# The impact of childhood sexual abuse and childhood traumatic events on outcome in adult inpatients with eating disorders

## TL;DR

This study found that childhood trauma, especially sexual abuse, is common in adult patients with eating disorders and is linked to worse treatment outcomes.

## Contribution

The study provides new evidence on how the severity of childhood traumatic events affects remission rates in eating disorder patients.

## Key findings

- High prevalence of severe childhood sexual abuse and traumatic events was found in patients with eating disorders.
- Patients with severe childhood trauma had lower remission rates compared to those without such experiences.
- Trauma severity was associated with higher baseline symptoms and poorer treatment outcomes.

## Abstract

Childhood traumatic events (CTE) are frequently described in patients with eating disorders. However, the understanding of how such events impact eating disorder treatment outcome is limited. The aim of this study was to examine the prevalence of childhood sexual abuse (CSA) or any CTE at baseline in a naturalistic transdiagnostic sample, and to evaluate how such events affect symptom change and rates of remission at follow-up.

The sample comprised 228 adult female former eating disorder inpatients (Mage = 24.6 years), of which 61.4% (n = 140) had been diagnosed with anorexia nervosa at baseline, 21.1% (n = 48) with bulimia nervosa, and 17.5% (n = 40) with other specified feeding or eating disorder including binge eating. Data on CSA/ CTE exposure were collected from the patients’ hospital records and were rated for degree of severity (severe, moderate to low, or no). Analyses of prevalence, group differences, and rates of remission at follow-up were performed.

Findings showed high prevalence of high severity CSA and CTE at admission, respectively 33% (n = 75) and 48.7% (n = 111). Moreover, although all patients showed significant improvement in symptoms from baseline to follow-up, a significant association was found between severity of CTE exposure and remission group affiliation with 24% of those with severe CTE exposure and 40% of those with no CTE exposure being in remission.

Despite considerable heterogeneity in demographic characteristics, treatment and length of follow-up, severity of CTE exposure was associated with remission at follow-up. Thus, patients with the highest CTE severity showed the poorest prognoses. Findings from this study underline the importance of addressing trauma experiences in assessment and therapy and indicate that CTE severity level should be considered when assessing trauma experiences.

In a group of patients with different types of eating disorder, high prevalences of childhood traumatic events were found. Patients that had experienced severe childhood sexual abuse had more eating disorder- and depressive symptoms at baseline than patients without such events. In addition, patients that had experienced any severe childhood traumatic event had slightly higher eating disorder symptoms than those without such events and than those that had experienced less severe trauamtic events. Although patients with eating disorders and childhood traumatic events had significantly less symptoms at follow-up than at baseline, those with more severe traumatic events had lower levels of remission than patients without traumatic experiences. This underlines the importance of addressing trauma events in eating disorder treatment.