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The mediational significance of negative/depressive affect in the relationship of childhood maltreatment and eating disorder features in adolescent psychiatric inpatients

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Abstract

OBJECTIVE: Childhood maltreatment is a risk factor for eating disorder and negative/depressive affect appears to mediate this relation. However, the specific elements of eating- and body-related psychopathology that are influenced by various forms of childhood maltreatment remain unclear, and investigations among adolescents and men/boys have been limited. This study investigated the mediating role of negative affect/depression across multiple types of childhood maltreatment and eating disorder features in hospitalized adolescent boys and girls. METHOD: Participants were 148 adolescent psychiatric inpatients who completed an assessment battery including measures of specific forms of childhood maltreatment (sexual, emotional, and physical abuse), negative/depressive affect, and eating disorder features (dietary restriction, binge eating, and body dissatisfaction). RESULTS: Findings suggest that for girls, negative/depressive affect significantly mediates the relationships between childhood maltreatment and eating disorder psychopathology, although effects varied somewhat across types of maltreatment and eating disorder features. Generalization of mediation effects to boys was limited.

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References

  1. Hussey JM, Chang JJ, Kotch JB. Child maltreatment in the United States: Prevalence, risk factors, and adolescent health consequences. Pediatrics 2006; 118: 933–42.

    Article  PubMed  Google Scholar 

  2. Grilo CM, Sanislow C, Fehon DC, et al. Psychological and behavioral functioning in adolescent psychiatric inpatients who report histories of childhood abuse. Am J Psychiatry 1999; 156: 538–43.

    CAS  PubMed  Google Scholar 

  3. Carter JC, Bewell C, Blackmore E, et al. The impact of childhood sexual abuse in anorexia nervosa. Child Abuse Negl 2006; 30: 257–69.

    Article  PubMed  Google Scholar 

  4. Wonderlich SA, Crosby RD, Mitchell JE, et al. Relationship of childhood sexual abuse and eating disturbance in children. J Am Acad Child Adolesc Psychiatry 2000; 39: 1277–83.

    Article  CAS  PubMed  Google Scholar 

  5. Wonderlich SA, Rosenfeldt S, Crosby RD, et al. The effects of childhood trauma on daily mood lability and comorbid psychopathology in bulimia nervosa. J Trauma Stress 2007; 20: 77–87.

    Article  PubMed  Google Scholar 

  6. Grilo CM, Masheb RM. Childhood psychological, physical, and sexual maltreatment in outpatients with binge eating disorder: Frequency and associations with gender, obesity, and eating-related psychopathology. Obes Res 2001; 9: 320–5.

    Article  CAS  PubMed  Google Scholar 

  7. Grilo CM, Masheb RM, Brody M, et al. Childhood maltreatment in extremely obese male and female bariatric surgery candidates. Obes Res 2005; 13: 123–30.

    Article  PubMed  Google Scholar 

  8. Suisman JL, Slane JD, Burt SA, et al. Negative affect as a mediator of the relationship between weight-based teasing and binge eating in adolescent girls. Eat Behav 2008; 9: 493–6.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Sweetingham R, Waller G. Childhood experiences of being bullied and teased in the eating disorders. Eur Eat Disord Rev 2007; 16: 401–7.

    Article  Google Scholar 

  10. van Gerko K, Hughes ML, Hamill M, et al. Reported childhood sexual abuse and eating-disordered cognitions and behaviors. Child Abuse Negl 2005; 29: 375–82.

    Article  PubMed  Google Scholar 

  11. Kennedy MA, Ip K, Samra J, et al. The role of childhood emotional abuse in disordered eating. J Emotion Abuse 2007; 7: 17–36.

    Article  Google Scholar 

  12. Kent A, Waller G, Dagnan D. A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: The role of mediating variables. Int J Eat Disord 1999; 25: 159–67.

    Article  CAS  PubMed  Google Scholar 

  13. Andrews B. Bodily shame in relation to abuse in childhood and bulimia: A preliminary investigation. Br J Clin Psychol 1997; 36: 41–9.

    Article  PubMed  Google Scholar 

  14. Hund AR, Espelage, DL. Childhood emotional abuse and disordered eating among undergraduate females: Mediating influence of alexithymia and distress. Child Abuse Negl 2006; 30: 393–407.

    Article  PubMed  Google Scholar 

  15. Mazzeo SE, Mitchell KS, Williams LJ. Anxiety, alexithymia, and depression as mediators of the association between childhood abuse and eating disordered behavior in African American and European American women. PsycholWomen Q 2008; 32: 267–80.

    Google Scholar 

  16. Murray C, Waller G. Reported sexual abuse and bulimic psychopathology among nonclinical women: The mediating role of shame. Int J Eat Disord 2002; 32: 186–91.

    Article  PubMed  Google Scholar 

  17. Waller G. Perceived control in eating disorders: Relationship with reported sexual abuse. Int J Eat Disord 1998; 23: 117–23.

    Article  CAS  PubMed  Google Scholar 

  18. Waller G, Meyer C, Ohanian V, et al. The psychopathology of bulimic women who report childhood sexual abuse: The mediating role of core beliefs. J Nerv Ment Disord 2001; 189: 700–8.

    Article  CAS  Google Scholar 

  19. Mazzeo SE, Espelage DL. Association between childhood physical and emotional abuse and disordered eating behaviors among female undergraduates: An investigation of the mediating role of alexithymia and depression. J Couns Psychol 2002; 49: 80–100.

    Google Scholar 

  20. Rohde P, Ichikawa L, Simone GE, et al. Associations of child sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse Negl 2008; 32: 878–87.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Grilo CM. Subtyping female adolescent psychiatric inpatients with features of eating disorders along dietary restraint and negative affect dimensions. Behav Res Ther 2004; 42: 67–78.

    Article  CAS  PubMed  Google Scholar 

  22. Grilo CM, Masheb RM, Wilson GT. Subtyping binge eating disorder. J Consult Clin Psychol 2001; 69: 1066–72.

    Article  CAS  PubMed  Google Scholar 

  23. Masheb RM, Grilo CM. Prognostic significance of two sub-categorization methods for the treatment of binge eating disorder: negative affect and overvaluation predict, but do not moderate, specific outcomes. Behav Res Ther 2008; 46: 428–37.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Stice E, Bohon C, Marti CN, et al. Subtyping women with bulimia nervosa along dietary and negative affect dimensions: Further evidence of reliability and validity. J Consult Clin Psychol 2008; 76: 1022–33.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Williamson DA, Womble LG, Smeets MAM, et al. Latent structure of eating disorder symptoms: A factor analytic and taxometric investigation. Am J Psychiatry 2002; 159: 412–8.

    Article  PubMed  Google Scholar 

  26. Baker JH, Maes, HH, Lissner L, et al. Genetic risk factors for disordered eating in adolescent males and females. J Abnorm Psychol 2009; 118: 576–86.

    Article  PubMed  Google Scholar 

  27. Klump KL, Gobrogge KL, Perkins PS, et al. Preliminary evidence that gonadal hormones organize and activate disordered eating. Psychol Med 2005; 36: 539–46.

    Article  PubMed  Google Scholar 

  28. Stice E, Hayward C, Cameron RP, et al. Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study. J Abnorm Psychol 2000; 109: 438–44.

    Article  CAS  PubMed  Google Scholar 

  29. Stice E, Killen JD, Hayward C, et al. Support for the continuity hypothesis of bulimic pathology. J Consult Clin Psychol 1998; 66: 784–90.

    Article  CAS  PubMed  Google Scholar 

  30. Zimmerman M, Francione-Witt C, Chelminski I, et al. Problems applying the DSM-IV eating disorders diagnostic criteria in a general psychiatric outpatient practice. J Clin Psychiatry 2008; 69: 381–4.

    Article  PubMed  Google Scholar 

  31. Eddy KT, Celio-Doyle A, Hoste RR, et al. Eating disorder not otherwise specified in adolescents. J Am Acad Child Adolesc Psychiatry 2008; 47: 156–64.

    Article  PubMed  Google Scholar 

  32. Johnson J, Cohen P, Kasen S, et al. Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Arch Gen Psychiatry 2002; 59: 545–52.

    Article  PubMed  Google Scholar 

  33. Paxton SJ, Neumark-Sztainer D, Hannan PJ, et al. Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. J Clin Child Adolesc Psychol 2006; 35: 539–49.

    Article  PubMed  Google Scholar 

  34. Millon T, Millon C, Davis RD. Millon Adolescent Clinical Inventory. Minneapolis, MN: National Computer Systems Assessments, 1993.

    Google Scholar 

  35. Millon T, Davis RD. The Millon Adolescent Personality Inventory and the Millon Adolescent Clinical Inventory. J Counsel Dev 1993; 71: 570–4.

    Article  Google Scholar 

  36. Murrie DC, Cornell DG. Psychopathy screening of incarcerated juveniles: A comparison of measures. Psychol Assess 2002; 14: 390–6.

    Article  PubMed  Google Scholar 

  37. Pinto M, Grilo CM. Reliability, diagnostic efficiency, and validity of the Millon adolescent clinical inventory: Examination of selected scales in psychiatrically hospitalized adolescents. Beh Res Ther 2004; 42: 1505–19.

    Article  Google Scholar 

  38. Romm S, Bockian N, Harvey M. Factor-based prototypes of the Millon Adolescent Clinical Inventory in adolescents referred for residential treatment. J Personal Assess 1999; 72: 125–43.

    Article  CAS  Google Scholar 

  39. Beck AT, Steer RA. Manual for the Revised Beck Depression Inventory. San Antonio, TX: Psychological Corporation, 1987.

    Google Scholar 

  40. Beck AT, Steer R, Garbin MG. Psychometric properties of the Beck Depression Inventory: 25 years of evaluation. Clin Psychol Rev 1988; 8: 77–100.

    Article  Google Scholar 

  41. Strober M, Green J, Carlson G. Utility of the Beck Depression Inventory with psychiatrically hospitalized adolescents. J Consult Clin Psychol 1981; 49: 482–3.

    Article  CAS  PubMed  Google Scholar 

  42. Rosenberg M. Society and the adolescent self-image. Princeton (NJ): Princeton University Press, 1965.

    Google Scholar 

  43. Winters NC, Myers K, Proud L. Ten-year review of rating scales, III: scales assessing suicidality, cognitive style, and self-esteem. J Am Acad Child Adolesc Psychiatry 2002; 4: 1150–81.

    Article  Google Scholar 

  44. Lorr M, Wunderlich R. Self-esteem and negative affect. J Clin Psychol 1988; 44: 36–9.

    Article  CAS  PubMed  Google Scholar 

  45. Stice E, Agras WS. Subtyping bulimics along dietary restraint and negative affect dimensions. J Consult Clin Psychol 1999; 67: 460–9.

    Article  CAS  PubMed  Google Scholar 

  46. Stice E, Fairburn CG. Dietary and dietary-depressive subtypes of bulimia nervosa show differential symptom presentation, social impairment, comorbidity, and course of illness. J Consult Clin Psychol 2003; 71: 1090–4.

    Article  PubMed  Google Scholar 

  47. Bernstein DP, Fink L. Childhood trauma questionnaire. San Antonio, TX: Psychological Corporation, 1998.

    Google Scholar 

  48. Bernstein DP, Ahluvalia T, Pogge D, et al. Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry 1997; 36: 340–8.

    Article  CAS  PubMed  Google Scholar 

  49. Walker EA, Unutzer J, Rutter C, et al. Costs of health care use by women HMO members with a history of childhood abuse and neglect. Arch Gen Psychiatry 1999; 56: 609–13.

    Article  CAS  PubMed  Google Scholar 

  50. Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl 2003; 27: 169–90.

    Article  PubMed  Google Scholar 

  51. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. J Pers Soc Psychol 1986; 51: 1173–82.

    Article  CAS  PubMed  Google Scholar 

  52. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008; 40: 879–91.

    Article  PubMed  Google Scholar 

  53. Preacher KJ, Rucker DD, Hayes AF. Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behav Res 2007; 42: 185–227.

    Article  Google Scholar 

  54. Anderson KP, LaPorte DJ, Crawford S. Child sexual abuse and bulimic symptomatology: Relevance of specific abuse variables. Child Abuse Negl 2000; 24: 1495–502.

    Article  CAS  PubMed  Google Scholar 

  55. Wang S. Traumatic stress and thyroid function. Child Abuse Negl 2006; 30: 585–8.

    Article  PubMed  Google Scholar 

  56. Webb M, Heisler D, Call S, et al. Shame, guilt, symptoms of depression, and reported history of psychological maltreatment. Child Abuse Negl 2007; 31: 1143–53.

    Article  PubMed  Google Scholar 

  57. Wilson GT, Grilo CM, Vitousek K. Psychological treatments for eating disorders. Am Psychol 2007; 62: 199–216.

    Article  PubMed  Google Scholar 

  58. Fairburn CG, Cooper Z, Doll HA, et al. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. Am J Psychiatry 2009; 166: 311–9.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Safer DL, Telch CF, Agras WS. Dialectical behavior therapy for bulimia nervosa. Am J Psychiatry 2001; 158: 632–4.

    Article  CAS  PubMed  Google Scholar 

  60. Ullman SE, Filipas HH. Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors. Child Abuse Negl 2005; 29: 767–82.

    Article  PubMed  Google Scholar 

  61. Chaplin TM, Hong K, Bergquist K, et al. Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving. Alcohol Clin Exp Res 2008; 32: 1242–50.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Lynskey MT, Fergusson DM. Factors protecting against the development of adjustment difficulties in young adults exposed to childhood sexual abuse. Child Abuse Negl 1997; 2: 1177–90.

    Article  Google Scholar 

  63. Grilo CM, Masheb RM, Wilson GT. A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder. J Consult Clin Psychol 2001; 69: 317–22.

    Article  CAS  PubMed  Google Scholar 

  64. Grilo CM, Masheb RM, Wilson GT. Different methods for assessing the features of eating disorders in patients with binge eating disorder: a replication. Obes Res 2001; 9: 418–22.

    Article  CAS  PubMed  Google Scholar 

  65. Rahbar-Morrisson K, Doss BD, Perez M. Body image and disordered eating in romantic relationships. J Soc Clin Psychol 2009; 28: 281–306.

    Article  Google Scholar 

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Correspondence to C. J. Hopwood PhD.

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Hopwood, C.J., Ansell, E.B., Fehon, D.C. et al. The mediational significance of negative/depressive affect in the relationship of childhood maltreatment and eating disorder features in adolescent psychiatric inpatients. Eat Weight Disord 16, 9–16 (2011). https://doi.org/10.1007/BF03327515

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