Adverse Childhood Experiences and Eating Disorders

Healthcare professionals working with pregnant women need to be aware of the high prevalence of underlying eating disorder symptoms and the possible association with a history of adverse experiences in childhood, according to the results of an ongoing study (Br J Psychiatry 2005;187:268).

The Avon Longitudinal Study of Parents and Children, also known as the “Children of the Nineties Project,” recruited 14,069 pregnant women in three districts in Avon, a city in southwest England, and then followed them with three questionnaires addressing parental mental health and childhood sexual abuse and experiences, including instances of unwanted sexual advances or exposure. R. Senior, MRCPsych, and colleagues used data from this study to explore early experiences recalled by pregnant mothers that were associated with lifetime and antenatal eating disorder symptoms.

Early experiences did play a role

A number of early experiences significantly predicted lifetime eating disorder symptoms. Women who reported eating disorder symptoms were more likely to recall that one or more of their parents had mental health problems, including alcohol abuse and depression. The highest odds ratios were for parental cruelty (emotional or physical), and childhood sexual abuse. In contrast, happy memories throughout childhood and a stable family situation were associated with a lower rate of eating disorder symptoms. The death of a parent and lower socioeconomic standing were not related to lifetime eating disorder symptoms. The most predictive variable was early sexual abuse.

Eating disorder symptoms reported during pregnancy, including self-induced vomiting, and laxative abuse to lose weight, were predicted by a similar set of early experiences, including parents with alcohol problems or depression, having emotionally or physically cruel parents, and having been sexually abused. Recalling parental alcoholism or mental health problems, depression or death, cruelty, divorce and early sexual abuse were all significant predictors of marked concern over shape and weight during pregnancy. Women who reported highly overprotective parents were also more likely to have marked concern over shape and weight. They were more likely to use laxatives and vomiting to control their weight during pregnancy. Early sexual abuse remained a significant independent predictor of lifetime eating disorder symptoms and greater-than-normal concern about shape and weight. Having a low level of social support also was a significant predictor of shape and weight concerns during pregnancy.

The authors note that maternal eating problems in the postnatal period can pose a particular risk to a developing child by interfering with healthy parenting and child growth. Thus, it is important to address early experiences that might be related to concerns about weight and shape.