Abstract
Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology.Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators.Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology.Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed.
Highlights
Eating disorders (EDs) are serious mental illnesses characterized by persistent unhealthy eating behaviors, distorted beliefs, and extreme concerns about weight and shape (American Psychiatric Association, 2013; Solmi et al, 2018a)
Looking at the distribution of the diagnosis, 48 out of 68 anorexia nervosa (AN) patient were included into the trauma+ subgroup (70.6%), 30 out of 37 bulimia nervosa (BN) patients were included into the trauma+ subgroup (81.1%), and all the patients with binge eating disorder (BED) diagnosis
The results of the present study suggest that traumatic experiences should be investigated in ED patients, especially when the severity of the psychopathology required hospitalization or led to the failure of different outpatient treatments
Summary
Eating disorders (EDs) are serious mental illnesses characterized by persistent unhealthy eating behaviors, distorted beliefs, and extreme concerns about weight and shape (American Psychiatric Association, 2013; Solmi et al, 2018a). This paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology
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