QUESTIONS AND ANSWERS: Childhood Abuse and Emotion Dysregulation

Q. Many studies have shown that physical and emotional child abuse is a risk factor for bulimia nervosa (BN), but is there any recent evidence concerning patients with anorexia nervosa (AN)? (HLG, Des Moines)

A. Much more has been written about the role of abuse during childhood and development of BN, but a recent report provides some new information about how childhood abuse experiences impact patients with AN. Sara E. Racine, PhD and Jennifer E. Wilds, PhD, from Ohio University and Western Psychiatric Institute and Clinic, respectively, recently explored the role of emotion regulation and abuse in 188 patients with AN. All the patients were inpatients or were receiving day hospital treatment, most were female and Caucasian, and the mean duration of illness was 8.41 years (Int J Eat Disord. 2015; 41:55).

Drs. Wildes and Racine hypothesized that emotion regulation difficulties due to childhood abuse might be related to the severity of AN symptoms. They noted that abusive experiences in childhood can lead to emotional avoidance, ambivalence about, and suppression of emotions. Parents who are abusive may also be poor role models for emotional regulation.

The participants completed two structured interviews and the trained interviewers administered several questionnaires, the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-1), the Eating Disorder Examination, 16th edition (EDE), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). The last questionnaire is a 28-item self-report measure that assesses a history of childhood emotional, sexual, and physical abuse.

The authors found that childhood emotional abuse had a particularly strong link to eating pathology in the patient’s AN, and that emotion dysregulation could account for the relationship between childhood emotional abuse and AN symptoms independent of AN subtype. However, since these results are cross-sectional, one cannot be certain of the causal relationships. In other worlds, while the hypothesized relationship (abuse leading to emotion dysregulation leading to AN) seems a highly logical one, it could also be that starvation found in AN impacted emotion regulation.

—SC