Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma

Background Adverse childhood experiences (ACEs) are prevalent, impact long-term physical and mental health, and are associated with eating disorders (EDs) in adulthood. The primary objectives of the current study were: (1) to examine and compare ACEs between two samples: treatment-seeking adults, and a nationally representative sample of adults, (2) to characterize ACEs items and total scores across demographic and diagnostic information in adults seeking treatment for an ED, (3) to statistically classify ACEs profiles using latent class analysis, and (4) to examine associations between ACEs profiles and diagnosis. Methods This cross-sectional study assessed patients with a DSM-5 ED receiving treatment between October 2018 and April 2020 at the inpatient, residential, or partial hospitalization levels of care at one of two private ED treatment facilities. ACEs were assessed with the Adverse Childhood Experiences Survey at admission. Generalized linear models and Welch's t-tests were used to compare ACEs in the current sample with national estimates. A latent class analysis was conducted to examine subgroups of ACEs responses, and differences in these classes by ED diagnoses were examined with multinomial logistic regression. Results Patients with EDs had significantly higher ACEs scores (M = 1.95, SD = 1.90) than the nationally representative sample (M = 1.57, SD = 4.72; t = 6.42, p < .001). Within patients with EDs, four latent classes of ACEs item endorsement were identified. Patients with other specified feeding or eating disorder (OSFED) and binge eating disorder (BED) were more likely to fall into the "Household ACEs" and "Abuse ACEs" groups, respectively, compared to anorexia nervosa-restricting subtype (AN-R). Conclusions Patients with EDs reported more ACEs than the nationally representative sample, and differences in total ACEs and latent class membership were found across ED diagnoses. The current study can inform the development of trauma-informed care for patients with EDs. Plain English summary Adverse childhood experiences (ACEs), such as abuse, are considered a significant public health crisis and are associated with mental and physical health problems later in life. The current study compared ACEs among a treatment-seeking sample of adults with eating disorders to a nationally representative sample, and found that patients with eating disorders reported higher ACEs scores. Within the eating disorder sample, females were more likely to report a history of sexual abuse than males. Four categories of ACEs emerged, representing four distinct clusters of ACEs item endorsement. Patients with binge eating disorder (BED) reported higher levels of ACEs than patients with anorexia nervosa - restricting subtype (AN-R). In addition, patients with other specified feeding or eating disorder (OSFED) were more likely to be characterized by high levels of household dysfunction than patients with AN-R. Screening for adverse childhood experiences among patients with eating disorders should be part of standard care, and more broadly, providing children with safe environments may lessen the long-term development of several serious illnesses, including eating disorders.