered eating attitudes and behaviors, including overeating, extreme and unhealthy weight control behaviors, binge eating and chronic dieting.

The team looked at data from the University of Minnesota's PROJECT EAT, which first began in 1998. "The initial goal was to sample from adolescents in the Minneapolis-St. Paul area, to get a sense of the prevalence of disordered eating and weight-related behaviors in adolescents," Emery said. "About every five years since, surveys were sent out to that group to document the course of these behaviors over time."

This study sampled 1,647 PROJECT EAT participants, who were first asked about childhood maltreatment during the fourth EAT assessment from 2015 through 2016. Emery explained that questions about childhood maltreatment were added to the EAT-IV wave because of growing interest in how abuse and neglect at a young age affect the way people eat as adults.

Over a third of the participants reported some form of childhood maltreatment, with nearly a fifth reporting emotional neglect and almost 16% reporting physical abuse. "This is fairly consistent with evidence coming out showing that about one in three adults will report a history of experiencing childhood maltreatment, which is fairly high and notable," Emery said.

"We found that emotional neglect was one of the strongest predictors of disordered eating in adulthood," she continued, adding that most previous research has studied abuse rather than neglect. "Emotional traumas, including emotional neglect and emotional abuse, can lead to problems with emotion regulation throughout the lifespan. When you're young and you're being yelled at or not being shown affection or made to feel important, you might not learn how to regulate your own emotions when you're raised in an emotionally invalidating environment. You may be more prone to engage in behaviors that are intended to quickly regulate your mood. A lot of disordered eating behaviors have been shown to briefly distract from a negative emotional experience."

According to the authors, who stressed effect size estimation above statistical significance in describing their findings, childhood maltreatment was more strongly tied to disordered eating among women than among men. Yet men appeared to have unique vulnerabilities, including a heightened risk of binge eating due to emotional neglect or emotional abuse. "Men are not immune from disordered eating," Emery said. "This is not a gendered disorder."

The researchers also looked at such factors as parental socioeconomic status, which was equated with the highest educational level either parent attained. "Education is pretty highly correlated with income, so you'll often see folks using education level as a measure of socioeconomic status," Emery explained. "For those who we didn't have parental education, we determined their socioeconomic status using other markers, like school services and public assistance."

"This sample is largely representative of the Minneapolis-St. Paul area, so it might not be generalizable to other studies," Emery said. She added that the study may be limited by its reliance on self-reporting as well as the effectiveness of the survey questions they administered. "It's possible that we didn't adequately capture everyone who had childhood maltreatment, or that we misclassified someone as having childhood maltreatment who maybe didn't," she explained, noting that the survey questions they used were adapted from previous measures of childhood maltreatment.

"We also assessed childhood maltreatment at EAT-IV," Emery continued. "Folks were in their late 20s to early 30s at that point in their lives, and so there could be some error in how they recalled their childhood experiences."

"I think this paper is one drop in the bucket of all the ways we've learned that childhood maltreatment can impact adult functioning," Emery said. She hopes this sort of research can motivate policymakers and public health advocates to identify those at risk of childhood maltreatment and prevent it from happening in the first place.

"And if we identify a child who has experienced maltreatment, we should try to get them into appropriate intervention and treatment services as early as possible," Emery added. "From this evidence, we know that there are long-standing consequences to childhood maltreatment. You don't just grow out of those experiences and no longer have problems because you've become an adult."

The study, "Childhood maltreatment and disordered eating attitudes and behaviors in adult men and women: Findings from project EAT," published March 23 in Appetite, was authored by Rebecca L. Emery, Cynthia Yoon, Susan M. Mason, and Dianne Neumark-Sztainer, University of Minnesota.

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